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The interest in adopting more sustainable diets can be a driver for consumers to engage the consumption of edible insects, even in countries where they are not culturally accepted as food. This work aimed to study the perceptions and knowledge of consumers in different countries towards edible insects and their relation with environment and sustainability. The present investigation was based on a questionnaire survey (11 questions) and this descriptive cross-sectional study was carried out on a non-probabilistic sample of 7221 participants from 14 countries. The participants in the survey revealed high knowledge (over 50%) about the sustainability issues related with edible insects as food. The sociodemographic variables education, sex and age are influential, by decreasing order of importance. Regarding living environment, rural areas have the lowest percentage of informed participants. Comparing countries, statistically significant differences were observed for all questions, making this the most important predictor for information about sustainability of edible insects. This is expected, having in mind that cultural influences are highly variable among the set of countries included in the study, with a high number of European countries, but also with Latin American countries like Mexico or Brazil, or Middle East countries like Turkey or Lebanon. info:eu-repo/semantics/publishedVersion

Background: Real-world data in patients with moderate psoriasis treated with apremilast is limited. Objectives: To evaluate the effectiveness and safety of apremilast in bio-naïve patients with moderate psoriasis in real-world clinical settings. Methods: This was a 52-week multicenter, observational, prospective study of adult outpatients with moderate psoriasis {[10% < body surface area < 20% or 10 < psoriasis area severity index (PASI) < 20] and 10 < dermatology quality of life index (DLQI) < 20} initiated on apremilast ≤7 days before enrollment. Missing data were imputed using the last observation carried forward method. Results: A total of 287 eligible patients (median age: 54.2 years; median psoriasis duration: 9.8 years) were consecutively enrolled. At baseline, the median DLQI and PASI scores were 12.0 and 11.8, respectively. The 52-week DLQI ≤ 5 and PASI75 response rates were 68.3% and 61.0%. At 52 weeks, 70.8% and 72.7% of the patients shifted from moderate/severe/very severe to clear/minimal scalp and palmoplantar psoriasis involvement, respectively; the pruritus severity state improved in 67.2%. The 52-week Kaplan–Meier estimated drug continuation rate was 85.3%. The adverse drug reaction rate was 19.9%. Conclusions: Apremilast is a safe and effective treatment for bio-naïve patients with moderate psoriasis and specific psoriasis manifestations. © 2022 European Academy of Dermatology and Venereology.

Food behaviour is governed by different kinds of motivations, some of individual nature and others related with the external food environment. This study investigated the eating motivations in sixteen countries with respect to commercial and marketing influences on food choices. The questionnaire survey was developed between September 2017 and June 2018, via online tools, targeting a convenience sample of residents in sixteen countries (Argentina, Brazil, Croatia, Egypt, Greece, Hungary, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Serbia, Slovenia and the United States of America). The number of valid responses received was 11, 919 participants. The data were treated using SPSS software, and the main statistical techniques used included exploratory factor analysis, evaluation of internal reliability through Cronbach’s alpha, cluster analysis (hierarchical and k-means) and logistic regression. The results obtained showed two groups of people: low motivated and notably motivated consumers. The results showed high asymmetries between countries, with highest percentage of highly motivated consumers in Egypt and the lowest percentage of highly motivated in Portugal. It was further observed that consumers more influenced by commercial and marketing aspects (the notably motivated) tend to be women, young, single, less educated, less likely to be professionally active, and those who live mostly in rural or suburban areas. Less exercise and overweight are also factors associated with greater propensity for commercial and marketing motivations. Furthermore, health problems such as shellfish or gluten intolerance, hypertension and high cholesterol confer less propensity to be in the segment of the notably motivated consumers. In conclusion, this work highlighted the role of geographic, sociodemographic and lifestyle factors as food choice determinants.

Resumo: Introdução – O consumo de insetos é uma prática tradicional ao longo da história humana, mas o seu consumo é muito variável de acordo com a região do globo. Objetivos – Pretendeu-se investigar o nível de conhecimento sobre insetos comestíveis numa amostra de participantes de treze países. Métodos – Os dados foram recolhidos em 2021 por questionário online. Obtiveram-se 6899 respostas válidas. Para a análise dos dados usou-se análise fatorial, análise de clusters e testes qui-quadrado. Resultados – Foram usados 27 itens para medir o conhecimento, utilizando uma escala do tipo Likert de cinco pontos. Aplicando análise fatorial obteve-se uma solução que explica 55% da variância total observada. Esta inclui 4 fatores que retiveram 22 dos 27 itens iniciais: F1 = Sustentabilidade (8 it); F2 = Nutrição (8 it); F3 = Fatores de Produção (2 it); F4 = Preocupações com a Saúde (4 it). A análise de clusters produziu três grupos de participantes (indivíduos 'receosos', 'agricultores' e 'ecológicos'). A caracterização dos clusters revelou que a idade não influenciou a inclusão nos clusters, enquanto sexo, escolaridade, país, meio onde reside, área profissional e rendimento influenciaram a composição dos clusters. Conclusões – O nível de conhecimento sobre insetos comestíveis é altamente variável de acordo com as características individuais e localização geográfica. Por outro lado, a segmentação permitiu identificar 3 tipos de indivíduos, 'receosos', 'agricultores' e 'ecológicos'. info:eu-repo/semantics/publishedVersion

