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Primary health care (PHC) is a central pillar of health systems internationally, based on the view of health as a universal and socially established right. The PHC services in Greece have been characterized over time by disintegration, and inefficiency, high levels of fragmentation and inequality, in terms of their access to the general population and geographical distribution, with incomplete implementation of the state health system. The recent, ongoing financial crisis, coupled with economic policies to reduce health expenditures, have exacerbated these problems and magnified the systematic weaknesses of PHC in Greece, as reflected by population health indicators, the financial burden of patients and the deteriorating quality of the services provided. These social inequalities in health, which developed in previous years, were intensified by the COVID-19 pandemic, which further highlighted the need to improve the health services provided and to promote a public health development strategy. Reform of PHC based on systematic evaluation can be a way of responding to its chronic weaknesses and meeting the urgent health needs of the population emanating from the crisis situation and the turbulent economic environment. Although several attempts have been made over the years to develop and implement a PHC system, these have been fragmented, and initiated from a technocratic perspective, diminishing the role of evaluation to a financial tool. The main characteristic of systematic evaluation should be continuous repetition of a circular process, consisting of collection of information, evaluation, and formulation of proposals for improvement and change. This process will support the universality of care and establish health as a social good, but it presupposes interdisciplinary and inter-professional cooperation, with the active involvement of patients. [ABSTRACT FROM AUTHOR]

Background. COPD is common and most patients first consult with a primary health care physician. However, management patterns of the disease in primary care frequently differ from those proposed by guidelines for the treatment of these patients. Objective. To determine if the treatment administered to COPD patients agreed with that proposed by the GOLD guidelines and determine if the adaptation of the treatment to the corresponding GOLD stage alters the COPD stage. Methods. 200 patients with COPD participated in the study. A questionnaire about symptoms and therapy was first filled in followed by a clinical examination and spirometry. The patients were classified according to their stage of the disease. The treatment was registered and two follow-up visits were planned within a period of six months. Results. Appropriate pharmacologic treatment according to GOLD guidelines was found in 40% of the patients. Following the adaptation of the treatment to the corresponding GOLD stage, was noticed, a reduction of the stage during the first and the second follow-up visits by 25.2% and 25.7% respectively. Conclusion. The main proportion of patients is undertreated by primary health care physicians. Therefore, there is the need of the implementation of COPD guidelines by primary health care physicians. [ABSTRACT FROM AUTHOR]

BACKGROUND: COPD primarily affects the lungs but also produces systemic consequences that are not reflected by the recent staging according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Body mass index (BMI) and fat-free mass index (FFMI) represent different aspects of nutrition abnormalities in COPD. We investigated whether BMI and FFMI could be related to parameters expressing airflow obstruction and limitation, exercise capacity, airway inflammation, and quality of life, and whether they would reflect the GOLD staging of the disease. METHODS: One hundred patients with clinically stable COPD equally classified into the five stages of the disease were evaluated for BMI, FFMI (measured by bioelectrical impedance analysis), airway obstruction and hyperinflation (FEV(1), FEV(1)/FVC, inspiratory capacity), exercise capacity (6-min walk distance [6MWD], Borg scale before and after 6MWD]), chronic dyspnea using the Medical Research Council (MRC) scale, airway inflammation (sputum differential cell counts, leukotriene B(4) in supernatant), and quality of life (emotional part of the chronic respiratory disease questionnaire). RESULTS: 6MWD was significantly associated with both BMI and FFMI values, while FFMI additionally presented significant correlations with MRC scale, percentage of predicted FEV(1), and FEV(1)/FVC ratio. No association was observed between the two nutritional indexes. BMI was not statistically different among patients in the five stages of COPD, while FFMI reflected the staging of the disease, presenting the highest values in stage 0. CONCLUSIONS: Nutritional status is mainly related to exercise capacity. FFMI seems to be more accurate in expressing variables of disease severity, as well as the current staging compared to BMI. [ABSTRACT FROM AUTHOR]

