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Objectives To characterize the distribution of case volumes within a surgical field.Design An analysis of British Spine Registry.Setting 295 centers in England that conducted at least one spinal operation either within the NHS or private settings between 1 May 2016 and 27 February 2021.Participants 644 surgeons.Main outcome measures Mathematical descriptions of distributions of cases among surgeons and the extent of workforce-level case-volume concentration as a surrogate marker.Results There were wide variations in monthly caseloads between surgeons, ranging from 0 to average monthly high of 81.8 cases. The curves showed that 37.7% of surgeons were required to perform 80% of all spinal operations, which is substantially less than in fields outside of healthcare.With the COVID-19 pandemic, the case volumes of surgeons with the highest volumes dropped dramatically, whereas those with the lowest case numbers remained nearly unchanged. This, along with the relatively low level of case-volume concentration within spinal surgery, may indicate an inevitability of at least some level of surgical care being provided by the relatively lower volume surgeons.Conclusions While there is a reasonable degree of workforce-level case volume concentration within spinal surgery, with high volume spinal surgeons providing a large proportion of care, it is not clear whether a further concentration of case volumes into those few hands is possible or desirable.

The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly during the first months of 2020 and continues to expand in multiple areas across the globe. Molecular epidemiology has provided an added value to traditional public health tools by identifying SARS-CoV-2 clusters or providing evidence that clusters based on virus sequences and contact tracing are highly concordant. Our aim was to infer the levels of virus importation and to estimate the impact of public health measures related to travel restrictions to local transmission in Greece. Our phylogenetic and phylogeographic analyses included 389 full-genome SARS-CoV-2 sequences collected during the first 7 months of the pandemic in Greece and a random collection in five replicates of 3,000 sequences sampled globally, as well as the best hits to our data set identified by BLAST. Phylogenetic trees were reconstructed by the maximum likelihood method, and the putative source of SARS-CoV-2 infections was inferred by phylogeographic analysis. Phylogenetic analyses revealed the presence of 89 genetically distinct viruses identified as independent introductions into Greece. The proportion of imported strains was 41%, 11.5%, and 8.8% during the three periods of sampling, namely, March (no travel restrictions), April to June (strict travel restrictions), and July to September (lifting of travel restrictions based on thorough risk assessment), respectively. The results of phylogeographic analysis were confirmed by a Bayesian approach. Our findings reveal low levels of onward transmission from imported cases during summer and underscore the importance of targeted public health measures that can increase the safety of international travel during a pandemic. IMPORTANCE Our study based on current state-of-the-art molecular epidemiology methods suggests that virus screening and public health measures after the lifting of travel restrictions prevented SARS-CoV-2 onward transmission from imported cases during summer 2020 in Greece. These findings provide important data on the efficacy of targeted public health measures and have important implications regarding the safety of international travel during a pandemic. Our results can provide a roadmap about prevention policy in the future regarding the reopening of borders in the presence of differences in vaccination coverage, the circulation of the virus, and the presence of newly emergent variants across the globe.

Abstract Background Wearing facemasks is of proven efficacy as a public health protective measure against COVID-19. Currently there are no observational data concerning the wearing of facemasks and the adherence to guidelines concerning their handling. Methods Registration of the way passers-by were wearing facemasks at 26 different locations of five major cities in Greece. The results were correlated with the rate of COVID-19 deaths in the region. Results In total, 119,433 passers-by were registered, 57,043 females (47.8%) and 62,390 males (52.2%). From the total sample, 81.1% were wearing the mask properly, 10.8% had their nose out, 6.2% were wearing it under the jaw, and 1.9% had no mask at all . There was a significant difference between males and females concerning any use of mask. Inappropriate use of was correlated with COVID-19 death rate in the studied region. Conclusion Our findings suggest that under conditions of mandatory wearing and in central locations of major cities, during walking, proper use of masks is suboptimal, but still contributes with some protection. Fear and risk perception seem to be strong factors contributing to adherence to proper mask wearing.