Food behaviour is governed by different kinds of motivations, some of individual nature and others related with the external food environment. This study investigated the eating motivations in sixteen countries with respect to commercial and marketing influences on food choices. The questionnaire survey was developed between September 2017 and June 2018, via online tools, targeting a convenience sample of residents in sixteen countries (Argentina, Brazil, Croatia, Egypt, Greece, Hungary, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Serbia, Slovenia and the United States of America). The number of valid responses received was 11,919 participants. The data were treated using SPSS software, and the main statistical techniques used included exploratory factor analysis, evaluation of internal reliability through Cronbach’s alpha, cluster analysis (hierarchical and k-means) and logistic regression. The results obtained showed two groups of people: low motivated and notably motivated consumers. The results showed high asymmetries between countries, with highest percentage of highly motivated consumers in Egypt and the lowest percentage of highly motivated in Portugal. It was further observed that consumers more influenced by commercial and marketing aspects (the notably motivated) tend to be women, young, single, less educated, less likely to be professionally active, and those who live mostly in rural or suburban areas. Less exercise and overweight are also factors associated with greater propensity for commercial and marketing motivations. Furthermore, health problems such as shellfish or gluten intolerance, hypertension and high cholesterol confer less propensity to be in the segment of the notably motivated consumers. In conclusion, this work highlighted the role of geographic, sociodemographic and lifestyle factors as food choice determinants. info:eu-repo/semantics/publishedVersion

In recent years, insects have been suggested as an alternative source of animal protein, and a more sustainable way to provide the needs in protein of the growing world population. Edible insects are nutritive foods, rich in macronutrients and particularly protein and fat, but also contain micronutrients important for many body functions, such as vitamins and dietary minerals. The project "EISuFood – Study about food habits and knowledge about edible insects as sustainable foods" is developed in different countries and aims to study the habits, knowledge, and perceptions of consumers in different social and cultural contexts to edible insects. The project was approved by the CERNAS-IPV Research Centre at the Polytechnic Institute of Viseu, in December 2020, and the Principal investigator and leader of the international team is Raquel Guiné. The project involves a total of 69 researchers in the 18 participating countries (Brazil, Cape Verde, Colombia, Croatia, Greece, Latvia, Lebanon, Lithuania, Mexico, Morocco, Nigeria, Poland, Romania, Serbia, Slovenia, Spain, Turkey, with Portugal being the leader country). The project involves four tasks as follows: 1. Preparation of the instruments for data collection ; 2. Collection of data in the 18 countries ; 3. Analysis of the data ; and 4. Preparation of scientific outputs and dissemination of results. The questionnaire used in the project addresses seven different dimensions: Culture and Tradition, Gastronomic Innovation and Gourmet Kitchen, Environment and Sustainability, Economic and Social Aspects, Commercialization and Marketing, Nutritional Aspects and, finally, Health Effects. The questionnaire was prepared by the whole international team and approved by the Ethics Committee of the Polytechnic of Viseu with Reference No. 45/SUB/2021. An initial screening involved the validation for the Portuguese sample1, before global application in all countries. The validation of this questionnaire confirms its usefulness for investigating consumer perceptions of and knowledge about edible insects, making possible its application in different countries

The present study explores issues of production, distribution and application of Lykion, a renowned and widely used medicine of the ancient world, by synthesizing literary archaeological and scientific evidence. Lykion has astringent and antimicrobial properties and was used to cure various skin and several other dis-eases. Miniature vessels have been characterized by researchers as carriers of medicinal and/or cosmetic sub-stances; amongst these, a special category distributed in various areas of the Eastern Mediterranean and South Italy bear inscriptions or stamps identifying Lykion as the vessels’ content and sometimes provide the name of the manufacturer as well. A comparative study of their typology with their unlabelled counterparts indicates similarities in terms of their content and use. The unlabelled examples are mostly characterised as vessels of storage and transportation of an alternative non-certified medicine produced by using a local plant variety with similar medicinal properties. In the latter case, the shape of the container could signal both the place of origin and the content. Hitherto analytical investigations that would confirm the validity of this hypothesis had yet to be conducted. The present research attempts, for the first time, to trace evidence regarding the content of 15 published ceramic vessels whose biconical and pear-shaped shapes are mostly associated with this particular medicine. The assemblage under study was excavated in ancient Abdera, a coastal city in West-ern Thrace, Greece. In order to investigate any absorbed content into the ceramic matrix of these vessels, 42 samples were extracted from their inner unglazed walls. The powder samples were then analysed by the com-plementary Infrared (IR) and Raman spectroscopies and consequently compared to spectra acquired from certified Greek plant varieties. Here we have detected remnant which bear similarities with the spectra of the species Rhamnus lycioides.

Background & aims: Undernutrition is widely prevalent in patients with cirrhosis and affects prognosis. Given the lack of data regarding the dietary intake (DI) and habits of patients with cirrhosis, the aim of the present study was to evaluate them by assessing diet's adequacy compared to the new guidelines, and the association of DI with nutritional status indicators. Methods: One hundred and eighty-seven patients (57.8% male, 59.9 ± 10.9 years old, 44.9% decompensated ones) with cirrhosis of various etiologies were enrolled. The patients' DI was assessed using three 24 h recalls, which were analyzed regarding macronutrients’ intake, food groups consumption, adherence to the Mediterranean diet and meal patterns. The Goldberg cut-off limits for the ratio of energy intake to resting energy expenditure were used to evaluate dietary underreporting and patients were accordingly classified as low or adequate energy reporters (LERs and AERs). Results: Among the AERs (n = 91, 48.7%) only 29.7% and 31.9% met current recommendations regarding energy and protein intake, accordingly. Patients reported low intake of several healthy food groups and low adherence to the Mediterranean diet. They reported a median of 4.3 eating episodes per day and they frequently omitted late evening snack. Nevertheless, no statistically significant associations were found between parameters of DI and annual and two-year survival. Conclusions: Low energy reporting was very frequent in this sample of patients with liver cirrhosis. Diet quality was rather poor, whereas energy and protein intakes were lower than those recommended. © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

