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Objective: Greece has been affected more than any other European country from the financial crisis that began in 2010. Just 20 months after Greece exited an eight-year long aid program, forecasts of a new recession within 2020 due to COVID-19 pandemic make concerns regarding the compromise of health care quality within the new crisis relevant once again. In this study we sought to evaluate clinical outcomes in patients with advanced lung cancer in the pre-crisis and crisis era in a dedicated oncology centre in Greece. Methods: A retrospective analysis of 522 consecutive medical records of lung cancer patients admitted in a Greek dedicated cancer hospital between the years 2008-2013 was performed. Progression Free Survival (PFS) and Overall Survival (OS) were calculated for advanced lung cancer compared over two consecutive time periods using 2010 as a cutoff point.Result: 71 and 78 patients comprised the study sample for the two periods. PFS and OS were similar over the two periods (7.73 [6.42-9.04] vs. 6.03 [5.02-7.04] and 13.70 [9.61-17.79] vs. 11.08 [7.74-15.92] months, respectively). Higher Performance Status (PS) was associated with worse survival measures over both periods, while no statistical significance was reached for OS in the latter period. Dissimilarities in PFS were observed between beneficiaries of different insurance trusts. Conclusion: Clinical outcomes for advanced lung cancer have not changed as a result of the financial crisis in our institution. The insurance provider seems to affect health outcomes. This old paradigm could serve as new guidance in the forthcoming recession due to COVID-19 pandemic.

Anti-SARS-CoV-2 spike RBD (receptor-binding domain) IgG antibody levels were monitored in 1643 volunteer healthcare workers of Eginition, Evangelismos, and Konstantopoulio General Hospitals (Athens, Greece), who underwent vaccination with two doses of COVID-19 BNT162b2 mRNA vaccine (Pfizer) and had no history of SARS-CoV-2 infection. Venous blood was collected 20–30 days after the second vaccine dose and anti-RBD IgG levels were determined using CMIA SARS-CoV-2 IgG II Quant (Abbott) on ARCHITECT i System or ADVIA Centaur SARS-CoV-2 IgG (Siemens) on Centaur XP platform. From the total population of 1643 vaccinees (533 M/1110 F; median age = 49; interquartile range-IQR = 40–56), 1636 (99.6%) had anti-SARS-CoV-2 IgG titers above the positivity threshold of the assay used. One-Way ANOVA Kruskal-Wallis H test showed a statistically significant difference in the median of antibody titers between the different age groups (p < 0.0001). Consistently, Spearman’s correlation coefficient (r) for IgGs and age as continuous variables was −0.2380 (p = 1.98 × 10−17). Moreover, antibody titers were slightly higher by 1.2-mean fold (p = 3 × 10−6) in the total female population of the three hospitals (median = 1594; IQR = 875–2584) as compared to males (median = 1292; IQR = 671.9–2188). The present study supports that BNT162b2 vaccine is particularly effective in producing high anti-SARS-CoV-2 IgG levels in healthy individuals, and this humoral response is age- and gender-dependent.

Baltic trade is one of the key examples of flourishing economic activity in early modern European history. This study empirically outlines the role of comparative resource advantages between 1750 and 1856, using trade data from the Sound Toll Registers Online. On the one hand, the results show the significance of relative land abundance for trade patterns between the Baltic Sea region and North-Western Europe: the land abundant Baltic Sea region was overall exporting more land-intensive commodities. On the other hand, however, the results also show a seeming paradox: increasing trade openness during the nineteenth century was not associated with a higher degree of specialization along these comparative advantages.

Land was an unambiguous constraint for growth in the pre-industrial period. In Britain it was overcome partly through the transition from traditional land-based goods to coal (vertical expansion) and partly through accessing overseas land, primarily from colonies (horizontal expansion). Kenneth Pomeranz suggested that horizontal expansion may have outweighed vertical expansion in the first decades of the nineteenth century. Taking a more complete approach to trade, we find that Britain was a net exporter of land embodied in traded commodities, apart from in the early nineteenth century, when potash (rather than cotton or timber) constituted the major land-demanding import from North America. The vertical expansion was generally larger than the horizontal expansion. In other words, Britain was not simply appropriating flows of land and resources from abroad but simultaneously providing its trading partners with even more land-expanding resources.

