Objective: The paper aims to model Health-and-Social-Care (H&Sc) services as Cause–Effect (CE) groups within a Bayesian framework, using cross- and self-causation dynamics. The contribution is that the data used are open and never studied before and are posted online by National Health Services Scotland (NHSS). Method and Material: The paper contributes to the ongoing discourse on how Machine Learning(ML), and Bayesian inference, can inform the purposes of policymaking. Cause–effect relationships and Bayesian methods can associate public services as causes-effects, through suitable likelihood functions and priors that binomial and normal distributions can imlplement. The study identified the optimal predictive distribution using the Maximum-a-Posteriori (MAP) estimation method. Moreover, the CE-matrix approach, enables the representation of multiple causes linked to a single effect-target in a tabular format, that facilitates interpretability and prediction. Results: The findings indicate that services related to 'Alcohol' can be predictors of other effect-services, while home-based services were identified as causes of subsequent hospital admissions. Moreover, low-demand services were observed in earlier years, particularly those with no records after 1997, whereas higher-demand services were newly introduced in later years. These findings may offer insights into latent inter-service relationships, and inform policy development. The cross- and self-causation in a Bayesian framework, determined that the posterior can be predicted by 5 to 10 previous observations and this is significantly affected by the level of zero-padding (percentage of past no-records). In later years, the CE models yield more probable demand patterns. Cause–effect relationships were identified between smoking-related services, mental-health support, and the epidemiological index of Primary-1-Education children's Body-Mass-Index (BMI). Conclusions: The conclusions drawn from this analysis may be particularly relevant for insurance providers and public policymakers, who can leverage Bayesian CE-linked service models for long-term care planning, especially for elderly and low-income populations. The validation of ser-vice interlinkages further enhances the potential for precise and efficient resource allocation.

Aim: The aim of this study was to evaluate the quality of sleep in critically ill patients in the Intensive Care Unit (ICU). Method and Material: This study investigated the night-time sleep of 135 patients admitted to the general ICU of the General Hospital of Athens “G. Gennimatas” between January 2021 and December 2023. Data were collected using the Richards Campbell Sleep Questionnaire (RCSQ). Sensory stimuli, including noise, light, nursing activities, and invasive procedures, were reduced during the night to improve patients’ sleep. Measures to reduce light included implementing special lighting during nursing tasks and using bedside lamps during care. Noise reduction strategies involved closing doors, minimizing monitor alarms, and discouraging staff from speaking near patient beds. Grouping patient care activities was also promoted to limit sleep disturbances. Results: Patients in the intervention group showed improved sleep quality compared to the control group, with a significant overall RCSQ score (p<0.05). Gender and age did not significantly affect sleep quality. However, hospital stay duration differed between groups, with the control group experiencing shorter stays. A negative correlation was observed between the duration of hospitalization and sleep quality, with longer stays linked to lower RCSQ scores. Additionally, extended mechanical ventilation was associated with poorer sleep quality. Conclusion: ICU patients often exhibit abnormal levels of alertness, poor quality of daytime sleep, disrupted nighttime sleep, and sleep patterns that lack both slow-wave and rapid eye movement (REM) sleep. Gaining a deeper understanding of the role circadian rhythms play in managing critical illness could pave the way for future chronotherapeutic strategies, enhancing clinical outcomes and promoting recovery for patients.

Background: Atherosclerosis, a chronic inflammatory vascular disease with lipid metabolism abnormalities, serves as a major pathological foundation for ischemic coronary heart disease (CHD). As lifestyle-related habits transform to sedentarism and unhealthy eating, the incidence of atherosclerosis increases. The beneficial impact of physical activity on the cardiovascular system is well-documented and widely acknowledged. Major health organisations strongly recommend regular participation in aerobic exercise for individuals to reduce all-cause and cardiovascular disease mortality and morbidity, whereas resistance exercise is suggested with caution. Method and Material: A literature search of the PubMed and Scopus databases was performed where 9 meta-analyses were retrieved, published in the English language from the past 10 years. This narrative review aims to evaluate the latest scientific evidence regarding the role of aerobic and/or resistance exercise in relation to atherosclerosis development, through the evaluation of its effect on lipids, and inflammatory markers. Results: The findings of the studies summarised here are inconsistent concerning which type of exercise exerts the maximum effect on atherosclerotic biomarkers. There is a moderate level of evidence suggesting that a combination of aerobic and resistance exercise is likely to provide the greatest benefit. Conclusions: Nevertheless, minimising sedentary behaviour on a population level, lowers the risk of several major chronic diseases, thereby decreasing healthcare costs. Thus, effective interventions to increase physical activity levels or reduce sedentary behaviour should be implemented.

