'Suicide rates in Crete, Greece during the economic crisis: the effect of age, gender, unemployment and mental health service provision'.

BACKGROUND: Recently, suicides in Greece have drawn national and international interest due to the current economic crisis. According to published reports, suicides in Greece have increased up to 40% and Crete has been highlighted as an area with the sharpest increase. AIM: To investigate the suicide mortality rates in Crete between 1999 and 2013 and their association with the economic crisis. METHODS: Data on suicides were selected from the Department of Forensic Medicine files of the University of Crete. RESULTS: Our analysis showed that (1) Crete, has the highest suicide mortality rate in Greece, however no significant increase was observed between 1999 and 2013, (2) there were opposing trends between men and women, with women showing a decrease whereas men showed an increase in that period, (3) there was a significant increase of suicides in middle-aged men (40-64 yrs) and elderly, although the highest unemployment rates were observed in young men and women, and (4) finally, there was a regional shift of suicides with a significant decrease in Western Crete and a significant increase in Eastern Crete. CONCLUSIONS: Although, Crete has the highest suicide mortality rates in Greece, we did not observe an overall increase during the last 15 years, including the period of economic crisis. Furthermore, there was an increase in middle-aged and elderly men, whereas young men and women showed oppositional trends during the years of austerity. This may be related to the culturally different expectations for the two genders, as well as that younger individuals may find refuge to either strong family ties or by immigrating abroad. Finally, the relative increase of suicides in Eastern Crete may be explained by factors, such as the lack of community mental health services in that area.

Nature of Li2O2 oxidation in a Li-O2 battery revealed by operando X-ray diffraction.

Fundamental research into the Li-O2 battery system has gone into high gear, gaining momentum because of its very high theoretical specific energy. Much progress has been made toward understanding the discharge mechanism, but the mechanism of the oxygen evolution reaction (OER) on charge (i.e., oxidation) remains less understood. Here, using operando X-ray diffraction, we show that oxidation of electrochemically generated Li2O2 occurs in two stages, but in one step for bulk crystalline (commercial) Li2O2, revealing a fundamental difference in the OER process depending on the nature of the peroxide. For electrochemically generated Li2O2, oxidation proceeds first through a noncrystalline lithium peroxide component, followed at higher potential by the crystalline peroxide via a Li deficient solid solution (Li(2-x)O2) phase. Anisotropic broadening of the X-ray Li2O2 reflections confirms a platelet crystallite shape. On the basis of the evolution of the broadening during charge, we speculate that the toroid particles are deconstructed one platelet at a time, starting with the smallest sizes that expose more peroxide surface. In the case of in situ charged bulk crystalline Li2O2, the Li vacancies preferentially form on the interlayer position (Li1), which is supported by first-principle calculations and consistent with their lower energy compared to those located next to oxygen (Li2). The small actively oxidizing fraction results in a gradual reduction of the Li2O2 crystallites. The fundamental insight gained in the OER charge mechanism and its relation to the nature of the Li2O2 particles is essential for the design of future electrodes with lower overpotentials, one of the key challenges for high performance Li-air batteries.

Impact of long-acting injectable antipsychotics vs. oral medication on relapses of patients with psychosis and bipolar disorder.

Relapse associated with multiple hospital readmissions of patients with chronic and severe mental disorders, such as psychosis and bipolar disorder, is frequently associated with non-adherence to treatment. The primary aim of the study was to compare the effectiveness of long-acting injectable (LAI) treatment, vs. oral medication in reducing readmissions of patients with psychotic or bipolar disorder in a community sample of 164 patients with psychosis and 29 patients with bipolar disorder (n = 193), with poor adherence to oral medication. The mean follow up period was 5.6 years and the number of readmissions were compared for an equal-length period of oral treatment preceding the onset of LAI administration. We observed a significant decrease of 45.2 % in total hospital readmissions after receiving LAIs treatment. The effect was significant both for patients with a pre-LAI treatment history of predominantly voluntary hospitalizations and with predominantly involuntary admissions. In addition, we observed equal effectiveness of first- vs. second-generation LAIs in reducing total hospital readmissions regardless of type of pre-treatment admission history (voluntary vs. involuntary). LAIs appear to be effective in reducing both voluntary and involuntary hospital readmissions in patients with psychosis and bipolar disorder with a history of poor adherence to treatment.

