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Aim: The aim of the study was twofold: to estimate smoking prevalence among nurses and to compare their knowledge, perceptions and attitudes towards smoking. Background: Given the critical role nurses have in the process of patients' smoking cessation both as counsellors and behavioural models, data are needed on their smoking rates and behaviour. Design: A cross sectional, comparative study was conducted. Methods: A convenience sample of 847 nurses working in various psychiatric and public hospitals in Northern Greece participated in the study. Data were collected between April and June 2020 using a battery of questionnaires. Results: Mental health nurses were less likely to consider quitting smoking within the next 6 months (P < 0.001), despite the fact that they reported higher levels of the importance of stop smoking compared to ward nurses (P < 0.05). However, ward nurses were more likely to quit smoking because of the cost of cigarettes (P = 0.024) and for personal reasons (P = 0.040). Conclusion: Prevalence of smoking in nurses is high. Training and educational programmes are needed to develop the appropriate culture of health promotion among nurses, thus provide a more active support to patients who smoke. Summary statements: What is already known about this topic? Smoking prevalence among nursing staff is high.Cultural variances may determine nursing staff's variability in their behaviour.Nurses can play a pivotal role in influencing their patients' smoking attitudes. What this paper adds? Mental health nurses are less likely to quit smoking compared with ward nurses.Specialized strategies that emphasize mental health nurses' perceptions and attitudes towards smoking are considered essential. The implications of this paper: It is imperative that educational institutes of nurses include in their bachelor programmes, courses that emphasize the importance of preventing smoking initiation along with smoking cessation strategies.Nurses who smoke should be supported by public health organizations in practice through tobacco cessation centres and several specialists. [ABSTRACT FROM AUTHOR]

Background Paget's disease of bone (PDB) is a relatively uncommon medical condition. Objective This study was conducted to estimate the prevalence and describe the clinical characteristics of PDB in Cyprus. Methodology A questionnaire was mailed, in two phases, to all orthopedics and rheumatologists at hospitals and private practices in Cyprus. Phase 1 determined the number of PDB patients followed at each hospital or practice, while Phase 2 gathered information on the clinical presentation of current patients. Results A total of 11 patients were located among the 45 physicians surveyed. The response rate of Phase 1 was 68.5%. All physicians who reported a PDB patient in Phase 1 also participated in Phase 2. Prevalence of PDB was estimated at 2.04 per 100.000 people. Male patients were seen more frequently compared to females (72.7% vs. 27.3%). The majority of patients (82.8%) reported the presence of at least one symptom. The most frequently reported complication was fracture, while no sarcomas were reported. The most frequent location of bone fracture was the spinal column, followed by the femur (45.5% vs. 36.7%). Rarity of the disease and lack of physician's information about the disease were the two most frequently reported difficulties by physicians for the diagnosis of PDB (20.8% vs. 22.9%). Conclusions This is the first study estimating prevalence and describing clinical characteristics of PDB in Cyprus. PDB is a very rare disease in this country affecting primarily the male population. Bone involvement is present in most cases and fractures are the most prevalent complications. [ABSTRACT FROM AUTHOR]

Copyright of Rostrum of Asclepius / Vima tou Asklipiou is the property of Technological Educational Institute of Athens and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In contemporary Portugal and Greece, the number of individuals who resort to alternative medicine continues to rise. From yoga, meditation and energy therapies to healing based on various religio-spiritual traditions, there is a variety of therapeutic practices one can choose from. The main objective of this paper is to show how a therapeutic and spiritual pluralism is produced through the implementation of transnational influences on spirituality and healing. It investigates the diverse ways in which the practice of spirituality through healing leads to a better understanding of how current processes of globalisation, transnationalism and multiculturalism affect, develop and negotiate one's individual, social, spiritual and medical identity. Based on ethnographic fieldwork in Lisbon and Athens, the Portuguese and Greek capital equivalently, the paper explores the pluralistic and transnational character of alternative medicine and the spiritual creativity with which such therapies are practised. Taking the role of the (spiritual) holistic practitioner as healer as a point of departure, it provides an empirical account of the shifting status of both religiosity and healthcare in two southern European countries that are still followed by the stereotype of being predominantly linked to Christianity as the denominational religion, and to biomedicine as the predominant healthcare system. [ABSTRACT FROM AUTHOR]

Background: Diadochokinetic rates tasks are frequently used for the assessment of diadochokinesia (DKK) in young and elderly adults. However, there is scarce research on healthy elderly adults over 65 years old, and little is known about the effect of different types of stimuli (non‐words/real words) in this specific population. Furthermore, the current research supports significant language variations, highlighting the need for language‐specific norms. Aims: To investigate the effect of age, gender and type of stimuli (non‐words versus real words) in DDK rates in healthy elderly adults of over 65 years of age, and to provide normative data for the Greek language. Methods & Procedures: The participants were 791 healthy monolingual Greek‐speaking adults (531 adults, aged 20–39 years; 157 participants aged 65–74 years; and 103 participants aged over 75 years). All participants were monolingual speakers of Greek and had normal hearing acuity, which allowed them to understand and follow instructions. Participants with a medical condition, which would affect DDK rates' performance, were excluded from the study. The time‐by‐count method was used, and all participants had to repeat as accurately and fast as possible: (1) four disyllabic non‐words (/′gaba/, /′taka/, /′kata/, /′baga/); (2) four disyllabic real words (/′kapa/, /′tapa/, /ka′la/, /′paka/); and (3) two trisyllabic non‐words (/′pataka/, /′badaga/). All responses were recorded and the speech samples that did not include at least 5 s of correct repetitions were excluded from the analysis. Outcomes & Results: Age affected DDK rates significantly, with older adults achieving slower DDK rates for all speech stimuli (non‐words/real words). Gender did not have an effect on the performance of DDK rates. The type of speech stimuli affected DDK rates significantly for all age groups. Analytically, trisyllabic non‐word stimuli were articulated more slowly than disyllabic non‐word stimuli, and real words were produced faster than non‐words. A linear regression analysis revealed that only the repetition of non‐words predicted 68.4% of the performance on the repetition of trisyllabic non‐words. Conclusions & Implications: The above results complement prior research, which supports that real word stimuli yield faster performance than non‐word stimuli. Clinicians should keep in mind that age, language and type of stimuli (non‐words/real words) affect significantly the performance of DDK rates, as well as the fact that different types of stimuli tap distinct underlying levels of speech. The current research highlights the need for language‐specific norms for different populations. What this paper adds: What is already known on the subject: DDK rates are significantly affected by the types of stimuli and language used. Moreover, the normal ageing process decreases performance in terms of DDK rates, but scarce evidence exists for healthy elderly adults over 65 years old. What this paper adds to existing knowledge: Most studies have examined DDK rates in healthy elderly people with restricted samples and using non‐word stimuli. The current study administered different types of stimuli (non‐words/words) in a large sample of healthy elderly participants. This is also the first study to attempt to provide DDK normative data for this population in the Greek language. What are the potential or actual clinical implications of this work?: The results of this study strongly suggest that clinicians should bear in mind the significant impact age and language have on performance in terms of DDK rates, especially when normative data are not available for a certain language or age group. Furthermore, non‐word and real‐word stimuli cannot be used interchangeably since they tap into distinct underlying levels of speech, thus providing clinicians with useful information about the level of breakdown and the proper treatment plan. [ABSTRACT FROM AUTHOR]

When a task is repeated, it becomes part of procedural memory. This type of memory dedicated to movement is called 'muscle memory', which allows one to perform actions unconsciously. Within the context of social media, muscle memory builds up if one uses SM applications frequently. In this paper, we investigate the effects of muscle memory within Instagram, and report the following findings: We designed a user study examining the speed and accuracy of using a newly changed interface which showed slower reaction time and more errors. Combining these results with users' perceived feelings lead us to conclude that in specific UX interface changes muscle memory can be applied as a dark pattern. [ABSTRACT FROM AUTHOR]

