Associations between sleep complaints, suicidal ideation and depressive symptoms among adolescents and young adults in Greece.

Depression prevalence increases significantly during adolescence/early adulthood. Depression in youth may present suicidal ideation, while suicide represents the leading cause of death in this age group. Moreover, adolescents/young adults frequently report sleep complaints that may partially be due to depressive symptoms. Studies on the associations between depression, sleep complaints and suicidality in this age group are limited. We aimed to examine associations between depressive symptoms, sleep complaints and suicidal ideation in a large (n = 2771), representative sample of adolescents (age: 15-17 years, n = 512) and young adults (age: 18-24 years, n = 2259) from the general population in Greece. A telephone structured questionnaire was administered. Depressive symptoms were assessed using the modified Patient Health-7 questionnaire score, while presence of suicidal ideation and sleep complaints were assessed using the ninth and third question of Patient Health-9 questionnaire, respectively. Mediation logistic regression analysis revealed significant direct paths from depressive symptoms to sleep complaints (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.19-1.24; OR 1.21, 95% CI 1.18-1.24) and suicidal ideation (OR 1.18, 95% CI 1.14-1.22; OR 1.18, 95% CI 1.14-1.22), as well as sleep complaints and suicidal ideation (OR 1.82, 95% CI 1.32-2.50; OR 1.91, 95% CI 1.33-2.76) in the total group and in young adults, respectively, but not among adolescents. Moreover, we detected a significant indirect effect of depressive symptoms on suicidal ideation mediated by sleep complaints (18.8%) in young adults. These findings support the hypothesis that treatment of sleep disturbances among youth with depression may independently further reduce suicidal risk.

Patients' intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries.

WHAT IS KNOWN AND OBJECTIVE: Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. METHODS: A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. RESULTS AND DISCUSSION: The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. WHAT IS NEW AND CONCLUSION: This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines.

Perceptions of primary care professionals on quality of services in rural Greece: a qualitative study.

INTRODUCTION: Greece is striving to limit its health expenditure to essential needs. General practice and the provision of Primary Health Care (PHC) mainly take place in rural settings, where approximately 200 Primary Health Care Centres (PHCCs) have been established. In order to determine how to optimize the effectiveness and efficiency of PHC services, it is important to first gain insights into the providers' perspectives. The aim of the study was to assess the perceptions of General Practitioners (GPs) and the directors of PHCCs regarding the effectiveness of available PHC services, and to elicit suggestions on how current services could be improved. METHODS: This qualitative study was based on semi-structured interviews. The setting was 21 PHCCs in the Epirus and Crete regions of Greece. Twenty-nine physicians were interviewed on aspects of capacity, resources, performance and quality of PHC services. Discussions were digitally recorded and transcribed verbatim. The transcriptions were then analysed using thematic content analysis. RESULTS: The main identified barriers to providing high-quality PHC services were: PHC service shortages in workforce and equipment; inadequate GP and paramedic training; the absence of position/job descriptions or duty statements for GPs and other PHC personnel; and limited public awareness about the role of GPs. Suggestions for remodelling the current PHC system included: the introduction of new technologies; GP empowerment; leadership reforms; and mechanisms for evaluating of the quality of services. Finally, areas of concern regarding future development and utilisation of private PHC infrastructure and services were highlighted. CONCLUSION: The methodology of this study and the results regarding remodelling the current PHC system could be used to inform policy-making in Greece, particularly in the current period of severe economic crisis; they may also be of relevance to other European countries facing similar challenges in allocating resources and reforming PHC.

Time trends of female breast cancer mortality in Greece during 1980-2005: a population based study.

