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The ENABLE program is a European intervention designed to increase student emotional resilience and management of social relationships. The present study aimed to investigate the effectiveness of social and emotional learning (SEL) and a combination of SEL with peer support (SEL+peer support) in a sample of 508 Greek early adolescents, between the ages of 11 to 14 by means of anonymous self-report questionnaires. Assessments were conducted prior to and after the 3-month piloting of the intervention, and indicated that overall students had high baseline social and emotional skills, as well as prosocial attitudes regarding bullying. The intervention improved problem-solving skills, and increased school satisfaction, as well as self-control and emotional awareness. After the intervention, students were more likely to report that they would seek help or report situations of bullying. Overall, this was the first study combining SEL with peer support in Greek primary and secondary schools, with promising results for the combined effectiveness of the programs.

Ethical principles have been considered, and in several respects regulated, along the entire blood procurement chain from donor motivation to transfusion to the patient. Consent of donors and voluntary non-remunerated donation are fields which have been addressed by codes of ethics and legislation. Caring for donor health is an area of further development of ethical standards. In part, blood products have also become a market, where commercial principles may synergize, but also creating issues in equality and maintaining human dignity that challenge societal solutions. At the bedside, the main global challenge remains to procure enough blood products for each patient in medical need. Allocation of rare blood, ethical evaluation of transfusion triggers, attitudes towards refusing blood transfusion and provision of blood products to remote settings are areas which should receive consideration.

BACKGROUND: Although the SARS-CoV-2 virus is transmitted mainly through the respiratory tract, possible transmission by transfusion from asymptomatic carriers should be explored. As yet there are no reports of transfusion transmission of COVID-19. Haemovigilance findings within a three-month surveillance period during the new coronavirus pandemic are presented. MATERIALS AND METHODS: Due to great demand and shortage, blood sessions in outpatient facilities were organized during the high prevalence period of COVID-19, alongside a national plan to monitor the evolving public health situation by random molecular screening of high-risk groups of the population. Haemovigilance protocols were implemented as well as surveillance for any COVID-19 case reported post-transfusion. A 14-day quarantine and follow-up molecular and antibody testing of any COVID-19 positive case was obligatory. RESULTS: Post-donation, post-transfusion information and molecular testing of swab samples collected from three asymptomatic donors at risk for COVID-19, revealed the case of an immunosupressed patient who had been transfused with whole blood derived platelets from a donor subsequently diagnosed with COVID-19. The recipient exhibited no symptoms of the disease. Molecular and antibody testing results were negative. CONCLUSION: Haemovigilance provided information supporting the absence of transfusion transmission of COVID-19, thus strengthening the hypothesis that, even if it cannot yet be definitively ruled out, COVID-19 is not transmitted through blood transfusion. As of early June 2020, a perfect test does not exist, therefore haemovigilance along with the implementation of strict proactive measures is crucial to identify eluding asymptomatic individuals and ensure blood safety during the pandemic.

Background and objectives The International Haemovigilance Network collects aggregate data on complications of blood donation from member haemovigilance systems (HVS). We analysed the data collected in 2006-2016 in order to learn from it and consider future improvements. Materials and methods National HVS entered annual data on donation complications and on annual whole blood and apheresis donations in the 'ISTARE' (International Surveillance of Transfusion Adverse Reactions and Events) online database. We calculated national and aggregate donation complication rates. Results Twenty-four HVS provided data for 138 country years (CY; median 7 CY, IQR 2-8), covering 155 M donations. The overall complication rate was 6·3/1000 donations and the median country rate 3·2/1000 (IQR 1·1-10·1). Overall and severe complication rates varied considerably between HVS. Vasovagal reactions (VVR) were most commonly reported: 4·6/1000 donations, median country rate 3·1/1000 donations (IQR 0·6-7·7). Rare complications included generalized allergic reaction (0·10/100 000) and major blood vessel injury (category available since 2015; 0·12/100 000). Eighteen HVS reported complications of whole blood donation (WBD) and apheresis separately (89 CY, 101·6 M WBD and 26·3 M apheresis donations). The median country VVR rate was 3·4/1000 WBD (IQR 1·0-9·1) and 1·5/1000 apheresis donations (1·0-4·2). Rates of venepuncture-related complications tended to be higher for apheresis: the median country rate of reported haematomas was 0·39/1000 WBD (IQR 0·31-1·2) vs. 4·2/1000 apheresis donations (0·69-5·6). Conclusion International reporting allows HVS to study rates of blood donation complications and capture information about very rare events. The present variability of reporting and severity assessment hampers comparisons between HVS and requires further work.