Prosodic aspects of cross-linguistic contact are under-researched, especially past contact that has subsequently ceased. In this paper, we investigate declarative and polar question tunes of contemporary Cretan Greek, a regional variety of Greek whose speakers were in contact with Venetian speakers during the four and half centuries of Venetian rule on the island, from 1204 to 1669. The F0 contours of the Cretan tunes and alignment of peaks and troughs of interest with the nuclear vowel are compared to the corresponding tunes in Venetian dialect and Venetian Italian and to those in Athenian (Standard) Greek, which are used as control. The data (1610 declarative utterances and 698 polar questions) were drawn from natural speech corpora based on pragmatic criteria: broad focus for declaratives, broad focus, and information-seeking interpretation for polar questions. The pitch contour shapes of the tunes are modeled using polynomial basis functions, and the F0 alignment points are determined analytically. The results show the robustness of contact effects almost three and a half centuries after regular contact ceased and indicate that the shapes of the F0 contours of Cretan and Venetian declarative and polar question tunes are similar. In addition, Cretan alignment patterns are similar to Venetian and significantly different from Athenian. Insights are gained from research into how long prosodic characteristics may persist in a recipient language—decades or even centuries after the cessation of contact. [ABSTRACT FROM AUTHOR]

Although leisure constraints that individuals have to cope with can negatively affect their social inclusion and satisfaction with life, little research has addressed the link between these variables. Therefore, the current paper examined the moderator role of leisure constraints on the relationship between satisfaction with life and leisure constraints among adults living in five different European countries. The respondents were 1,382 women and 877 men adults. The findings of analysis revealed that all factors used in the study accounted for 15% of the variance in satisfaction with life and social inclusion had a significant and positive impact on satisfaction with life. As a result, it can be said that leisure constraints had a moderating effect on the relationship between satisfaction with life and social inclusion. The present research study recommends that social inclusion should be encouraged through decreasing to leisure constraints to increase the life satisfaction. [ABSTRACT FROM AUTHOR]

This paper describes the digitalization process of an originally school-based educational programme to an online version and confirms its efficacy on teaching young children as well as their parents about stroke symptoms and the necessary actions needed to be taken in the event of a stroke. Forty children (20 children with neurodevelopmental disorders (NDDs) and 20 without NDDs), aged 4–9 years, as well as 35 of these children's parents (30–50 years old) participated in the study in Greece. All individuals watched 5 educational videos, designed and produced by the Super Grand League Team. Each video had a mean duration of 15 minutes. Most children had no prior knowledge neither in stroke symptoms nor to the appropriate actions after a stroke. Children's knowledge of stroke symptoms (except the symptom of speech disturbance) and the appropriate actions following stroke improved significantly immediately post training (p < 0.05). Children with NDDs demonstrated no significant differences when compared to their peers without NDDs in regards to the knowledge gains. In the same line, parents showed a significant increase in their knowledge as regards the stroke symptoms (p < 0.001). Only 2 parents (5.7%) knew the correct emergency number before participating in the online programme, while all of them (100%) responded correctly after the programme. The current work using multimodal remote education demonstrates significant improvement in learning about stroke symptomatology and the necessary steps that need to follow. Future work should evaluate the impact of digital interventions in respect of onset-to-door times and stroke outcomes. [ABSTRACT FROM AUTHOR]

Background Smoking rates in Greece are the highest recorded among OECD countries, but the historical and life-course evolution of smoking patterns is largely unknown. The present paper addresses this gap. Methods We produce nationally representative life-course trajectories of smoking and related mortality of eight generations of Greek men and women. We estimate the smoking–mortality correlation conditional on several confounders and project the estimates forward. Results We show that smoking prevalence among Greek men has plateaued at >60% for all but the youngest generation. For women, smoking prevalence is relatively lower, lags by several generations and follows a hump-shaped pattern. Smoking-attributable mortality is currently peaking for men (nearing 40% of total deaths) and is rising for women. We estimate that it takes ~20 years of smoking to maximize the smoking–mortality correlation (at 0.48 for men and 0.32 for women). Based on this estimation, we forecast that mortality rates will begin falling within the current decade. Conclusions The breadth of the Greek smoking epidemic has been high by international standards, reflecting the ineffective tobacco control efforts in the country. While smoking popularity fell during the Great Recession, policy vigilance is necessary to prevent a relapse once the economy recovers. [ABSTRACT FROM AUTHOR]

Purpose: Health literacy (HL) is considered an important prerequisite for informed, self-determined health decisions. HL research among older migrants is scarce, but especially important, as older people face great challenges regarding management of chronic illnesses and, therefore, are in need of adequate healthcare. Therefore, this paper aims to report HL in the domain of healthcare (HL-HC) among older migrants in Germany stratified by different countries of origin. Design/methodology/approach: Data were collected by a quota sample in North Rhine-Westphalia, Germany. Computer-assisted personal face-to-face interviews were conducted in German, Russian and Turkish. For this analysis, a subsample of 192 first-generation migrants aged 65–80 years from Turkey, Poland, Greece or Italy was drawn from the main sample (n = 1,000). HL-HC was assessed using a sub-index of health literacy survey European questionnaire 47. Data analyses comprised descriptive statistics, bivariate and multivariate analyses. Findings: Overall, 68.6% of the older migrants have limited HL-HC, and mean HL-HC scores vary significantly among different countries of origin. There is great variation in reported difficulties for the single HL-HC tasks by migrant groups. In multiple regressions, country of origin, not German as main language, low functional HL and low social status are significantly associated with lower HL-HC. Practical implications: Interventions should be aimed at smaller target groups and should consider language issues and possible differences related to countries of origin into account. Both individual skills and system-related aspects need to be addressed. Originality/value: This paper presents first data on HL-HC among older migrants in Germany and its determinants, stratified by different countries of origin. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students. Background: Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves. Design Longitudinal comparative study. Measurements We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self‐administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed. Results: There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake. Conclusion: Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health‐promoting role. We need strategies to safeguard the professional nursing practice. SUMMARY STATEMENT: What is already known about this topic? Nursing includes the promotion of health, the prevention of illness and the shaping of healthy behaviours.Nurses are in a unique position to help individuals and communities modify their health risk behaviours.An important determinant for providing lifestyle advice is the lifestyle of nurses themselves. What this paper adds? Using a longitudinal comparative study design, we recorded no major differences in behavioural health risk factors between nursing students and nonnursing peers at the beginning and the end of their studies.In relation to their first year of studies, both nursing students and nonnursing peers engaged in more health risk behaviours during their final year in delivery/junk food consumption, sunburns, hashish/marijuana use and number of sexual partners. The implications of this paper: Multiple strategies are needed to target norms regarding the scope of professional practice of nursing and advance undergraduate nursing curricula to explicitly provide the required knowledge for health promotion, lifestyle counselling and behaviour change interventions. [ABSTRACT FROM AUTHOR]

Purpose: We prospectively evaluated the association between quality of plant-based diets and 10-year first fatal/non-fatal cardiovascular disease (CVD) incidence. Methods: ATTICA study was conducted in the greater metropolitan Athens area, Greece, during 2001–2002 studying men and women (aged > 18 years old) free of CVD at baseline. Follow-up CVD assessment (2011–2012) was achieved in n = 2,020 participants (n = 317 cases). Dietary assessment was based on a validated semi-quantitative paper-based food frequency questionnaire. Overall, healthful, and unhealthful plant-based dietary indices (PDI, hPDI and uPDI) were calculated through a standard published procedure. The association between plant-based indices and CVD outcome has been evaluated via Cox regression analysis. Results: The CVD event rate was 15.7% (n = 317) with a median follow-up time of 8.41 years. The highest (3rd PDI tertile) vs. lowest (1st tertile) adherence to plant-based pattern—irrespective to healthfulness of food products consumed—was inversely associated with CVD (hazard ratio (HR) 0.56; 95% confidence interval (95% CI) 0.14, 2.25) yet the CI was wide. Ranking from 1st to 2nd and 3rd hPDI tertile the CVD event rate was 6.4%, 10.5% and 16.2%, respectively (p = 0.003). Multi-variable adjusted analysis revealed that participants assigned in 2nd and 3rd hPDI tertile had 47% (HR 0.53; 95% CI 0.25–1.08) and 68% (HR 0.32; 95% CI 0.16–0.63) lower risk to develop CVD compared with their 1st tertile counterparts. Conversely, a positive association between uPDI and CVD risk was revealed in dose–response analysis (HR(per5unitsincreaseinuPDI) 1.34; 95% CI 0.95–2.37)). Conclusions: Quality of plant-based diets is important and needs to be considered, as not all plant-source foods have beneficial cardiovascular effects. [ABSTRACT FROM AUTHOR]