Despite the volume of publications dedicated to unraveling the biological characteristics and clinical manifestations of SARS‐CoV‐2, available data on pregnant patients are limited. In the current review of literature, we present an overview on the developmental course, complications, and adverse effects of COVID‐19 on pregnancy. A comprehensive review of the literature was per-formed in PubMed/Medline, Embase, and Cochrane Central databases up to June 2021. This article collectively presents what has been so far reported on the identified critical aspects, namely complications during pregnancy, delivery challenges, neonatal health care, potential routes of viral transmission, including vertical transmission or breastfeeding, along with the risks involved in the vaccination strategy during pregnancy. Despite the fact that we are still largely navigating un-charted territory, the observed publication explosion in the field is unprecedented. The overwhelm-ing need for data is undoubtable, and this serves as the driver for the plethora of publications wit-nessed. Nonetheless, the quality of data sourced is variable. In the midst of the frenzy for reporting on SARS‐CoV‐2 data, monitoring this informational overload is where we should head to next, con-sidering that poor quality research may in fact hamper our attempts to prevail against this unpar-alleled pandemic outbreak. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Background Apremilast is an oral phosphodiesterase-4 inhibitor indicated for patients with moderate-to-severe chronic plaque psoriasis and active psoriatic arthritis. Objectives To examine the effectiveness of apremilast on Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI) and nail, scalp and palmoplantar involvement, when administered prior to biologics. Methods This 52-week real-world study included biologic-naive adults with moderate psoriasis (psoriasis-involved body surface area 10% to = 3, or 0 if baseline score was 1 or 2. The adverse drug reaction rate was 21.0% (serious: 2.0%). Conclusions These interim results indicate that through 24 weeks, apremilast improved quality of life and reduced disease severity in biologic-naive patients with moderate plaque psoriasis, while demonstrating safety consistent with the known safety profile.

Background: The impact of the COVID-19 pandemic on European gynaecological cancer patients under active treatment or follow-up has not been documented. We sought to capture the patient perceptions of the COVID-19 implications and the worldwide imposed treatment modifications. Methods: A patient survey was conducted in 16 European countries, using a new COVID-19-related questionnaire, developed by ENGAGe and the Hospital Anxiety & Depression Scale questionnaire (HADS). The survey was promoted by national patient advocacy groups and charitable organisations. Findings: We collected 1388 forms; 592 online and 796 hard-copy (May, 2020). We excluded 137 due to missing data. Median patients’ age was 55 years (range: 18–89), 54.7% had ovarian cancer and 15.5% were preoperative. Even though 73.2% of patients named cancer as a risk factor for COVID-19, only 17.5% were more afraid of COVID-19 than their cancer condition, with advanced age (>70 years) as the only significant risk factor for that. Overall, 71% were concerned about cancer progression if their treatment/follow-up was cancelled/postponed. Most patients (64%) had their care continued as planned, but 72.3% (n = 892) said that they received no information around overall COVID-19 infection rates of patients and staff, testing or measures taken in their treating hospital. Mean HADS Anxiety and Depression Scores were 8.8 (range: 5.3–12) and 8.1 (range: 3.8–13.4), respectively. Multivariate analysis identified high HADS-depression scores, having experienced modifications of care due to the pandemic and concern about not being able to visit their doctor as independent predictors of patients’ anxiety. Interpretation: Gynaecological cancer patients expressed significant anxiety about progression of their disease due to modifications of care related to the COVID-19 pandemic and wished to pursue their treatment as planned despite the associated risks. Healthcare professionals should take this into consideration when making decisions that impact patients care in times of crisis and to develop initiatives to improve patients’ communication and education. © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Background Accurate assessments of muscle mass in patients with cirrhosis are necessary in clinical practice. Computed tomography (CT) of the upper abdomen has been proposed as a useful method for quantifying muscle mass. Recently, Carey et al developed specific cutoffs for muscle wasting based on the skeletal muscle index at the L3 vertebra (L3-SMI) for cirrhotic patients. The aim of the present study was to assess the concurrent validity of the newly proposed cutoffs of Carey et al, along with others widely used in several clinical contexts, using dual energy X-ray absorptiometry (DXA) as the reference method. Methods Data were evaluated from 97 Caucasian patients (59.8% male, 59.1±11.6 years old, 45.4% decompensated) with cirrhosis of various etiologies. Muscle mass was assessed using the appendicular lean mass index (ALMI) by DXA and the L3-SMI by CT. Low L3-SMI was defined in relation to 5 different cutoffs. Results Low muscle mass prevalence was 13.4% according to ALMI and 26.8-45.4% according to the different cutoffs applied for L3-SMI. The Carey et al, Prado et al and Montano-Loza et al cutoffs showed similar sensitivity (all 69.2%) and specificity (79.8%, 76.2% and 75.0%, respectively) and high accuracy (78.4%, 75.3% and 74.2%). The Carey et al cutoffs showed the highest diagnostic validity against DXA: the multivariate odds ratio adjusted for age, sex, body mass index category, disease etiology and model for end-stage liver disease score (95% confidence interval) was 5.88 (1.36-25.4), P=0.018. Conclusion Compared to DXA, the cutoffs for identifying muscle wasting proposed by Carey et al were proven to be the most accurate. © 2020 Hellenic Society of Gastroenterology.