Summary: Leukotriene E4 (LTE4) is implicated in asthma pathophysiology and possibly in chronic obstructive pulmonary disease (COPD) as one of the causes of persistent bronchoconstriction and mucus hypersecretion. Cigarette smoking stimulates cysteinyl leukotrienes (CysLTs) production. We investigated whether LTE4 is equally increased in asthma and COPD and whether smoking significantly affects LTE4 levels. Secondary outcomes involved correlations with inflammatory and functional parameters. We studied 40 patients with COPD [20 smokers], 40 asthmatics [20 smokers] and 30 healthy subjects [15 smokers]. Spirometry (FEV1% pred., FEV1/FVC) was performed, urine was collected for measurement of LTE4 and creatinine, induced sputum was collected for differential cell counts and serum for ECP. LTE4/creatinine levels (pg/mg) [mean (sd)] were increased in asthmatic patients compared to COPD and controls, [125.6(54.5) vs. 54.5(19) vs. 55.9(18.9)pg/mg, respectively, P<0.0001 for asthma]. Smoking significantly affects LTE4 levels only in asthmatic patients [164 (48) vs. 87 (26.3), P<0.0001 for smokers]. The only significant correlation was between eosinophils in induced sputum and LTE4/creatinine levels in asthmatics. In conclusion, patients with asthma presented higher LTE4 values compared to normals and patients with COPD. Smoking significantly affects LTE4 values only in asthmatics indicating a different underlying CysLTs inflammatory process in this condition. [Copyright &y& Elsevier]

Risdiplam (EVRYSDI®) is a centrally and peripherally distributed, oral survival of motor neuron 2 (SMN2) pre‑mRNA splicing modifier that has been widely approved for the treatment of spinal muscular atrophy (SMA). RAINBOWFISH (NCT03779334) is a global, open-label, single-arm, multicentre, Phase 2 study assessing the efficacy, safety and pharmacokinetics/pharmacodynamics of risdiplam in infants with genetically diagnosed and presymptomatic SMA from birth to 6 weeks of age (at first dose), regardless of SMN2 copy number. The study enrolled 26 infants: eight infants had two SMN2 copies, 13 infants had three SMN2 copies and five infants had ≥4 SMN2 copies. The primary efficacy (PE) population (n=5) had two SMN2 copies and baseline compound muscle action potential (CMAP) amplitudes ≥1.5mV. Drug dosage was adjusted to achieve a target exposure of approximately 2,000 ng∙ hr/mL. The primary endpoint was met after 12 months of risdiplam treatment with 4/5 (80%) infants in the PE population able to sit without support for ≥5 seconds (Item 22 of the Gross Motor Scale of the Bayley Scales of Infant and Toddler Development, third edition [BSID-III]). Irrespective of CMAP amplitude, 7/8 infants with two SMN2 copies were able to sit without support for ≥30 seconds (BSID‑III Item 26), including all infants with CMAP amplitude <1.5 mV (n=3). Out of 26 infants, 24 (92%) were able to sit without support, 13 (50%) were able to stand unaided and 12 (46%) were able to walk independently at Month 12, as assessed by the Hammersmith Infant Neurological Examination, Module 2. At Month 12, all infants were alive without permanent ventilation, maintained their swallowing and feeding abilities and no adverse events (AEs) led to withdrawal or treatment discontinuation. Most AEs were not considered treatment-related and resolved over time. One infant met the criteria for development of clinically manifested SMA. Here we report, for the first-time, the 2-year efficacy and safety data from RAINBOWFISH. [ABSTRACT FROM AUTHOR]

Facioscapulohumeral muscular dystrophy (FSHD) is marked by progressive muscle weakness in facial, shoulder girdle, upper arms, lower limbs, and abdominal muscles, causing considerable morbidity and decreasing quality of life. There are currently no approved therapies for FSHD. The primary form, FSHD1, is linked to harmful overactivity of the DUX4 gene, resulting in muscle atrophy and weakness. Studies indicate that abnormal DUX4 expression triggers inflammatory processes in the initial stages of the disease. Patients with FSHD1 had increased inflammatory and reduced anti-inflammatory cytokines levels, indicating chronic inflammation. IL-6 levels strongly correlate with clinical severity in patients, and with functional scores in patients and FSHD-like mouse models. Here we present the study design of ReInForce (NCT06222827), a bicentric, randomized, double-blind, placebo-controlled, Phase 2 study to investigate the safety and efficacy of satralizumab, an IL-6 receptor inhibitor, in adults with FSHD1. Patients (N=40) will receive 120 mg satralizumab or placebo subcutaneously at Weeks 0, 2, 4 and then every 4 weeks until Week 48. The 48 weeks of the Double-Blind period will be followed by a 48-week Open Label period. The study will evaluate efficacy by assessing changes in muscle composition and function, as well as measures of clinical disease progression. Given the pathological relevance of inflammation in FSHD, and the correlation of IL-6 levels with disease severity, satralizumab may reduce muscle and systemic inflammation, thereby reducing fibrofatty degeneration in FSHD. [ABSTRACT FROM AUTHOR]