Teacher hiring is often a dysfunctional time-consuming bureaucratic procedure, which is not always completed on time due to organisational impediments, budget cuts and slow-moving political processes. Specifically, late hiring has been reported to affect negatively teachers' as well as students' performance. This study examined the extent of late hiring in parallel support, which is a Greek institution aiming to support students with disabilities and special education needs within the mainstream classroom. Actually, this paper examined the number of parallel support teachers in Greek primary and secondary education who were hired on time as well as the percentage of recruitment per hiring phase during the school years 2018--2019 and 2019--2020. Results indicated high percentages of late hiring in this institution for both educational levels lead to the suggestion that the Greek State virtually divided the students into two categories; the 'privileged' who were supported from the start and the 'non-privileged' who were belatedly supported. The researchers conclude that policies in Greece concerning hiring of parallel support teachers need fundamental changes in organisation and funding, in order to serve the students' needs and signalise a strike against ableism. [ABSTRACT FROM AUTHOR]

Purpose: An individual's lack of social connections and social isolation is often associated with feelings of loneliness which is regarded as having a negative effect on health. This paper describes the development and assessment of a 10 item 'Personal Sociability and Connections Scale' (PeSCS) to measure individual's disposition and accompanying skills to seek out companionship and engage in interpersonal relations. Methods: The study was conducted at a rural primary care unit in Northern Greece. A total of 199 attenders were recruited over a 6-week period in 2020 and questionnaires completed. This informed the 10-items PeSCS that comprises Social, Behavioral, and Emotional components focusing on the expression of social comfort, willingness to share experiences, stories and concepts, and feelings of similarity at first contact. Reliability of the PeSC scale was assessed and the relationship with scale scores examined as an indicator of convergent validity. A multivariate linear regression analysis was performed to examine the relationship of PeSC scale score with the characteristics of participants. Results: Assessment of reliability of PeSC scale produced a Cronbach's alpha of 0.809. The relationship between components and the total PeSCS scores identified significant correlations (p <.001). At a multivariate level, male gender was the sample characteristic with a significant association with scale levels (p <.05) and higher annual income with Social component (p <.05). Otherwise the distribution of sociability dispositions was similar across population groups. Conclusion: The 10-item PeSC scale forms a simple and quick to complete measure whose overall reliability was rated as 'meritorious'. The PeSC instrument may be a useful tool for assessing the causes and appropriate responses to the negative health effects of loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Background: The traditional Mediterranean diet is defined as the dietary pattern in the countries of the Mediterranean basin between the 1950s and 1960s, and it is now widely accepted that has a beneficial effect on health. A debate exists from empirical and research data if the traditional Mediterranean diet remains the main dietary pattern of the region or if it has changed overtime. Aims: This systematic review addresses whether the people of Cyprus and Greece still follow the traditional Mediterranean diet or whether the diet has become more 'Westernised'. Methods: The MEDLINE database was searched using relevant free terms and independently reviewed by two authors. In addition, all reference lists of identified studies were hand-searched to identify additional, relevant studies. Results: The review resulted in 18 research papers that met the inclusion and exclusion criteria and represented 15 independent studies. The main outcome was consistent between studies and indicated moderate adherence of the Greek, and (probably) of the Cypriot, population to the Mediterranean diet. The majority of studies found no statistically significant differences by gender. There was an observed inter-study lower adherence to the Mediterranean diet by the younger population. Few studies addressed intra-study variations by age. Conclusions: This review shows that adherence to the Mediterranean diet is moderate in Greece (and probably also in Cyprus).This suggests a continuing transition from dietary patterns in the 50s-60s towards a more Westernized diet. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the possibilities and the growth prospects of medical tourism in Greece, while particularly focusing on the dialysis process. Patients with end-stage renal failure have the right to any treatment deemed necessary during their journey to another city or country away from the place where their treatment normally takes place. Design/methodology/approach: The survey has been conducted among 193 kidney disease patients that underwent extra-renal dialysis in two public and three private artificial kidney units in Thessaloniki. The study population consists of patients with end-stage chronic renal failure (CRF) that undergo dialysis. For the purpose of this study, quantitative research was carried out via a structured and anonymous questionnaire. The design and structure of the study were based upon questionnaires from two relevant questionnaires. The questionnaires were modified appropriately to respond to the subject in question. Finally, for the analysis of the data, the SPSS software has been used. Findings: One of the most obvious results is that patients on dialysis treatment have limited both the frequency and the duration of their vacation. The 8.3% of patients that did not use to travel increased to 37.8%, whereas only 22.3% continue to travel 2–4 times a year. Patients that keep on going on vacation frequently claim that a break from the daily routine improves their quality of life. Most of the participants (up to 36.3%) claim they feel healthier, while 34.2% stated they experience a normal life when they escape their everyday life and travel far from home. The 69.9% claim that Greece has the potentials to be a popular medical tourism destination. However, a well-structured and government-financed assistance programme is absent. The processing of data has revealed a positive correlation between age and tourism behaviour. Additionally, according to the research results, younger patients tend to be better informed regarding medical tourism in comparison with older ones. Social implications: Considering the patients to be potential travellers facilitates the development, realization and promotion of medical tourism. Originality/value: This study attempts to investigate, for the first time, the tourism behaviour of chronic kidney disease patients. The study highlights a sensitive issue, patients' right to treatment without geographical or distance-related obstacles. [ABSTRACT FROM AUTHOR]

INTRODUCTION Low-level knowledge of problematic substance use during the perinatal period may lead to numerous adverse outcomes. We sought to determine maternal tobacco, alcohol and caffeine consumption during the perinatal period during the COVID-19 pandemic. METHODS This prospective cohort study recruited women from five Greek maternity hospitals between January and May 2020. Data were collected with a structured questionnaire initially completed by postpartum women during their hospitalization and re-administered via telephone interview in the first, third and sixth month postpartum. RESULTS The study sample consisted of 283 women. Smoking rates decreased during pregnancy (12.4%) compared to the pre-pregnancy period (32.9%, p<0.001) and during lactation (5.6%) compared to the antenatal period (p<0.001). The smoking rate increased again after breastfeeding cessation (16.9%) compared to the rate during lactation (p<0.001), but remained lower than the pre-pregnancy rate (p=0.008). Only 1.4% of the women reported breastfeeding cessation due to smoking, whereas those who smoked more during pregnancy were more likely to cease breastfeeding (OR=1.24; 95% CI: 1.05--1.48, p=0.012). Regarding alcohol consumption, it was significantly lower during pregnancy (5.7%), lactation (5.5%) and after breastfeeding cessation (5.2%) compared to the pre-pregnancy period (21.9%, p<0.001 for all correlations). Women who consumed alcohol during lactation were less likely to wean (OR=0.21; 95% CI: 0.05--0.83, p=0.027). Caffeine intake decreased during pregnancy compared to preconception period (p<0.001), while in lactating women it remained at low rates until the 3rd month of follow-up. Caffeine consumption at one month postpartum (β=0.09; SE=0.04, p=0.045) was positively associated with longer duration of breastfeeding. CONCLUSIONS Tobacco, alcohol and caffeine consumption decreased in the perinatal period compared to the preconception period. The pandemic may have contributed to the downtrend in smoking and alcohol consumption due to COVID-related restrictions and fear of potential illness. Nevertheless, smoking was associated with reduced duration of breastfeeding and breastfeeding cessation. [ABSTRACT FROM AUTHOR]