Defining the needs of ICU patient families in a suburban/rural Greek population: a prospective cohort study.

AIM: To define the needs of intensive care unit patients' families in the specific suburban/rural population of Crete Island. BACKGROUND: Families of intensive care unit patients have specific needs that should also be addressed by the intensive care unit-care team. Current research has mostly concentrated on families from an urban setting, therefore may not be applicable to other populations. DESIGN: Prospective cohort study. METHODS: Family members of patients admitted in the intensive care unit for ≥ 48 hours over 18 months, in a mixed medical-surgical, 11 bed closed intensive care unit. Questionnaire: The Greek translation of Critical Care Family Need Inventory, which consists of 45 need items covering the information, reassurance, proximity, support and comfort domains. Each item was scored on a four-point scale (1 = very important to 4 = not important). Participants were also asked to single out the most important need from the Critical Care Family Need Inventory and complete a questionnaire on basic demographic characteristics. RESULTS: Two hundred and thirty (65%) family members completed the questionnaire. Mean score for each of the 45 items ranged from 1.03-3 (scale from 1: very important-4: not important). Fourteen items were rated by responders as very important (mean score <1.25). Reassurance need items were consistently singled out as most important regardless of the participant's background. Participants with a lower educational and socio-economical status rated support need items as more important than those with a higher status. CONCLUSION: In this particular suburban/rural population, both 'universal' reassurance needs and specific support needs related to responders' educational or socio-economical background were identified. RELEVANCE TO CLINICAL PRACTICE: Enhanced recognition of these needs may improve quality of care offered by intensive care unit-care team to families of their patients.

Infections in patients with traumatic brain injury who undergo neurosurgery.

OBJECTIVE: Several factors place victims with traumatic brain injury (TBI) at increased risk for infection. The purpose of this study was to delineate the frequency, types and risk factors for infection in patients with TBI who undergo neurosurgery. MATERIALS AND METHODS: Retrospective surveillance of infections in patients with TBI, aged  ≥18 years who underwent neurosurgery in University of Crete between 1999 and 2005. RESULTS: Two hundred fifty-eight patients (76.7% men) who underwent 342 procedures were included. One hundred forty-two infections occurred, mainly lower respiratory tract infections (44.4% of the number of infections) and surgical site infections (SSIs) (25.4%). In multivariate analysis, SSIs were independently associated with the length of stay (p < 0.001), history of malignancy (p = 0.008), CSF leak (p = 0.012), any concomitant infection (p = 0.010), particularly urinary tract infections (p = 0.001) and the use of lumbar and/or ventricular drains (p = 0.005). Meningitis was independently associated with the total length of stay (p < 0.001), the need for intubation and mechanical ventilation beyond surgery (p = 0.028) and the presence of a lumbar and/or ventricular drain (p < 0.001). CONCLUSIONS: Respiratory tract infections were common in patients with TBI who underwent surgery with Acinetobacter spp. being the emerging offending pathogens. Device-related postoperative communication of the CSF and the environment was a significant risk factor for SSI development and meningitis in particular. Malignancy was an independent risk factor for SSIs. The prevalence of the offending pathogens must be determined institution by institution for the establishment of proper antibiotic treatment on suspicion.

Association between insomnia symptoms and cognitive impairment in the Cretan Aging Cohort.