The role of agriculture has been central in Africa’s long-term economic development. Previous research has argued that low productivity of African economies has posed significant challenges in African efforts to produce an agricultural surplus or develop commercial agriculture. Low agricultural productivity has also served as a key explanation for the transatlantic slave trade, on the basis that it was more profitable to export humans overseas than to grow and export produce. The field has however suffered from a lack of comparable empirical evidence. This paper contributes to this field by presenting quantitative data on historical land- and labour productivity in Africa, from a case study of the agricultural productivity in Senegambia in the early nineteenth century. Focusing on five key crops, our results suggest that both land- and labour productivity was lower in Senegambia than it was in all other parts of the world for which we have found comparable data. We thus lend support to claims that stress ecological factors as one of the main determinants of Africa’s historical development.

Although out-of-hospital cardiac arrests (OHCA) are a major cause of mortality internationally, data regarding survival in Greece remains scarce and inconclusive. The aim of this study is to assess the immediate and 24-hour survival of OHCA sufferers during a 5-year period in a public hospital in Athens. A retrospective study was conducted on all cardiac arrests that were transferred to our hospital during a five-year period (2011-2015). Our primary objective was to calculate return of spontaneous circulation (ROSC) and 24-hour survival ratios. Our secondary objective was to estimate 30-day survival. Demographic data was also collected. 283 OHCA were included in the study. The mean age was 67.2 years and the male: female ratio was 2. Medical history was available for 33.6% of patients. 72.1% of cases were transferred to the emergency department by ambulance and 2.8% by private means of transport. Cardiopulmonary resuscitation was attempted on 57.6% of cardiac arrests, 8.6% regained ROSC and 6.1% survived for 24 hours. The 30-day survival was expected to be less than 3.5%. In our institution, ROSC, 24-hour and expected 30-day survival were lower than the European average and in accordance with the recent prospective Eureca One study. However, data from our institution cannot be generalised and multicenter studies are required in order to clarify OHCA outcomes in Greece.

Listeria monocytogenes (L. monocytogenes) is a Gram-positive bacillus that infects immunocompromised persons, neonates, pregnant women and, occasionally, previously healthy individuals. L. monocytogenes brain abscesses are particularly rare.We present a 62-year-old female on corticosteroid treatment due to a recent diagnosis of autoimmune hepatitis, who suddenly developed right hemiparesis mimicking a stroke. A brain computerized tomography (CT) scan revealed a brain abscess and the blood cultures drawn yielded L. monocytogenes. A conservative treatment without surgical intervention was selected. The patient was commenced on intravenous ampicillin and gentamicin and showed remarkable improvement. She was successfully discharged on oral amoxicillin with probenecid. Since the subsequent magnetic resonance imaging (MRI) study and CT scans exhibited reduction in the size of the abscess, the antimicrobial treatment was discontinued after a three-month period. The patient underwent regular follow-up visits with no signs of relapse.

Background We aimed to consolidate our clinical observations regarding the development of pulmonary hypertension following pneumonectomy for lung cancer. Methods Sixty-nine of 82 initially selected patients without pulmonary or cardiac comorbidities, who underwent pneumonectomy for lung cancer between October 2009 and October 2011, accomplished our protocol. Mean patient age was 60.6 years (range 44–78 years) and 10.1% were women. Results Postoperative complications occurred in 16 (23.2%) patients. Mortality at 1, 12, and 18 months postoperatively was 4.3%, 15.9%, and 29%, respectively. One year postoperatively, 37.9% of patients developed mild to moderate pulmonary hypertension and 3.4% had severe pulmonary hypertension. The calculated mean pulmonary artery systolic pressure at 1, 6, and 12 months postoperatively was 21.9 ± 6.6, 27.3 ± 9.3, and 34.1 ± 14 mm Hg, respectively ( p Conclusions Pulmonary hypertension may occur after pneumonectomy with its known adverse effects. Patients with late postoperative pulmonary artery systolic pressure > 35.5 mm Hg are at higher risk of a suboptimal clinical outcome.