Pharmacy customer satisfaction is a predictor of customers' behaviour and thus becomes a critical issue in the highly competitive pharmacy sector. Therefore, the aim of this paper was to determine the evaluative criteria that customers use in selecting an independent community pharmacy as their regular one, as well as their contribution to customer satisfaction. Moreover, areas of customer service that can provide competitive parity or advantage to a pharmacy are identified. A survey was carried out among randomly selected customers of pharmacies located in Thessaloniki, Greece, using a structured questionnaire. A total of 223 usable questionnaires were collected. Descriptive statistics and MUlticriteria Satisfaction Analysis (MUSA) were used for data analysis. The findings highlight reputation, community contribution, and professional expertise/behaviour of the pharmacist(s) and staff, as the criteria that contribute the most to customer satisfaction and choice of a pharmacy as a regular one. Also, the study outcomes suggest that the above variables combined with a fast and error‐free service, respect and confidentiality can be used as advantages against competition. The current research findings provide directions for strategic actions that could help a pharmacy to enhance customer satisfaction and consequently build long‐term relationships with patients and stand out from the competition. [ABSTRACT FROM AUTHOR]

Background: The knowledge of the profile of home health care patients is required to ensure the optimal planning of the care provided, the best organization and management of home health care (HHC) services around one country. Objective: The aim of this paper was to describe the demographic and clinical profile of users of HHC services in Greece, and the sociodemographic profile of the informal caregivers and the volunteers, during the “ΑΚΕΣΩ- Ι” project. Methods & Materials: In this cross-sectional study the sample consisted of patients who received HHC services in 3 major cities in Greece during a 20-month period. Variables of the study were patients', caregivers' and volunteers' sociodemographic characteristics and patients' clinical characteristics. Results: Patients were over 65 (80.71%) and female (68.37%). Nearly half of the patients (46.8%) received care for medical problems, and 83.82% were insured. The informal caregivers were female (93%), middle and older adults, had a Bachelor’s degree, and 52% of them were employed. Half of the volunteers were older adults, females (91%), with secondary level of education (48%) and employed (50%). Conclusions: This is the first study in Greece, which provides a population-based profile of the users’ characteristics, and the profile of informal caregivers and volunteers of formal HHC services. The findings highlight a significant number of key changes in the organization and operation of HHC services which can motivate policy makers to make sound decisions. [ABSTRACT FROM AUTHOR]

In this paper, Stamatoula Pylarinou with her supervisor Prof. Sarantos Kapidakis reports on an analysis of bibliographic data of the publications of Greek hospital personnel, conducted as part of Stamatoula's doctoral research in the Department of Archive, Library and Museum Sciences at the Ionian University in Corfu, Greece. Using freely available data, they demonstrate the questions posed and the insights gained from the analysis of the scientific publications of personnel of public hospitals in Greece, in particular amid the years of austerity in Greece. With regard to impact on practice, they suggest that these procedures for the processing of medline/PubMed bibliographic data can improve communication among hospital librarians and administration or patients, adding value to their duties and enhancing the information and services they can provide. F.J. [ABSTRACT FROM AUTHOR]

Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this pilot study, we assessed the effectiveness and acceptability of an educational program designed to prevent alcohol-related behaviors among high school students. The program was rooted in the Theory of Planned Behavior principles (TPB) and supplemented with life-skills teaching. A total of 352 participants were involved, representing 10 secondary schools in central Greece. Among these, 257 students (Mage: 14.51 ± 1.34 years) constituted the experimental group, while 95 were assigned to the control group. The experimental group received a 10-session program, one per week. The results revealed that the experimental group had a significant improvement on knowledge about alcohol, perceived behavioral control (PBC), and alcohol-related behavior between pre- and post-intervention measurements. Additionally, students expressed high levels of satisfaction with the program. These findings offer substantial evidence for the practicality and effectiveness of an alcohol prevention initiative that is rooted in theory and supported by life-skills education when implemented within a school environment. [ABSTRACT FROM AUTHOR]

Background: In the world of elderly people and people with chronic diseases, caregivers give a solution to caring at home. This study aimed to evaluate the burden of caregivers of patients with chronic diseases in primary health care and identify possible demographic and other determinants of it. Methods: This was a cross-sectional study with a convenience sample, which was conducted in two health centers. The sample comprised 291 caregivers who visited the aforementioned health centers in Patra, Greece. A composite questionnaire was utilized: the first part included demographic data and care-related information and the second included the Zarit Burden Interview and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results: The highest mean score in the DASS was recorded in the depression subscale and the lowest in the stress subscale. Concerning the Zarit Burden Interview, the highest mean score was recorded in the personal strain subscale and the lowest in the management of care subscale. The highest correlation was recorded between role strain and anxiety and the lowest was between management of care and stress. Similarly, the total score in the Zarit Burden Interview correlated significantly (in a positive direction) with depression, anxiety, and stress. Conclusions: Most of the caregivers of patients with chronic diseases in primary health care experienced a moderate to severe burden (especially in the dimension of personal strain) and moderate depression. The experienced burden was positively associated with depression, anxiety, and stress. There were significant differences in the caregivers' burden according to several demographic and care-related characteristics. [ABSTRACT FROM AUTHOR]

The importance of night sleep for maintaining good physical and cognitive health is well documented as well as its negative changes during aging. Since Mild Cognitive Impairment (MCI) patients bear additional disturbances in their sleep, this study aimed at examining whether there are potential mixed effects of sleep and afternoon time of day (ToD) on the storage, processing, and updating components of working memory (WM) capacity in older adults with MCI. In particular, the study compared patients' performance in the three working memory components, in two-time conditions: "early in the morning and after night sleep", and "in the afternoon and after many hours since night sleep". The Working Memory Capacity & Updating Task from the R4Alz battery was administered twice to 50 older adults diagnosed with MCI. The repeated measures analysis showed statistically significant higher performance in the morning condition for the working memory updating component (p < 0.001). Based on the findings, it seems that the afternoon ToD condition negatively affects tasks with high cognitive demands such as the WM updating task in MCI patients. These findings could determine the optimal timing for cognitive rehabilitation programs for MCI patients and the necessary sleep duration when they are engaged in cognitively demanding daily activities. [ABSTRACT FROM AUTHOR]

Many claim a high prevalence of single motherhood plays a significant role in America's high child poverty. Using the Luxembourg Income Study, we compare the "prevalences and penalties" for child poverty across 30 rich democracies and within the United States over time (1979–2019). Several descriptive patterns contradict the importance of single motherhood. The U.S. prevalence of single motherhood is cross-nationally moderate and typical and is historically stable. Also, child poverty and the prevalence of single motherhood have trended in opposite directions in recent decades in the United States. More important than the prevalence of single motherhood, the United States stands out for having the highest penalty across 30 rich democracies. Counterfactual simulations demonstrate that reducing single motherhood would not substantially reduce child poverty. Even if there was zero single motherhood, (1) the United States would not change from having the fourth-highest child poverty rate, (2) the 41-year trend in child poverty would be very similar, and (3) the extreme racial inequalities in child poverty would not decline. Rather than the prevalence of single motherhood, the high penalty for single motherhood and extremely high Black and Latino child poverty rates, which exist regardless of single motherhood, are far more important to America's high child poverty. [ABSTRACT FROM AUTHOR]

The present study contributes to the development of effective measures to evaluate classroom climate, especially in elementary education where these remain limited. In addition, it addresses a typical "flaw" of several studies by approaching classroom climate as a group-level construct rather than an individual characteristic. Following a multilevel approach, we attempted to establish validity evidence for an adapted version of the Classroom Behavioral Climate (CBC) questionnaire and examine its equivalence across two contexts. The participants included 2963 students from 176 fourth and fifth grade classes. Multilevel Confirmatory Factor Analyses resulted in a shorter version of the CBC with three correlated factors in both countries. Two-level models performed better than the single-level models. Configural, metric, and partial scalar invariance was also achieved. The study highlights the need for researchers and practitioners to use appropriate methods and instruments to evaluate the classroom environment based on their research aims and intended use. [ABSTRACT FROM AUTHOR]