Background: Vaccination is vital for achieving population immunity to severe acute respiratory syndrome coronavirus 2, but vaccination hesitancy presents a threat to achieving widespread immunity. Vaccine acceptance in chronic potentially immunosuppressed patients is largely unclear, especially in patients with asthma. The aim of this study was to investigate the vaccination experience in people with severe asthma., Methods: Questionnaires about vaccination beliefs (including the Vaccination Attitudes Examination (VAX) scale, a measure of vaccination hesitancy-related beliefs), vaccination side-effects, asthma control and overall safety perceptions following coronavirus disease 2019 (COVID-19) vaccination were sent to patients with severe asthma in 12 European countries between May and June 2021., Results: 660 participants returned completed questionnaires (87.4% response rate). Of these, 88% stated that they had been, or intended to be, vaccinated, 9.5% were undecided/hesitant and 3% had refused vaccination. Patients who hesitated or refused vaccination had more negative beliefs towards vaccination. Most patients reported mild (48.2%) or no side-effects (43.8%). Patients reporting severe side-effects (5.7%) had more negative beliefs. Most patients (88.8%) reported no change in asthma symptoms after vaccination, while 2.4% reported an improvement, 5.3% a slight deterioration and 1.2% a considerable deterioration. Almost all vaccinated (98%) patients would recommend vaccination to other severe asthma patients., Conclusions: Uptake of vaccination in patients with severe asthma in Europe was high, with a small minority refusing vaccination. Beliefs predicted vaccination behaviour and side-effects. Vaccination had little impact on asthma control. Our findings in people with severe asthma support the broad message that COVID-19 vaccination is safe and well tolerated., Competing Interests: Conflict of interest: A. Bossios reports support from Novartis for attending meetings, outside the submitted work; participation on a data safety monitoring or advisory board for AstraZeneca, GSK, Novartis, Teva and Sanofi, outside the submitted work; and is a member of the Steering Committee of SHARP, Secretary of Assembly 5 (Airway Diseases, Asthma, COPD and Chronic Cough) of the European Respiratory Society and Vice-chair of the Nordic Severe Asthma Network, outside the submitted work. K. Katsoulis reports payment or honoraria for lectures presentations, speakers bureaus, manuscript writing or educational events from GSK, Novartis and AstraZeneca; and support received from Menarini and Novartis for attending meetings and/or travel, outside the submitted work. K. Kostikas reports grants or contracts from AstraZeneca, Boehringer Ingelheim, Chiesi, Innovis, ELPEN, GSK, Menarini, Novartis and NuvoAir, outside the submitted work; consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, ELPEN, GSK, Menarini, Novartis and Sanofi-Genzyme, outside the submitted work; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi, ELPEN, GSK, Menarini, Novartis, Sanofi-Genzyme and WebMD, outside the submitted work; and is a member of the GOLD Assembly, disclosures made outside the submitted work. N. Rovina reports receiving honoraria for lectures and presentations from Chiesi, AstraZeneca, Menarini, Gilead and Baxter, outside the submitted work. K. Bieksienė reports receiving lecture honoraria from Berlin-Chemie, AstraZeneca and Norameda, outside the submitted work. A. ten Brinke reports grants from Teva and GSK, outside the submitted work; consulting fees from AstraZeneca, GSK, Novartis, Sanofi-Genzyme and Teva, outside the submitted work; and payment or honoraria for lectures received from AstraZeneca, GSK, Sanofi-Genzyme and Teva, outside the submitted work; and is Chair of the Dutch severe asthma registry RAPSODI, outside the submitted work, and ERS SHARP CRC national lead for the Netherlands. R. Chaudhuri reports grants or contracts from AstraZeneca, outside the submitted work; payment of honoraria for lectures from GSK, AstraZeneca, Teva, Chiesi, Sanofi and Novartis, outside the submitted work; support for attending meetings and/or travel from Chiesi, Sanofi and GSK, outside the submitted work; and participation in advisory board meetings for GSK, AstraZeneca, Teva, Chiesi and Novartis, outside the submitted work. H. Rupani reports grant funding from GSK and AstraZeneca, outside the submitted work; payments for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, GSK, Novartis and Teva, outside the submitted work; and is an associate editor of this journal. P. Howarth is an employee of GSK, disclosure made outside the submitted work. C. Porsbjerg reports grants or contracts from AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi and ALK, outside the submitted work; consulting fees from AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi and ALK, outside the submitted work; personal honoraria from AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi and ALK, outside the submitted work; participation on a data safety monitoring or advisory board for AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi and ALK, outside the submitted work. E.H. Bel reports research grants from GSK and Teva, outside the submitted work; and consulting fees from AstraZeneca, GSK, Sterna Biologicals, Chiesi Pharmaceuticals, Sanofi/Regeneron and Teva, outside the submitted work. M.E. Hyland reports grants or contracts from Teva outside the submitted work; and payment received from GSK for writing educational material for respiratory nurses, outside the submitted work. The remaining authors have nothing to disclose., (Copyright ©The authors 2023.)

