Rostrum of Asclepius Vol 17, No. 3 (2018): July - September 2018

Quality in health services may be expressed as an equilibrium scale of measurement of both dimensions, ie physical and mental. It is an individual but also a collective search for securing personal prosperity and social solidarity respectively. Its assurance stems from the assessment of basic, customized and predefined criteria based on structures, processes and results. The quality of mental health is still considered an underestimated concept, which will be an element of our larger focus, as its servicing resources remain elementary and therefore inadequate in many countries. The effects of mental health on the public health system are maximized by the impact of their direct and indirect costs. To address the cumulative effects of mental disorders, the World Health Organization issued in 2003 a package of instructions to deal with them. In Greece, the improvement of the quality of mental health has been a priority in recent years with the legislative initiative of Law 4421/2017 being an important step. The mental health policies of the states of the world community can exploit quality perspectives in mental health services as the key to safeguarding prosperity results, expressed in principle by deterring human rights abuses and secondly by smoothly reintegrating people facing mental disorders into society. A basic prerequisite for policymaking is therefore the awareness of the entire community of the burdens caused by mental disorders. Establishing more effective measures and mechanisms adapted to Greek standards, will contribute to further improvement of quality and normalization of mental disorders.

Keywords: Health service quality criteria, mental disorders, World Health Organization recommendations, mental health policies

Introduction: Most women choose breast reconstruction at the same time as mastectomy. The most common method of breast reconstruction is with tissue expanders (implementation). The relief from the postoperative pain of mastectomy and reconstruction is of major importance. Not only because post-operative pain can become chronic neuropathic, but also because the post-operative immune suppression it exposes the woman with breast cancer to the risk of metastases. Aim: To investigate the methods of postoperative pain management in mastectomy and immediate breast reconstruction with tissue expander in order to promote the best analgesic approach. Methods: A bibliographic review was carried out on Pubmed, Google and Elsevier internet databases using keywords of the last 10 years. Results: Women undergoing mastectomy and breast reconstruction suffer severe post-operative pain with significant side effects from various systems. The algology aims to reduce the use of opioids, using other analgesics. The ideal analgesic regimen does not exist. Multimodal analgesia provides satisfactory levels of postoperative analgesia, while the use of certain analgesic drugs and techniques provides additional benefit to patients because they protect them against possible metastasis. Conclusions: The best treatment for postoperative pain is achieved by using systemic multimodal analgesia and preventive analgesia prior to surgery. The most important role in the treatment of post-operative pain is the choice of the most appropriate analgesic regimen, personalized and based on the patient's benefits, the means provided, the cost and the culture of the organism. It is recommended to use a multifactorial, systemic and prophylactic analgesia, in combination with a local injection of analgesic to the surgical wound.

Keywords: Analgesia after breast surgery, mastectomy, pain management, pain in breast implant reconstruction, acute postoperative pain

Introduction: Adult obesity, among men and women, is a common phenomenon in the developed countries. A great amount of the obese women is trying to find the solution to the problem of obesity in the gym, exercising on the gym treadmill. High Intensity Interval Training (HIIT) seems to be extremely popular. Aim: To explore the results of the HIITon a gym treadmill in women aged 25-50 years, with specially designed protocols lasting 12 weeks. Material and Method: The following tools were necessary for the quantitative and the qualitative research: (1) Measurement Protocol, (2) Observation Protocol, (3) Axis Questionnaire used in semi- structured interviews. The measurement tools used were the skinfold caliper, the body weight scale and the height measurement scale. The clinical trials of the Experimental Group were performed on a gym treadmill, performing HIIT. Two Groups were formed with 15 women each: Experimental and Control. Both Groups followed a specially designed nutritional protocol. Results: HIIT resulted in a statistically significant reduction of the subcutaneous body fat and body weight. The reduction in body fat is differentiated by the classification of obesity. The observed reduction in body fat in the Experimental Women’s Group was statistically significant greater after the 3rd measurement. The number of the sessions seemed to be of great importance for the marginal means of the Body Mass Index (BMI). The «round apple” somatotype scored the largest reductions in the body fat in both Groups. Conclusions: HIIT on a gym treadmill was especially effective in reducing the body fat, the body weight, the abdominal skinfold, and the BMI and in defining the obesity. The best response on training on the gym treadmill, concerning the body fat reduction, was observed among the women with “round apple” somatotype. The Control Women’s Group with “round apple” somatotype, who had literally followed the specially designed nutritional protocol, resulted in the greatest body fat reduction, among the other somatotypes. Each next session seems to be statistically significant, whereas the final number of the sessions seems to be of great importance.

Keywords: Body fat reduction, gym treadmill, high intensity interval training, somatotype

Introduction: The unsuccessful navigation of citizens to health care services is a major issue in health care systems. Health care systems should seek to minimize any access barriers and aim for the continuous improvement of services. Aim: To explore the experiences of a small number of citizens in Greece, with emphasis on how they perceive their access to health care services. Methods: A small qualitative study was carried out via semi-structured interviews with users of health care services in Athens and at one of the Greek islands from December 2014 to April 2015. A World Health Organization questionnaire based on Tanahashi's theoretical framework guided the interview process. A convenience sample was used. The study also utilised Tanahashi's theoretical framework as a guide regarding availability, access, acceptability, coverage and effectiveness of health services. The material was analyzed according to the methodology of Braun & Clarke’s qualitative thematic content analysis. Results: The emerging obstacles were the following: (a) labor shortage and infrastructure regarding the availability of health services, (b) dire economic situation, lack of security, lack of information about facilities, geographical distance and informal payments regarding access to healthcare, (c) waiting lists and social discrimination regarding acceptance of care, (d) identified operational problems regarding coverage upon contact, (e) lack of confidence public structures, financial hardship and directed prescribing regarding effective coverage. The emerging facilitating factors were health professionals' efforts and the assistance of users' families. Conclusions: A great number of obstacles were identified, while access to health services was facilitated by health professionals and users' families.

Keywords: Effectiveness, availability, economic crisis, access, health services

Introduction: The increasing number of teen smokers is a global multi-factorial problem with health, economic, social and cultural influences. The attitudes of young people about smoking and smoking habit are shaped by the modern lifestyle, socio-economic status and living environment during of adolescent period. Aim:The aim of the present study was to determine the prevalence of smoking in adolescents, aged 13–18 years old, to investigate their attitudes towards smoking and determine the contribution of social influences to onset and continuation of smoking. Material and Method: The studied sample consisted of 873 students of senior high school and high school, from two cities of Central Greece. The data collected by using an anonymous self – reported questionnaire during the period 01/10/2011 – 25/02/2012. The level of statistical significance was set at P = 0.05. Data analysis was performed by the SPSS 17.0 statistical package (IBM Corporation, Armonk, NY, USA). Results: The attitudes of the sample towards smoking appear positive. Young people believe that the teenager who smokes are modern, closer to fashion, and consider it normal to smoke to their peers. Young people have positive attitude in adults smoking and also in light cigarettes. The linear regression model for predicting the attitudes towards smoking shows a negative correlation between age and attitudes to smoking (the younger people had more positive attitudes towards smoking). Conclusion: The present study showed a positive attitude of teenagers in smoking and smoking habit. Young people mostly believe that smoking is a normal activity that enjoys young people and also it acceptance.

Keywords: Smoking, adolescent, attitude, family