Current barriers to PHR adoption among patients include cost, concerns that information is not protected or private, inconvenience, design shortcomings, and the inability to share information across organizations. However, in the future, when these concerns are addressed, and health data are portable and understandable , PHRs will likely prove to be invaluable. While patient demand could be the primary driver of innovations in telehealth, our results suggest that clinician acceptance is the more important component and the literature supports this.
To open the country for summer tourism – the backbone of the Greek economy – the government introduced safety regulations to contain the spread of the virus. Overall, the measures proved successful; infection rates remained relatively low over the summer, particularly on the islands. However, it quickly became apparent that refugees were excluded from the freedom of movement that tourists enjoyed. In March, all camps in the country were put under lockdown, meaning no resident was supposed to leave the camp premises other than for urgent matters such as doctors or hospital visits, errands for medication, etc. But throughout the summer while the country was opening up for tourists, the lockdown of camps was repeatedly extended.
Vasoactive mediators such as vascular endothelial growth factor are released in response to bacterial toxins and proinflammatory mediators . VEGF is intrathecally released from invading neutrophils in the CSF in bacterial meningitis . VEGF induces the formation of transcellular canals called vesiculo-vacuolo organelles and causes loss of intercellular tight junctions . Blocking VEGF reduces cerebral edema in experimental cerebral ischemia, but the role of VEGF in blood-brain barrier disruption in bacterial meningitis awaits further evaluation .
Some anti-inflammatory cytokines, such as transforming growth factor beta, possess neurotrophic functions. Transforming growth factor beta 2 has additional beneficial effects, since it inhibits cerebrovascular changes and brain edema in bacterial meningitis . The clinical efficacy of corticosteroids is proof of the principle that reduction of injury to the central nervous system can be achieved by modulation of the host response. For example, although tissue injury, such as disruption of the blood-brain barrier, cerebral edema, and mild neuronal injury, always occurs in meningitis, some patients survive the disease and recover fully. This illustrates the natural capacity of the body to repair injured tissues, at least in part. Strengthening of the body’s repair systems may present a second major avenue to achieving benefit and reducing permanent tissue damage in the central nervous system.
Vasculitis characterized by subintimal infiltration of cerebral blood vessels by neutrophils causes narrowing of the vascular lumen and vasospasms . Release of vasoconstrictive agents, such as the endothelins, what sector of the economy generates raw materials directly from the natural environment? and vasodilatory agents, such as nitric oxide, causes loss of autoregulation of cerebral perfusion pressure. In the face of systemic hypotension, these events further decrease cerebral perfusion .