The introduction of a new vaccine into immunization programs represents a significant advancement in the global effort to combat vaccine-preventable diseases. Data from the World Health Organization support that immunization prevents between 2 and 3 million deaths each year across various diseases, underscoring its pivotal role in global health. The present study aims to assess the knowledge, attitudes, and anticipated vaccination practices among health professionals in Central Greece in response to the potential introduction of new Respiratory Syncytial Virus (RSV) vaccination guidelines by the National Vaccines Committee. Among the 450 health professionals solicited for the study, 219 provided responses, yielding a response rate of approximately 55%. A substantial majority (70.3%) accurately identified the vaccine's current availability, and 62.1% were aware of the current recommendation for RSV vaccination in pregnant women. In response to whether health professionals support the inclusion of an RSV vaccine in the national vaccination program if it becomes commercially available and is recommended by the Greek National Immunization Program, general practitioners showed the most support, with an average score of 4.86 (95% CI, 4.69–5.00), followed by pediatricians at 4.76 (95% CI, 4.63–4.89), pulmonologists at 4.68 (95% CI, 4.36–5.00), and obstetricians at 4.33 (95% CI, 3.95–4.71). Concerning general opinions on vaccinations, a high level of agreement was noted among the majority of health professionals, excluding nurses. Pharmacists recorded the highest agreement, with a perfect score of 5 (CI, 5.00–5.00), followed closely by pediatricians at 4.99 (CI, 4.97–5.00), GPs at 4.95 (CI, 4.85–5.00), pulmonologists at 4.93 (CI, 4.83–5.00), obstetricians at 4.74 (CI, 4.42–5.00), and nurses at 3.80 (CI, 3.06–4.54). A tailored approach to education is needed to ensure that healthcare professionals can communicate more effectively about RSV risks and vaccination benefits, fostering a proactive stance towards disease prevention and patient care. In essence, our study underscores the importance of knowledge in shaping a compassionate and responsive healthcare environment, ready to meet the challenges of RSV head-on. [ABSTRACT FROM AUTHOR]

Background: Adverse Childhood Experiences (ACEs) are linked to the development of anxiety in adolescence. According to recent studies, the COVID-19 pandemic represents a novel ACE that is associated with anxiety among adolescents. This study investigates the relationship between ACEs, COVID-19, and anxiety in adolescents. Methods: A cross-sectional study was conducted using a community sample of 248 boys and girls ages 12 to 15 years (mean = 13.50 years) from five high schools in Eastern Attica. A total of four questionnaires were used: (1) Demographic Questionnaire, (2) State–Trait Anxiety Inventory for Children—STAIC, (3) Adverse Childhood Experiences Scale, and (4) COVID-19 Impact Scale. Results: The results demonstrated a moderate association between the total number of ACEs and anxiety (trait and state) in adolescence (trait anxiety: ρ = 0.37, p < 0.001; state anxiety: ρ = 0.29, p < 0.001). Girls scored significantly higher than boys on both trait anxiety (U = 4353, p < 0.001; mean difference = 5.5) and state anxiety (U = 5822.5, p = 0.014; mean difference = 2). The number of ACEs was found to be significantly related to the impact of COVID-19 (β = 0.025, p < 0.001). Conclusions: This study highlights the significant link between ACEs and increased anxiety in adolescents, which is further exacerbated by the COVID-19 pandemic. The findings indicate that girls are more affected than boys. These results emphasize the need for targeted mental health interventions to enhance coping mechanisms, reduce stress, and address anxiety in adolescents, particularly during global crises like the pandemic. Developing such programs is essential for supporting the mental well-being of youth facing multiple stressors. [ABSTRACT FROM AUTHOR]

This work provides the ethnobotanical data concerning the traditional use of medicinal plants in Macedonia region (Northern Greece), which has, up to now, been poorly investigated. The aim of the present study was to collect, analyze, and evaluate information on the use of medicinal plants among different population groups living in Central Macedonia. The study was carried out in the area of two small cities, Edessa and Naoussa, and nearby villages. The ethnobotanical data were gathered through extensive and semistructured interviews. The informants belonged to different population groups living in the study areas and were involved, at least partially, in agriculture. Together with detailed reports on each species, data were also summarized by some indices, such as Fidelity Level (FL) and Informant Consensus Factor (Fic). A group of 96 informants was interviewed and 87 plant taxa with medicinal uses were cited. Medicinal plants are used to treat a wide range of diseases, in particular ailments of the respiratory tract and skin disorders. The importance of the traditional use of plants to cure and prevent common and some uncommon diseases had been highlighted. About 55% of medicinal plants mentioned by the informants had been previously reported to be sold in Thessaloniki herbal market as traditional remedies. Medicinal uses of some endemic taxa had been reported, e.g., Satureja montana subsp. macedonica, a member of the S. montana group restricted to Northern Central Greece, Origanum dictamnus, an endemic species of Crete, and six Balkan endemics, i.e., Achillea holosericea, Digitalis lanata, Helleborus odorus subsp. cyclophyllus, Sideritis scardica, Thymus sibthorpii, and Verbascum longifolium. Several differences in Traditional Ethnobotanical Knowledge (TEK) were observed in relation to social and cultural components of the population. Only 7 species (Crataegus monogyna, Hypericum perforatum, Matricaria chamomilla, Rosa canina, Sambucus nigra, Sideritis scardica, and Tilia platyphyllos) were commonly reported by all population groups, whereas 30 out of 87 taxa (34%) were exclusively mentioned by a single group. All groups are incorporated in the local society and do not identify themselves as members of different ethnic groups, although they try to preserve their distinctiveness by keeping their traditions and dialects. Nevertheless, our data show that the knowledge regarding the medicinal plant use was rarely accompanied by preservation of linguistic diversity concerning the plant names. This work contributes to improve the knowledge on the traditional use of plants in the folk medicine of a region like Central Macedonia where different population groups live together, partially maintaining their traditions. A part of data of this paper has been presented as posted at 112° Congress of Italian Botanical Society (IPSC), Parma 20-23 September 2017. [ABSTRACT FROM AUTHOR]

The current paper examines teaching practices in three first-grade primary classrooms (age range from five years and nine months old to six years and nine months old) in Greek Cypriot public schools, exploring whether the wider changes in critical literacy education declared on a policy level are influencing classroom literacy practices. Greek Cypriot public education has followed the language policies developed in Greece since the island gained independence in 1960. However, from 2010, there has been a full-scale educational reform in Cyprus at all levels of education, and for the first time, a critical literacy model has been implemented. Drawing data from research conducted into classroom practices and discourse, the current paper analyses literacy teaching in three Greek Cypriot classrooms, focusing on the materials used, the idea of textuality, the role of metalanguage and the notion of language legitimacy produced in the classroom. The overall aim is to document how the model of critical literacy is applied (or not) in these classrooms, and to explore the limitations and difficulties encountered, especially in the first grade of primary school where students need to move from emerging to developing literacy, i.e. they need to acquire the mechanisms of reading and writing. The methodology adopted follows the methods used in micro-ethnography, focusing in this case on participant observation of literacy classes and interviews with teachers in three classrooms. [ABSTRACT FROM PUBLISHER]

Context The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. Discussion and conclusions This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. [ABSTRACT FROM AUTHOR]