Trichoepitheliomas are benign skin tumors with follicular differentiation that present most commonly as solitary lesions. They can also present as multiple centrofacial papules due to several mutations in the CYLD gene. Multiple unilateral trichoepitheliomas in a linear or dermatomal distribution may rarely be seen. Herein, we report a case of multiple unilateral trichoepitheliomas on the face of a healthy 34-year-old woman of Caucasian origin.

Malnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5-54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients. © The Authors 2019.

Lifestyle interventions remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD). This randomised controlled single-blind clinical trial investigated the effect of Mediterranean diet (MD) or Mediterranean lifestyle, along with weight loss, in NAFLD patients. In all, sixty-three overweight/obese patients (50 (sd 11) years, BMI=31·8 (sd 4·5) kg/m2, 68 % men) with ultrasonography-proven NAFLD (and elevated alanine aminotransferase (ALT) and/or γ-glutamyl transpeptidase (GGT) levels) were randomised to the following groups: (A) control group (CG), (B) Mediterranean diet group (MDG) or (C) Mediterranean lifestyle group (MLG). Participants of MDG and MLG attended seven 60-min group sessions for 6 months, aiming at weight loss and increasing adherence to MD. In the MLG, additional guidance for increasing physical activity and improving sleep habits were given. Patients in CG received only written information for a healthy lifestyle. At the end of 6 months, 88·8 % of participants completed the study. On the basis of intention-to-treat analysis, both MDG and MLG showed greater weight reduction and higher adherence to MD compared with the CG (all P

Background this study aimed to assess the significance of serum levels of vascular endothelial growthfactor (VEGF) in non-alcoholic fatty liver disease (NAFLD). Methods Sixty-seven consecutive NAFLD patients and 47 healthy controls who visited our liver clinics between May 2008 and December 2010 were included. the NAFLD diagnosis required elevated alanine aminotransferase and/or gamma-glutamyl transpeptidase levels, evidence of hepatic steatosis on ultrasound and/or liver histology, and exclusion of other causes of liver injury. Serum VEGF levels were determined by an enzyme immunoassay. Liver biopsy was obtained in 34 NAFLD patients. Histological lesions were scored by a liver histopathologist. Results Serum VEGF levels tended to be lower in matched NAFLD patients than in healthy controls (296±146 vs. 365±186 pg/mL, P=0.092); levels in patients withnon-alcoholic steatohepatitis (NASH) also tended to be lower than in those withsimple fatty liver (FL) (279±149 vs. 359±190 pg/mL, P=0.095); while VEGF levels were significantly lower in NASH patients than in healthy controls (279±149 vs. 365±186 pg/mL, P=0.041). VEGF levels offered poor predictability for the differentiation between NAFLD patients and controls or between NASH and flpatients. However, patients withhigh VEGF levels (≥300 pg/mL) were significantly more likely to have FL, either in the total NAFLD population (67% vs. 35%, P=0.019) or in the 34 NAFLD patients withliver biopsy (57% vs. 15%, P=0.023), while those withhigh VEGF levels also had a significantly lower mean fibrosis score (0.7±0.9 vs. 1.6±1.0, P=0.017). Conclusion Our data suggest that serum VEGF levels are equally high in healthy controls and in patients withsimple fatty liver, but tend to decrease when NASH develops. © 2017 Hellenic Society of Gastroenterology.

Several lifestyle habits have been described as risk factors for nonalcoholic fatty liver disease (NAFLD). Given that both healthy and unhealthy habits tend to cluster, the aim of this study was to identify lifestyle patterns and explore their potential associations with clinical characteristics of individuals with NAFLD. One hundred and thirty-six consecutive patients with ultrasound-proven NAFLD were included. Diet and physical activity level were assessed through appropriate questionnaires. Habitual night sleep hours and duration of midday naps were recorded. Optimal sleep duration was defined as sleep hours ≥ 7 and ≤ 9 h/day. Lifestyle patterns were identified using principal component analysis. Eight components were derived explaining 67% of total variation of lifestyle characteristics. Lifestyle pattern 3, namely high consumption of low-fat dairy products, vegetables, fish, and optimal sleep duration was negatively associated with insulin resistance (β = −1.66, P = 0.008) and liver stiffness (β = −1.62, P = 0.05) after controlling for age, sex, body mass index, energy intake, smoking habits, adiponectin, and tumor necrosis factor-. Lifestyle pattern 1, namely high consumption of full-fat dairy products, refined cereals, potatoes, red meat, and high television viewing time was positively associated with insulin resistance (β = 1.66, P = 0.005), although this association was weakened after adjusting for adiponectin and tumor necrosis factor-α. A “healthy diet-optimal sleep” lifestyle pattern was beneficially associated with insulin resistance and liver stiffness in NAFLD patients independent of body weight status and energy intake. © 2017, Canadian Science Publishing. All rights reserved.