Background: Exercise is an important building block in the management of type 2 diabetes. Perceptions of benefits and barriers related to that behavior may affect individuals' tendency towards protective behaviors such as exercise. Aim: The aim of this study was to examine the fear of COVID-19, anxiety of COVID-19 and descriptive features as predictors of exercise benefit-barrier perception in type 2 diabetes patients during the COVID-19. Method: The research sample consisted of 161 patients with type 2 diabetes. Patient diagnosis form, Exercise Benefits-Barriers Scale, Coronavirus (COVID-19) Fear Scale (CFS) and Coronavirus Anxiety Scale (CAS) were used as data collection tools. The data was shown as percentage and mean ± standard deviation (SD), and Pearson/Spearmen correlation and linear regression analyses were used to examine the relationship between the variables. Results: In the study, when asked what the biggest barrier to exercising as a person with diabetes was, 38.31% of the individuals with type 2 diabetes said "COVID-19 pandemic". The total exercise benefit perception of individuals with diabetes was significant (F: 17.873, p<.001). In addition, for the perception of total exercise benefit, paying attention to risky situations (Hypoglycemia or hyperglycemia preventive behaviors) before doing physical activity (β = -.384), development of diabetic foot in the last six months (β =.163), COVID-19 anxiety (β =.205) were found to be statistically significant predictors (p<.001). Conclusion: At the end of the study, it was found that illiteracy, having a history of diabetic foot development in the last six months, being married and an increase in the level of COVID-19 anxiety increased the perception of exercise benefit in individuals with Type 2 diabetes.

Background: Acute myocardial infarction is one of the leading causes of death in the developed world. The purpose of this research is to study the biopsychosocial rehabilitation of patients with myocardial infarction six months after their release from the heart attack unit. Method and Material: The population of the study consisted of patients who had suffered a myocardial infarction and had been hospitalized in the heart attack unit of a University General Hospital six months ago. The study sample was 100 patients. The sampling method is simple randomization. Results: Problems of anxiety and sadness with a percentage of 50% are in first place, followed by problems of pain and discomfort at a percentage of 24%, problems in performing usual daily activities at a percentage of 22%, mobility problems at a percentage of 16 % and finally the problems of self-care at a rate of 12%. There is a statistically significant difference between genders, with men being more affected with mobility problems (p-value= 0.014) and with performing usual activities (/p-value= 0.003). Patients who are ≤65 years of age appeared to be more affected compared to those >65 years of age in terms of mobility problems (/p-value= 0.009). Conclusions: Quality of life improves for most patients after myocardial infarction. Whether or not patients have problems on one or more dimensions of the EQ-5D is highly related to the patient's profile. Fewest problems are observed in the self-care dimension and most problems are reported in the anxiety or sadness dimension.

No abstract available

Background: The healthcare professionals have had to adapt their current practices and implement new strategies, to ensure a safe patient care environment during the COVID-19 pandemic. In addition, their training in the new conditions of the pandemic has been challenging. Aim: The aim of this short review is to provide a brief record of the experiences and challenges faced by healthcare professionals and how these can constitute lessons for a new health crisis. Method and Material: We conducted literature research in two electronic databases for the period from 2020 to 2022, using keywords. The collected material was classified based on the objectives set. A selection of literature sources was made, followed by a review with the creation of note cards. Results: The review of the selected sources reveals challenges in the practice of healthcare professionals, the continuation of professional development and research activities, as well as the adoption of digital technologies and tools for communication, information and training. The lack of experience of healthcare professionals from a previous pandemic crisis and the delay in the digital transformation of healthcare are some of the obstacles, which can become lessons for the preparedness of the healthcare systems towards a new health crisis. Conclusions: The findings highlight the essential role of a well-trained and well-informed healthcare workforce, to adequately face a health crisis. The analysis of these findings can contribute to the detection and identification of emerging needs of healthcare professionals, allowing policymakers to implement effective interventions for the continuing development of the workforce.