The predominant climatological wind regime in summer over the Greek Seas and especially over the Aegean Sea is undoubtedly the Etesian winds system, very well known since the time of the ancient Greeks, who first identified and described its main characteristics. The Etesian winds have been under continuous and intensive research since early 1900s, and numerous papers have been published, which have revealed all the secrets associated with the physical mechanisms responsible for their creation and maintenance. The ordinary synoptic situation, which is closely associated with the appearance of spells of Etesian winds outbreaks over the Aegean Sea, refers to cases in which the Subtropical Jet Stream (SJS) is situated over the Greek mainland. Then the frontal surfaces associated with the Polar Jet Stream (PJS), or a polar jet streak, passing through Greece from the north can cause severe weather in northern Greece as far south as Larisa (39.39° N, 22.26° E). Precipitation does not usually occur south of Larisa, because the SJS constitutes a barrier to the southward extension of the upper half of the frontal surface. In this case, cold advection occurs in the lower troposphere, resulting in a drop in temperatures even in southern Greece, due to the establishment of an Etesian winds outbreak. Thereafter, these north-easterly winds persist for a long time, weakening gradually, following the variation of the pressure gradient due to the combination of the mobile dynamic anticyclone positioned over the Balkans, after the passage of the cold front and the permanent Cyprus surface low. The main goal of this article is to investigate how much the case of a time period around 9 July 2022 differs from the conceptual model mentioned above, as deep convection occurred over all of Greece over three successive days, breaking the Etesian winds regime and defeating the low tropospheric stability usually accompanying this wind regime.

Abstract Background This paper attempts to evaluate the primary health care system by evaluating health centres in Greece. Methods Malmquist Index Data Envelopment Analysis is applied to study the total productivity of 155 health centres in Greece during 2016–2018. The data were collected from the Ministry of Health and submitted to quality tests to ensure validity and avoid bias. Results This paper measures the productivity of each of the 155 health centres in Greece and how it shifted during 2016–2018. In addition, the overall productivity change of the 155 health centres over time is calculated and analysed as being due to technical efficiency or technological efficiency. The analysis of the mean values showed a decrease of 0.9% in the overall productivity factor from 2016 to 2017 and a decrease of 5.2% from 2017 to 2018. The overall decrease in the productivity of the 155 health centres was 3.1%. From 2016 to 2018, 59 health centres changed their productivity mainly due to technological change and 91 changed mainly due to technical efficiency change. One health centre showed regression to its total productivity due to equal regression of its technical efficiency and technology. Conclusions The method used is nonparametric data envelopment analysis along with the Malmquist index to include panel data in the analysis. Meaningful results were extracted by indicating the number of health centres that improved their productivity, regressed in productivity, or remained constant through the period 2016–2018. This paper may contribute to improving health centres’ efficiency and productivity. Furthermore, valuable results can be extracted for the National Health Care System to match available resources that correspond to each health centre’s needs, as well as for manager planners and stakeholders in primary health care.

We describe response measures to an outbreak involving 128 (33.4%) coronavirus disease cases (46.1% asymptomatic) among 383 persons onboard a passenger ship. Multivariate analysis indicated that dining in certain rooms and bar areas, nationality, working department (for crew members), and quarantining onboard the ship were significantly associated with infection.

This article aims to investigate the reliability and validity of the Trait Emotional Intelligence Questionnaire-Adolescent Short Form (TEIQue-ASF) score in a sample of 440 Greek adolescents. The instrument's score demonstrated good internal consistency and was significantly correlated with core self-evaluations as well with somatic complaints, self-report psychopathology, and personal strengths. It also explained a statistically significant increase in the prediction of outcome variables beyond core self-evaluations. It is concluded that the findings of the present study provide evidence that support the interpretation and use of the TEIQue-ASF score to assess the emotional self-perceptions of Greek adolescents.

Our study based on current state-of-the-art molecular epidemiology methods suggests that virus screening and public health measures after the lifting of travel restrictions prevented SARS-CoV-2 onward transmission from imported cases during summer 2020 in Greece. These findings provide important data on the efficacy of targeted public health measures and have important implications regarding the safety of international travel during a pandemic.

Introduction: Intraoperative imaging and stereotactic navigation in spinal surgery to guide instrumentation placement and tumour resection is well documented. However, image depiction is restricted to high attenuation structures such as osseous tissue and metal objects. Vascular anatomy like major arteries or vascular neoplasm cannot be depicted. We reported angiographically enhancing intraoperative cone-beam imaging (O-arm) to facilitate resection of a craniocervical junction neoplasm that distorted the course of vertebral artery, and discussed the feasibility of this technique. Methods: We performed intraoperative angiography employing the O-arm for image acquisition, and applied the images in S7 Stealth Station to guide tumour resection in an occipitocervical osseous tumour in which the course of the vertebral artery was heavily distorted. Results: Intraoperative findings matched the 3D navigation images demonstrating the V3 and upper V2 segments of the vertebral artery in close proximity to the tumour. Complete en bloc tumour removal was achieved without injury to the adjacent vertebral artery. No intra- or postoperative complications occurred. Conclusion: It is feasible intraoperatively to acquire angiographically enhancing cone-beam imaging of spinal tumour in close proximity to the V3 and upper V2 segments of vertebral artery. It appears to facilitate safe tumour resection by mapping critical vascular structures in the surgical field that is initially occult to direct vision. Such novel use of technique warrants further validation.