Background/Aim Immigrants have multiple barriers to access to health care systems. We evaluated the adherence to follow-up and treatment recommendations of chronic hepatitis B virus (HBV) Greek and immigrant patients. Methods In total, 1001 consecutive adult patients with chronic HBV infection who visited our clinics for the first time between 2002 and 2011 were included. All patients born outside Greece were considered immigrants. Diagnosis was considered to be complete if patients could be classified into HBeAg-positive chronic hepatitis B (CHB), inactive carriers, HBeAg-negative CHB, or decompensated cirrhosis. Results Of the patients, 56% were Greeks and 44% were immigrants. Greeks visited our clinics at a significantly older mean age (50 vs. 35 years, P

Background: Dietary and physical activity (PA) habits have been suggested as important factors for nonalcoholic fatty liver disease (NAFLD). Published data are mainly focused on the effect of either diet or exercise, whereas data on other aspects like sleep remain sparse. The aim of this study was to explore potential associations between dietary intake, PA, and sleeping habits, and the presence of NAFLD. Methods: One hundred patients with ultrasound-proven NAFLD and 55 healthy controls matched for age, sex, and body mass index were included. Dietary habits were assessed through a semiquantitative validated food frequency questionnaire. PA level was assessed with a validated questionnaire. Total night sleep hours and duration of midday rest were also recorded. Optimal sleep duration was defined as sleep hours ≥7 and ≤9 hr/day. Results: Patients compared to controls consumed less vegetables and nuts, more sweets, drank less coffee and alcohol (all P < 0.05), and exhibited a lower level of PA (P = 0.006). PA level [odds ratio (OR) per 100 metabolic equivalent of task-min/day = 0.74, 95% confidence interval (CI) 0.61-0.89, P = 0.002] was associated with lower probability of having NAFLD, whereas sweets consumption (OR = 2.13, 95% CI 1.22-3.71, P = 0.008) was associated with increased probability, after adjusting for several confounders, including body weight status. Optimal sleep duration was marginally and inversely associated with NAFLD presence (OR = 0.38, 95% CI 0.14-1.01, P = 0.05). Conclusion: Higher PA level and optimal sleep duration are associated with lower likelihood, whereas sweets consumption is associated with higher likelihood of having NAFLD. These associations are independent of body weight status and energy intake. © Copyright 2017, Mary Ann Liebert, Inc. 2017.

No experimental studies have been conducted on the impact of low EA on bone metabolism in relevant physically active populations. We evaluated the effects of low EA on bone turnover markers (BTMs) in a cohort of Caucasian, physically active eumenorrheic women (Study 1) and men (Study 2), and compared effects between sexes (sex comparison). These two studies were performed using a randomised, counterbalanced, crossover design. Eleven eumenorrheic women [peak aerobic capacity (VO2 peak): 47.9±5.5 ml·kg-1·min-1] and eleven men (VO2 peak: 54.2±5.3 ml·kg-1·min-1) completed two 5-day protocols; controlled (CON; 45 kcal·kgLBM-1·d-1) and restricted (RES; 15 kcal·kgLBM-1·d-1) EAs. Participants ran daily under supervision on a treadmill at 70% of their VO2 peak resulting in an exercise energy expenditure (EEE) of 15 kcal·kgLBM-1·d-1 and consumed diets providing 60 and 30 kcal·kgLBM-1·d-1 (based on participants’ habitual dietary composition). The effects of short-term (3 days) low EA induced by diet or exercise alone on BTMs in Caucasian, physically active eumenorrheic women (Study 3) and oral contraceptive (OCP) users were explored (Study 4), and compared effects between groups (comparison between eumenorrheic women and combined OCP users). Studies 3 and 4 were performed using a randomised, counterbalanced, crossover design. Ten eumenorrheic women (VO2 peak: 48.1 ±3.3 ml·kg-1·min-1) and 10 combined OCP users (VO2 peak: 47.9±5.5 ml·kg-1·min-1) completed three 3-day protocols; controlled (CON; 45 kcal·kgLBM-1·d-1) and restricted through diet (D-RES; 15 kcal·kgLBM-1·d-1) and restricted through exercise (E-RES; 15 kcal·kgLBM-1·d-1) EAs. In CON, D-RES and E-RES participants consumed diets providing 45, 15 and 45 kcal·kgLBM-1·d-1 with standardised composition (50% carbohydrates, 20% protein and 30% fat) in all experimental conditions. In E-RES only, participants completed supervised laboratory exercise sessions at an exercise intensity of 70% of their VO2 peak that resulted in an EEE of 30 kcal·kg LBM-1·d-1.\ud \ud Study 1: Short-term low EA at 15 kcal·kgLBM-1·d-1 decreased bone formation [Amino-terminal propeptide of type 1 procollagen (P1NP) AUC; P

Background: While there is currently no cure for multiple sclerosis (MS), treatment with biologic disease-modifying drugs (bDMDs) can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (ESY) hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients’ experiences. Methods: A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socio-economic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period. Results: During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties. Conclusion: Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry. © 2016 by Kerman University of Medical Sciences.