Background: Spinal muscular atrophy (SMA) is a neuromuscular disease caused by homozygous deletion or loss-of-function mutations of the survival of motor neuron 1 (SMN1) gene, resulting in reduced levels of SMN protein throughout the body. Patients with SMA may have multiple tissue defects, which could present prior to neuromuscular symptoms., Objective: To assess the signs, comorbidities and potential extraneural manifestations associated with SMA in treatment-naïve patients., Methods: This observational, retrospective and matched-cohort study used secondary insurance claims data from the US IBM® MarketScan® Commercial, Medicaid and Medicare Supplemental databases between 01/01/2000 and 12/31/2013. Treatment-naïve individuals aged≤65 years with≥2 International Classification of Diseases, Ninth Revision (ICD-9) SMA codes were stratified into four groups (A-D), according to age at index (date of first SMA code recorded) and type of ICD-9 code used, and matched with non-SMA controls. The occurrence of ICD-9 codes, which were converted to various classifications (phecodes and system classes), were compared between groups in pre- and post-index periods., Results: A total of 1,457 individuals with SMA were included and matched to 13,362 controls. Increasing numbers of SMA-associated phecodes and system classes were generally observed from pre- to post-index across all groups. The strongest associations were observed in the post-index period for the youngest age groups. Endocrine/metabolic disorders were associated with SMA in almost all groups and across time periods., Conclusions: This exploratory study confirmed the considerable disease burden in patients with SMA and identified 305 unique phecodes associated with SMA, providing a rationale for further research into the natural history and progression of SMA, including extraneural manifestations of the disease.

Background: Risdiplam is an orally administered therapy that modifies pre-mRNA splicing of the survival of motor neuron 2 (SMN2) gene and is approved for the treatment of spinal muscular atrophy. The FIREFISH study is investigating the safety and efficacy of risdiplam in treated infants with type 1 spinal muscular atrophy versus historical controls. The primary endpoint of part 2 of the FIREFISH study showed that infants with type 1 spinal muscular atrophy attained the ability to sit without support for at least 5 s after 12 months of treatment. Here, we report on the safety and efficacy of risdiplam in FIREFISH part 2 over 24 months of treatment., Methods: FIREFISH is an ongoing, multicentre, open-label, two-part study. In FIREFISH part 2, eligible infants (aged 1-7 months at enrolment, with a genetically confirmed diagnosis of spinal muscular atrophy, and two SMN2 gene copies) were enrolled in 14 hospitals in ten countries across Europe, North America, South America, and Asia. Risdiplam was orally administered once daily at 0·2 mg/kg for infants between 5 months and 2 years of age; once an infant reached 2 years of age, the dose was increased to 0·25 mg/kg. Infants younger than 5 months started at 0·04 mg/kg (infants between 1 month and 3 months old) or 0·08 mg/kg (infants between 3 months and 5 months old), and this starting dose was adjusted to 0·2 mg/kg once pharmacokinetic data were available for each infant. The primary and secondary endpoints included in the statistical hierarchy and assessed at month 12 have been reported previously. Here we present the remainder of the secondary efficacy endpoints that were included in the statistical hierarchy at month 24: the ability to sit without support for at least 30 s, to stand alone, and to walk alone, as assessed by the Bayley Scales of Infant and Toddler Development, third edition gross motor subscale. These three endpoints were compared with a performance criterion of 5% that was defined based on the natural history of type 1 spinal muscular atrophy; the results were considered statistically significant if the lower limit of the two-sided 90% CI was above the 5% threshold. FIREFISH is registered with ClinicalTrials.gov, NCT02913482. Recruitment is closed; the 36-month extension period of the study is ongoing., Findings: Between March 13 and Nov 19, 2018, 41 infants were enrolled in FIREFISH part 2. After 24 months of treatment, 38 infants were ongoing in the study and 18 infants (44% [90% CI 31-58]) were able to sit without support for at least 30 s (p<0·0001 compared with the performance criterion derived from the natural history of untreated infants with type 1 spinal muscular atrophy). No infants could stand alone (0 [90% CI 0-7]) or walk alone (0 [0-7]) after 24 months of