Introduction Dehumanization is the phenomenon that concerns the non-attribution of humanness to other human beings and has two dimensions, animalistic and mechanistic. The aim of the present study is to study dehumanization and self-dehumanization in patients with psychosis and organic disease. Methods The sample consisted of 200 people who were hospitalized in Athens, Greece, in 2017. Participants were asked to answer the dehumanization questionnaire, the mechanistic self-dehumanization scale, the human nature and human uniqueness characteristics questionnaire, and the adult attachment questionnaire. Results It was found that patients with organic disease and patients with psychosis do not perform mechanistic and animalistic dehumanization of themselves. Still, it seems that insecure attachment (anxiety and obsession) contributes positively to their mechanistic dehumanization and negatively to their mechanistic self-dehumanization. From the insecure attachment, only the dimensions of stress and obsession affect the mechanistic dehumanization. Conclusions It is important to take measures to train specialists in the hospital so that they can establish a safe therapeutic relationship with the patient so that patients will not resort to dehumanization and self-dehumanization as a defense against the stress of hospitalization.

The study aims to evaluate the Knowledge, Attitude and Perception (KAP) of different societal groups concerning the implementation of targeted community-based mosquito surveillance and control interventions in different citizenship regimes. Targeted surveys were carried out within Malakasa camp for migrants and refugees, neighboring residential areas and urban areas in the wider Athens metropolitan area to investigate different knowledge levels and the role that both local and migrant communities can play in the implementation of community-based interventions based on their attitudes and perceptions. A scoring system was used to rate the collected responses. Results indicate different levels of KAP among the various groups of respondents and different priorities that should be considered in the design and execution of community interventions. Findings indicate a lower level of Knowledge Attitudes and Perceptions for the migrants, while the rate of correct answers for Perception significantly improved for migrants following a small-scale information session. The study highlights disparities in the levels of knowledge for certain public health issues and the feasibility of certain approaches for alleviating health-related challenges such as mosquito-borne diseases. Findings suggest that essential preparedness is needed by public authorities to respond to public health challenges related to migration and the spread of vector-borne diseases.

Introduction Dehumanization is defined as the denial to people of their humanness. It is distinguished into animalistic and mechanistic dehumanization. The aim of this study is to examine whether professionals in a public hospital dehumanize the patient and self-dehumanize. Methods We used the Dehumanization Questionnaire, the Mechanistic Self-Dehumanization Scale, the Human Nature and Human Uniqueness Characteristics Questionnaire, the General Causality Orientation Scale and the Adult Attachment Questionnaire. The sample consisted of 135 mental health professionals (20 from a general hospital and 115 from a psychiatric hospital), 134 other health professionals from the general hospital and 84 people from the general population. Results Health professionals dehumanize the hospitalized patient more than the general population. The secure attachment acts protectively on self-dehumanization and negatively on the dehumanization of the hospitalized patient. Finally, autonomous people are not self-dehumanized. Conclusions Our findings indicate that measures should be taken for health professionals so that they do not dehumanize the patient.

The established practices of intensive agriculture, combined with inadequate soil Κ replenishment by conventional inorganic fertilization, results in a negative environmental impact through the gradual exhaustion of different forms of K reserves in soils. Although biochar application as soil amendment has been established as an approach of integrated nutrient management, few works have focused on the impact of biochar application to soil K availability and crop uptake. This review provides an up-to-date analysis of the published literature, focusing on the impact of biochar in the availability of potassium in soil and crop growth. First, the effect of biomass type and pyrolysis temperature on potassium content of biochar was assessed. Second, the influence of biochar addition to the availability of potassium in soil and on potassium soil dynamics was examined. Finally, alternative methods for estimating available K in soils were proposed. The most promising biomasses in terms of potassium content were grape pomace, coffee husk and hazelnut husk however, these have not been widely utilized for biochar production. Higher pyrolysis temperatures (500 °C) increase the total potassium content whereas lower temperatures increase the water-soluble and exchangeable potassium fractions. It was also determined that biochar has considerable potential for enhancing K availability through several distinct mechanisms which eventually lead directly or indirectly to increased K uptake by plants. Indirect mechanisms mainly include increased K retention capacity based on biochar properties such as high cation exchange capacity, porosity, and specific surface area, while the direct supply of K can be provided by K-rich biochar sources through purpose-made biochar production techniques. Research based on biochar applications for soil K fertility purposes is still at an early stage, therefore future work should focus on elucidating the mechanisms that define K retention and release processes through the complicated soil-biochar-plant system.

