Monitoring interhospital transfers in Western Greece during 2003-2011: its role in health policy.

INTRODUCTION: Interhospital transfers (ITs) could provide insight into regional healthcare efficiency and evidence for policy-making. The aim of this study was to analyse ITs carried out in the Western Greece region over a nine-year period. METHODS: Archives of the National Center of Emergency Medical Services of Patras and official healthcare resources were used to analyze patient transfers from rural to 'reception' hospitals in the area, during the period 2003-2011, by hospital, medical, seasonal and population variations. RESULTS: A total of 2500 ITs from the eight rural hospitals to the central ones in the metropolitan area of Patras were monitored yearly. Transfer rates per population ranged between less than 0.3% and more than 1.0%. Only a few patients transferred outside the area (0.9%). Almost 10% of total transfers regarded diagnostic evaluation (mostly CT scan). Transfer rates were inversely related to hospital admission rates (Pearson -0.973, p=0.027), while time (in minutes) (Pearson -0.903, =0.036) and distance (in kilometers) between the rural and central hospitals (Pearson -0.907, p=0.034) also exhibited significant relationships. The level of understaffing does not have a clear effect on ITs. CONCLUSIONS: By monitoring ITs, it becomes evident where efforts should be prioritized and which of the interconnections should be optimized in a specific network of health care. In this case, interventions should be focused towards the (a) very high transfer rates from the general hospital (GH) of Aigio, (b) lack of orthopedists at GH Kalavryta, which could provide a 24 hour emergency service in a tourist ski area, (c) understaffing in the microbiological laboratory and lack of a CT scanner at GH Mesologi, and (d) lack of radiologists in several hospitals, rendering the installed equipment worthless. By monitoring the ITs, real needs and win-win actions may emerge in the complex interplay of infrastructural factors.

Correlation between the Personal and Social Performance scale (PSP) and the Positive and Negative Syndrome Scale (PANSS) in a Greek sample of patients with schizophrenia.

BACKGROUND: Psychosocial dysfunction is one of schizophrenia's core features, often leading to a deprecation of independent living and significant failure to maintain a competent quality of life. Cognitive and occupational performance as well as psychosocial functioning is moreover recognized as determinants of treatment response. Therefore, the elaboration of measures regarding social performance besides scales that assess psychopathology is essential. The Personal and Social Performance (PSP) scale has been found to be as much valid as reliable for assessing social functioning in the acute and stable stage of schizophrenia. The aim of this study was to estimate the correlation between the PSP and Positive and Negative Syndrome Scale (PANSS) (convergent validity) in patients with schizophrenia during routine clinical practice. METHODS: A longitudinal study with a six-month follow-up is presented. Correlation between the PSP scale and the Positive and Negative Syndrome Scale (PANSS) was conducted in a Greek sample of 2010 patients with schizophrenia in outpatient setting in two successive visits. PANSS and PSP scales were used for the assessment of psychopathological symptoms and social and personal functioning. RESULTS: The PSP subscales scores were well correlated with each other with Spearman correlation coefficients (r) ranging from 0.56 to 0.76 on both visits in three out of the four main areas, whereas in the category of "disturbing and aggressive behavior" the correlations were lower but still significant. Furthermore, total PSP score showed high association to PANSS total score in the first (r = -0.59) as well as in the second visit (r = -0.50). Regression analysis showed that one point decrease of PANSS's total score is associated with a 0.42 points increase on the PSP scale. PSP and PANSS scales exhibited high convergent validity. CONCLUSIONS: The PSP could provide additional valuable information in the assessment of schizophrenia related social functioning and treatment response.

The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ): a novel tool for assessing self-empowerment through a constellation of daily activities.

BACKGROUND: The main goal of stress management and health promotion programs is to improve health by empowering people to take control over their lives. Daily health-related lifestyle choices are integral targets of these interventions and critical to evaluating their efficacy. To date, concepts such as self-efficacy, self-control and empowerment are assessed by tools that only partially address daily lifestyle choices. The aim of this study is to validate a novel measurement tool, the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ), which aims to assess the concept of empowerment through a constellation of daily activities. METHODS: Therefore, we performed principal component analysis (PCA) of 26 items that were derived from the qualitative data of several stress management programs conducted by our research team. RESULTS: The PCA resulted in the following five-factor solution: 1) Dietary Healthy Choices, 2) Dietary Harm Avoidance, 3) Daily Routine, 4) Organized Physical Exercise and 5) Social and Mental Balance. All subscales showed satisfactory internal consistency and variance, relative to theoretical score ranges. Subscale scores and the total score were significantly correlated with perceived stress and health locus of control, implying good criterion validity. Associations with sociodemographic data and other variables, such as sleep quality and health assessments, were also found. CONCLUSIONS: The HLPCQ is a good tool for assessing the efficacy of future health-promoting interventions to improve individuals' lifestyle and wellbeing.