treatment. The most frequently reported adverse event was upper respiratory tract infection, in 22 infants (54%); the most common serious adverse events were pneumonia in 16 infants (39%) and respiratory distress in three infants (7%)., Interpretation: Treatment with risdiplam over 24 months resulted in continual improvements in motor function and achievement of developmental motor milestones. The FIREFISH open-label extension phase will provide additional evidence regarding long-term safety and efficacy of risdiplam., Funding: F Hoffmann-La Roche., Competing Interests: Declaration of interests RM has received consulting fees from Biogen, F Hoffmann-La Roche, and Novartis Gene Therapies, and speaker honoraria from F Hoffmann-La Roche and Novartis Gene Therapies. RM reports that he received travel or meeting attendance support and fees for serving on advisory boards from F Hoffmann-La Roche, Novartis Gene Therapies, and Biogen. MMB has received speaker honoraria and payment for serving on advisory boards for F Hoffmann-La Roche, Sanofi, Novartis, Biogen, and UCB. KR reports she has received consulting fees from F Hoffmann-La Roche, Biogen, and Novartis; she has received support from Biogen for attending meetings; she has received speaker honoraria from F Hoffmann-La Roche and Biogen, and has served on advisory boards for F Hoffmann-La Roche and Biogen. LS reports grants from F Hoffmann-La Roche, Biogen, and Novartis, and consultancy fees from F Hoffmann-La Roche, Biogen, Novartis, BioHaven Pharmaceuticals, and Scholar Rock. He has received speaker fees from and served on advisory boards for F Hoffmann-La Roche, Biogen, and Novartis. He reports he holds the position of secretary at the World Muscle Society. HX declared no competing interests. EZ reports grants from Fundação de Amparo à Pesquisa do Estado de São Paulo, The Brazilian National Council for Scientific and Technological development, Sarepta Therapeutics, F Hoffmann-La Roche, Biogen, and Novartis. He has received consulting fees from F Hoffmann-La Roche, Novartis, Biogen, Sanofi, Astellas, and Sarepta Therapeutics. EZ received speaker honoraria from and served on advisory boards for F Hoffmann-La Roche, Novartis, Biogen, Sanofi, and Astellas. He has received travel and meeting attendance support from F Hoffmann-La Roche, Novartis, Biogen, Sanofi, and Sarepta Therapeutics. GB reports that he has received consulting fees and speaker honoraria from Biogen, F Hoffmann-La Roche, and Novartis Gene Therapies. GB has received fees for serving on advisory boards and has received equipment for indirect calorimetry to University College London from F Hoffmann-La Roche. CB reports he has received grants or contracts from Biogen, Novartis, and F Hoffmann-La Roche. He has served on advisory boards for Sarepta Therapeutics, F Hoffmann-La Roche, Novartis, and Biogen; he has received support from Sarepta Therapeutics and Biogen for attending meetings. JWD has received research grants from Biogen, Cytokinetics, Ionis Pharmaceuticals, Novartis Gene Therapies, F Hoffmann-La Roche, and Scholar Rock. He reports that he has received consulting fees from Shift Therapeutics and that he has served on advisory boards for Biogen, Cytokinetics, Epirium Bio, Ionis Pharmaceuticals, Novartis Gene Therapies, F Hoffmann-La Roche–Genentech, and Scholar Rock. ND reports he has received support from F Hoffmann-La Roche for provision of FIREFISH and SUNFISH clinical trials study materials, paid to the institution (Ghent University Hospital [US Gent]). He reports that he has received consulting fees for the SUNFISH trial advisory board, has received support for attending meetings, travel, or both, and for serving on advisory boards from F Hoffmann-La Roche. AK has received consulting fees for serving on advisory boards for AveXis, Novartis Gene Therapies, Biogen, and F Hoffmann-La Roche. She has received speaker honoraria from F Hoffmann-La Roche and Biogen. AK reports that The Swiss-Reg-NMD receives unconditional financial support from PTC Therapeutics, Sarepta Therapeutics, Pfizer, and F Hoffmann-La Roche and research grants from Novartis Gene Therapies and Biogen. She reports that she receives research grants from the Swiss Foundation for Research on Muscle Diseases. EM has received grants or contracts from Biogen. He has received speaker honoraria for lectures from Biogen, F Hoffmann-La Roche, Novartis, and AveXis. EM reports he has served on advisory boards for Biogen, F Hoffmann-La Roche, Scholar Rock, Novartis, AveXis, and Cytokinetics. DV reports grants from PTC Therapeutics, F Hoffmann-La Roche, Novartis, Biogen, NS Pharma, Sarepta Therapeutics, and Pfizer. He has received