Background: Nation-wide SARS-CoV-2 seroprevalence surveys provide valuable insights into the course of the pandemic, including information often not captured by routine surveillance of reported cases. Methods: A serosurvey of IgG antibodies against SARS-CoV-2 was conducted in Greece between March and December 2020. It was designed as a cross-sectional survey repeated at monthly intervals. The leftover sampling methodology was used and a geographically stratified sampling plan was applied. Results: Of 55,947 serum samples collected, 705 (1.26%) were found positive for anti-SARS-CoV-2 antibodies, with higher seroprevalence (9.09%) observed in December 2020. Highest seropositivity levels were observed in the “0–29” and “30–49” year age groups. Seroprevalence increased with age in the “0–29” age group. Highly populated metropolitan areas were characterized with elevated seroprevalence levels (11.92% in Attica, 12.76% in Thessaloniki) compared to the rest of the country (5.90%). The infection fatality rate (IFR) was estimated at 0.451% (95% CI: 0.382–0.549%) using aggregate data until December 2020, and the ratio of actual to reported cases was 9.59 (7.88–11.33). Conclusions: The evolution of seroprevalence estimates aligned with the course of the pandemic and varied widely by region and age group. Young and middle-aged adults appeared to be drivers of the pandemic during a severe epidemic wave under strict policy measures.

A serosurvey of IgG antibodies against SARS-CoV-2 was conducted in Greece between May and August 2020. It was designed as a cross-sectional survey and was repeated at monthly intervals. The leftover sampling methodology was used and a geographically stratified sampling plan was applied. Of 20,110 serum samples collected, 89 (0.44%) were found to be positive for anti-SARS-CoV-2 antibodies, with higher seroprevalence (0.35%) observed in May 2020. The highest seroprevalence was primarily observed in the “30–49” year age group. Females presented higher seroprevalence compared to males in May 2020 (females: 0.58% VS males: 0.10%). This difference reversed during the study period and males presented a higher proportion in August 2020 (females: 0.12% VS males: 0.58%). Differences in the rate of seropositivity between urban areas and the rest of the country were also observed during the study period. The four-month infection fatality rate (IFR) was estimated to be 0.47%, while the respective case fatality rate (CFR) was at 1.89%. Our findings confirm low seroprevalence of COVID-19 in Greece during the study period. The young adults are presented as the most affected age group. The loss of the cumulative effect of seropositivity in a proportion of previous SARS-CoV-2 infections was indicated.

Depressive symptoms in adolescence have been a subject of considerable controversy in terms of their nature, severity and identification. Therefore, the objective of this study was to examine the presence of depressive symptoms in Greek adolescent high school students and to explore the relationship between depressive symptoms and sociodemographic characteristics. For that purpose, a cross-sectional study design was conducted in two public schools in Megalopolis, Greece, from April 2012 to July 2012, using a self-administered questionnaire based on DSM-IV. The target population involved 222 high school students and the response rate was 74.75%. Data was analyzed using trend x2 test, student’s t-test and bivariate analysis. The analysis of survey data was conducted using the SPSS (19.0). Main findings demonstrate that 3.6% had symptoms of major depressive episode. Furthermore, depressive symptoms were significantly higher in girls, while statistically significant relationships were found between students’ physical(P

An attempt is made to study the basic characteristics of the atmospheric circulation which caused the mixed-type (large-scale and convective-scale) elongated heavy rainfalls in the Greek area from 21 to 23 October 1994 leading to extensive floods in Attica, Karditsa-Trikala and Kassos island territories and the loss of eleven human lives. The analysis showed that during this time period a blocking-type anticyclone dominated the mid-tropospheric circulation of central and eastern Europe. Greece was situated at the south flank of the large surface anticyclone which was blocking the north-eastern progression of a synoptic-scale frontal depression coming from western Mediterranean and rejuvenating over Sicily area by dynamical factors. Along with the blocking anticyclone a quasi-stationary surface front crossing the northern coasts of Turkey and through Greek mainland and the eastern coast of the Adriatic Sea reached the Eastern Alps. This synoptic situation was associated with the advection of warm and moist unstable air masses along the height of the whole troposphere towards Greece coming from south over the Mediterranean, whereas in the lower part of the planetary boundary layer cold and moist masses coming from north-east were passing over the Black and the Aegean Seas being warmed from below, interleaving the warm moist air over Greece which resulted in an unstable saturated mixing layer. Strong low tropospheric convergence and positive advection of absolute vorticity at 500 hPa were bringing the saturated mixing layer up to the level of free convection releasing the real latent instability. So in the continuous upslide rain many thunderstorms occurred. Their intensity depends partly on local factors. The combination of the elongated and of large-scale and convective-scale heavy precipitation along with local factors resulted in the extensive floods over Greece. These rainfalls according to other Greek authors who studied their main parameters statistically can be classified in the category of "natural disasters".