Adolescent Stress Questionnaire: reliability and validity of the Greek version and its description in a sample of high school (lyceum) students.

Adolescence is a crucial phase of human life characterized by enhanced exposure and vulnerability to various stressful stimuli. The Adolescent Stress Questionnaire (ASQ) is a useful measure to evaluate possible sources of stressors affecting the adolescent equilibrium. The present study examines the scientific properties of the Greek version of ASQ to measure perceived stress among 250 Greek adolescents. The confirmatory factor analysis (CFA) results showed a good fit of the original structure of ASQ to the observed data in the Greek sample. A good internal reliability was also confirmed by high Cronbach's alpha values. In line with previous research, girls reported more stress than boys. Overall, the Greek ASQ is a valid and reliable instrument for evaluating adolescent stress.

Two-Month Consumption of Orange Juice Enriched with Vitamin D3 and Probiotics Decreases Body Weight, Insulin Resistance, Blood Lipids, and Arterial Blood Pressure in High-Cardiometabolic-Risk Patients on a Westernized Type Diet: Results from a Randomized Clinical Trial.

This study examined the effects of orange juice (OJ) supplemented with vitamin D3 (2000 IU) and probiotics (Lacticaseibacillus casei Shirota and Lacticaseibacillus rhamnosus GG, 108 cfu/mL) on cardiometabolic risk factors in overweight and obese adults following a Westernized-type diet. Fifty-three high-risk individuals were randomly assigned to one of two groups. Over 8 weeks, one group consumed a vitamin D3 and probiotic-enriched OJ and the other regular OJ (control). Diets remained unchanged and were documented through food diaries. Measures of metabolic and inflammatory markers and blood pressure were measured at the start and end of the study. Post-intervention, the enriched OJ group showed the following significant metabolic improvements (without changes in triglycerides, inflammation, or central blood pressure): reduced fasting insulin, peripheral blood pressure, body weight (-1.4 kg 95% CI: -2.4, -0.4), energy (-270 kcal 95% CI: -553.2, -13.7), macronutrient (dietary fat -238 kcal 95% CI: -11.9, -1.0; carbohydrates -155 kcal 95% CI: -282.4, -27.3; sugars -16.1 g 95% CI: -11.9, -1.0) intake, and better lipid profiles (total cholesterol -10.3 mg/dL 95% CI: -21.4, 0.9; LDL-C -7 mg/dL 95% CI: -13.5, -0.5). The enriched OJ led to weight loss, less energy/macronutrient consumption, improved lipid profiles, and increased insulin sensitivity after 8 weeks in those following a Westernized diet, thus indicating potential benefits for cardiometabolic risk. This study was a part of FunJuice-T2EDK-01922, which was funded by the EU Regional Development Fund and Greek National Resources.

Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes: Systematic review.

OBJECTIVE: To investigate the way that family stress influences glycemic control among patients with diabetes who are younger than 18 years of age. DATA SOURCES: PubMed and Scopus were searched for relevant studies published since 1990 using the following key words: diabetes type 1, glycemic control, family stress, family conflict, and family function. STUDY SELECTION: In total, 1478 papers were identified in the initial search. The final review included 6 cohort studies, 3 cross-sectional studies, and 1 qualitative review in which family stress was assessed using specific diabetes-related conflict measurement instruments, and glycemic control was evaluated by glycosylated hemoglobin measurement. SYNTHESIS: In most studies family stress was negatively correlated with patients' glycemic control. Family function was strongly related to patients' glycemic control, while family conflict was adversely associated with glycemic control. Families of low socioeconomic status, those of adolescents with diabetes, and those of single parents were more prone to diabetes-related stress and thus more susceptible to worse glycemic control. CONCLUSION: Therapeutic psychological interventions and educational programs can help alleviate family diabetes-related stress and will likely improve glycemic control.