Social patterns in bullying show consistent gender differences in adolescent perpetration and victimization with large cross-national variations. Previous research shows associations between societal gender inequality and gender differences in some violent behaviors in adolescents. Therefore, there is a need to go beyond individual associations and use a more social ecological perspective when examining gender differences in bullying behaviors. The aim of the present study was twofold: (1) to explore cross-national gender differences in bullying behaviors and (2) to examine whether national-level gender inequality relates to gender differences in adolescent bullying behaviors.Traditional bullying and cyberbullying were measured in 11-year-olds to 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n = 200,423). We linked individual data to national gender inequality (Gender Inequality Index, 2018) in 46 countries and tested their association using mixed-effects (multilevel) logistic regression models.Large cross-national variations were observed in gender differences in bullying. Boys had higher odds of perpetrating both traditional and cyberbullying and victimization by traditional bullying than girls. Greater gender inequality at country level was associated with heightened gender differences in traditional bullying. In contrast, lower gender inequality was associated with larger gender differences for cyber victimization.Societal gender inequality relates to adolescents' involvement in bullying and gendered patterns in bullying. Public health policy should target societal factors that have an impact on young people's behavior.

The aim of the study was to assess the prevalence of online exposure to pornography in European adolescents and its relationship to sociodemographic and psychopathological correlates. A cross-sectional school-based survey of 10,930 adolescents (5211 males/5719 females), aged 14–17 years old (mean age 15.8 ± 0.7) was carried out in six European countries (Greece, Spain, Poland, Romania, the Netherlands, and Iceland). Anonymous self-completed questionnaires covered exposure to pornography, internet use and dysfunctional internet behavior, and psychopathological syndromes (measured by Achenbach’s Youth Self-Report). The prevalence of any online exposure to pornography was 59% overall and 24% for exposure at least once a week. The likelihood of online exposure to pornography was greater in male adolescents, heavier internet users, and those who displayed dysfunctional internet behavior. Country-specific analyses confirmed that the gender effect existed in every country, although its strength varied, from an odds ratio of 1.88 in Poland to 14.9 in Greece. Online exposure to pornography was shown to be associated with externalizing problem scale scores, especially rule-breaking and aggressive behavior, but also associated with higher scores in competences, namely activities and social competence. Exposure to pornography is ubiquitous, more relevant to boys, and is associated with both positive qualities/competences and externalizing behavioral problems.

Background This systematic review aims to assess how different urbanisation patterns related to rapid urban growth, unplanned expansion, and human population density affect the establishment and distribution of Aedes aegypti and Aedes albopictus and create favourable conditions for the spread of dengue, chikungunya, and Zika viruses. Methods and findings Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using the PubMed, Virtual Health Library, Cochrane, WHO Library Database (WHOLIS), Google Scholar, and and the Institutional Repository for Information Sharing (IRIS) databases. From a total of 523 identified studies, 86 were selected for further analysis, and 29 were finally analysed after applying all inclusion and exclusion criteria. The main explanatory variables used to associate urbanisation with epidemiological/entomological outcomes were the following: human population density, urban growth, artificial geographical space, urban construction, and urban density. Associated with the lack of a global definition of urbanisation, several studies provided their own definitions, which represents one of the study’s limitations. Results were based on 8 ecological studies/models, 8 entomological surveillance studies, 7 epidemiological surveillance studies, and 6 studies consisting of spatial and predictive models. According to their focus, studies were categorised into 2 main subgroups, namely “Aedes ecology” and “transmission dynamics.” There was a consistent association between urbanisation and the distribution and density of Aedes mosquitoes in 14 of the studies and a strong relationship between vector abundance and disease transmission in 18 studies. Human population density of more than 1,000 inhabitants per square kilometer was associated with increased levels of arboviral diseases in 15 of the studies. Conclusions The use of different methods in the included studies highlights the interplay of multiple factors linking urbanisation with ecological, entomological, and epidemiological parameters and the need to consider a variety of these factors for designing effective public health approaches., Author summary The expansion of urbanisation is often associated with the emergence and spread of vector-borne diseases by creating favourable conditions for the survival of Aedes species and the spread of dengue, chikungunya, and Zika viruses. This systematic review examined the relationship of urbanisation to the emergence and spread of Aedes mosquito–borne diseases and epidemics. From a total of 523 identified studies, 29 were included in the analysis. Studies were categorised into 2 main subgroups, namely “Aedes ecology” and “transmission dynamics” according to the main influence factors posed by urbanisation. Selected articles showed a clear relationship of urbanisation with distribution and density of Aedes mosquitoes and a robust association between vector production, human population density, and disease transmission. Differing definitions of ’urbanisation’ and the interplay of numerous factors linking urbanisation with ecological, entomological, and epidemiological parameters highlight the need for a multidimensional perspective when assessing the impacts of rapid and unplanned urban expansion and when designing effective control programmes.

