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A giant gastric ulcer penetrating into liver is a rare entity. Information is limited and the management recommendations are not clear. The surgical team has to consider several factors, before choosing between a major or minor procedure.

Doctor-patient interaction was examined under game theory’s concept. Our aim was to investigate which model fits more along, calculating the payoffs for every involved part. We conducted a cross-sectional study and a sample of 95 pairs of surgeon-patient questionnaires was collected. The outcomes of interest were time of the session along with compliance to treatment. A set of sociodemographic factors was used along with interaction dependent factors. Descriptive statistics were followed by chi-square tests, t-tests and univariate logistic regression models for statistically significant continuous variables. Mean time of the session was 15.8 minutes. Longer session time was related statistically significantly to non-compliance. Also, type of treatment was statistically significantly correlated with compliance. Less compliance was observed in patients to whom a surgical treatment was proposed. In our example of consultation game, most information provided by the consultant was associated with non-adherence to treatment.

The aim of the study was to examine the factors associated with health-service use, obtain a self-assessment of health status, and evaluate overall satisfaction with healthcare in adults living in the city of Patras, Greece. We designed a cross-sectional study. A random sample of 312 people from Patras was collected to assess respondents’ use of health services, their subjective perceptions of health status, and their satisfaction with healthcare services. Univariate analyses with Pearson’s chi-square test and Student’s t-test were followed by multivariate logistic regression models investigating the impact of socioeconomic factors on health-service use and satisfaction. Of the respondents, 17.9% hadused a healthcare service at least once within the last 12 months. Self-assessments of health status above average were reported by 66.3% of respondents, and 61.2% were satisfied with their healthcare services. Multivariate logistic regression analyses identified the predictive factors for healthcare visits, subjective perceptions of health status, and satisfaction with healthcare services. Below average subjective health perception was more likely in the older, female, and socioeconomically deprived population with chronic medical conditions. Females with chronic medical conditions were more likely to use healthcare services, and they had a greater likelihood to be satisfied with their healthcare services. Recognition of people’s needs and satisfaction with services will lead to more rational implementations of health-directed policies.

Introduction The influence of trauma- and surgical stress-induced decrease of CD4 count on anastomotic leaks after penetrating abdominal trauma has to date not been investigated. A prospective study was performed to explore the effect of CD4 count 24 h after surgery on the anastomotic leak rate and to identify risk factors for anastomotic leaks. Methods This was a prospective study including 98 patients with small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma. Univariate analysis identified risk factors for the development of anastomotic leak and also investigated the predictive value of the CD4 count for this complication. Results Of the 98 patients 23 patients (23%) were HIV-infected. The overall leak rate was 13%. Univariate analysis including all potential risk factors with p-values 6units and delayed anastomosis after damage control surgery. Survival rates were analysed with the χ2 test and did not show a significantly higher mortality rate in patients with low CD4 count. The negative impact of trauma and subsequent surgery on the cell mediated immunity was demonstrated by the fact that 55 (73%) of the HIV-negative patients had a CD4 count less than 500 cells/μl 24 h postoperatively. HIV-infection had no significant influence on the leak rate, however all HIV infected patients that developed an anastomotic leak died. Conclusion A low post-operative CD4 count is a predictor for anastomotic leaks irrespective of HIV-serostatus. Low postoperative serum albumin, high injury severity, gunshot wound as mechanism of injury, blood transfusion requirement >6 units and delayed anastomosis were further risk factors for anastomotic complications. Postoperative CD4 count and serum albumin should be considered in the decision making process of performing an anastomosis or diverting stoma for patients after “clip and drop” of the bowel as part of damage control surgery.