PURPOSE: Population aging, characteristic of modern Western societies, is associated with various forms of cognitive decline. Insomnia/insomnia-type symptoms have been reported as modifiable risk factors for cognitive decline. The objective of this study was to examine, in a comprehensive way (a) the prevalence and the risk factors associated with insomnia-type symptoms and (b) the association of insomnia-type symptoms with cognitive impairment in a large, homogeneous, community-dwelling population in the island of Crete, Greece. METHODS: Our sample consisted of 3066 community-dwelling elders aged 60-100 years participating in the Cretan Aging Cohort. All participants were interviewed with a structured questionnaire assessing demographics, physical and mental health, sleep, lifestyle habits and cognitive function using the Mini Mental State Examination (MMSE). Furthermore, insomnia-type symptom prevalence was estimated in the presence of one or more sleep complaints. Linear and logistic regression analyses examined (a) the association between insomnia-type symptoms and demographics, physical/mental health and lifestyle and (b) the association between cognition and insomnia-type symptoms. RESULTS: Prevalence of one or more insomnia-type symptoms was 64.6%. Multivariate analyses showed that female gender, widowhood, benzodiazepine use and physical ailments were significantly associated with insomnia-type symptoms. Multivariate models also showed that insomnia-type symptoms were associated with increased odds of cognitive impairment (p < 0.0001). CONCLUSIONS: In a large population of older people in Crete, Greece, insomnia-type symptoms are very prevalent and associated with increased risk for cognitive impairment. Future studies should assess whether treatment of sleep problems improves or delays the deterioration of cognitive function in older adults.

Non-O1, non-O139 Vibrio cholerae bacteremic skin and soft tissue infections.

BACKGROUND: Non-O1, non-O139 Vibrio cholerae can cause sporadic cases of gastroenteritis and extra-intestinal invasive infections, following exposure to contaminated seawater or freshwater or after consumption of raw seafood. Bacteremic infections with skin and soft tissue manifestations are uncommon and in most cases are associated with liver cirrhosis, haematologic malignancies, diabetes mellitus and other immunosuppressed conditions. METHODS: The medical literature was reviewed and we found 47 published cases of non-O1, non-O139 Vibrio cholerae bacteremic skin and soft tissue infections. A fatal case of bacteremia with bullous cellulitis in a 43-year-old patient with liver cirrhosis is described, which is the first reported in Greece. RESULTS: From January 1974 to May 2015, a total of 48 patients with non-O1, non-O139 Vibrio cholerae bacteremia with skin and soft tissue infections were reported. Males predominated. Liver cirrhosis, chronic liver disease and alcohol abuse were common comorbidities. The soft tissue lesions most commonly described were localised cellulitis, with or without bullous and haemorrhagic lesions (66.7%), while necrotising fasciitis was more rare (29.2%). Of the 48 patients with non-O1, non-O139 V. cholerae bacteremic skin and soft tissue infections, 20 (41.7%) died despite treatment. CONCLUSION: Although rarely encountered, non-O1, non-O139 Vibrio cholerae should be included in the differential diagnosis of bacteremic skin and soft tissue infections in patients with underlying illnesses and epidemiologic risk factors. Timely and appropriate antibiotic and surgical treatments are important in the management of the infection.

Operando Nanobeam Diffraction to Follow the Decomposition of Individual Li2O2 Grains in a Nonaqueous Li-O2 Battery.

Intense interest in the Li-O2 battery system over the past 5 years has led to a much better understanding of the various chemical processes involved in the functioning of this battery system. However, detailed decomposition of the nanostructured Li2O2 product, held at least partially responsible for the limited reversibility and poor rate performance, is hard to measure operando under realistic electrochemical conditions. Here, we report operando nanobeam X-ray diffraction experiments that enable monitoring of the decomposition of individual Li2O2 grains in a working Li-O2 battery. Platelet-shaped crystallites with aspect ratios between 2.2 and 5.5 decompose preferentially via the more reactive (001) facets. The slow and concurrent decomposition of individual Li2O2 crystallites indicates that the Li2O2 decomposition rate limits the charge time of these Li-O2 batteries, highlighting the importance of using redox mediators in solution to charge Li-O2 batteries.