Quality of Life Variables Assessment, Before and After Pancreatoduodenectomy (PD): Prospective Study.

INTRODUCTION: The treatment of pancreatic cancer is a complex problem, due to late diagnosis, the need for specialized surgical treatment, the large number of relapses and poor survival. OBJECTIVE: To evaluate the quality of life of patients with periampulary pancreatic cancer before and after pancreatoduodenectomy (PD). MATERIAL & METHOD: The sample was collected in the "Attikon" University General Hospital (Chaidari). It consists of 20 subjects with a mean age of 65.9 years (SD = 10,2 years). For the quality of life measurement, we used the (EORTC) QLQ-C30 version 3.0., as well as the EORTC QOL-PAN26. RESULTS: From the sample of 20 patients who participated, full data were collected for 18 of them during the first month, 17 during the third month and 16 during the sixth month.Regarding symptoms, as they were recorded with the QLQ-30 questionnaire, there was a significant increase of fatigue, a significant reduction of pain and constipation, while economic difficulties increased.  As for the mean and median values for the dimensions of the PAN-26 questionnaire during monitoring, there was a significant decrease in pancreatic and liver pain symptoms during follow-up, while the gastrointestinal symptoms increased in frequency. In addition, the body image and sexuality worsened. CONCLUSIONS: The surgical treatment of pancreatic cancer with pancreatoduodenectomy (PD), according to the early survey data using the (EORTC) QLQ-C30 version3.0, and the EORTC QOL-PAN26 questionnaires, seems to have a favorable impact on quality of life, as evidenced by the improvement of most parameters evaluated during the study period.

Multimorbidity and unmet citizens' needs and expectations urge for reforms in the health system of Cyprus: a questionnaire survey.

OBJECTIVE: This study aims to investigate the prevalence of multimorbidity in Cyprus and the extent to which citizens are satisfied with the currently provided healthcare and to provide recommendations on the basis of findings. DESIGN: A nationally based survey conducted through personal interviews, using a structured questionnaire designed for this survey. SETTING: Cyprus rural and urban areas (excluding Turkish occupied areas). PARTICIPANTS: Four hundred and sixty-five Cypriot adults, average age 53 years. MAIN OUTCOME MEASURES: Lifetime prevalence of self-reported non-communicable diseases. RESULTS: This study demonstrated initial evidence for a high prevalence of non-age specific multimorbidity among Cypriots and dissatisfaction with their doctors, especially for the time allocated to discuss their general state of health. Recommendations focus on a new cost-effective, person-centred model of healthcare. The model prioritizes prevention rather than treatment, targeting the determinants of complexity before their influences create conditions that demand high-cost interventions, and it is based on three fundamental principles: (1) tackling health as a political issue, (2) empowering the patient and (3) introducing Applied Nutrition in the system. CONCLUSIONS: This study threw light into the issue of patient complexity and revealed unmet people's needs and expectations for a more person-centred care, providing a first challenge to the single disease-based system of healthcare in Cyprus. The findings of the study may have important implications for government policies and highlight the need for more research in this area to inform policy makers, particularly in view of the fact that a new Health System is currently being designed.

Socioeconomic determinants of non-communicable-diseases among the Cypriot population: questionnaire study.

OBJECTIVE: To investigate the extent to which the socioeconomic status of Cypriots is associated with the lifetime prevalence of self-reported non-communicable disease (NCDs), with emphasis on those accounting for most Death and Disability-adjusted Life Years (DALYs) among the population, including cardiovascular disease (CVD), metabolic risks and neuropsychiatric disorders. DESIGN: A nationally based survey conducted through personal interviews, using a structured questionnaire design. SETTING: Cyprus rural and urban areas (excluding Turkish-occupied areas). PARTICIPANTS: Four hundred and sixty-five Cypriot adults of an average age of 53 years. MAIN OUTCOME MEASURES: Lifetime prevalence of self-reported NCDs. RESULTS: Most self-reported NCDs were shown to have significant associations with socioeconomic status, defined for this study by level of education and family income. Education was significantly inversely associated with CVD (18.1% at elementary education level (EE); 2.7% at high school education level (HE); and 1.7% at University/College education level (UE)), hypertension (23.4% at EE; 8.6% at HE; and 2.6% at UE), hypercholesterolaemia (12.8% at EE; 7.1% at HE; and 5.2% at UE), obesity (10.7% at EE; 4.7% at HE; and 3.5% at UE), diabetes (13.8% at EE; 2.4% at HE; and 0.9% at UE), and drug addiction (7.6% at EE; 1.6% at HE; and 0.0% at UE). Depression was more frequent amongst middle level graduates (3.2% at EE; 5.1% at HE; and 2.6% at UE). Income was significantly negatively associated with CVD (r = -0.130, p = 0.005), stress (r = -0.103, p = 0.028) and drug addiction (r = -0.117, p = 0.012), and significantly positively associated with the 'no problems' statement (r = 0.201, p = 0.000) which was reported by almost two fifths of the population. Worth noting is stress which, demonstrating no socioeconomic discrimination, was reported by high percentages of the population (17.2% of the sample). CONCLUSIONS: Although with some limitations, this study has provided initial evidence for the existence of socioeconomically determined health inequalities, which may have potentially important implications for understanding the deeper aetiology of common NCDs and for informing public policies. More research in this area is required to reveal the magnitude of NCDS-socioeconomic relation.