Prevalence of diet-related behaviors (i.e., breakfast consumption, eating with the family) and their asso-ciation with a 17-point diet quality score, constructed on the basis of reported frequency (in days/week) of vegetable, fruit, sweets and sugar-sweetened beverages consumption, was investigated among 3525 adolescents (51.5% girls) aged 11, 13 and 15 years, who were participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) cross-sectional study, during 2018. Almost one-third (32.9%) of the sample had breakfast &le, 1 day/weekdays, 20.2% rarely ate with the family, 26.1% had a meal while watching TV &ge, 5 days/week, 31.7% had a snack in front of a screen &ge, 5 days/week and 24.1% ate in fast-food restaurants at least once/week. Multivariable ordinal logistic regression revealed that eating breakfast &le, 1 day/weekdays compared to 4&ndash, 5 days/weekdays (Odds ratio (OR): 1.56, 95% con-fidence interval (CI): 1.34&ndash, 1.82), eating rarely with the family compared to almost every day (OR: 1.35, 95% CI: 1.13&ndash, 1.60) and eating in fast-food restaurants &ge, 2 times/week vs. rarely (OR: 4.59, 95% CI: 3.14&ndash, 6.70) were associated with higher odds of having poor diet quality. High frequency of having meals/snacks in front of a screen/TV was also associated with poor diet quality. Efforts to prevent or modify these behav-iors during adolescence may contribute to healthier diet.

The purpose of this study was to identify burnout profiles in Greek secondary school teachers using latent profile analysis. Burnout was measured using the Maslach Burnout Inventory (MBI) in a sample of 460 teachers. In partial agreement with the literature, latent profile analysis revealed four profiles: Burnout (high on all three dimensions of the MBI), Engagement (low on all three), Overextended (high on exhaustion only) and Ineffective (high on inefficacy only). The most common profile among the teachers in this sample was overextended (50%). Teachers in each profile behaved differently with regard to job satisfaction and attitudes towards school-related sources of problems. In particular, Burnt-out teachers were more negative than the Engaged ones in almost all variables assessed, except educational policy, while differences between the two intermediate profiles were less marked. Engaged teachers showed the highest levels of job satisfaction, followed by Overextended and Ineffective, with Burnt-out teachers showing the lowest levels. The derived profiles and their different attitudes showed the significance of all three dimensions of burnout syndrome. In practical terms, interventions appropriately targeted to each profile can be designed and implemented to prevent or reduce burnout.

Autism spectrum disorders (ASD) constitute a public health concern with increasing prevalence worldwide. We aimed to estimate prevalence and age at diagnosis in Greece, where no large-scale prevalence study has ever been conducted. Aggregate data were collected on ASD diagnoses by gender and calendar year of diagnosis up to 2019, for children born in 2008 and 2009, from the Centers for Educational and Counseling Support, which evaluate children to receive special educational support in school. Coverage was 87.1% of centers and 88.1% of schoolchildren born in 2008&ndash, 9. ASD prevalence overall was 1.15% (1.83% males, 0.44% females, ratio 4.14:1), ranging from 0.59% to 1.50% in Greece&rsquo, s 13 regions. In five regions, prevalence differed significantly between centers. Overall, only 3.8% of diagnoses were made before the fourth year after birth and 42.7% before the sixth year, with considerable variation between regions. Approximate mean age at diagnosis was six years and one month, and about three months earlier for girls than for boys. Our results provide evidence-based information to guide service planning and development at national and regional levels. Particular attention should be paid to smoothing out inequalities regarding service accessibility and provision. Emphasis should be given to earlier identification and diagnosis of ASD.

Determining the structure and assessing the psychometric properties of multidimensional scales before their application is a prerequisite of scaling theory. This involves splitting a sample of adeq...

The measurement of wellbeing provides an important indicator of the welfare of nations and presents opportunities for policy making. Researchers generally share the view of wellbeing as a multidimensional concept. The 2012 European Social Survey (ESS) measurement of personal and social wellbeing, a combination of theoretical models and evidence from statistical analysis, is defined as a six-dimensional construct: evaluative wellbeing, emotional wellbeing, functioning, vitality, community wellbeing and supportive relationships. In this paper, the proposed theoretical structure is investigated and the psychometric properties of the measure are assessed for 17 European countries. This involved splitting each country’s sample randomly into halves and performing Exploratory Factor Analysis (EFA) on the first half-samples. EFA resulted in a four-factor solution for Germany, Netherlands, Portugal, Slovenia, Spain, Switzerland and the UK, a five-factor solution for Belgium, Finland, France, Ireland, Norway, Poland, Russian Federation and Sweden, and a six-factor solution for Denmark and Hungary. These results were supported by Confirmatory Factor Analysis (CFA) performed on the second half-samples. Subscales were constructed based on analysis of the total samples, applying a simple transformation in order to deal with the different number of response categories used for the wellbeing items. Reliabilities and internal consistencies were investigated. Although the definition of each subscale differs from the proposed structure and across countries, the analysis did produce reliable and valid summary measures (subscales) of wellbeing for informing social policy in each country.