Background This study is a population-based cross-sectional survey in the health cities framework for improving and directing health policies. The aim of the study was to examine the prevalence of common mental disorders (CMD) and their relationship with the health services use in adults living in Cyprus. More specifically, among many of the health-related behaviours addressed in this paper, we investigate the association between diagnosed mental disorders and self-reported CMD 1 via the use of health services and the factors contributing to those disorders. Methods A representative, stratified sample of 1002 people from Cyprus was collected between April 2013 and April 2014. Structured, face-to-face interviews were used to assess people's use of the health services, psychiatrist-diagnosed depression, anxiety and self-reported depression and anxiety. Associations of health services use and CMD were made via Pearson's chi-square test and, in order to investigate the CMD relationship with socioeconomic factors further, we used multivariate logistic regression models. Results The prevalence of psychiatrist-diagnosed CMD was 3.5%, and CMD symptomatology was 29.8%. Hospital admission within the last 12 months was 28.6% among CMD-diagnosed cases, compared to 6.4% in non-CMD cases. Further, doctor visit rates were 54.3% among those with CMD, compared to 23.1% in non-CMD participants. Relative results are also shown for CMD symptomatology. Multivariate logistic regression analyses identified the predictive factors for CMD diagnoses and CMD symptomatology. Conclusions Recognition, diagnosis and proper management of populations at risk for a CMD is of special interest, with respect to their associations with socioeconomic factors.

Background: The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)- seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication. Methods: 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep SSI incidence rates were evaluated. Results: Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61% vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250 cells/µl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis. Conclusion: HIV-infection is not an independent risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin, relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.&nbsp

The aim of this study is to provide a profile of cervical cancer screening practices among the women in Patras and to assess factors associated with cervical cancer screening uptake. Data from a representative sample of 873 women were analyzed. 67.2% had at least one Pap test in their life, with 54.4% having been tested in the previous three years. Women aged 35-44 and 45-54 years were more likely to have had a recent Pap test (OR>3) as well as married/partnered women (OR=2.4). Unemployed women and women with the lowest educational level were less likely to have had a recent Pap test. Compared to women with a monthly household income of

Intraoperative use of specialized equipment and disposables contributes to the increasing cost of modern liver surgery. As a response to the recent severe financial crisis in our country we have employed a highly standardized protocol of liver resection that minimizes intraoperative and postoperative costs. Our goal is to evaluate cost-effectiveness of this protocol. We evaluated retrospectively all patients who underwent open hepatic resections for 4 years. All resections were performed by the same surgical team under selective hepatic vascular exclusion, i.e., occlusion of the hepatoduodenal ligament and the major hepatic veins, occasionally combined with extrahepatic ligation of the ipsilateral portal vein. Sharp parenchymal transection was performed with a scalpel and hemostasis was achieved with sutures without the use of energy devices. In each case we performed a detailed analysis of costs and surgical outcomes. Our cohort included 146 patients (median age 63 years). 113 patients were operated for primary or metastatic malignancies and 33 for benign lesions. Operating time was 121 ± 21 min (mean ± SD), estimated blood loss was 310 ± 159 ml (mean ± SD), and hospital stay was 7 ± 5 days (mean ± SD). Six patients required admission in the ICU postoperatively. 90-day mortality was 2.74 %, and 8.9 % of patients developed grade III/IV postoperative complications (Clavien–Dindo classification). Total in-hospital cost excluding physician fees was 6987.63 ± 3838.51 USD (mean ± SD). Our analysis suggests that, under pressing economic conditions, the proposed surgical protocol can significantly lessen the financial burden of liver surgery without compromising patient outcomes.

Introduction Depression is the most common mental health problem in late life. Objectives To estimate the prevalence of depression in the elderly and to investigate associations with risk factors. Methods A cross-sectional study was conducted among the members of four day care centers for older people (KAPI), three in the municipality of Patras, West-Greece and in one KAPI in the municipality of Tripolis, Peloponnese-Greece. A total of 378 individuals took part in the study. A questionnaire was developed to collect basic demographic data. Moreover, to all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied, to screen for depressive symptoms. Results According to GDS-15, 48.1% of the studied population screened positive for depressive symptoms (38.6 % moderate, 9.5% severe). In 139 members of KAPI of Tripolis, depressive symptoms were more frequent in women than in men (62.9% vs 45.5%, p=0.012), in not married (85.6% vs 38.9%, p>0.001), in participants without children (91.7% vs 49.2%, p>0.001), in subjects suffering from insomnia (88.6% vs 6.7%. p>0.001), in participants with low monthly income (63.7% vs 25.8%, p>0.001) and in older adults with co-morbidity (62.4% vs 4.5%, p>0.001). In 239 members of KAPI of Patras, depression were more frequent in women (54.6% vs 37.4%, p=0.027), in not married (55.6% vs 38.9%, p=0.038), in subjects living alone (62% vs 38.1%, p=0.003) and in elderly with co-morbidity (50.8% vs 27.5%, p=0.02). Conclusions The present study reveals high prevalence and several risk factors for developing depression in the specific population of the elderly.