Prevalence and risk factors of excess weight in school children in West Greece.

The present study estimated the prevalence of childhood obesity and identified risk factors in 10-13 year old children. A cross-sectional study was conducted, including 200 children and their parents, in seven randomly-selected primary schools across Patras, Greece. Height, weight, and waist circumference were measured, and self-reported information was collected via face-to-face interviews. Body mass index was calculated for the children and their parents. The effect of risk factors on overweight and obesity was analyzed using regression analysis. The prevalence of overweight and obesity was 32% and 10.5%, respectively. The odds of being overweight/obese increased in children whose parents had a lower educational level and/or higher body mass index. Fewer daily meals and more time spent in front of the television and/or on the computer were significantly associated with obesity in 10-13 year old children. The prevalence of excess weight in primary school children in Patras is of concern, especially for boys. Children's nutritional habits, leisure activities, and parental characteristics influence their somatometric characteristics. These findings highlight the need for future weight loss interventions targeted at this population.

Use of a relaxation technique by mothers of children with autism: a case-series study.

Mothers of children with autism are subject to considerable stress by having to adjust to the disorder and to cope with practical and social issues. Evidence on the effects of relaxation training on stress of these mothers is scarce. The purpose of this pilot case-series study was to examine the role of a simple 6-week daily stress management technique on mothers of children with autism. Mothers' stress measurements and children's functionality were assessed using validated instruments. Participants were 11 mothers of children with autism seen consecutively in the autism clinic of a children's hospital. Statistically significant median reductions of perceived and parental stress were noted after the 6-week intervention. Median stress scores were lower by 37.1% and 33% from the baseline values of the perceived stress scale and parental stress index, respectively. Stress was not significantly correlated with children's functioning. Stress management seems to have benefits for mothers of children with autism.

Stress as a risk factor for multiple sclerosis onset or relapse: a systematic review.

BACKGROUND: Stress has been considered a triggering factor for multiple sclerosis (MS) since the description of the disease by Jean-Martin Charcot. Until our times, many published studies have supported that both MS onset and relapse could be predisposed by psychological stress. This review aims to synthesize existing knowledge of the relationship between psychological stress and MS onset and relapse, focusing mainly on the quality of observational studies. METHODS: We hand-searched MEDLINE with the terms 'stress and multiple sclerosis', using English language restrictions, from January 1980 to November 2010. We included only observational longitudinal studies. The Newcastle-Ottawa scale proposed by the Cochrane Collaboration was used for assessing the quality of the observational studies. RESULTS: Seventeen publications were analyzed, 5 for MS onset (1 cohort and 4 case-control studies) and 12 for MS relapse (9 cohort and 3 case-control studies). We found a marked heterogeneity in stress measurement that mostly targeted the environmental approach to stress. Only 2 publications used radiological criteria for MS relapse. Quality issues were identified mainly for comparability, meaning that studies failed to control adequately for various triggering and psychosocial factors in the stress-MS relationship. Also, selection and blinding problems were identified in most case-control studies. All studies, with only 2 exceptions, resulted in favor of the stress-MS relationship, but due to marked stress measurement heterogeneity, no secure conclusions could be drawn. CONCLUSIONS: Future studies should incorporate a multidisciplinary approach to stress measurement and radiological criteria for MS. We further encourage researchers to test the effect of early life stress and stress management techniques on the clinical course of the disease.

Cryosurgery is more effective in the treatment of primary, non-superficial basal cell carcinomas when applied during and not prior to a five week imiquimod course: a randomized, prospective, open-label study.

Combinational cryosurgery during daily imiquimod application ('immunocryosurgery') efficiently cures invading basal cell carcinoma (BCC). Since timing of the cryosurgery is considered crucial for effectiveness, our aim was to compare efficacy of two different timing schemes of the combination of cryosurgery and topical imiquimod: Cryosurgery (a) 2 weeks after (Arm I) vs (b) prior to the initiation of a 5 week daily imiquimod course (Arm II). 16 patients with 21 BCC were recruited in this prospective, randomized, open-label trial. 14 patients with 17 BCC were evaluated (Arm I: 7 patients/10 tumors vs Arm II: 7 patients/7 tumors) during scheduled interim analysis at 6 month follow-up (two patients dropped out, one non-compliant and one lost to follow up). The trial was revoked because study Arm I ('immunocryosurgery') was significantly superior to Arm II (adjuvant imiquimod) in achieving tumor clearance (10/10 vs 3/7 tumors; p=0.0147) and by overall treatment efficacy (9/10 vs 2/7 relapse-free tumors; p=0.0345). The same overall efficacy persisted after at least 18 months follow-up for those patients with tumor clearance after the trial treatment. The timing of cryosurgery during imiquimod application substantially determines the efficacy of this combinational approach in the treatment of BCC.