Background: In the healthcare sector, a traditionally resource-intensive sector, Human Resources stand at the centre of the discussion on efficiency and performance improvement, and, ultimately, improved quality of care provided to patients and citizens. In the light of their important role in the internal development of the organisation and the externally realized "added value", employees are the targets of various communication efforts, either upwards or downwards, by human resource departments, which aim primarily at asserting the satisfaction employees get from their job. Aim: This paper presents the findings of a satisfaction survey conducted among healthcare employees in a specialized, not-for-profit hospital in Greece. Methodology: To conduct this research and measure healthcare employees' satisfaction, the authors created and used a novel questionnaire in 244 employees of a hospital. The hospital, although a part of the Greek National Health Service (NHS), enjoys a unique legal status, which gives room for manoeuvre and managerial flexibility. Results: The survey showed that, despite the fact that employees lack the benefit of permanency of the public servant status that the rest of the NHS staff enjoy in Greece, they are quite satisfied with their jobs. They all, irrespective of grade and specialization, expressed satisfaction with the following: (a) the working environment, (b) the working hours and (c) the anxiety caused by work. Nonetheless, with the exception of higher-level medical personnel, employees seemed dissatisfied with their salaries, promotional opportunities and education. It appeared as well that an employees' satisfaction survey: (a) can support the efforts of a healthcare organisation to get ISO certification and (b) enhances the communication between the management team and the employees. Conclusions: It is open for discussion whether these findings would be either valid in a longer term perspective or transferable and directly applicable to different organisational settings. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to investigate the prescribing behavior and applied practices of doctors who are the heads of clinical departments in the National Health System in Greece. Moreover, this paper aims to evaluate a set of factors influencing them in this conduct through both their scientific and managerial status. Design/methodology/approach – The sample consisted of 123 clinical department-heads in 15 hospitals and a questionnaire specifically designed for the purposes of this research effort was used. Prescribing criteria were divided into three categories: scientific, functional and behavioral. Demographic data were also included. The data were processed using SPSS17 statistical package. Multivariate Analysis of Variance (MANOVA) of the mean of the parameters identified was applied. Findings – The survey assessed, revealed and evaluated the most important factors affecting the selection process of selecting pharmaceuticals on a department head level. Existing gaps in scientific information and rational management of procedure implementation were detected. Different perceptions of doctors-department heads towards prescribing criteria emanating from their previous experience on decision-making positions, age and hospital spatial characteristics (urban-provincial) were also highlighted. Originality/value – The results of this survey provide both researchers and health policy makers with a better insight of the factors influencing prescribing behavior, and decision-making processes of doctors-department heads in the context of a Public Health Care System. [ABSTRACT FROM AUTHOR]

Introduction: The aims of the study were to identify and analyze the determinants associated with outpatient satisfaction in Greek primary care. This is because there is a general consensus that primary care is the linchpin of effective person-centered care delivery. Methods: A cross-sectional survey was conducted with 1012 patients' exit interviews; sociodemographic variables were included in the questionnaire to obtain data on the satisfaction of primary care users with 20 public primary healthcare centers in Athens between June 2019 and April 2021. Statistical analysis was applied to 55 items and eight dimensions of patient satisfaction, namely, arrival and admission, waiting before the appointment, cleanliness of toilets, medical examination and behavior of physician, behavior of nursing staff, laboratories, departure, and contribution of the PHCs. Descriptive analyses and multiple linear regression were used to analyze the factors influencing patient satisfaction through coefficients (β) with 95% confidence intervals and associated tests of statistical significance. Results: Τwo-thirds (74.21%) of this survey's participants ranged from 45 to 74 years of age. More than half of the participants were women (62.15%). The most common reasons for visits were pathological (26.48%), followed by cardiological conditions (9.78%), orthopedics (9.49%), gynecologic conditions (8.70%), and ophthalmologic problems (7.31%). In the center of satisfaction with primary care was the medical care and the behavior of the physician (β = 0.427; p < 0.01), followed by the time during appointment (β = 0.390; p < 0.01). Dimensions like "accessibility and availability, 2.19/5"; "waiting times, 2.89/5"; "infrastructure of facilities (2.04/5) and cleanliness of them, (2/5)"; "laboratories, 2.99/5" and "bureaucracy in the departure, 2.29/5" were crucial for the trust and satisfaction of patients. Overall satisfaction was rated at a moderate level (2.62 ± 0.18) while person-centered care was rated as weak (2.49 ± 0.28). Conclusions: Greece is recommended to increase the sensitivity of the use of the primary health care system by patients as a first contact, continuous, comprehensive, and effective patient- and family-focused care. [ABSTRACT FROM AUTHOR]

Background: it is widely accepted that living in the digital transformation era, the need to develop and update new professional skills and tools in health sectors is crucially important. Therefore, this study aimed to explore the reliability and validity of the Digital Competence Indicators tool in assessing the digital skills of Greek health professionals. Methods: in this cross-sectional study, 494 health professionals, including doctors (175) and registered nurses (319) working in four Greek hospitals were recruited and willingly participated using a convenience-sampling method. The original framework of Digital Competence Indicators was translated from English to Greek based on guidelines for cross-cultural adaptation of questionnaires. The validity of the tool was explored using confirmatory factor analysis (CFA) to verify the fit of the model using inductive techniques. The instrument reliability was confirmed using Cronbach's alpha (α) and McDonald's Omega coefficients. Results: the reliability was estimated at 0.826 (Cronbach's-α) and 0.850 (McDonald's Omega-ω). The indicators of CFA were all calculated within an ideal range of acceptance. Specifically, the CFA comparative fit index produced the following adjustment indices: x2/df = 1.152 (p = 0.037), CFI = 0.997, Lewis index (TLI) = 0.966, and root mean square error of approximation (RMSEA) = 0.018. Conclusions: The present study demonstrated that the Digital Competence Indicator instrument has high reliability, internal consistency, and construct validity and, therefore, it is suitable for measuring digital skills of health professionals. [ABSTRACT FROM AUTHOR]

Background/Objectives: The childhood consumption of non-sugar-sweetened (NSS) soft drinks is a growing concern due to its potential health implications. This study investigated demographic, anthropometric, and lifestyle factors influencing NSS soft drink consumption among children. Methods: A sample of 1304 children and their parents were surveyed. Results: Analysis revealed that nearly 60% reported consuming NSS soft drinks at least once a week. Also, positive associations were found between NSS soft drink consumption and lower socioeconomic status, increased total beverage consumption, higher maternal BMI, and parental soft drink habits. However, upon employing multivariable models, only the association between total and NSS soft drinks consumption remained statistically significant (OR = 18.925, p < 0.05 for children; OR = 3.801, p < 0.05 for parents), highlighting the pivotal role of parental behavior in shaping children's consumption patterns. Conclusions: These findings emphasize the importance of tracking parental habits, revealing a strong correlation between parental behavior and children's soft drink consumption patterns. Understanding these factors is crucial for developing effective public health strategies for children, which should prioritize not only individual behaviors but also parental modeling and household dynamics. [ABSTRACT FROM AUTHOR]

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The hypothesis of this randomized controlled trial was that a clinical decision support system (CDSS) would increase adherence to the Mediterranean diet (MD) among adolescent females with polycystic ovary syndrome (PCOS). The objective was to assess the impact of personalized MD plans delivered via a CDSS on nutritional status and psychological well-being. Forty adolescent females (15–17 years) with PCOS were randomly assigned to the MD group (n = 20) or the Control group (n = 20). The MD group received personalized MD plans every 15 days via a CDSS, while the Control group received general nutritional advice. Assessments were conducted at baseline and after 3 months. Results showed significantly increased MD adherence in the MD group compared to the Control group (p < 0.001). The MD group exhibited lower intakes of energy, total fat, saturated fat, and cholesterol, and higher intakes of monounsaturated fat and fiber (p < 0.05). Serum calcium and vitamin D status (p < 0.05), as well as anxiety (p < 0.05) were improved. In conclusion, tailored dietary interventions based on MD principles, delivered via a CDSS, effectively manage PCOS in adolescent females. These findings highlight the potential benefits of using technology to promote dietary adherence and improve health outcomes in this population. ClinicalTrials.gov registry: NCT06380010. [ABSTRACT FROM AUTHOR]

