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PURPOSE The aim of this study was to highlight the impact of the COVID-19 pandemic on the practice of orthopaedics in Greece and Cyprus. METHODS The survey used the online questionnaire from AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie; Society for Arthroscopy and Joint Surgery) to facilitate the comparison between different European countries. The questionnaire was distributed online to members of the HAOST (Hellenic Association of Orthopaedic Surgery and Trauma), the ΟΤΑΜΑΤ (Orthopaedic and Trauma Association of Macedonia and Thrace) and the CAOST (Cypriot Association of Orthopaedic Surgery and Trauma). The questionnaire consisted of 29 questions, which included demographic data, questions on the impact of the pandemic on the practice of orthopaedic surgery and questions on the impact on the personal and family life of orthopaedic surgeons. RESULTS The questionnaire was sent to 1350 orthopaedic surgeons in Greece and Cyprus, 303 of whom responded (response rate 22.44%). 11.2% of the participants reported cancellation of overall orthopaedic procedures. According to 35.6-49.8% of the participants, arthroscopic procedures were continued. As regards elective primary arthroplasties, 35.3% of the participants reported that these continued to be performed at their hospitals. Post-operative follow-ups as well as physiotherapy were affected by the pandemic, and changes were also observed in the habits of orthopaedic surgeons in their personal and family lives. CONCLUSION The orthopaedic service in Greece and Cyprus decreased during the first wave of the COVID-19 pandemic. Arthroscopic procedures and total joint replacements decreased significantly, but not to the same extent as in other countries. Health systems were not fully prepared for the first wave of the pandemic and the various countries took social measures at different times and to different extents. Thus, studying the impact of the pandemic on the practice of orthopaedic surgery in different countries can help health systems to better prepare for future pandemics; public health can then be shielded and hospitals can continue to provide high-quality orthopaedic care. LEVEL OF EVIDENCE Level V.

Introduction: The new disease covid 19 from the day it was declared a pandemic (March 2020) until today has significantly differentiated the map of health inequalities around the world. Social protection systems and the welfare state continue to receive strong shocks. Aim: This paper attempted to present the effects of the social protection components, to describe the causes that exacerbated health inequalities and to report on the measures taken by the welfare states in an effort to alleviate the problems that arose during the pandemic. Methods: Literature review in international databases (PubMed, Google Scholar) using specific keywords in Greek and English, in published books and references on the internet. Results: The conceptual definition of the terms equality in health, health determinants, welfare state, social protection systems, contributes to the understanding of the effects of the new disease covid 19 impact on the health status and health care of the population. Gender, age, financial status, comorbidity of mental and physical problems, living conditions, are directly related to susceptibility to the disease. The virus affects all areas of social protection. The aid measures taken concern work, insurance, housing, education and sickness and housing benefits were given. Conclusion: Covid 19 disease increases health inequalities, alongside people who are disadvantaged due to their socio-economic status and health status are more susceptible to the new coronavirus. The pandemic is pushing social protection systems in many ways.

Introduction:Care delivery from nursing staff to patients in hospital environment may involve the exertion of considerable muscular force and, as a result, there is a consequent risk of developing musculoskeletal disorders (MSDs). The aim of this prospective study was to investigate the relationship between reported MSDs and perceived caring behaviors among nursing staff. Methods: A total of 250 questionnaires were completed in three Greek hospitals during February and March 2019. The Nordic Musculoskeletal Questionnaire for the evaluation of MSDs and the Caring Behaviors Inventory-24 (CBI-24) for the assessment of caring behaviors were used. Results:A total of 185 participants (74%) were found to have at least one MSD. Back (64.3%), neck (63.2%) and shoulder (58.4%) pain were the most commonly reported MSDs. The mean score on the CBI-24 scale was 5.06 (SD=0.51) and the mean “Connectedness” dimension was 4.59 (SD=0.74). Elbow MSDs were significantly associated with the lowest score in the “Knowledge and skills” dimension (p=0.024) and the lowest overall nursing score (p=0.048). Linear regression analysis showed that the lowest nursing care score was associated with left-handed nurses (p=0.008) of low hierarchical position (p=0.013), suffering from elbow MSDs (p=0.002), for which they did not seek treatment (p=0.023). Participants who continued to work on a regular basis despite MSDs showed a lower score on the dimensions of “Respectful” (p=0.05) and “Connectedness” (p=0.01). Conclusion:The nursing staff showed high percentage of MSDs that negatively affected their perceived dimensions of caring behaviors. These findings could be used to prevent and deal with work-related MSDs, reduce occupational hazards and improve hospital patient care.

Introduction: The welfare state is characterized by an expanded social function and aims at the well-being of its citizens. Social policy is a key pillar of its operation. Purpose: The review of the literature on the typologies of the welfare state and the proposal of health policies for the elimination of health inequalities. Methodology: Review of literature in international databases, using as keywords "welfare state, typologies, unmet needs, health inequalities". Results: The welfare state was studied by many researchers, such as Titmuss, Espring-Andersen and Ferrera, who classified it into models. The typologies they proposed were criticized for their shortcomings and weaknesses, but can be used as a tool for comparison and evolution. The failure of the welfare state is reflected in its inability to eliminate social inequalities. One category of inequalities is health inequalities that occur to varying degrees across health systems. Through surveys, recipients of health services can report their unmet needs for health care, resulting conclusions about unequal access, use and quality of services and investigate the causal factors related to or not related to the health system of each country. Conclusions: The removal of social inequalities comes with the adoption of health policies. The study of the different models of the welfare state and the unmet needs of the citizens comparatively highlights the weaknesses of the state and the way in which it must adapt to the new data. Reforms are needed and must be done with particular emphasis on vulnerable populations