Gender differences in Greek centenarians. A cross-sectional nation-wide study, examining multiple socio-demographic and personality factors and health locus of control.

BACKGROUND: Centenarians are exceptional ageing paradigms, offering valuable information on achieving longevity. Although, there are several studies examining different biomedical factors as determinants of longevity in centenarians, little is known about gender differences with respect to personality traits and health locus of control. METHODS: Nation -wide study carried out in Greece, between 2007 and 2010. Our final sample of analysis consisted of 400 centenarians who reported on sociodemographic, disease-related and personality factors and health locus of control (HLC). Gender differences were investigated by simple nonparametric comparisons. Bivariate correlations between personality factors and internal and external HLC were obtained. RESULTS: Women centenarians outnumbered men by a ratio of 1.68 to 1. Significant gender sociodemographic differences were noted, with men reporting less often widowhood, more often centenarian 1st degree relatives and smoking. Higher BMI score was measured in males than females. Concerning personality variables, females were more reward-dependent and adaptable than men, while men were more optimistic than women. No differences were found on health locus of control profile between the genders. Positive correlations between self-directness and spirituality with internal locus of control in men and negative correlations between optimism and external locus of control in women emerged as the main gender disparities in the correlation analyses. Self-directness in men and optimism in women were consistently correlated with the two HLC subscales. CONCLUSIONS: Gender differences should be incorporated in future basic research and epidemiological studies of longevity. Informed policies on ageing and wellbeing programs should also take into account gender issues to increase efficacy by targeting health locus of control.

Comparative mortality ratios of cancer among men in Greece across broad occupational groups.

AIM: The purpose of this study was to compare site-specific cancer death rates in male workforce across major occupational groups in Greece. METHODS: Data on cancer mortality in men aged 25-69 years during the period 2000-2005 were obtained from National Statistical Service of Greece. Age- and site (ICD-10)-specific cancer death rates and the ratio of standardized cancer death rates (i.e. the comparative mortality ratio and 95% confidence interval) across seven major occupational groups (ISCO-88) were calculated. RESULTS: The proportion of total deaths due to cancer was ranged between 6.6, 24.3, 37.4, and 39.4% for the age groups of 15-39, 40-49, 50-59, and 60-69 years, respectively. Respiratory and gastrointestinal malignancies constituted 70% of the total cancer mortality in our population. Groups of elementary occupations, skilled agricultural workers, and plant workers showed very high mortality ratios of respiratory cancer while low ratios were found for the groups of professionals, legislators, senior officials, and managers and paradoxically for craft and related workers. Compared to the other groups, skilled agricultural and elementary groups showed higher rates of gastrointestinal and other or no determined malignancies in the age groups of 40-49 and 50-59 years old. Plant workers and machine operators/assemblers exhibited high mortality rates for most cancer sites especially in the elders group (60-69 years) and a mortality ratio of genitourinary cancer that differed significantly compared to any other group. CONCLUSIONS: Up to 3.5-fold variations were found in site-specific cancer mortality ratios among men in Greece across broad occupational groups. The extent of the variation attributed to specific socioeconomic and/or occupational factors could not be estimated in the current study but the observed differences might stimulate thinking and preventive actions as well as point to potential hypotheses to pursue using research methods in which job and life related factors should be directly measured and controlled.

Lifestyle and self-rated health: a cross-sectional study of 3,601 citizens of Athens, Greece.