BACKGROUND: Changes in female breast cancer mortality trends have been observed in recent years in western countries. The aim of the present study was to analyse breast cancer mortality in Greece, between 1980 and 2005. METHODS: Time trends of breast cancer mortality were calculated per 100,000 women in the whole female population of Greece, in different age groups, and in different areas of the country. Mortality data and population age distribution were provided by the National Statistical Service of Greece. RESULTS: Overall, female breast cancer mortality in Greece had an increasing trend during 1980-2005. Subgroup analysis according to age showed that this increase was confined to women older than 70 years. In contrast, a mild decrease was noted after the mid-1990s in women 40-69 years old. There were no notable regional differences in breast cancer mortality. CONCLUSIONS: The increasing trend of breast cancer mortality in women aged 70 years and older could be attributed to limited use of secondary prevention methods and rare administration of systemic cytotoxic chemotherapy in these women. In contrast, implementation of these strategies could explain the recent reduction of breast cancer mortality in younger age groups.

Influence of acute anterior cruciate ligament deficiency in gait variability.

The objective of this study was to compare the gait variability of patients with isolated anterior cruciate ligament (ACL) deficiency (experimental group) with that of healthy individuals (control group). The hypothesis was that the gait variability of the experimental group would be higher than the control group. The experimental group consisted of 20 men with an ACL tear and the control group consisted of 20 healthy men without any neurological and/or musculoskeletal pathology or injury. The gait acceleration signal was analysed using the Gait Evaluation Differential Entropy Method (GEDEM). The GEDEM index of the experimental group in the medio-lateral axis was significantly higher than that of the control subjects. A receiver operating characteristic (ROC) analysis was used to assess the diagnostic value of the method and to determine a cut-off entropy value. The GEDEM cut-off value had a 95.6% probability of separating isolated ACL patients from healthy subjects.

Α 10-gigawatt attosecond source for non-linear XUV optics and XUV-pump-XUV-probe studies.

The quantum mechanical motion of electrons and nuclei in systems spatially confined to the molecular dimensions occurs on the sub-femtosecond to the femtosecond timescales respectively. Consequently, the study of ultrafast electronic and, in specific cases, nuclear dynamics requires the availability of light pulses with attosecond (asec) duration and of sufficient intensity to induce two-photon processes, essential for probing the intrinsic system dynamics. The majority of atoms, molecules and solids absorb in the extreme-ultraviolet (XUV) spectral region, in which the synthesis of the required attosecond pulses is feasible. Therefore, the XUV spectral region optimally serves the study of such ultrafast phenomena. Here, we present a detailed review of the first 10-GW class XUV attosecond source based on laser driven high harmonic generation in rare gases. The pulse energy of this source largely exceeds other laser driven attosecond sources and is comparable to the pulse energy of femtosecond Free-Electron-Laser (FEL) XUV sources. The measured pulse duration in the attosecond pulse train is 650 ± 80 asec. The uniqueness of the combined high intensity and short pulse duration of the source is evidenced in non-linear XUV-optics experiments. It further advances the implementation of XUV-pump-XUV-probe experiments and enables the investigation of strong field effects in the XUV spectral region.

Accelerometry for evaluation of gait pattern in healthy soccer athletes.

An accelerometer system was used to measure the characteristics of the motion of 133 healthy male soccer athletes in a 30-s walking test and the data obtained were analysed using the gait evaluation differential entropy method (GEDEM). GEDEM processes gait acceleration data and calculates an index that provides a quantitative evaluation of a subject's gait, at low cost and with negligible effect on the subject. The GEDEM index was not significantly correlated with age, body weight, body mass index, or the number of years of active training. The GEDEM value for the anterior-posterior axis showed a small negative statistically significant correlation with height and the vertical axis was moderately and statistically significantly positively correlated with the time spent training per week. The triaxial accelerometry system described here is easy for subjects and testers to use, and enables measurements to be made on the sports field to evaluate an athlete's musculoskeletal condition with respect to gait stability.

Responses of human frontal cortex to surprising events are predicted by formal associative learning theory.

Learning depends on surprise and is not engendered by predictable occurrences. In this functional magnetic resonance imaging (fMRI) study of causal associative learning, we show that dorsolateral prefrontal cortex (DLPFC) is associated specifically with the adjustment of inferential learning on the basis of unpredictability. At the outset, when all associations were unpredictable, DLPFC activation was maximal. This response attenuated with learning but, subsequently, activation here was evoked by surprise violations of the learned association. Furthermore, the magnitude of DLPFC response to a surprise event was sensitive to the relationship that had been learned and was predictive of subsequent behavioral change. In short, the physiological response properties of right DLPFC satisfied specific predictions made by associative learning theory.

