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This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services. [ABSTRACT FROM AUTHOR]

Purpose: Thalassemia is one of the most common genetic disorders in the Mediterranean region, and is therefore considered a serious public health issue. In chronic conditions of this kind, survival and quality of life (QOL) of the patients are of the utmost importance and are influenced by psychological and social constraints. The current study aimed to examine various factors affecting the psychological burden, focusing on anxiety and depression levels, as well as the quality of life (QOL) of people suffering from thalassemia in Crete (Greece). Methods: A cross-sectional study was carried out in 2018 in 119 patients suffering from thalassemia from three hospitals. Validated scales were used to assess the relative parameters using multivariate regression analysis. Results: The data sample comprised 56 men (47.1%) and 63 women (52.9%) with an overall mean age of 39.7 years (± 8.5). Most of the participants exhibited low levels of anxiety/depression and high quality of life. Moreover, quality of life was found to relate positively with health status (p < 0.001), but multivariate logistic regression revealed that every unit on the anxiety score significantly increases the odds ratio for a lower quality of life score (OR: 1.66; 95% CI: 1.19–2.32) or a reverse relationship with health status (OR: 0.97; 95% CI: 0.94–1.00). Conclusion: Overall, the patients were found to have a fairly normal life, resembling the standards of the general population. They are highly aware of their quality of life and exhibit low levels of anxiety and depression. [ABSTRACT FROM AUTHOR]

Purpose: The current study aims to examine the use of preventive and other health services among adults aged 50+ in eleven European countries. Methods: The data used were derived from 16,120 adults aged 50+ years participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Preventive Health Services Utilization score (PHSUs) and Health Care Services Utilization score (HCSUs) were assessed as a composite value from answers to 12 and 16 questions respectively, on a scale ranging from 0 to 100. Estimations were based on a complex study design. Results: Participants from Central European countries were found to have significantly higher mean PHSU and HCSU scores than their counterparts in Northern and Southern regions, (p < 0.05) and also exhibited a greater gap between the two scores (29.3, 95% CI: 28.6–30.1). Overall mean PHSU score was 39.9 (95% CI: 39.4–40.4) and mean HCSU score 12.4 (95% CI: 12.2–12.7). Women have a higher mean PHSUs and HCSUs (p < 0.001); as age increases, PHSUs falls and HCSUs rises (p < 0.001). Better educated participants appear to have higher mean PHSUs and HCSUs (p < 0.001). In addition, both of the above scores increase in the presence of chronic diseases (p < 0.001). Conclusion: Strong correlation is seen between comorbidity, increasing age, educational level, and retirement on the one hand, and increased use of health services on the other hand. The use of health services is a major issue with regard to public health policy formulation. [ABSTRACT FROM AUTHOR]