The aim of the study was a cost and clinical effectiveness analysis between moist wound healing dressings and gauze in a homecare set up for the treatment of stage III and IV pressure ulcers up to complete healing. In addition, we assessed the overall economic burden on the Healthcare System. Treatment method for each patient was chosen randomly by using sealed opaque envelopes. The authors monitored the healing progress and recorded treatment costs without interfering with the treatment process. The healing progress was estimated by using surface measurement transparent films. To estimate treatment costs, the authors took into account labor costs, cost of dressings, as well the cost of other materials such as cleansing gauzes, normal saline, syringes, examination gloves, antiseptics and adhesive tape. The patient group under treatment with moist wound healing dressings consisted of 27 men and 20 women aged 75.1 ± 8,6 and had an average ulcer surface of 43.5 ± 30.70 cm2; the patient group under treatment with gauze comprised 25 men and 23 women aged 77.02 ± 8.02 and had an average ulcer surface 41.52 ± 29.41 cm2 (p = 0.25, 95% CI, Student's t test). The average healing time for the moist wound healing dressings group' was 85.56 ± 52.09 days, while 121.4 ± 52.21 days for the "gauze group" (p = 0.0001, 95% CI, Student's t test). The dressing change frequency per patient was reduced in the "moist wound healing dressings group," 49.5 ± 29.61, compared with a dressing change frequency per patient of 222.6 ± 101.86 for the "gauze group" (p = 0.0001, 95% CI, Student's t test). The use of moist wound healing dressings had a lower total treatment cost of 1,351 € per patient compared with, the use of gauzes (3,888 €). © 2016 by the Wound Healing Society.

Background/aim Two-dimensional shear-wave elastography (2D-SWE) is a new elastographic technique that is increasingly being used across several indications. We assessed the reliability and applicability of 2D-SWE in patients with various chronic liver diseases and attempted to identify parameters potentially affecting liver stiffness. Methods We included all patients with chronic liver disease who underwent 2D-SWE examination over a 15-month period. Patients with acute hepatitis, active cholestatic disease, or severe heart failure were excluded. The procedures were performed by three adequately trained operators. Standard operating procedures for liver ultrasonography and elastography were followed. Results 2D-SWE was reliable in 98% of 605 patients. SD to mean liver stiffness value ratio greater than 9.14%, which was considered an indicator of reliability, was associated independently with age more than 50 years, obesity, or overweight, and use of statins for hyperlipidemia. 2D-SWE was applicable, requiring a median time of 7 min per examination and exceeding 15 min in only 5.5% of patients. Worse applicability expressed as duration more than 0.7 min per reliable measurement was associated independently with age more than 50 years and obesity. The mean and median liver stiffness values were 11.6 and 7.7 kPa, respectively. Liver stiffness more than 7.7 kPa was associated independently with age more than 50 years and increased waist circumference. Conclusion 2D-SWE represents an applicable method of assessment of liver fibrosis that can provide reliable results in the vast majority of patients with chronic liver diseases. Older age and obesity may affect the reliability and applicability of the method as well as the severity of liver fibrosis. © 2016 Wolters Kluwer Health, Inc.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is one of the top leading causes of death and disability, and its management is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. The study aim was to describe COPD prescribing patterns in Greece by using existing health administrative data for outpatients. Methods: This is a retrospective cross-sectional study based on prescriptions collected by the largest social insurance fund, during the first and last trimester of 2012. Selection criteria were the prescription of specific active substances and a COPD diagnosis. Extracted information included active substance, strength, pharmaceutical form and number of packages prescribed, diagnosis, time of dispensing, as well as insurees' age, gender, percentage of copayment and social security unique number. Statistical analysis included descriptive statistics and logistic regression. Results: 174,357 patients received medicines for COPD during the study period. Patients were almost equally distributed between male and female, and age above 55 years was strongly correlated with COPD. Most patients received a long-acting beta agonist plus inhaled corticosteroid combination (LABA +ICS), followed by long-acting muscarinic agonist (LAMA). 63% patients belonging in the 35-54 age received LABA+ICS. LAMA was prescribed more frequently among males and was strongly correlated with COPD. Conclusion: The study provides big data analysis of Greek COPD prescribing patterns. It highlights the need for appropriate COPD classification in primary care illustrating the role of electronic prescribing in ensuring appropriate prescribing. Moreover, it indicates possible gender differences in treatment response or disease severity, and the impact of statutory co-payments on prescribing. © 2016 Souliotis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Recent studies demonstrated the efficiency of feedback-based gating control in mitigating congestion in urban networks by exploiting the notion of network fundamental diagram (NFD). The employed feedback regulator of proportional-integral(PI)-type targets an operating NFD point of maximum throughput to enhance the mobility in the urban road network during the peak period, under saturated traffic conditions. In previous studies, gating was applied directly at the border of the protected network (PN), i.e. the network part to be protected from over-saturation. In this work, the recently developed feedback-based gating concept is applied at junctions located further upstream of the PN. This induces a time-delay, which corresponds to the travel time needed for gated vehicles to approach the PN. The resulting extended feedback control problem can be also tackled by use of a PI-type regulator, albeit with different gain values compared to the case without time-delay. Detailed procedures regarding the appropriate design of related feedback regulators are provided. In addition, the developed feedback concept is shown to work properly with very long time-steps as well. A large part of the Chania, Greece, urban network, modelled in a microscopic simulation environment under realistic traffic conditions, is used as test-bed in this study. The reported results demonstrate a stable and efficient behaviour and improved mobility of the overall network in terms of mean speed and travel time.