The economic aspects of the problem of invasive mosquitoes present a new challenge to science. The impacts of mosquitoes on humans are intensifying in many regions as several factors – such as climate change and increased transport – create favorable conditions for the entry of invasive mosquitoes. At the same time budget constraints limit public prevention measures and demand clear justification of additional costs for controlling invasive mosquitoes. Consequently, the benefits arising from preventive policies should be clearly articulated and included in the evaluation process. The present study evaluates the potential benefits of alternative prevention measures in the metropolitan area of Athens, Greece, representative of the geographically and climatically vulnerable Mediterranean cities. The study differentiates the health and nuisance costs associated with invasive mosquito species from those associated with native mosquito species. In contrast to other findings in the literature, the benefits from controlling health impacts were found to be higher than those of avoiding nuisance. This is mainly related to the high health risk induced by new invasive species. Another important finding is that the expected benefits of mosquito control programs clearly outweigh the respective costs.

Greece is among the countries hit most severely by the recent global economic recession. Given that poverty early in life can have long-lasting implications, investigation of the recession’s impact on adolescents’ well-being is critical for guiding relevant policies and interventions. We examined its impact on adolescents’ lives in Greece and trends in well-being indicators before and during the crisis. Data were drawn from three successive waves (2006, 2010 and 2014) of the HBSC survey in Greece. Stratified probability samples of between 3500 and 4200 students aged 11, 13 and 15 years completed anonymous questionnaires in their classrooms. Data were analysed by X2 tests and logistic regression taking account of the complex survey design. Latent class analysis (LCA) of the repercussions of the crisis perceived by adolescents such as parental unemployment, fights within the family and constraints on going on holidays was conducted. Student’s life satisfaction has fallen. Older students reported effects of the crisis more than younger ones. While cannabis use increased among boys, smoking and alcohol consumption decreased in both genders. Logistic regression including the latent classes showed that reporting more repercussions of the economic crisis was associated with more cannabis use and smoking among students of both genders, and more alcohol consumption among boys. The findings enhance our understanding of the impact of the economic crisis on adolescents and families in Greece. These data can aid in shaping policies to protect families and their offspring from the repercussions of adverse economic conditions.

Determining the structure and assessing the psychometric properties of constructs (scales) before their use is a prerequisite of scaling theory. This involves splitting randomly a sample of adequate size into two halves and first performing exploratory factor analysis (EFA) on one half-sample in order to assess the construct validity of the scale. Secondly, the structure suggested by EFA is validated by carrying out confirmatory factor analysis (CFA) on the second half. Based on the full sample, the psychometric properties of the resulting scales or subscales are assessed. The appropriate methods of analysis depend on the level of measurement of the items defining the scale. In this paper, we carry out the investigation and assessment of the 2012 European Social Survey (ESS) short eight-item version of the Center for Epidemiologic Studies Depression (CES-D 8) scale for Italy and Spain when items are considered as ordinal.

The expansion of urban ecosystems and climate change, both outcomes of massive lifestyle changes, contribute to a series of side effects such as environmental deterioration, spread of diseases, increased greenhouse gas emissions and introduction of invasive species. In the case of the Athens metropolitan area, an invasive mosquito species—the Asian tiger mosquito (Aedes albopictus)–has spread widely in the last decade. This spread is favoured within urban environments and is also affected by changing climatic trends. The Asian tiger mosquito is accompanied by risks of mosquito-borne diseases, greater nuisance levels, and increased expenses incurring for its confrontation. The main aims of this paper are (i) to estimate the various costs associated with the control of this invasive species, as well as its health and nuisance impacts, (ii) to evaluate the level of citizens’ well-being from averting these impacts and (iii) to record citizens’ and experts’ perceptions regarding alternative control measures. Evidence shows that experts tend to place a high value on mosquito control when associated with serious health risks, while citizens are more sensitive and concerned about the environmental impacts of control methods. The synthesis of results produced by the current study could act as a preliminary guide for the estimation of societal welfare from the confrontation of similar problems in the context of a complex ecosystem., Author summary This paper is based on several years’ collaboration among researchers from various disciplines, key health policy makers and stakeholders in an attempt to evaluate the economic dimensions related to the presence of the Asian Tiger Mosquito (Aedes albopictus) and the challenges of tackling mosquito-borne disease outbreaks in Greece and Southern Europe. Similar studies have been conducted and continue to be published in Europe and the USA examining the socioeconomic benefit from the implementation of relevant control and prevention strategies. These studies conclude that there are significant benefits related both to the reduction of nuisance levels and the reduction of the health risks posed by various mosquito species. In our case, the application of an updated economic analysis on the effectiveness of relevant public control and prevention programs provides essential information for public health decision-making, bearing in mind the significant restructuring of the public sector and the fiscal crisis apparent in the European South.