As of March 11, 2020, Coronavirus disease (COVID-19) has been declared a pandemic from WHO organization. On June 30, 2020, the disease has already spread in all continents numbering 10 million confirmed cases and 500.000 deaths(1). In regions with limited cases, health-care units suffice to provide routine services and manage infected with coronavirus patients simultaneously. However, during an epidemic outbreak, the high number of cases compared to the shortage of health workforce increases the risk of system collapse. In order to respond adequately, hospitals should reprioritize their services, including operations and outpatient clinics and protect its personnel from infection(2) Shrinkage of surgical activity in emergency surgeries saves equipment and personnel necessary for the care of COVID-19 patients and protects high risk patients from getting infected(3). In order to maximize the provided urological surgeries, 4 parameters should be considered: the emergency of the operation, the risk of infection, the capacity of the hospital and cooperation between different urological departments. Initially, all emergency surgeries should be performed promptly in order to ameliorate the health status of the patient and reduce hospital stay (Table 1). In case the results of COVID-19 test, are not readily available the operation should be performed without delay in special operating rooms and the patient treated in separate wards. Regarding elective operations, all non-oncological surgeries should be postponed. In oncological diseases, where possible, opt for alternative treatments, such as radiotherapy with ADT in prostate cancer or ablation of renal tumors. Next, all surgical candidates should be tested for COVID-19 before surgery. In case of positive result, the surgery should be rescheduled. In countries where this measure is not feasible, preoperative evaluation of the respiratory tract from an internist, including a chest x-ray is suggested. Following that, the operating program should be adapted to hospital capacities. In case of small number of COVID-19 cases, surgical candidates should continue to be treated according to oncological severity. On the contrary, when hospital capabilities are overwhelmed by the inflow of COVID-19 patients consider treating patients with the longest expected survival, irrespective of the underline disease. Otherwise, urologist must consider maximizing the number of treated patients and minimizing the hospital stay, possibly by performing less time-consuming surgeries particularly in patients without good performance status. The expertise of each center should also be evaluated and candidates for radical, time-consuming operations referred to specialized centers (Figure 1). During de-escalation phase, special attention should be given in patients with urolithiasis and ureteral stents, since they are at increased risk of encrustation and complicated pyelonephritis (4). All previous measures could reduce attendance in hospitals with the cost of increasing waiting lists. Despite, closure of outpatient departments prevents crowding and hinders dispersion of the virus(5), the demand for urological services is ongoing and, also expected to increase during the de-escalation phase of COVID-19 pandemic. However, there is no single protocol in the management of urological patients. In order to preserve general population healthy and face current demands the urologist should consider the following questions (Figure 2). 1. Is this case an emergency? In order to provide consultation in urological patient urologists are encouraged to use telemedicine(6). Through video-communications urologist can diagnose effectively common urological disease and even prescribe medications and tests. Additionally, urologists can screen patients with acute urological problems and symptoms of COVID-19 infection referring appropriately. Particularly patients at increased risk for severe COVID-19 pneumonia such as renal transplant patients, oncological patients and those with renal dysfunction should have their clinical evaluation through telemedicine(7). On the contrary, the inability to perform clinical and diagnostic tests, along with the lack of experience in teleconsultation lowers diagnostic accuracy. 2. Is there a possibility of COVID-19 infection? Screening for COVID-19 is necessary for all urological patients. Regarding outpatients, phone screening about respiratory symptoms within the last 14 days (fever, cough, myalgia, fatigue, dyspnea), travel history and fever could detect high risk patients requiring further referral to special units.

Financial crisis in Greece has brought many changes in health care, not only in population level but also in financial level. There have been investigated the changes in the Greek citizens’ health level, by the presentation of the changes in values of the healthy life indicator in the last decade. It is presented a significant decline, in contrast with the equivalent indicator in Sweden and the European average where it is presented a rapid rise. In financial level, the adjustment programme which has been applied resulted the recession of Greek economy and the consequent reduction of public funding in health, the support of private expenditure so as the rise of the indicator of the citizens’ unmet needs for health care. The use of generic drugs constitutes a mean of saving health resources. However, its pervasiveness in Greece is presented low, in contrast with the other European countries. It occurs that there have been many changes in the health field of our country the last decade, with consequences in citizens, especially the socioeconomic sensitive groups. The question that is been raised is how the meta- memorandum policies will manage to reverse the current data so as our country will succeed to return to growth rates and development.&nbsp

Purpose: The purpose of this study was to validate the Greek version of the Tinnitus Handicap Inventory. Method: Eighty-six adult patients with chronic tinnitus participated in the study. Sociodemographic data and medical history were recorded during the interview. The patients underwent audiological examination and they were asked to fill in three questionnaires: the Greek version of the THI (THI-GR), the Greek version of the State-Trait Anxiety Inventory (STAI) and the brief Tinnitus Severity Scale Questionnaire (TSSQ). Results: The THI-GR showed good internal consistency, comparable to the original version. Cronbach's alpha was equal to 0.92, which suggests a robust reliability. All THI-GR subscales along with total score were significantly and positively correlated with the TSSQ grade and the audiogram results indicating the existence of convergent validity. Furthermore, THI-GR's subscales were significantly correlated with both State and Trait subscales, which indicates a correlation between tinnitus and stress. Conclusions: This study highlighted the high reliability and validity of the THI-GR as a self-report measure for the evaluation of tinnitus-related annoyance and psychological distress in clinical practice.