The purpose of the present study is to estimate the impact of pharmaceutical spending reduction on public revenue, based on data from the national health accounts as well as on reports of Greece’s organizations. The methodology of the analysis is structured in two basic parts. The first part presents the urgency for rapid cutbacks on public pharmaceutical costs due to the financial crisis and provides a conceptual framework for the contribution of the Greek pharmaceutical branch to the country’s economy. In the second part, we perform a quantitative analysis for the estimation of multiplier effects of public pharmaceutical expenditure reduction on main revenue sources, such as taxes and social contributions. We also fit projection models with multipliers as regressands for the evaluation of the efficiency of the particular fiscal measure in the short run. According to the results, nearly half of the gains from the measure’s application is offset by financially equivalent decreases in the government’s revenue, i.e., losses in tax revenues and social security contributions alone, not considering any other direct or indirect costs. The findings of multipliers’ high value and increasing short-term trend imply the measure’s inefficiency henceforward and signal the risk of vicious circles that will provoke the economy’s deprivation of useful resources. Copyright © 2015 Souliotis, Papageorgiou, Politi, Frangos and Tountas.

A collection of Roman glass samples from Ancient Messene, Greece, was analysed non-destructively for colouring elements and non-colouring additives such as fining agents, opacifiers and decolourizers, by comparing the chemical composition with the observed optical spectra. The resulting information on ion speciation is important for the discussion of technological parameters such as the applied melting temperatures or the prevalent redox conditions. Speciation also helps to distinguish intentionally added dopants from impurities. This knowledge might be used in provenancing the raw materials. The Roman assemblage under study included purple coloured Mn3+-containing glasses, but also samples with high levels of colourless Mn2+. Manganese ions can either be considered a residue of recycling, or are indicative of an intentional addition, either as a fining or as a decolouring agent. Antimony oxide was either added as a fining agent, resulting in good quality transparent glasses, or as crystalline antimonates which act in glass mosaic tesserae as opacifiers. The much weaker molar extinction coefficient and the partial reduction of blue Cu2+ to colourless Cu+ explain why CuO is a weaker colouring agent than CoO. The colours of iron-bearing glasses range from light blue to green and from yellow to dark brown, reflecting a complex interplay between redox conditions and the presence of sulphur in the glass melt.Quantitative speciation of dopants will be reviewed on the basis of the ligand field theory. The different transition probabilities will be demonstrated on differently doped soda lime silicate glasses which were prepared for this purpose in the laboratory. © 2014 Elsevier Ltd.

The latest regulatory change in the distribution system of biologic disease-modifying, antirheumatic drugs limited their sale only through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (NHS) hospitals, adding to the complexity of access to effective treatment for rheumatoid arthritis (RA) in Greece. The aim of this paper was to assess the barriers to access RA treatment, by recording patients', rheumatologists' and EOPYY pharmacists' experiences. One twenty-three patients, 12 rheumatologists and 27 pharmacists from Athens and other urban areas in Greece participated in the study. Three types of standardized questionnaires were used to elicit information from each group of respondents using the method of personal interview for patients and the method of postal survey for doctors and pharmacists. During the last year, 26 % of patients encountered problems in accessing their rheumatologist and 49 % of patients experienced difficulties in accessing their medication. Ninety-two percent of rheumatologists and 96 % of pharmacists confirmed that patients experience difficulties in accessing RA medication. The most commonly reported reasons for reduced access to medical treatment were travel difficulties and long distance from doctor's clinic, as well as delays in booking an appointment. The most frequently reported barriers to access pharmaceutical treatment were difficulties in the prescription process, distance from EOPYY pharmacies and medicine shortages in NHS hospitals. The study showed that RA patients are facing increased barriers to access timely and effective treatment. Redesign of the current system of distribution ensuring the operation of additional points of sale is deemed necessary. © 2013 Springer-Verlag Berlin Heidelberg.

Histological severity is often mandatory for the management of HBeAg-negative chronic HBV patients. We evaluated the performance of transient elastography (TE) in this setting. We included 357 untreated HBeAg-negative patients with >= 1 reliable liver stiffness measurement (LSM-kPa) by TE: 182 inactive carriers with HBV-DNA < 2000 (n = 139) or 2000-19 999 IU/mL (n = 43) and 175 patients with chronic hepatitis B (CHB). In carriers, HBV-DNA > 2000 and/or LSM > 6.5 were considered as biopsy indications. LSMs did not differ between carriers with low and high viremia, but were lower in carriers than in patients with CHB (5.8 +/- 1.7 vs 9.0 +/- 5.6, P < 0.001) offering moderate differentiation between these two groups (AUROC: 0.705). LSMs did not change significantly in carriers after 16 (12-24) months. In carriers with a liver biopsy, Ishak’s staging scores were similar between cased with low and high viremia but higher in cases with LSM > 6.5 than 2000 IU/mL, 2/10 (20%) carriers with only LSM > 6.5 and 5/10 (50%) carriers with both HBV-DNA > 2000 and LSM > 6.5 (P = 0.009). In patients with CHB, LSMs correlated significantly with grading and staging scores and offered excellent accuracy for >= moderate, >= severe fibrosis or cirrhosis (AUROC >= 0.919-0.950). TE can be helpful for the noninvasive assessment of HBeAg-negative chronic HBV patients. In conclusion, LSMs offer excellent accuracy for fibrosis severity in HBeAg-negative patients with CHB and can identify carriers with high risk of moderate fibrosis, which may be present in up to 35% of carriers with LSM > 6.5 kPa and 50% of carriers with LSM > 6.5 kPa and HBV-DNA > 2000 IU/mL.