Purpose: Multiple behavioral risk factors (MBRFs) related to lifestyle have been associated with non-communicable diseases, but there is limited evidence on their prevalence in undergraduate medical students and their association with academic performance. Methods: During 1989–2017, data from 1447 medical students of the University of Crete, Greece (mean age 21.8 ± 2.2 years), were analyzed. MBRFs assessed included smoking, high body weight, physical inactivity, risky alcohol consumption and low consumption of fruits and vegetables. Academic performance was based on the grades received in the mandatory Clinical Nutrition course and the overall medical degree (scale of 0–10). Results: Of the sample, 25.8% were smokers, 30.7% had high body weight, and 67.2% had low consumption of fruits and vegetables. Prevalence of having 'no MBRFs' and having 'multiple clustering' and '3+ factors' was 15.8% and 12.3%, respectively. Men had almost twice the prevalence of multiple clustering compared with women (16.5% vs. 8.4%, p < 0.001). Participants who had none compared with 3+ MBRFs had higher mean grades in the Clinical Nutrition course (6.34 vs. 5.94, p = 0.027, p = 0.003) and overall degree (7.39 vs. 7.22, p = 0.021, p = 0.002). As the number of MBRFs increased (from 'none' to '1,' '2' and '3+' factors), the proportion of graduates receiving a distinction also decreased (6.1%, 3.3%, 3.3% and 0.0%, respectively, p = 0.001). Conclusion: Overall, high prevalence of MBRFs was observed in this sample of medical students, while MBRF clustering was prospectively inversely associated with academic performance. These findings highlight the need for preventive lifestyle strategies to improve these students' behavioral risk factors and academic performance during their studies. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the association of blood hypertension and certain behavioral risk factors with cognitive decline in elderly individuals. Methods: A subsample of 92 elderly people aged ≥ 75 years was taken from 411 people (aged 65+ years) living in a rural area of Crete, Greece. Detailed medical and family/social history data were recorded on a standard validated health card, and cognitive disorders were assessed using the Mini Mental State Examination (MMSE). The participants were evaluated for behavioral risk factors such as physical inactivity, smoking, alcohol consumption and dietary habits. Multiple logistic regression analysis was conducted to assess the risk (odds ratios, OR) of cognitive impairment. Results: The mean age of participants was 80.8 ± 4.3 years old with 66.3% being married, and their MMSE mean score was 23.4 ± 4.6; 46.7% had severe and/or mild symptoms of cognitive decline, while more than half (67.4%) had been diagnosed with hypertension. Living alone (OR: 3.48, p = 0.034), being physically inactive (OR: 5.65, p = 0.046) and low consumption of fruits and vegetables (OR: 4.16, p = 0.018) were found to increase the odds of cognitive impairment, while elderly people with hypertension were also found to have lower odds of cognitive impairment (OR: 0.42, p > 0.05). Conclusion: Although the observational character of this study carries some potential limitations, the reverse association of cognitive capacity with hypertension constitutes a 'paradox' phenomenon and is in contrast to the current literature. Further research with a larger sample is needed to better understand the observed association. [ABSTRACT FROM AUTHOR]

This study investigated the prevalence and risk factors of injuries on a cohort of 123 Greek team's professional football players during three consecutive seasons, 2015/16-to-2017/18. Injuries were assessed and regression analysis was used to evaluate the potential risk factors. Three-quarters of the players were recorded as injured with 2.3 injuries/injured player, and the injury incidence was 55 injuries/1,000 match-playing-exposure-hours. The mean rehabilitation days were 29.3/injured player (95%CI 22.4–36.8) and 13.0/injury (95%CI 8.6–17.4). The majority of injured players has been found to have moderate-to-major/severe injuries and most of the injuries were traumatic than overuse (p < 0.05). The number of injuries were related to the recurrence of injury (beta = 0.646, p < 0.001) and the rehabilitations days (beta = 0.271, p < 0.001). High prevalence of injuries was found as the recurrence of injury and rehabilitation days were their main predictive risk factors. In order to reduce the risk of injuries, continuous effort is required in the rehabilitation of players. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe.Methods: Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators.Results: Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p < 0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p < 0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs = 2.08; 95% CI 1.24-3.48) and the third (ORs = 1.75; 95% CI 1.03-2.96) multiple regression models.Conclusion: In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population. [ABSTRACT FROM AUTHOR]

Aim: The Seven Countries’ Study showed that in the 1960s, participants in the island of Crete, Greece, had among the lowest cardiovascular (CVD) mortality rates in the world, but in recent years CVD rates in Crete have increased. This study aimed to assess changes in CVD-risk occurring since the Seven Countries’ Study.Subject and methods: Secondary analysis was performed in two cohorts of men (aged 40-60 years) in Crete-Greece, in 1960 (Seven Countries’ Study’s participants) and 1997 (random sample of men of the same age and residence areas). The HeartScore was used to estimate the (1) 10-year CVD-risk and (2) 10-year CVD-risk based on body mass index (BMI), of 627 (1960 cohort) and 93 (1997 cohort) Cretan men.Results: Between 1960 and 1997, 10-year CVD-risk (3.4 vs. 4.7%, P < 0.001) and risk based on BMI (1.6 vs. 3.0%, P < 0.001) increased by 38 and 88%, respectively. During this period, the proportion of overweight/obese participants (21.8 vs. 83.9%, P < 0.001) and participants with hypercholesterolemia (51.5 vs. 81.7%, P < 0.001), as well as physical inactivity (37.3 vs. 56.0%, P = 0.001) increased. The prevalence of high and very high CVD-risk (≥5%) almost doubled (+90%), mainly due to concomitant increases in total cholesterol levels (+84%, P < 0.001) during this period. CVD-risk increased between 1960 and 1997 in this population of Cretan men.Conclusions: Appropriate public health initiatives are needed to promote the traditional, health-promoting lifestyle of men in Crete observed in the 1960s in the Seven Countries’ Study. [ABSTRACT FROM AUTHOR]