Purpose: Diversity considerations are of paramount significance in the clinical assessment and treatment of speech disorders in bilingual children and adults who speak a less common language (and/or its dialects). While comprehensive assessment is essential for culturally and linguistically diverse (CLD) populations, this is clinically challenging due to the indeterminacy entailed in the process and incumbrances in access to resources. This clinical tutorial outlines key considerations necessary for holistic, ecological, and dynamic assessments of speech disorders internationally, focusing on Greek. Method: Pertinent literature is reviewed to provide the relevant theoretical backdrop for the ecosystemic protocol, both conceptually and schematically. Greek is utilized as an example language, aiming to underscore knowledge, tools, and other resources on clinically relevant aspects of dialectal, interlanguage (adult second language [L2]), and child multilingual (L2/third language) variation in Greek-dominant speakers. Results: The tutorial highlights facets of Greek speech and scripts a primary assessment model for clinical use mostly targeting clinicians that are not speakers or cognizant of the language, also viewing speech in linguistic diversity as a sociolinguistic construct. Recommendations for clinical practices are outlined proposing a specific action plan, exemplified by a case scenario. Conclusions: The demonstrated ecosystemic paradigm in holistic, ecological protocols for clinical assessment of speech disorder in CLD speakers addresses the need for nonlinear, multilevel assessment of variable language exposure and use; being sensitive to individual speaker specificities; the sociolinguistic environment; and employing people-first, culturally sensitive, and dynamic strategies in clinical assessment. The stance also simplifies disambiguation tasks regarding the difference disorder dichotomy, enhancing existing clinical procedures. [ABSTRACT FROM AUTHOR]

To delineate new directions of urban development in a context of demographic shrinkage in Southern Europe, the present study illustrates a comparative analysis of the demographic balance in metropolitan Athens, Greece (1956–2021). The analysis delineates short-term and long-term dynamics of the natural population balance, considering the impact of the Great Recession and COVID-19 pandemic, and assuming a contemporary increase in gross mortality rates and a marked fertility reduction associated with birth postponement. To address such objectives, we have compared the natural growth of population (the ratio of the total number of births to deaths) at ten year intervals (1956, 1960, 1970, 1980, 1990, 2000, 2009, 2019, 2020, 2021) in 115 municipalities of metropolitan Athens, controlling for the local context. The empirical results of descriptive statistics, spatial analysis, correlation statistics, non-parametric inference, and exploratory multivariate techniques outline the indirect impact of COVID-19 on population dynamics, being in some ways additive to the already observed effects of the Great Recession, reinforcing demographic shrinkage in specific local contexts. The COVID-19 pandemic and the Great Crisis likely accelerated the typical outcomes (population aging and low fertility) of the second demographic transition in Greece. These dynamics are associated with more volatile (and possibly reduced) immigration flows and with enhanced emigration, fueling urban shrinkage and a progressive economic decline of metropolitan regions, as our evidence suggests for Athens. Additional research should ascertain the aggregate, indirect role of pandemics in population dynamics as a proxy of urban and regional decline in European regions exposed to long-term aging. [ABSTRACT FROM AUTHOR]

The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well as at a personal level, for the appropriate management of an older person's health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes, this is very solid, but in other cases, there is a considerable gap in terms of accurate and well-grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as, for instance, Program of Research on Integration of Services for the Maintenance of Autonomy 7 (PRISMA 7), the gold standard tool of Fried criteria, is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale (CFS) has been validated for translation but not for the capacity to detect frailty. The aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). Seventy-four male and female participants (mean age 80.47 years SD = ±7.45 years, minimum–maximum age = 65–95) have been evaluated for their frailty status using different tools. We observed that the PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥2 and indicates a sensitivity of 88.1% and specificity of 99.9% with a good correlation with SPPB measurements (r = −0.858; p < 0.001). When CFS was validated using SPPB, it demonstrated a very good correlation (r = −0.838; p < 0.001 respectively) as was the case for the modified Fried Criteria (r = −0.725; p < 0.001). All items demonstrated a good correlation between them. We here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek, and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing item 6 of the questionnaire. [ABSTRACT FROM AUTHOR]

Background:In the past, Greek drug-affected families had predominantly been conceptualized as one of the main causes of drug problems. This study explored the ways drug-affected families respond to, and cope with, a relative’s drug problem by examining the perceptions of both Greek drug users and drug-affected families. Method:A qualitative study comprised of semi-structured in-depth interviews was conducted in two state drug agencies in Thessaloniki, Greece. A total of 40 adult problem drug-using men and women and eight parents of problem drug users were asked to reflect on the ways families respond to, and cope with, drug use. The method of data analysis involved a manual systematic identification of themes in participant narratives in line with analytic induction principles. Results:After discovery of the drug problem, all families were reported as coping with their adult children’s drug problems in ways consistent with the stress-strain-coping-support model. The emergent high engagement and low withdrawal coping exhibited by study participants can be contextualized by situating these strategies within the Greek cultural milieu and the notion of familism. While the data illustrate the importance of family solidarity in the face of addiction, caution is invited in making generalizations as sample selection may provide an alternative explanation for study findings. Conclusion:The paper advocates for a non-pathological view of drug-affected families and highlights the importance of cultural context. The stress-strain-coping-support model helps to depathologise and better understand family reactions to problem drug use. Implications for non-stigmatizing and culturally relevant policy and practice are outlined. [ABSTRACT FROM PUBLISHER]

Accessible summary What is known on the subject The care of an adult son or daughter with psychosis is filled with overwhelming demands caused by the symptomatology and illness exacerbations., Parents display disenfranchised grief over multiple losses and report increased levels of emotional burden., Most studies use quantitative methods and rely on pre-existing theoretical frameworks to investigate, through psychometric measures, the effects of being a carer., Meaning attributions to the disorder, and changes in parent-child relations over time, are poorly understood., What this paper adds to existing knowledge This hermeneutic phenomenological study illuminates the subjective experience of parenting a son or daughter with psychosis, as it is lived and described by parents of young adults with psychosis., Findings suggest that the parents' perceptions of their child changes over the course of the disorder, leading to a redefinition of the parent-child relationship, causing alternations in attachment., Findings illuminate the parents' profound guilt over having contributed or not prevented the disorder, over not being 'good' parents and feeling ambivalent towards an 'intimate stranger.' Guilt is compensated by absolute dedication to the son or daughter's care, at the expense of their own well-being., What are the implications for practice Interventions for parents must be available as soon as possible, both during hospitalization and after discharge., Professionals should provide a therapeutic space, where parents could express intimate thoughts and feelings, address guilt, fear and resentment issues, be assisted in their parenting role as well as in the reconstruction of a sense of self and self-esteem., Professionals are invited to facilitate illness acceptance, provide accurate information, assist parents to redefine their relationship to the child and facilitate the integration of the traumatic experience into their personal and family narrative., Professionals must develop in depth awareness of their biases and attitudes, have an ongoing training on how to respond to the parents' needs, facilitate therapeutic change and accompany families through the course of their adult child's illness trajectory., Abstract Introduction Children who are diagnosed with psychosis often rely on their parents for prolonged care. The impact of such care is partially understood as most studies use quantitative methods and pre-existing theoretical frameworks that limit their investigation to emotional burden, and emotional responses. Aim Explore the parents' lived experience of caring for a child with psychosis. Method A hermeneutic phenomenological design was used with a sample of 16 parents of children with psychotic disorders who were hospitalized or attended the outpatient clinic of a large psychiatric Greek hospital. Results Identified themes were as follows: (i) the psychosis experience, (ii) redefinition of the parent-child relationship over the course of the disorder and (iii) challenges of parenting a child with psychosis. Discussion 'Caring for an intimate stranger' reflects the parents' overall experience, involving changes in the parent-child relationship, ambivalence towards caretaking and profound guilt, compensated by self-sacrifice parenting practices. Implications for practice: Findings highlight the necessity to train mental health professionals to provide individualized information; facilitate family communication; address the parents' guilt, ambivalence, meaning attributions that compromise adjustment; and support them through the challenges of parenting a son or daughter with psychosis. [ABSTRACT FROM AUTHOR]