The present study attempts to offer insight into the volume, cost, and productivity of the operation of a cardiac echocardiographic laboratory (echo-lab) in a major public hospital of Greece and thus to contribute, on a practical level, to the widening of knowledge in the strategic field of secondary and tertiary healthcare management. The conducted research includes the basic step of the deployment of a primary data registry in the echo-lab and unfolds in three levels, i.e. the variability measurement of the quantity and cost of medical services provided to different patient populations, the assessment of operating costs and the development of productivity indexes. The results show that the mean costs of provision do change among distinct patient populations. The most important, from a financial standpoint, population cluster appears to be the one corresponding to outpatients. Productivity indices presented in this analysis constitute an essential piece of information which the public healthcare system is currently largely lacking, and which, combined with the pricing and the diagnosis-related group coding system of hospitals, can be used to improve efficiency in the management of secondary and tertiary care. © 2014, Katsi et al.; licensee Springer.

Background. Thyroglobulin (Tg) is used as a postoperative marker for the follow-up of patients with thyroid carcinoma, but there is no consensus regarding the value that may indicate possible recurrence. Aim. To evaluate Tg levels as a marker for recurrence of thyroid carcinoma. Subjects and methods. Demographics and survival of 80 patients who underwent total thyroidectomy for well-differentiated thyroid cancer were analysed and related to Tg levels. Tg measurements were performed when patients were euthyroid, after completion of treatment. Results. The median Tg value was 1.3 ng/ml. Higher values were found in males, high-risk patients and patients with recurrent disease. Using the median Tg value as cut-off, patients were divided into two groups (group I ≤1.3 ng/ml and group II >1.3 ng/ml). There was a significant correlation between values >1.3 ng/ml and recurrence. When survival was related to Tg values, there was a tendency towards worse prognosis in group II. The best predictive cut-off value for recurrence was found to be 1.3 ng/ml, which had a sensitivity of 77% and a specificity of 57%. Conclusions. Although low, a cut-off Tg level of 1.3 ng/ml represents a simple indication for further investigation in patients receiving thyroxine after completion of treatment for thyroid cancer, in the absence of measurement of anti-Tg auto-antibodies.

Liposarcomas are malignant tumors derived embryologically from mesodermal tissues. An unusual site of presentation is the spermatic cord, presenting as an inguinal or scrotal mass. We report a rare case of a liposarcoma of the spermatic cord, mimicking a testicular tumor. The patient was operated, and an orchidectomy, including the tumor, was performed. To our knowledge, there are about 185 similar cases reported in the literature.

Water, under the climatic conditions of the Earth, is found in three natural states, as a solid, as a liquid and as a gas. Since the quantities of water on the Earth's surface are constant, at least for the last few million years, then the entire historic evolution of human society, and especially since the appearance of Homo sapiens, is directly depended on the climatic changes and their consequences on the natural state of water. It has been calculated that the available water in nature will not be enough to cover the human needs, when the Earth population doubles. Water, in the future, will formulate a "new world order". Lots of characters of Greek Mythology are related to water. People had created their Gods in order to help them with their fears, their necessities, trying to explain the inexplicable for them natural phenomena. The use of Mythology in the environmental education could help the student to better understand that (i) the environment does not remain static; (ii) the environmental changes have led "Homo sapiens" to create myths in order to understand and to explain the phenomena that provoked them; (iii) the balance of the Earth ecosystem is easy to disturb; (iv) the human intervention causes unexpected consequences; (v) the knowledge of the environmental changes of the past leads to environmental realization, resulting in a more rational usage of natural resources. © 2007 Elsevier B.V. All rights reserved.

Background: Despite rapid advances in the management of preterm infants, periventricular leukomalacia (PVL) remains a considerable problem in neonatal intensive care. The aim of this study was to determine whether hypocarbia is associated with the development of PVL in mechanically ventilated, preterm infants and to emphasize the importance of avoiding this disturbance. Methods: The authors evaluated 52 mechanically ventilated infants with a gestational age of

Two new alkaloids, megistophylline I (1) and megistophylline II (2), were isolated from the bark of Sarcomelicope megistophylla. Their structures have been elucidated on the basis of MS and NMR data.

The paper presents the philosophy, the aim, the development, the advantages, and the potential shortcomings of the TUC (Traffic-responsive Urban Control) strategy. Based on a store-and-forward modeling approach and using well-known methods of the Automatic Control Theory, the approach followed by TUC designs (off-line) and employs (on-line) a multivariable regulator for traffic-responsive co-ordinated network-wide signal control. Simulation investigations are used to demonstrate the efficiency of the proposed approach. Based on the presented investigations, summarising conclusions are drawn and future work is outlined.

Background Contact dermatitis can complicate the treatment of leg ulcers and is an acquired phenomenon resulting from the use of topical medications. Objective To show the incidence of contact dermatitis reactions to topical medications applied to leg ulcers and to evidence changing trends in such reactions through comparison of two case series about 20 years apart. Subjects and methods We studied two groups of patients with leg ulcers that were patch tested with contact allergens in 1973-1974 and in 1994-1995. Results One or more positive patch tests was present in 75% and 40% of the patients, respectively. A decrease in the incidence of positive reactions to neomycin, local anesthetics and parabens mix was seen in 1994-1995. The most important contact allergens in 1994-1995 were fragrance mix, colophony and the excipients wool alcohols and amerchol. Other relevant sensitizers were formaldehyde, neomycin and gentamycin. Conclusion The changing trends in contact allergens over the last 20 years may be explained by changes in the components of topical agents used for treatment. (C) 1998 Elsevier Science B.V. All rights reserved