Validity of St. George's Respiratory Questionnaire for Greek patients with chronic obstructive pulmonary disease.

The purpose of the present study was to examine the validity of St. George's Respiratory Questionnaire (SGRQ), a disease-specific survey of health-related quality of life, in adult Greek patients with chronic obstructive pulmonary disease (COPD). Questionnaire scores, dyspnea scores, spirometry values, and demographic data were collected from 72 patients with a diagnosis of COPD exacerbation. Follow-up visits were performed at 1-mo. intervals for the first 3 mo. after discharge and a final visit was performed 6 mo. after discharge. 27 (37.5%) patients were readmitted during the follow-up period. Recovery after exacerbation was prolonged and questionnaire scores were sensitive to the patients' health-status changes across time. The SGRQ discriminated COPD patients according to disease stage, and the SGRQ scores during the recovery course were related to readmission. Correlations between the SGRQ and % FEV1 were not significant during exacerbation but a significant negative correlation was observed during the stable phase of the disease. The SGRQ appeared to have acceptable discriminant and concurrent validities in Greek COPD patients who differed according to their exacerbation stage.

Somebody else's heart inside me: a descriptive study of psychological problems after a heart transplantation.

This study describes the psychological problems of heart transplant recipients. Using a qualitative research approach, interviews were conducted with 42 patients(35 men and 7 women). Analysis of the data revealed concerns about the donor's heart and how receiving somebody else's heart might affect the recipient's own personality; feelings of guilt for the donor's death and feelings of gratitude towards the donor's family; and concerns about the recipient's own heart. These findings provide health care professionals with pointers that may aid improved information provision and maximise the use of existing coping strategies.

Resistance of the yeast-like fungi strains isolated from different ontogeneses of patients.

The susceptibility of the yeast-like fungi strains was assessed using the Fungitest method. The yeast-like fungi strains isolated from 406 patients with symptoms of candidiasis (oral cavity, vagina, urethra, skin, nails, and stomach) were evaluated. Differences between the susceptibility of strains isolated from different sites of the body to tested drugs were found. High resistance of tested strains to several antimycotics were identified. Fungitest is an easy and effective method in assessing the susceptibility of yeast-like fungi strains to antimycotics.

Frequency of operative trauma to anal sphincters: evaluation with endoanal ultrasound.

Sphincter trauma after anorectal surgery is usually asymptomatic. Frequency of trauma cannot be established with the clinical examination only. The frequency of operative sphincter defects and their correlation with disorders of continence was evaluated with the endoanal ultrasound. This study includes 123 subjects who had undergone anorectal surgery in the past and were examined with endoanal ultrasound for various indications such as continence disorders, recurrent fistula, idiopathic perineal pain, or simple postoperative follow-up. No subjects had isolated external anal sphincter defects. Nineteen of 123 patients (15%) had minor or major continence disorders, 55 patients (45%) had no sphincter defects, 42 (34%) had only internal anal sphincter (IAS) defects, and 26 (21%) had simultaneously external and internal anal sphincter (EAS) defects. The incidence of IAS and EAS trauma after Milligan-Morgan hemorrhoidectomy was 1/18 (5.5%) and 0/18 respectively; after fistula repair, 24/42 (57%) and 12/42 (29%); and after anal dilatation, 13/17 (76%) and 4/17 (24%). Sixteen of 26 patients (62%) with EAS trauma and 51/68 patients (75%) with IAS trauma did not report any disorders of continence. In patients with two or more operations, the frequency of IAS trauma was 74%, 30% for EAS trauma, and 26% for continence disorders.