Objective: The objective of this study was to estimate the prevalence and probable under-diagnosis of depressive symptoms in elderly of an urban and semi-urban area in Greece. Materials and Methods: A cross-sectional study was conducted among the members of 4 days care centers for older people (KAPI), three in the municipality of Patras, West-Greece, and in one in Tripolis, Peloponnese, Greece. A total of 378 individuals took part in the study, aged >60 years. A questionnaire was developed to collect basic demographic data, including three questions from the European Health Interview Survey, regarding self-reported or by a physician-diagnosed depression. Moreover, to all participants the Greek validated version of the Geriatric Depression Scale-15 (GDS-15) was applied, to screen for depressive symptoms. Results: According to GDS-15, 48.1% of the studied population screened positive for depressive symptoms (38.6% moderate, 9.5% severe), whereas having ever been affected with chronic depression reported 19.0% by themselves. In 162 members of KAPI of Patras and in 106 of Tripolis, who never reported have been affected by depression and depressive symptoms were observed in 27.7% and 44.7%, respectively. In 28 individuals from Patras, who reported not to know if they have depression and in 10 from Tripolis, depressive symptoms were observed in 60.7% and 90%, respectively, applying the GDS-15. Conclusion: Except the high prevalence, the present study reveals a remarkable under-detection of depressive symptoms in older adults. Various interventions in primary care are necessary so as to increase detection rates of depression among the elderly.

Introduction Sleep problems are common in older people and often associated with mood disorders, such as anxiety or depression. Aims The present study examined the association between sleep disturbances in older adults and frequency of depressed mood and other aggravating factors. Methods The sample consisted of 139 subjects, aged >65 years, members of day care center for older people (KAPI) in the municipality of Tripolis, Greece. Geriatric Depression Scale (GDS-15) was applied, to screen the elderly for depression. Athens Insomnia Scale (AIS), a self-assessment psychometric instrument, was used to quantify sleep difficulty. Statistics was processed with SPSS 17.0. Results 56.8% of older people reported inadequate sleep, based on AIS. According to GDS-15, 53.3% of the studied population screened positive for depressive symptoms (43.2% moderate, 10.1% severe). In 79 persons who reported insomnia, 70.9% and 17.7% observed moderate and severe depression respectively, applying the GDS-15. Sleep disorders were more frequent in women (67.7% vs 48.1%, p=0.02), in not married, including divorced and widowed, (85.2% vs 44.7%, p=0.004) and in subjects without children (91.7% vs 53.2%, p=0.25). Insomnia was common in elderly with chronic diseases compared to elderly without co-morbidity (65.8% vs 9.1%, p Conclusions Sleep disorders between the elderly of this study are common and strongly associated with depression. Determining the causality of the sleep disturbance could help to treat insomnia in the elderly and improve overall their health.

Introduction The city of Patras participates in the “Healthy Cities” project implemented by the WHO - Europe office. Within this framework the “Profile of the city of Patras” was examined and depicted in a study conducted among the city's population. Aims To estimate the frequency of depressive disorders as reported by the citizens of the city and examine burdening as well as protective factors. Methods A representative random stratified sample was selected to be interviewed, including 769 men and 930 women, from the city area. Participants answered a questionnaire which enquired among other on self perceived physical and mental health. Participants were also asked the following questions: “Do you have/had in the past depression or/and anxiety?” and “Have you received a medical diagnosis for this disorder?”. Results Approximately 55% of the sample reported they had experienced anxiety and depression (41% moderate and 14% severe episodes). Diagnosed depression was reported by 3%. Depressive disorders were more frequently reported by women (65%, p Conclusions Anxiety and depression are frequently reported disorders among the citizens of Patras although official medical diagnosis is rarely provided and consequently therapy is rarely offered. Specific population groups -women, elderly citizens, patients with chronic diseases- are more vulnerable to depressive disorders requiring specialized medical attention.