Sleep quality and associated factors in the context of COVID-19, among prehospital emergency personnel, in North-Eastern Greece.

BACKGROUND: The stressful conditions that emerged during the Coronavirus disease 2019 (COVID-19) pandemic have had a negative impact on sleep quality in large part of the healthcare worker population. This study aimed to assess the self-reported quality of sleep among members of the Emergency Ambulance Service personnel of the National Emergency Center in the region of Thrace, Northeastern Greece, and to investigate its associations with perceived stress, feelings, and perceptions of well-being during the COVID-19 pandemic. METHODS: The study was conducted from March to May 2021 using an online structured questionnaire, and the collected data included: socio-demographic characteristics, occupational and medical history, distress and mental health issues due to COVID-19 and the following self-administrated instruments: Pittsburgh Sleep Quality Index (PSQI), WHO-5 Well-Being Index (WHO-5), and Perceived Stress Scale-14 items (PSS-14). RESULTS: Among the 74 participants, 71 % were poor sleepers (i.e., PSQI >5). The majority (83 % of the sample) reported feelings of stigma due to their occupation, with the proportion being higher among women (100 % vs 78 % in men, p =0.05) and poor sleepers (95 % vs 65 % in good sleepers, p =0.03). Poor sleepers had significantly lower WHO-5 scores than good sleepers (13.8 ± 4.9 vs 16.9 ± 5.8, p =0.04) and were experiencing significantly more anxiety and/or sadness at the time they answered the questionnaire (69.1 % vs 35.3 %, p =0.02). Perceived stress was significantly positively correlated with the "Latency" dimension of the PSQI (p =0.03). CONCLUSIONS: Poor sleep quality and feelings of stigmatization were prevalent for most of the sample. Poor sleep quality was associated more frequently with reported feelings of stigmatization, anxiety and/or sadness, and impaired well-being. HIPPOKRATIA 2021, 25 (3):126-133.

Respiratory decision support systems

Computerized decision support systems help both health professionals and patients make the right diagnostic and therapeutic decisions in a timely fashion, capitalizing on the available knowledge as well as on data-driven methods. The wealth of data, which have been made available via connected health technologies, the broader uptake of systems biology/medicine, and the technological progress of artificial intelligence are the three pillars leveraging such systems in respiratory care. In addition, for decision support, the following should be considered: (a) the complex interaction of the respiratory system with the circulatory and other systems, (b) the respiratory system decision-making spans in many directions and time scales, in acute and chronic care, and (c) the wealth of informative measurements and signals can contribute in this. This chapter will present methodological analysis for several respiratory disorders, namely sleep apnea, respiratory infections (including the COVID-19 pandemic), chronic lung diseases, and ventilation in respiratory care, including the data and methods applicable in each case. © 2022 Elsevier Inc. All rights reserved.

Comparison of sleep characteristics during the first and second period of restrictive measures due to COVID-19 pandemic in Greece.

OBJECTIVE: The first wave of coronavirus pandemic and concomitant restrictive measures affected sleep. We slept more than usual, but the quality was worse. As the pandemic continues, a second period of restrictive measures was initiated, and no data exist about their impact on sleep. The aim of this study was to compare quantity and quality of sleep between the two periods of restrictive measures, due to the Coronavirus Disease-19 (COVID-19) pandemic in Greece. MATERIALS AND METHODS: A web-based survey using a short 13-item questionnaire was created and was distributed online. This included information about demographic and professional data, quantitative and qualitative characteristics of sleep, degree of abidance in lockdown measures, and data about COVID-19 infection or close contact with active confirmed cases. RESULTS: A total of 1,078 questionnaires were evaluated (first period, n=963; second period, n=115). Sleep duration was shorter during the second lockdown (mean difference -0.51h; 95% confidence interval, (CI), -0.82, -0.19, p=0.002). Compared to usual habits, sleep increased in first wave (mean difference +0.37h; 95% CI, 0.26, 0.47; p<0.001) and decreased in second wave (mean difference -0.35h; 95% CI, -0.60, -0.09; p=0.009). Regarding quality of sleep, less participants reported good quality of sleep during the second wave compared to the first (p=0.006). Finally, compliance to restriction measures was lower and the prevalence of confirmed illness or close contact with COVID-19 cases among participants was higher during the second period than during the first one (p<0.001 and p=0.028, respectively). CONCLUSIONS: Our data showed that sleep duration increased during the first lockdown and decreased in the second one, when compared to usual habits. Moreover, sleep quality progressively deteriorated, as the restrictive measures due to coronavirus pandemic continued.

The present and future of inhalation therapy for the management of obstructive airway diseases: Emphasis on pressurized metered-dose inhalers

Inhalation therapy has an ancient history and has been recognized as the most effective and safe way of delivering pharmaceutical compounds directly to the airways for the treatment of respiratory diseases. Nowadays, a great variety of devices exist;nebulizers, soft mist inhalers (SMIs), pressurized Metered Dose Inhalers (pMDIs) and single- or multi-dose Dry Powder Inhalers (DPIs). The choice for the optimal device is patient-specific and depends on the advantages and disadvantages of each device category, and the patients' age and capacity to use them correctly. Factors that determine therapeutic success, apart from the previously mentioned, are: the physician-patient relationship, the patient's opinion, willingness, and preferences for certain medical devices, and proper training on device use. Various sources of evidence indicate that frequent change of devices is associated with treatment failure and should be avoided in order to achieve good therapeutic outcomes. The most frequently used types of inhalation devices for management of chronic and acute obstructive respiratory diseases are the pMDIs. Despite having some environmental footprint and requiring a good technique by the users to achieve reliable therapeutic effects, these devices are essential tools for primary care physicians and pulmonologists. In the COVID-19 era, and despite diametrically opposed opinions on the appropriateness of using nebulizers, most experts recommend against their use in order to reduce the potential risk of spreading the SARS-CoV-2 virus. If required, most experts recommend the use of pMDI via a spacer, except for life threatening exacerbations. The ongoing research, to improve the underlying technologies of these devices, introduce environmentally friendlier propellants and combine these devices with modern applications of telemedicine and artificial intelligence, creates new pathways for the continuous utilization of these inhalation devices in everyday clinical practice.