Optimal treatment of a recurrent giant craniopharyngioma: lessons from a case.

A case of a 33-year-old man presented with symptoms of dramatic deterioration of the level of consciousness because of a recurrence of a previously aspirated and irradiated craniopharyngioma is described. The tumor had grown enormously in dimensions and was extending in the region of hypothalamus, third ventricle and brain stem, with signs of local compression and obstructive hydrocephalus. Radical surgical excision, despite the size and the location of the lesion, was the therapy of choice. The surgical technique is described. We conclude that in expert hands, microsurgery aiming at total removal should be the therapeutic option for the treatment of recurrent as well as primary craniopharyngiomas.

Suprasellar and intrasellar paragangliomas.

Neoplasms of the sellar region are entities with a large differential diagnosis. Although paraganglionic cells have not been demonstrated in the pituitary or adjacent structures, the existence of sellar region paragangliomas is well-documented. To elucidate, in this area the nature of these unusual tumors is relatively difficult. Clinical history, physical examination, radiographic investigation as well as intraoperative gross observation are the same as those of sellar meningioma or pituitary adenoma. Immunohistochemistry, using neuroendocrine markers and electron microscopy are the two definitive diagnostic methods to differentiate among these entities. The clinical management, the possible pathogenesis of the tumor, the importance of immunohistochemistry in making the diagnosis and the clinical outcome of these patients are discussed.

Fate of natural organic matter at a full-scale Drinking Water Treatment Plant in Greece.

The aim of this study was to investigate the fate of natural organic matter (NOM) and subsequent changes during the various treatment processes at a full-scale Drinking Water Treatment Plant (DWTP). Monthly sampling campaigns were conducted for 1 year at six sites along DWTP of Thessaloniki, Northern Greece including raw water from the Aliakmonas River that supplies DWTP and samples from various treatment processes (pre-ozonation, coagulation, sand filtration, ozonation, and granular activated carbon (GAC) filtration). The concentration of NOM and its characteristics as well as the removal efficiency of various treatment processes on the basis of dissolved organic carbon, UV absorbance, specific ultra-violet absorbance, fluorescence intensity, hydrophobicity, biodegradable dissolved organic carbon, and formation potential of chlorination by-products trihalomethanes (THMs) and haloacetic acids (HAAs) were studied. The concentration of dissolved organic carbon (DOC) in reservoir of the Aliakmonas River ranged from 1.46 to 1.84 mg/L, exhibiting variations regarding UV, fluorescence, and hydrophobic character through the year. Along DWTP, a significant reduction of aromatic, fluorophoric, and hydrophobic character of NOM was observed resulting in significant elimination of THM (63%) and HAAs (75%) precursors.

An improved optical flow tracking technique for real-time MR-guided beam therapies in moving organs.

Magnetic resonance (MR) guided high intensity focused ultrasound and external beam radiotherapy interventions, which we shall refer to as beam therapies/interventions, are promising techniques for the non-invasive ablation of tumours in abdominal organs. However, therapeutic energy delivery in these areas becomes challenging due to the continuous displacement of the organs with respiration. Previous studies have addressed this problem by coupling high-framerate MR-imaging with a tracking technique based on the algorithm proposed by Horn and Schunck (H and S), which was chosen due to its fast convergence rate and highly parallelisable numerical scheme. Such characteristics were shown to be indispensable for the real-time guidance of beam therapies. In its original form, however, the algorithm is sensitive to local grey-level intensity variations not attributed to motion such as those that occur, for example, in the proximity of pulsating arteries.In this study, an improved motion estimation strategy which reduces the impact of such effects is proposed. Displacements are estimated through the minimisation of a variation of the H and S functional for which the quadratic data fidelity term was replaced with a term based on the linear L(1)norm, resulting in what we have called an L(2)-L(1) functional.The proposed method was tested in the livers and kidneys of two healthy volunteers under free-breathing conditions, on a data set comprising 3000 images equally divided between the volunteers. The results show that, compared to the existing approaches, our method demonstrates a greater robustness to local grey-level intensity variations introduced by arterial pulsations. Additionally, the computational time required by our implementation make it compatible with the work-flow of real-time MR-guided beam interventions.To the best of our knowledge this study was the first to analyse the behaviour of an L(1)-based optical flow functional in an applicative context: real-time MR-guidance of beam therapies in moving organs.