Climate change, urbanization, and financial crisis have created a dramatic mixture of challenges in Southern Europe, increasing further the risks of transmission of new vector-borne diseases. In the last decade, there has been a wide spread of an invasive mosquito species Aedes albopictus, commonly known as the Asian tiger mosquito, in various urban ecosystems of Greece accompanied by greater risks of infectious diseases, higher nuisance levels, and increased expenses incurred for their control. The aim of the present paper is to investigate citizens’ perception of the Aedes albopictus problem and to evaluate various policy aspects related to its control. Findings are based on the conduct of a web-based survey at a national scale and the production of national surveillance maps. Results indicate that citizens are highly concerned with the health risks associated with the new mosquito species and consider public prevention strategies highly important for the confrontation of the problem while, at the same time, surveillance maps indicate a constant intensification of the problem. The spatial patterns of these results are further investigated aiming to define areas (regions) with different: (a) Levels of risk and/or (b) policy priorities. It appears that citizens are aware of the invasive mosquito problem and appear prone to act against possible consequences. Climate change and the complex socio-ecological context of South Europe are expected to favor a deterioration of the problem and an increasing risk of the transmission of new diseases, posing, in this respect, new challenges for policy makers and citizens.

Aims. Information on high risk drug use in Turkey particularly at the regional level is lacking. The present analysis aims at estimating high risk cannabis (HRCU) and high risk opiate use (HROU) in the cities of Ankara, Istanbul and Izmir. Design and Methods. Capture-recapture (CRC) and multiplier methods (MM) were applied based on treatment and police data stratified by age and gender in the years 2009 and 2010. Case definitions refer to ICD-10 cannabis (F.12) and opiate (F.11) disorder diagnoses from out- and inpatient treatment records and illegal possession of these drugs as recorded by the police. Results. HRCU was estimated at 28,500 (8.5 per 1,000; 95%-CI: 7.3-10.3) and 33,400 (11.9 per 1,000; 95%-CI: 10.7-13.5) in Ankara and Izmir, respectively. Using multipliers based on CRC estimates for Izmir, HRCU in Istanbul was estimated up to 166,000 (18.0 per 1,000; range: 2.8-18.0). CRC estimates of HROU resulted in 4,800 (1.4 per 1,000; 95% CI: 0.9-1.9) in Ankara and multipliers based on these gave estimates up to 20,000 (2.2 per 1,000; range: 0.9-1-7) in Istanbul. HROU in Izmir was not estimated due to the low absolute numbers of opiate users. Discussion and Conclusions. While HRCU prevalence in both Ankara and Izmir was considerably lower in comparison to an estimate for Berlin, the rate for Istanbul was only slightly lower. Compared to the majority of European cities HROU in these three Turkish cities may be considered rather low.

BACKGROUND West Nile virus (WNV) infection, commonly asymptomatic, may cause mild West Nile fever (WNF) or potentially fatal neuroinvasive disease (WNND). An outbreak of 262 cases of the new Lineage 2 strain in Greece in 2010 continued with high mortality (17%) in WNND. The objective was to investigate ABO, D, and Lewis blood groups, as well as HLA Class I and Class II alleles, in relation to WNV Lineage 2 disease morbidity. STUDY DESIGN AND METHODS A cohort of 132 Greek WNV cases in 2010 to 2013 (65% male; mean age 64 years; 41% WNF, 59% WNND) was compared to 51,339 healthy WNV-negative blood donors and 246 healthy subjects. RESULTS Blood group A was more common in WNV cases (51%) than blood donors (39%) and group O less common (32% vs. 42%). D negativity within group A was higher in WNV than in blood donors (18% vs. 10%, p = 0.044). The frequency of secretors (Lewis(a–b+)) was 60% in WNV and 68% in donors (p = 0.16). HLA alleles C*08, DRB1*O4:O5, and DQB1*O2 occurred significantly less frequently in WNV than controls (p

Taking GDP as the standard economic indicator for economic welfare, recent Resources-Economy studies indicate the “dematerialization” of the economy, the so-called decoupling effect. This conclusion seems to alleviate concerns over resource scarcity and limits to growth, and feeds optimism for green growth and sustainability prospects. However, the validity of GDP as the sole and unambiguous measure of the ultimate outcome of the economy has been severely disputed. There is nowadays increasing interest in broader welfare measurements that capture more aspects of economic output and hence constitute better approximations of well-being. The present paper provides an overview of the above discussion and sets out to explore the relevance of three alternative welfare indicators – the Human Development Index (HDI), the Index of Sustainable Economic Welfare (ISEW) and the Genuine Progress Indicator (GPI) – as a basis for evaluating the dependency of welfare and its major engine, the economy, on natural resources. Increasing welfare appears to require a disproportionate use of resources. Strong and increasing dependency on resources at the global level and in giant countries such as China and India may have serious implications for current sustainability policies and the United Nations Sustainable Development Goals.