Although it has been proven that decreasing the arterial blood pressure decreases cardiovascular morbidity and mortality,25% of hypertensive patients receiving antihypertensive treatment achieve target values, which are mainly attributed to failure of the patients to comply to treatment. Ensuring patient compliance to antihypertensive treatment, to prevent the development of hypertension-associated complications, has proven to be challenging in several countries. The aim of the present study was to investigate the knowledge, perceptions and practices applied by doctors treating hypertensive patients regarding patient compliance to the prescribed treatment. We also aimed to assess the possible barriers physicians face to using reinforcement methods and currently available guidelines. A total of 202 doctors from the Serres and Drama prefectures of Greece participated in this study. The data collection comprised a quantitative method questionnaire and the data were processed using Stata 8.0 statistical software. The results demonstrated that 84.7% of the participating doctors do not use the current guidelines for compliance, whereas only 10.1% have consultations lasting15 min when discussing the medication with their patients. In addition, the majority (84.7%) of the doctors do not practice peer mentoring and consider the most effective interventions to be providing information and discussing the medication with their patients. In conclusion, the level of patient compliance to antihypertensive medication is unsatisfactory and the main reason is considered to be the non-use of guidelines by the treating physicians. Patients may benefit from further education of health professionals in this field.

This paper aims to investigate the stress management skills of Christian Orthodox monks and nuns, as measured by Antonovsky's scale sense of coherence (SOC). A case-control study was designed to test the hypotheses whether monks and nuns have higher SOC than secular people. The study population consisted of 193 individuals, 96 monks and nuns (study group) and 97 secular men and women (control group). SOC score was higher in monks and nuns as compared to the secular population (p = 0.002), men as compared to women (p = 0.012) and persons of older age (p = 0.004) as compared to younger individuals.

Objective: The objective of this study is the assessment of the impact of a brief patient group education intervention (Conversation Maps TM ) in people with type 2 Diabetes Mellitus. Methods: A total of 138 people with type 2 Diabetes Mellitus who were regular patients at the diabetic clinic of a Primary Health Care setting in Attica participated in the study. The intervention group attended a structured group, brief educational programme (three sessions of two hours each). The main outcome measures were glycated hemoglobin (HbA1c), Body Mass Index (BMI), triglycerides, High-density lipoprotein (HDL), Low-density lipoprotein (LDL), measured at baseline and six months after the intervention. Results: After 6 months, significant reductions were observed between the baseline and follow-up data in HbA1c ( p < .001) in BMI (p < .007) in triglycerides ( p < .003), in LDL-cholesterol ( p < .001), while the mean HDL-cholesterol remained stable ( p = .397). Conclusions: Group-based patient education with Conversation Maps TM for people with type 2 diabetes is effective in the improvement of clinical outcomes.

This study aims to assess the impact of a brief patient group education intervention in people with type 2 diabetes mellitus. The sample, 193 people with type 2 diabetes mellitus who were patients at the diabetic clinic of a primary health care setting in Attica, was assigned to two groups, intervention (138 individuals) and control group (55 individuals). The intervention group, instead of receiving standard care, attended a structured group educational programme using Conversation Maps while the control group had standard care. The main outcome measures were HbA1c, body mass index (BMI), triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), measured at baseline and 6 months after the intervention. After 6 months, significant differences in changes ofthestudiedparameterswereobservedbetween the groups in HbA1c, 1.4 (95% CI: 1.1, 1.7), (P

IntroductionMusic has been proposed as a safe, inexpensive, nonpharmacological antistress intervention. The purpose of this study was to determine whether patients undergoing cataract surgery while listening to meditation music experience lower levels of blood pressure and heart rate.MethodsTwo hundred individuals undergoing cataract surgery participated in the study. Hundred individuals listened to meditation music, through headphones, before and during the operation (intervention group) and 100 individuals received standard care (control group). Patients stress coping skills were measured by the Sense of Coherence Scale (SOC Scale). Systolic and diastolic blood pressure and heart rate were defined as outcome measures.ResultsAccording to the SOC Scale, both groups had similar stress coping skills (mean score: 127.6 for the intervention group and 127.3 for the control group). Before entering the operating room (OR) as well as during surgery the rise in systolic and diastolic pressures was significantly lower in the intervention group ( P < 0.001). Among patients receiving antihypertensive therapy, those in the intervention group presented a lower increase only in systolic pressure ( P < 0.001) at both time recordings. For those patients in the intervention group who did not receive antihypertensive treatment, lower systolic blood pressure at both time recordings was recorded ( P < 0.001) while lower diastolic pressure was observed only during entry to the OR ( P = 0.021). Heart rate was not altered between the two groups in any of the recordings.ConclusionsMeditation music influenced patients' preoperative stress with regard to systolic blood pressure. This kind of music can be used as an alternative or complementary method for blood pressure stabilizing in patients undergoing cataract surgery.