A comparative study of acquisition schemes for diffusion tensor imaging using MRI.

This study has investigated the effects of the selection of the diffusion-weighted (DW) gradient directions on the precision of a diffusion tensor imaging (DTI) experiment. The theoretical analysis provided a quantitative framework in which the noise performance of DTI schemes could be assessed objectively and for the development of novel DTI schemes, which employ multiple DW gradient directions. This generic framework was first applied to the examination of two commonly used DTI schemes, which employed 6 DW gradient directions and hitherto were used indiscriminately under the sole condition of noncollinearity. It was then used to design and assess a novel 12-DW-gradient-direction DTI protocol, which employed the same total number of DW acquisitions as the two conventional schemes (12). This theoretical investigation was then corroborated using rigorous simulation and DTI experiments on both an isotropic phantom and a healthy human brain. Both the theoretical and the experimental analysis demonstrated that the two conventional schemes showed a significantly different noise performance and that use of the new multiple-DW-gradient-direction scheme clearly improved the precision of the DTI measurements.

Reversal of experimental delayed cerebral vasospasm by angiotensin-converting enzyme inhibition.

Delayed cerebral vasospasm is an important determinant of the clinical outcome after subarachnoid hemorrhage, but its prevention and treatment has met with limited success. Since cerebral arteries were found to be sensitive to the vasoconstrictor effect of angiotensin II, the possibility of angiotensin's contribution to this vasospasm was investigated. Delayed cerebral arterial spasm was documented angiographically 72 hours after introduction of blood in the subarachnoid space of dogs. Following injection of the angiotensin-converting enzyme inhibitor, teprotide, repeat cineangiograms at 30, 60, and 90 minutes demonstrated partial or total release of spasm of the basilar artery and its branches. It is concluded that angiotensin II participates in the delayed cerebral vasospasm after hemorrhage, and that angiotensin inhibition may release the spasm and prevent cerebral ischemia.

A new method of cranioplasty. Technical note.

A new method of cranioplasty is described. The skull defect is exposed, and an impression is taken which is used for the construction of a plaster of Paris model of the defect. Methyl methacrylate is molded to the model and thus an accurate reproduction of the skull defect is produced. The technique has the main advantage of good cosmetic appearance and strength.

Retained intracranial metallic foreign bodies. Report of two cases.

The authors discuss two examples of extensive migration of retained metallic foreign bodies. The potential for further neurological injury from migration, formation of neurotoxic breakdown products, and the danger of infection are factors to be assessed when considering the removal of retained intracranial metallic foreign bodies.

A prospective cohort study of the outcome of acute whiplash injury in Greece.

OBJECTIVE: An earlier pilot study suggested that the late whiplash syndrome is uncommon in Greece. The purpose of the present study is to extend the evaluation to a larger sample, and include the prevalence of specific symptoms in the evaluation. METHODS: In a prospective, cohort study, a total of 180 accident victims were consecutively recruited following Emergency ward presentation. A standard questionnaire asked about neck pain, headache, shoulder pain, limb numbness or pain, and dizziness. Accident victims were followed for 6 months. RESULTS: In the initial 4 weeks after the accident, accident victims reported neck pain, headache, shoulder pain, arm numbness or pain, and dizziness, but at 4 weeks more than 90% had recovered from these, the remainder of the subjects having minor symptoms (not requiring therapy), and returning to their pre-accident state of health (which included minor symptoms). There were no cases of chronic disability. CONCLUSION: In Greece, symptoms after an acute whiplash injury are self-limiting, brief, and do not appear to evolve into the so-called late whiplash syndrome.