Families constitute a primary source of care for people with severe mental illness but often face substantial difficulties in fulfilling their role. Family psychoeducational interventions have been developed to address these problems with established efficacy and effectiveness. Among the variants of family psychoeducation, the relatives group is particularly understudied internationally, and in Greece no study has explored its effectiveness. The present study endeavors to assess the effectiveness of relatives-group psychoeducation in improving family cohesion, alleviating caregivers’ burdens, and reducing depressive symptomatology in relatives of those suffering from schizophrenia spectrum disorders. In total, 131 people took part in the study, 83 received intervention, and 48 were assigned to the control (treatment as usual). The research instrument consisted of the Family Ritual Scale, the Family Burden Scale, and CES-D. A self-constructed questionnaire was used to collect the sociodemographic ...

Plasma transfusions may result in transfusion reactions. We used the International Surveillance of Transfusion-Associated Reactions and Events (ISTARE) database, containing yearly reported national annual aggregate data on transfusion reactions from participating countries, to investigate risks of plasma transfusion reactions and compare transfusion reaction risks for different plasma types. We calculated risks for plasma transfusion reactions and compared transfusion reaction risks between plasma types using random effects regression on repeated measures. The ISTARE database contains data from 23 countries, reporting units issued and/or transfused and transfusion reactions observed for some portion of 7 years (2006-2012). Interquartile ranges (IQRs) of plasma transfusion reaction risks were: allergic reactions (5·6-72·2 reactions/105 units transfused); febrile non-haemolytic transfusion reactions (0-9·1); transfusion-associated circulatory overload (0-1·9); transfusion related acute lung injury (TRALI) (0-1·2); and hypotensive reactions (0-0·6). Apheresis plasma was associated with more allergic reactions [odds ratio (OR) = 1·29 (95% confidence interval: 1·19-1·40)] and hypotensive reactions [OR = 2·17 (1·38-3·41)] than whole blood-derived plasma. Pathogen-inactivated plasma was associated with fewer transfusion reactions than untreated plasma.

SUMMARY Objectives/Background Haemovigilance is an effective tool for identifying adverse effects of blood components. We analyse cumulative haemovigilance data in order to compare the two secured therapeutic plasmas that have been in use for more than 11 years in Greece – methylene blue-treated fresh frozen plasma (MB-FFP) and quarantine fresh frozen plasma (Q-FFP) – regarding safety and adverse events. Methods/Materials Data from the centralised active haemovigilance system of Greece for the period 2001–2011 were used to examine the association between FFP types and adverse events. Post-transfusion information on infectious and non-infectious adverse events was analysed. Events were examined by reaction type, severity and imputability to transfusion. Results The incidence of adverse events was higher with Q-FFP (1:3620) than MB-FFP (1 : 24 593) by a factor of 6·79 [95% confidence interval (CI) 2·52–27·8]. Allergic adverse events were also commoner with Q-FFP (1 : 7489) than with MB-FFP (1:24 593), by a factor of 3·28 (95% CI 1·17–13·7). All adverse reactions experienced by the MB plasma recipients were considered to be mild. Conclusion Haemovigilance over 11 years has demonstrated the long-term safety of MB-FFP in comparison to untreated quarantine FFP. In addition to lowering the adverse event rate, implementing the system on a national scale in at-risk countries would presumably reduce the transmission of severe viral infections including emerging infectious diseases by transfusion.

Aim Previous studies of the association between polydrug use and other risk behaviours have generally been limited to specific substances and a small number of behaviours. The aim of this study is to obtain better insight into polydrug use (comprising legal and illegal substances: tobacco, alcohol, tranquillisers/sedatives, cannabis, and other illegal drugs) and its association with co-occurring problem behaviours drawn from various broad domains (sexual, aggressive, delinquent, school achievement, relationships) among European adolescents. Methods Data were obtained from 101,401 16-year-old students from 35 European countries participating in the 2011 ESPAD survey. Associations between polydrug use and other problem behaviours were examined by multinomial and binary logistic regression analyses. Results Tranquillisers/sedatives appeared among the commonest combinations in the polydrug use pattern, especially for females. A strong trend was found between levels of involvement with polydrug use and other problem behaviours for both genders. The highest associations with polydrug use were for problems with the police, risky sexual behaviour and skipping school. Gender differences showed higher prevalences among boys than girls of problem behaviours of aggressive, antisocial type, while girls prevailed over boys in relationship problems. Conclusion An incremental relationship exists between the level of involvement with polydrug use and the co-occurrence of problem behaviours. Preventative interventions should consider the misuse of tranquillisers/sedatives within the context of polydrug use by adolescents and expand their target groups towards multiple problem behaviours.