Background: Patients with chronic heart failure (CHF) present microcirculation alterations and vascular endothelial dysfunction. Exercise training programs have been shown to improve the functional status of these patients, however less is known yet about the acute systemic effect of exercise on peripheral muscle microcirculation. The aim of the present study was to investigate the acute effect of a respiratory muscle exercise bout on the microcirculation of non-exercising muscles (systemic effect). Materials and Methods: Thirty-four (30♂/4♀) stable CHF patients, with a mean age of61.4±9.2 years, ejection fraction (EF): 33.9±7.8%, maximal inspiratory pressure (MIP): 78.2±27.1 cmH2O, VO2max: 17.5±4.05 ml/kg/min, VE/VCO2 slope: 32.7±6.4 and a New York Heart Association classification (NYHA) ≥ ΙΙ participated in the study. Microcirculatory assessment was performed at rest and immediately after the respiratory exercise program (5 sets/10 repetitions, training load: 60% of MIP). Basal tissue oxygen saturation (StO2),oxygen consumption rate (OCR) and reperfusion rate (RR) were measured utilizing near-infrared spectroscopy(NIRS) at the thenar muscle along with the vascular occlusion test (VOT). Results: RR (%/min), following the release of vascular occlusion, as well as OCR (%/min) increased after the respiratory exercise program (from 3.4±1.6 to 3.9±1.7, p=0.007, and from 12.7±3.8 to 13.2±3.9, p=0.021 respectively), whereas the corresponding basal StO2values difference did not reach the level of statistical significance (from 85.5±6.4. to 84.7±6.2, p=0.065). Conclusions: In the present study, concerning patients with CHF, after an acute respiratory exercise bout, dynamic microcirculatory indices assessed by NIRS in peripheral, non-exercising muscles, were significantly altered.

Background: Hepatobiliary surgery is a high-end surgery comprising of complex operations associated with high economic burden to a healthcare system. The aim of this study was to evaluate the cost-effectiveness of a hepatobiliary surgery highly standardized operative protocol, that minimizes intraoperative and postoperative costs, implemented by the same surgical team, in a Greek university hospital for a five-year period (2012-2016). Method and Material: The digital medical records of all patients undergoing liver resection at a tertiary university hospital from January 2012 to December 2016 by a single surgical team were retrospectively reviewed. The financial cost of the patients’ treatment was calculated in collaboration with the hospital’s logistics department, and it involved all preoperative, intraoperative, and postoperative expenses from admission to discharge, excluding physician fees and salary cost of the hospital’s nurses. Results: In this study, 127 patients underwent hepatectomy. The patient’s health status was improved after the surgery in most of the cases (121, 95.2%). The mean Length of Stay (LOS) was 13.4 (SD±17.3) days. The mean total hospitalization cost was 4,729 (SD ± 5,486) euros (€), while the cost of surgery, the higher mean cost was noted in 2013 (925, SD±974.64 €) and the lower in 2015 (142, SD±219 €). Conclusions: This protocol allows the performance of hepatectomies with a significantly decreased cost without compromising patient outcomes.

Background: The Modified Mini Mental State (3MS) is the extended version of the original Mini Mental State test with additional items improving the coverage of the remaining cognitive functions of the original version. Aim: The aim of this pilot study is to translate the Modified Mini Mental State test and assess its psychometric properties, in order to enable the use of 3MS test for Greek speakers. Method and Material: Independent sample t-test analysis was performed to test for differences between the study groups (N=105) and dependent sample (N=37), while pair sample t-test for pre-post differences in the treatment group for the 3MS. Results: Cronbach’s a was 0.867 showing very good internal consistency. Children in the cases group presented significantly lower scores after the tonsil operation as compared to controls revealing good discriminant validity of the measurement. Finally, test-retest scores were shown to be significantly correlated, revealing excellent test-retest reliability of the measurement. Conclusions: The reliability and validity of the 3MS test is established for the healthy children undergoing routine surgery population.