BACKGROUND: Self-rated health (SRH) is a popular health measure determined by multiple factors. International literature is increasingly focusing on health-related behaviors such as smoking, dietary habits, physical activity, even religiosity. However, population-based studies taking into account multiple putative determinants of SRH in Greece are scarce. The aim of this study was to clarify possible determinants of SRH with an emphasis on the relationship between SRH and lifestyle variables in a large sample of urban citizens. METHODS: In this one-year cross-sectional study, a stratified random sample of 3,601 urban citizens was selected. Data were collected using an interview-based questionnaire about various demographic, socioeconomic, disease- and lifestyle related factors such as smoking, physical activity, dietary habits, sleep quality and religiosity. Multivariate logistic regression was used separately in three age groups [15-29 (N = 1,360), 30-49 (N = 1,122) and 50+ (N = 1,119) years old] in order to identify putative lifestyle and other determinants of SRH. RESULTS: Reporting of good SRH decreased with age (97.1%, 91.4% and 74.8%, respectively). Overall, possible confounders of the lifestyle-SRH relationship among age groups were sex, education, hospitalization during the last year, daily physical symptoms and disease status. Poor SRH was associated with less physical activity in the 15-29 years old (OR 2.22, 95%CI 1.14-4.33), with past or heavy smoking, along with no sleep satisfaction in the 30-49 years old (OR 3.23, 95%CI 1.35-7.74, OR 2.56, 95%CI 1.29-5.05, OR 1.79, 95%CI 1.1-2.92, respectively) and with obesity and no sleep satisfaction in the 50+ years old individuals (OR 1.83, 95%CI 1.19-2.81, OR 2.54, 95%CI 1.83-3.54). Sleep dissatisfaction of the 50+ years old was the only variable associated with poor SRH at the 0.001 p level of significance (OR 2.45, 99%CI 1.59 to 3.76). Subgroup analyses of the 15-19 years old individuals also revealed sleep dissatisfaction as the only significant variable correlated with SRH. CONCLUSIONS: Slight differences in lifestyle determinants of SRH were identified among age groups. Sleep quality emerged as an important determinant of SRH in the majority of participants.

Bronchoalveolar lavage fluid cellular profile in workers exposed to chrysotile asbestos.

The cellular profile of bronchoalveolar lavage fluid (BALF) in asbestos-exposed population remains controversial. We, therefore, aimed to investigate BALF in apparently healthy individuals that were exposed in asbestos-related work for a long period of time. Participants were selected among employees of a car brakes and clutches factory that used chrysotile asbestos. Selection criteria were an employment history of ≥ 15 years and the absence of severe respiratory disease. The total number and type of BALF cells, the existence of dust cells, iron-laden macrophages and asbestos bodies were assessed. Thirty-nine workers (25 men), with a mean age of 46.2 ± 4.2 years and a mean employment time of 23.5 ± 4 years, participated. Asbestos bodies were observed in 14 out of 39 (36%) specimens, dust cells in 37 and iron-laden macrophages in all. Those with asbestos bodies had at least 3 times higher probability to have lymphocytosis (lymphocytes > 11%: 64% vs 28%, p = 0.027) and had an increased percentage of iron-laden macrophages compared to those without asbestos bodies (median values: 42% vs 13%, p = 0.08). Smokers (36%) had less lymphocytes compared to non and ex-smokers (median values: 6% vs. 13%, p = 0.002), and iron-laden macrophages count had a positive relation (r = 0.31, p = 0.05) to lymphocyte count. Asbestos-exposed asymptomatic individuals with the presence of asbestos bodies in the BALF are more likely to have lymphocytic alveolitis while concurrent dust exposure and smoking habits hold a significant role.

Survival after laryngectomy: a review of 133 patients with laryngeal carcinoma.

Survival trends in survival for laryngeal cancer in Europe are varied. Five-year survival varied around 60-64% but numbers below 50% have been commonly reported. The aim of this study was to assess the factors influencing survival in patients with laryngeal cancer in our region. A total of 128 male and 5 female patients with larynx cancer (91 glottic and 42 supraglottic) were treated at Patras University Hospital between March 1992 and August 2004. Except 3, all were smokers and 56 (41%) heavy alcohol users. Postsurgical staging showed that most had been classified at stages III (38%) and IV (49%). By histology, 31 tumors were classified as poorly differentiated, 78 as moderately differentiated and 23 as well differentiated. All patients underwent laryngectomy with extension of the procedure where appropriate. Also, a total of 45 patients received adjuvant therapy (either chemotherapy or radiotherapy). Farmers, construction workers, professional drivers and mechanics and coffee shop and bar employees account for more than 70% of patients. Results showed that 64 (48.1%) patients died during the follow-up, 58 (43.6%) of them died from cause related to their disease. With a median follow-up of 25 months, the 5-year disease-free survival (DFS) was 53% and the 5-year overall survival (OS) was 45%. Significant prognostic factors for OS included patient age, advanced staging, heavy alcohol use and poor tumor differentiation while for DFS affected mainly by poor tumor differentiation. We conclude that the disease stage at presentation, tumor grade and alcohol consumption prove to be important predictors for the OS as well as the DFS in our series.