Fuzzy Cognitive Networks (FCN) stem from Fuzzy Cognitive Maps (FCM), initially introduced by Kosko to model complex behavioral systems in various scientific areas. This chapter presents basic definitions related to FCM and the traditional way of their operation. It starts with a brief bibliographical introduction, presenting various extensions of the initial model and areas of application. Since their convergence is a crucial point for the development of Fuzzy Cognitive Networks, particular emphasis is given to the subject of their convergence to equilibrium points and some noticeable peculiarities that may appear. Then, the scope of Part II of this book is analyzed and the organization of the relevant chapters is presented.

In this paper, an adaptive control method for trajectory tracking of robot manipulators, based on new neuro-fuzzy modelling is presented. The proposed control scheme uses a three-layer neural fuzzy network (NFN) to estimate system uncertainties. The function of robot system dynamics is first modelled by a fuzzy system, which in the sequel is approximated by a combination of high order neural networks (HONNs). The overall representation is linear in respect to the unknown NN weights leading to weight adaptation laws that ensure stability and convergence to unique global minimum of the error functional. Due to the adaptive neurofuzzy modelling, the proposed controller is independent of robot dynamics, since the free parameters of the neuro-fuzzy controller are adaptively updated to cope with changes in the system and the environment. Adaptation laws for the network parameters are derived, which ensure network convergence and stable control. A weight hopping technique is also introduced to ensure that the estimated weights stay within pre-specified bounds. The simulation results show very good approximation performance of the proposed representation as compared with a simple NN approximator and very good tracking abilities under disturbance torque compared to conventional computed torque PD control.

Capecitabine (Xeloda(®)) is an oral fluoropyrimidine which is produced as a pro-drug of fluorouracil, and shows improved tolerability and intratumor drug concentrations following its tumor-specific conversion to the active drug. We have searched the Pubmed and Cochrane databases from 1980 to 2009 with the purpose of reviewing all available information on Capecitabine, focusing on its clinical effectiveness against colorectal cancer. Special attention has been paid to trials that compared Capecitabine with standard folinic acid (leucovorin, LV)-modulated intravenous 5-fluorouracil (5-FU) bolus regimens in patients with metastatic colorectal cancer. Moreover the efficacy of Capecitabine on metastatic colorectal cancer, either alone or in various combinations with other active drugs such as Irinotecan and Oxaliplatin was also assessed. Finally, neoadjuvant therapy consisting of Capecitabine plus radiation therapy, for locally advanced rectal cancer was analysed. This combination of chemotherapy and radiotherapy has a special role in tumor down staging and in sphincter preservation for lower rectal tumors. Comparative trials have shown that Capecitabine is at least equivalent to the standard LV-5-FU combination in relation to progression-free and overall survival whilst showing a better tolerability profile with a much lower incidence of stomatitis. It is now known that Capecitabine can be combined with other active drugs such as Irinotecan and Oxaliplatin. The combination of Oxaliplatin with Capecitabine represents a new standard of care for metastatic colorectal cancer. Combinating the Capecitabine-Oxaliplatin regimen with promising new biological drugs such as Bevacizumab seems to give a realistic prospect of further improvement in time to progression of metastatic disease. Moreover, preoperative chemo-radiation using oral capecitabine is better tolerated than bolus 5-FU and is more effective in the promotion of both down-staging and sphincter preservation in patients with locally advanced rectal cancer. Finally, the outcomes of recently published trials suggest that capecitabine seems to be more cost effective than other standard treatments for the management of patients with colorectal cancer.