An attempt is made to investigate the role of the jet streaks upstream an upper tropospheric diffluent trough in its evolution. A proof of the relationship that controls the rate of change of the mean absolute vorticity in the region of the diffluent trough is provided. It is demonstrated that for certain value of the rate of the increasing mean regional vorticity, a cut-off low can develop in the upper troposphere, which is likely to trigger the initiation of surface cyclogenesis, under favourable lower tropospheric conditions. Therefore, it seems that this approach offers to the operational meteorologists a simple tool to evaluate the numerical weather prediction of a cyclonic development in southern Europe and to decide for its uncritical accept or rejection when the initial atmospheric conditions in northwest Europe are similar to those described above. This diagnostic tool is then applied to the case of cyclogenesis that occurred on the 29th January 1994 in Greece, in order to demonstrate its practical significance.

The main objects of study in this paper are the synoptic scale atmospheric circulation systems associated with the rather frequent phenomenon of coloured rain and the very rare phenomenon of dust or sand deposits from a Saharan sandstorm triggered by a developing strong depression. Analysis of two such cases revealed that two days before the occurrence of the coloured rain or the dust deposits over Greece a sand storm appeared over the north-western Sahara desert. The flow in the entire troposphere is southerly/south-westerly with an upward vertical motion regime. If the atmospheric conditions over Greece favour rain then this rain contains a part of the dust cloud while the rest is drawn away downstream adopting a light yellow colour. In cases where the atmospheric circulation on the route of the dust cloud trajectories is not intensively anticyclonic dust deposits can occur on the surface long far from the region of the dust origin. Such was the case on 4th April, 1988, when significant synoptic-scale subsidence occurred over Italy and towards Greece. The upper air data, in the form of synoptic maps, illustrate in detail the synoptic-scale atmospheric circulations associated with the emission-transport-deposition and confirm the transportation of dust particles.

OBJECTIVE To conduct psychometric evaluation of the Greek version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and assess correlation between the scores on BSES-SF and the Edinburgh Postnatal Depression Scale (EPDS). METHOD Τhe study was conducted at the largest maternity hospital in Athens, Greece, where 173 eligible pregnant women completed the BSES-SF and the EPDS during their visit to the antenatal outpatient department and 3 days after delivery. The infant feeding method was determined 6 months postpartum. Exploratory factor analysis (EFA) was carried out to evaluate the construct validity of the BSES-EF scale and the internal consistency was analyzed with Cronbach’s α. The predictive validity was assessed by comparison of the BSES-SF total score, using Student’s t-test, between the women who reported exclusive breastfeeding 6 months postpartum and those that did not. Stepwise multiple linear regression analyses was performed to identify variables independently associated with the BSES-SF total score. P values reported were two-tailed, with statistical significance set at 0.05. Data analysis was conducted using the Statistical Package for Social Sciences (SPSS), version 22.0. RESULTS The mean BSES-SF score before birth was 44.2±11.1 and 3 days after birth it had increased significantly to 47.7±12.1 (p<0.001). Internal consistency reliability for the BSES-SF was acceptable, with Cronbach’s α 0.93. Exploratory factor analysis indicated a one-factor structure, with the extracted factors explaining 52.7% of the total variance. The predictive validity of BSES-SF was significant for breastfeeding at 6 months. The BSES-SF score was significantly negatively correlated with the EPDS score before birth (r=- 0.23, p=0.002) and 3 days after the birth (r=-0.22, p=0.008). Higher BSES-SF scores were recorded by women with higher educational level and those who had received breastfeeding support from the obstetrician. CONCLUSIONS The Greek version of the BSES-SF demonstrated satisfactory reliability and validity for measuring the breastfeeding self-efficacy of women. The international applicability of the BSES-SF is further evidenced by the results of this study. [ABSTRACT FROM AUTHOR]

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Copyright of Archives of Hellenic Medicine / Arheia Ellenikes Iatrikes is the property of Athens Medical Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)