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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