An 8-week Stress Management Program in Information Technology Professionals and the Role of a New Cognitive Behavioral Method: a Pilot Randomized Controlled Trial.

AIM: The aim of this study is to compare and evaluate the sort-term benefits of the effects of an 8-week stress management techniques in information technology professionals. METHODS: In this parallel randomized controlled trial, participants were randomly assigned to either the stress management group (n=40; relaxation breathing, progressive muscle relaxation, guided imagery) or in the Pythagorean Self awareness group (n=41). Self-reported validated measures were used to evaluate perceived stress, health locus of control, anxiety and depression. RESULTS: All groups were found with significantly better cognitive speed and verbal memory at the end of the follow-up. Taking into account the group by time interaction coefficients, PSAT was found significantly superior to standard SM with regards to depression, emotional intelligence, lifestyle and personal control and verbal memory suggesting that verbal memory improvement through time should be mostly attributed to PSAT. On the other hand, the cognitive speed improvement during follow-up should be attributed to both interventions. CONCLUSIONS: These findings provide important insight into the role of stress management. Future studies should focus on randomized, controlled trials with larger samples and longer follow-up times.

Fenticonazole activity measured by the methods of the European Committee on Antimicrobial Susceptibility Testing and CLSI against 260 Candida vulvovaginitis isolates from two European regions and annotations on the prevalent genotypes.

The activity of fenticonazole was studied against 260 West and Southeast European vulvovaginal candidiasis isolates, and low MICs were displayed. Fenticonazole was assessed by European Committee on Antimicrobial Susceptibility Testing and CLSI microdilution methods for the first time, and the results showed excellent agreement (97%) and significant interclass correlation coefficient (P < 0.0001). Also, the levels of agreement for the results for itraconazole, fluconazole, and ketoconazole were 84%, 90%, and 98% (P < 0.0001), respectively. Multilocus typing by PCR fingerprinting and subsequent cluster analysis delineated geographically associated alignments for Candida albicans and fluconazole resistance-related clusters for Candida glabrata.

Correlation of mechanical dyssynchrony with QRS duration measured by signal-averaged electrocardiography.

BACKGROUND: Preimplantation left ventricular dyssynchrony is considered a prerequisite for a beneficial response to cardiac resynchronization therapy (CRT). However, electrical dyssynchrony estimated by QRS duration (QRSd) on ECG has not been proven to be an optimal surrogate of mechanical dyssynchrony. We evaluated the correlation of mechanical dyssynchrony with QRSd as measured by signal-averaged electrocardiography (SAECG) in comparison with measurements based on conventional surface ECG and with onscreen measurements based on digital ECG. METHODS: We included 49 consecutive patients with decompensated heart failure (40 men, aged 66.8 +/- 9.5 years), New York Heart Association (NYHA) class II-IV, and LVEF < or = 40%. QRSd was calculated by manual measurement of 12-lead ECG, on-screen measurement of computer-based ECG, and calculation of total ventricular activation time on SAECG. RESULTS: Only 60.4% of the studied patients had QRS > or = 120 ms based on measurements derived by SAECG compared to 69.4% by using on-screen measurement of computer-based ECG and 73.5% based on surface ECG (P=0.041). Interventricular but not intraventricular delay was correlated with QRSd. The correlation of interventricular dyssynchrony with QRSd was stronger when measured by SAECG than by surface ECG (r=0.45, P=0.001 vs r=0.35, P < 0.01). Among patients with ischemic cardiomyopathy, no significant correlation was demonstrated between mechanical dyssynchrony and QRSd. In nonischemic patients, interventricular delay was significantly correlated with QRSd measured by surface ECG (r=0.45, P < 0.05) and SAECG (r=0.46, P < 0.05). CONCLUSIONS: The use of SAECG results in different patient classification in wide QRS complex category as compared to surface ECG. Furthermore, QRSd measured by SAECG is correlated with interventricular but not intraventricular dyssynchrony in heart failure patients.