Aims Tranquillisers and sedatives are valuable medicines with high misuse potential, increasingly used by adolescents without a doctor's prescription. We examined the changing association between lifetime non-prescribed use of tranquillisers or sedatives and their prescribed use in European adolescents in 2003-2011. Design Cross-sectional data from 199,231 16-year-old students were collected through anonymous questionnaires administered in schools in 22 European countries participating in the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2003, 2007 and 2011. Results Logistic regression analyses showed a modest increase in lifetime non-prescribed use of tranquillisers or sedatives (adjusted OR [AOR] = 1.08, 95% CI: 1.06-1.11, p < 0.001) and a decrease in prescribed use (AOR = 0.89, 95% CI: 0.87-0.91, p < 0.001) between 2003 and 2011. Adjusting for gender and survey year, any versus no prescribed use increased the odds tenfold for non-prescribed use (AOR = 10.15, 99% CI: 9.60-10.74, p < 0.001). Adjusting also for changes in cannabis use did not affect the strength of the association. Interactions of factors with survey year showed that between 2003 and 2011, there was an increase of 38% in the odds that tranquilliser or sedative misusers had not used these drugs also with a doctor's prescription (AOR = 1.38, 99% CI: 1.28-1.50, p < 0.001). Conclusion The waning strength of the association between prescribed and non-prescribed use of tranquillisers or sedatives among adolescents may suggest changes both in the patterns of use and the channels of diversion and access to this class of medication in Europe.

Running away from home and suicide attempts during adolescence are high-risk behaviors for safety and health, and a “way out” from negative life experiences. To examine the self-reported prevalence of running away and suicide attempts among adolescents in Greece in the midst of a severe economic recession which is exerting pressure on families, and to identify associated psychosocial factors. Data were drawn from a nationally representative school survey (n = 23,279, 15–19 years old). Students answered in their classrooms an anonymous questionnaire under the supervision of trained researchers. Each behavior was reported by one in nine adolescents (11.3 % for lifetime suicide attempts and 11.6 % for lifetime running away). Among those who reported the one behavior, a quarter also reported the other. Logistic regression analyses indicated that these behaviors share several common psychosocial correlates: family related (quality of parental relationships, parental monitoring), school related (poor performance and dissatisfaction), substance use, and emotional, psychological and behavioral problems. Gender was a significant correlate but in opposite directions for running away (more common among boys) and suicide attempts (more common among girls). Socioeconomic status was not a significant correlate for either behavior, possibly because the impact of the economic crisis on parents had not yet filtered down to their children in 2011 (the survey year). Findings suggest the need for timely interventions towards vulnerable youth and their families by identifying personal, familial and school factors associated with these two health- and life-compromising behaviors.

Aims: The study explored the prevalence and correlates of the non-prescribed use (misuse) of prescription opioid analgesics in a nationally representative sample of adolescent students in Greece. METHODS: Cross-sectional data were collected through anonymous questionnaires administered to a random stratified sample of 676 high schools involving 23,279 students aged 15-19 in 2011. FINDINGS: About 16.2% reported lifetime misuse, 6.3% repeated misuse at least three times - most of them to alleviate pain. RESULTS of multivariate logistic regression showed that among the strongest correlates of repeated misuse were peer misuse (Odds ratio [OR] = 4.10, 99% Confidence Interval [CI] = 3.11-5.42), past prescription of opioid analgesics (OR = 3.19, 99% CI = 2.28-4.48 in males, OR = 2.38, 99% CI = 1.78-3.19 in females), lifetime misuse of tranquilisers/sedatives (OR = 3.16, 99% CI = 2.22-4.48), and frequent use of over-the-counter analgesics (OR = 2.37, 99% CI = 1.92-2.92). Other correlates included: female gender, daily smoking (by girls), frequent alcohol use, antisocial behaviour, physical or emotional maltreatment, and past prescription of tranquilisers/sedatives. Illicit drug use failed to explain opioid analgesics misuse. CONCLUSIONS: Misuse of prescription analgesics is common among adolescents in Greece and seems to emerge within a self-treating rather than a mood-altering context of use.

The complex relation between energy use and the economic process has long attracted attention. Issues such as the scarcity of energy resources, energy theory of value, degrowth and a-growth approaches are closely related to the relationship between energy and development. The present study traces the implications of the Energy-GDP causality dialogue for the context of the growth-degrowth debate, where the energy-development link plays a decisive role. In that context, the present research investigates the possible existence of a fundamental “macro” direction of causality between energy use and economic growth that is not influenced by study-specific characteristics and events. Towards this objective, we perform a meta-analysis that takes into account 158 studies on causality between energy and GDP, covering the period 1978–2011. This is the first time, to our knowledge, that meta-analysis has been applied to investigate the direction of the energy and GDP causal relationship. The meta-analysis results neither support the existence of a fundamental “macro” direction, nor the so-called “neutrality hypothesis (E ≠ GDP)” in the causal relationship between energy consumption and economic growth.