Purpose: The current study aims to examine the utilization of preventive health services in relation to social isolation among older Europeans adults. Methods: Data on 5,129 adults 65 years of age and older was obtained from the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004/05). Prevalence of social isolation indicators (living arrangements, marital status, number of children, contact with children, proximity to children, activity participation, social exchange) was assessed in relation to preventive health services utilization, which was ascertained by a 12-item composite score (PHSUs). Estimations were based on the complex study design. Results: Diverse facets of social isolation were differently associated to preventive care. Significantly lower mean PHSUs were found for adults living unpartnered, who were unmarried, had no children and were socially disengaged. A similar pattern was thus drawn regarding the clustering of social isolation indicators (4+). Considerable variations were detected across SHARE countries in the distribution of PHSUs among socially isolated adults. Conclusion: Socially isolated individuals were found to receive fewer preventive services. This finding confers important evidence on the potential factors that affect the use of preventive health services among older adults. It is also suggestive of the need to develop public health and social policies with the aim to alleviate social isolation and as a means to enhance preventive care uptake in later life. [ABSTRACT FROM AUTHOR]

Background: Smoking is among the health risk behaviors taken up by many adolescents with lifelong consequences and associations with multiple health risk behaviors. Smoking and smoking initiation in adolescence involves an interaction between micro-, meso-, and macro systems, including neighborhoods and the greater community.Objectives: To examine the associations of individual social and economic capital with self-reported health, life satisfaction, and smoking behavior in adolescents.Methods: Using a multistage random sampling of junior high school students (16–18 years old) in Crete, Greece, 703 adolescents (90.2% 16 years old; 55.6% girls, participation rate 84.2%) completed an anonymous questionnaire based on HBSC study and the Youth Social Capital Scale (YSCS) during April–June 2008. Multiple logistic regression models were performed adjusted for potential confounders.Results: Adolescents with high participation in their neighborhoods and communities (higher structural social capital) displayed lower odds for daily smoking; those feeling unsafe (lower cognitive social capital) were at greater odds of daily smoking. Adolescents with less friends and acquaintances had lower odds of having tried tobacco products. Smoking was not related to any economic capital variables (perceived affluence, paternal and maternal employment status). Adolescents with low/medium versus high total social capital were at higher odds for low life satisfaction and fair/bad versus excellent self-rated health.Conclusions/Importance: Social capital theory may provide a better understanding in identifying the social context that is protective or harmful to adolescents' smoking. Public health organizations at all levels need to incorporate social capital theory in their interventions. [ABSTRACT FROM PUBLISHER]

Aim: The aim of this study was to estimate the differences in prevalence of multiple behavioral risk factors (MBRFs) for chronic diseases in European adults, from eleven North, Central and South European countries. Subjects and methods : We used data from 26,656 adults, aged 50+ years, participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Physical inactivity, high body weight, smoking and risky alcohol consumption were assessed and estimated based on sampling weights, controlling for socioeconomic characteristics. Results: 53.4 % of adults had 2+ MBRFs. Prevalence in the total sample was highest for physical inactivity (71.2 %) and lowest for smoking (18.1 %). The cluster of high body weight and physical inactivity had the highest prevalence of MBRFs (35.4 %), with higher prevalence in Southern Europe ( p < 0.05). Smoking and alcohol consumption presented the greatest degree of clustering (observed to expected ratio = 2.44). Spain and Greece had the highest prevalence of clustering 2+ MBRFs, whereas Southern European countries had a higher mean number of MBRFs, compared to North and Central European regions ( p < 0.05). Conclusion: Prevalence of MBRFs varied between countries, with Southern European countries engaging in more risky behaviors. Primary prevention programmes should be developed to reduce MBRFs in this population. [ABSTRACT FROM AUTHOR]