This paper focuses on the evaluation of the therapeutic use of photocards by prisoners and facilitators in a counselling psychology led European project, based on responses to open-ended questionnaires. It is part of a wider project, involving seven partner organisations in six European countries (England, Finland, Greece, Italy, Malta and Romania), which developed and trialled four different approaches to using photography in the context of counselling in prisons. Of the 51 inmates that participated in the project, 48 (94%) completed the questionnaires; of those, 39 (77%) were available for individual analysis due to prison restrictions in one partner organisation only allowing group data. Of those 39, who returned their completed questionnaires, over 92% found the therapeutic use of photographs either very helpful (56.4%) or helpful (35.9%), and the remaining 7.7% described it as average. From the thematic analysis, main themes emerging regarding inmates’ experiences of working with photocards were that it: facilitates emotional expression and sharing; unlocks memories and reconnects with life outside; fosters insight, reflection and self-growth; breaks the monotony of prison life and, overall aids emotional learning. A thematic analysis of 11 psychological therapists/facilitators’ perspectives showed that the use of photocards: gives clients a voice; provides a safe and collaborative frame and a therapeutic relationship; and, provides a useful icebreaker, helpfully overcoming anxieties of both client and psychotherapist/facilitator. Overall, photocards were considered useful as their projective nature can help facilitate prisoners’ strong need for expression in a context where there are limited opportunities and trust is fragile. [ABSTRACT FROM PUBLISHER]

Workplace bullying is common among nurses and negatively affects several work-related variables, such as job burnout and job satisfaction. However, no study until now has examined the impact of workplace bullying on quiet quitting among nurses. Thus, our aim was to examine the direct effect of workplace bullying on quiet quitting and to investigate the mediating effect of coping strategies on the relationship between workplace bullying and quiet quitting in nurses. We conducted a cross-sectional study with a convenience sample of 650 nurses in Greece. We collected our data in February 2024. We used the Negative Acts Questionnaire—Revised, the Quiet Quitting Scale, and the Brief COPE to measure workplace bullying, quiet quitting, and coping strategies, respectively. We found that workplace bullying and negative coping strategies were positive predictors of quiet quitting, while positive coping strategies were negative predictors of quiet quitting. Our mediation analysis showed that positive and negative coping strategies partially mediated the relationship between workplace bullying and quiet quitting. In particular, positive coping strategies caused competitive mediation, while negative coping strategies caused complimentary mediation. Nurses' managers and policy makers should improve working conditions by reducing workplace bullying and strengthening positive coping strategies among nurses. [ABSTRACT FROM AUTHOR]

Simple Summary: Moderate hypofractionated radiotherapy (MHRT) has emerged as the preferred treatment modality for localized prostate cancer. The aim of this prospective study was to evaluate late rectal toxicity while performing a comprehensive dosimetric analysis in conjunction with rectoscopy results in the setting of MHRT. We confirmed in an homogeneous population (20 patients) that when 3DCRT is employed, delineation of rectal wall and its subsegments can provide a more in depth accurate dosimetric analysis. Furthermore, we identified that dose endpoints V52.17Gy and V56.52Gy, when hypofractionated schedule (2.75 Gy per fraction) is used, may have a significant impact on rectal mucosal injury. Implementing these variables in clinical practice may result in a decrease rate of late rectal toxicity; more data is needed to assist in further validation of this conclusion. Background: Moderate hypofractionated radiotherapy (MHRT) has emerged as the preferred treatment modality for localized prostate cancer based on randomized controlled studies regarding efficacy and toxicity using contemporary radiotherapy techniques. In the setting of MHRT, available data on dosimetric parameters and late rectal toxicity are limited. Aim: To present the effects of MHRT on late rectal toxicity while conducting an extensive dosimetric analysis in conjunction with rectoscopy results. Methods: This is a prospective study including patients with intermediate-risk prostate adenocarcinoma. All patients were treated with MHRT 44 Gy in 16 fractions to the seminal vesicles and to the prostate, followed by a sequential boost to the prostate alone of 16.5 Gy in 6 fractions delivered with three-dimensional conformal radiation therapy (3DCRT). Acute and late toxicity were assessed. Endoscopy was performed at baseline, every 3 months post-therapy for the first year, and every 6 months for the year after. The Vienna Rectoscopy Score (VRS) was used to assess rectal mucosal injury related to radiotherapy. Dosimetric analysis for the rectum, rectal wall, and its subsegments (upper, mid, and low 1/3) was performed. Results: Between September 2015 and December 2019, 20 patients enrolled. Grade 1 late gastrointestinal toxicity occurred in 10% of the patients, whereas 5% had a grade ≥2. Twelve months post radiotherapy: 4 (20%) patients had VRS 1; 2 (10%) patients had VRS 2; 1(5%) patient had VRS 3. 24 months post radiotherapy, VRS 1 was observed in 4 patients (20%) and VRS 2 in 3 (15%) patients. The dosimetric analysis demonstrated noticeable variations between the rectum, rectal wall, and rectal wall subsegments. The dosimetric analysis of the rectum, rectal wall, and its mid and low segments with respect to rectoscopy findings showed that the higher dose endpoints V52.17Gy and V56.52Gy are associated with rectal mucosal injury. Conclusions: A thorough delineation of the rectal wall and its subsegments, together with the dosimetric analysis of these structures, may reduce late rectal toxicity. Dosimetric parameters such as V52.17Gy and V56.52Gy were identified to have a significant impact on rectal mucosal injury; additional dose endpoint validation and its relation to late GI toxicity is needed. [ABSTRACT FROM AUTHOR]

Bone calcium turnover is aggravated in pregnant women recommended to bed rest. In the present cross-sectional study, we aimed to clarify whether preterm neonates would benefit from calcium supplementation during pregnancy. Forty-two mothers (37.5 ± 6.7 years), recommended bed rest at home, and 42 preterm neonates (24–37 weeks gestational age) were enrolled. Neonates' serum calcium was quantified at birth. Mothers' calcium intake from foods and supplements during pregnancy was assessed. Serum 25-OH-D was measured in both mothers and neonates at birth. Results showed that mothers' calcium intake from foods was significantly lower than the recommended daily reference value (p < 0.001), while total calcium intake including supplements was close to the calcium reference value of 1000 mg/day (p = 0.648). Neonates' serum calcium concentration was significantly higher in mothers receiving calcium supplementation during pregnancy compared to mothers who did not (p < 0.001). A significant association between neonates' serum calcium levels and mothers' calcium supplementation was evident, even when adjusted to mothers' age, pre-pregnancy BMI, gestational age, and neonates' birth weight (beta = +0.460, p = 0.025). A statistically significant correlation between neonates' and mothers' serum 25-OH-D levels was found (r = 0.891, p < 0.001). In conclusion, calcium status in preterm neonates, born by bedridden women, could be enhanced after calcium supplementation during gestation. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to identify and evaluate patient-relevant experiences that fulfill the expectations and demands of society in Greece and those that could be improved by offering a better quality of care. The satisfaction of health service recipients is one of the key elements of the success of a health system. Methods: A cross-sectional survey was conducted to obtain data on satisfaction with hospitalization from patients admitted to 10 public hospitals in Athens between June 2019 and December 2021. Statistical analysis was applied to 57 items and 7 dimensions of patient satisfaction, namely waiting–arrival–admission, nursing staff, medical staff, other staff, service and quality of food, interior environment, and procedures. Results: A total of 3724 patients, aged ≥ 18 years, who had experienced hospitalization and agreed to participate in the study were included, the response rate of which was 93%. Patient satisfaction and experience with healthcare services provided by hospitals is moderate, with almost two-thirds of patients (67.38%) satisfied with the care they received. The encounter with the medical–nursing personnel (3.75/5) and other staff (4/5) were factors that positively affected patients' overall satisfaction with hospitalization. However, there were some causes of dissatisfaction, mainly associated with waiting hours, easy access to medical services or services received in emergencies, delays of planned procedures (3.50/5), or problems with old facilities and equipment (3.56/5). Conclusion: Based on the patients' judgment, the performance of hospitals was rated at a 'tolerable' level. Professionalism and the education of personnel led to a positive treatment outcome and improved the experience of patients to a good level. However, public hospitals continued to be underfunded and lacked strong support, which affected staff communication and responsiveness to patients' requirements, while smart technologies and the simplification of procedures were not adopted to help staff provide a better quality of healthcare. The results suggest that there is plenty of room for improvement. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single-item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses. This study was not registered. [ABSTRACT FROM AUTHOR]