A method of generalized projections (MGP) ghost correction algorithm for interleaved EPI.

Investigations into the method of generalized projections (MGP) as a ghost correction method for interleaved EPI are described. The technique is image-based and does not require additional reference scans. The algorithm was found to be more effective if a priori knowledge was incorporated to reduce the degrees of freedom, by modeling the ghosting as arising from a small number of phase offsets. In simulations with phase variation between consecutive shots for n-interleaved echo planar imaging (EPI), ghost reduction was achieved for n = 2 only. With no phase variation between shots, ghost reduction was obtained with n up to 16. Incorporating a relaxation parameter was found to improve convergence. Dependence of convergence on the region of support was also investigated. A fully automatic version of the method was developed, using results from the simulations. When tested on in vivo 2-, 16-, and 32-interleaved spin-echo EPI data, the method achieved deghosting and image restoration close to that obtained by both reference scan and odd/even filter correction, although some residual artifacts remained.

Microvessel density in brain tumors.

Sections from formalin fixed paraffin embedded tumor tissue from 165 patients with brain tumors including 62 meningiomas, 80 supratentorial astrocytomas (19 astrocytomas-grade I/II, 20 anaplastic astrocytomas-grade III, 41 glioblastomas-grade IV), 7 cerebellar astrocytomas-grade I/II, one gliosarcoma, 7 oligodendrogliomas, 3 ependymomas and 5 medulloblastomas were immunostained for factor VIII-related antigen in order to highlight microvessel endothelial cells. Microvessel count (MVC; the highest number of microvessels in three areas of highest vascular density at X200 magnification) was determined and correlated with histological grade of tumors and patients' sex and age. The mean MVC was 27.9 in meningiomas. Astrocytic tumors, particularly malignant astrocytomas (grade III, IV), were highly vascular. The mean MVC as regards the supratentorial astrocytic neoplasms was 14.5 in astrocytomas (grade I/II), 42.3 in anaplastic astrocytomas (grade III) and 50.2 in glioblastomas (grade IV). All cerebellar astrocytomas studied, even though well differentiated (grade I/II), were highly vascularised tumors (MVC: 41.1. A comparison of the mean MVC vlaues showed that there was a statistically significant difference between supratentorial astrocytomas (Grade I-II) and cerebellar astrocytomas (Grade I-II) (p = 0.0004), anaplastic astrocytomas (Grade I-II) (p = 0.00004) and glioblastomas (p = 0.00001). There was no significant difference between cerebellar astrocytomas and anaplastic astrocytomas (p = 0.8) and glioblastomas (p = 0.4). Astrocytic neoplasms showed statistically significant higher mean MVC from meningiomas (p = 0.002). The mean MVC was 14.1 in oligodendrogliomas, 22.7 in ependymomas and 19.6 in medulloblastomas. In one gliosarcoma that was studied the MVC was 40. The MVC appeared to be independent of the age and sex of patients. This study supports the importance of microvessel density as a measure of angiogenesis, as well as a further morphologic feature in the classification of brain tumors. The determination of microvessel density may become useful in the planning and monitoring of anti-angiogenesis therapies of these tumors.

In vivo proton MR spectroscopy: the diagnostic possibilities of lipid resonances in brain tumors.

The lipid resonances detected in proton MR spectra of brain tumors were evaluated from the diagnostic point of view. Seventy five non-radiated brain tumors were examined in vivo and lipids were detected in 29% of anaplastic astrocytomas grade III, 60% of glioblastomas multiforme and 50% of metastatic tumors. Lipids were also detected in all brain abscesses and an epidermoid cyst. No lipids were detected in benign tumors (low grade and pilocytic astrocytomas, oligodendrogliomas, meningiomas, pituitary adenomas etc.). Thus, the presence of lipids in the MR spectra is indicative of malignancy (with a few exceptions).