consulting fees from F Hoffmann-La Roche, Novartis, AveXis, and Biogen; he has received speaker honoraria for lectures from PTC Therapeutics, F Hoffmann-La Roche, Janssen, and Novartis. DV has served on advisory boards for AveXis, Biogen, Novartis, and F Hoffmann-La Roche. YW reports she has received payment from F Hoffmann-La Roche for the FIREFISH part 2 trial to support the study according to agreement and has received grants or contracts from UCB and Biogen for clinical trial support. BD reports grants from F Hoffmann-La Roche during the conduct of the study; and grants from PTC Therapeutics, Fibrogen, AveXis, Genentech, Ionis Pharmaceuticals, Biogen, Sarepta Therapeutics, and Summit. He reports research support from the National Institutes of Health and National Institute of Neurological Disorders and Stroke, Slaney Family Fun for spinal muscular atrophy, Spinal Muscular Atrophy Foundation, CureSMA, and Working on Walking Fund. He served on advisory boards for AveXis, Vertex, Genentech, F Hoffmann-La Roche, Sanofi–Genzyme, Sarepta Therapeutics, and Biogen; he reports his role as a member of the data safety monitoring board for Amicus Inc, outside of the submitted work. AD, MEK, KG, BJ, HK, EG, and PF report that they are current employees and stockholders in F Hoffmann-La Roche., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: At the beginning of the pandemic, there have been considerable concerns regarding coronavirus disease 2019 (COVID-19) severity and outcomes in patients with severe asthma treated with biologics., Objective: To prospectively observe a cohort of severe asthmatics treated with biologics for the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and disease severity during the COVID-19 pandemic., Methods: Physicians from centers treating patients with severe asthma all over Greece provided demographic and medical data regarding their patients treated with biologics. Physicians were also asked to follow up patients during the pandemic and to perform a polymerase chain reaction test in case of a suspected SARS-Cov-2 infection., Results: Among the 591 severe asthmatics (63.5% female) included in the study, 219 (37.1%) were treated with omalizumab, 358 (60.6%) with mepolizumab, and 14 (2.4%) with benralizumab. In total, 26 patients (4.4%) had a confirmed SARS-CoV-2 infection, 9 (34.6%) of whom were admitted to the hospital because of severe COVID-19, and 1 required mechanical ventilation and died 19 days after admission. Of the 26 infected patients, 5 (19.2%) experienced asthma control deterioration, characterized as exacerbation that required treatment with systemic corticosteroids. The scheduled administration of the biological therapy was performed timely in all patients with the exception of 2, in whom it was postponed for 1 week according to their doctors' suggestion., Conclusion: Our study confirms that despite the initial concerns, SARS-CoV-2 infection is not more common in asthmatics treated with biologics compared with the general population, whereas the use of biologic treatments for severe asthma during the COVID-19 pandemic does not seem to be related to adverse outcomes from severe COVID-19., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Objective: To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants., Design: Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology., Setting: Telephone interview with babies' mothers or fathers., Participants: Representative sample of infants who participated in the national neonatal screening programme (n 549 in 2017, n 586 in 2007)., Results: We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and <1 % of babies, respectively, were exclusively breast-feeding. We also found early introduction of solid foods (after the 4th month of age). Maternity hospital practices favouring breast-feeding were more prevalent in 2017, but still suboptimal (63 % experienced rooming-in; 51 % experienced skin-to-skin contact in the first hour after birth; 19 % received free sample of infant formula on discharge)., Conclusions: We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates - particularly rates of exclusive breast-feeding - remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding 'culture' and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

Introduction: Mepolizumab is a monoclonal antibody against IL-5 for the treatment of severe eosinophilic asthma. The aim of the current study was to present a predesigned interim analysis of the data of patients who have completed 1 year of therapy with mepolizumab., Methods: This study is a prospective multicenter, noninterventional 2-year observational study and aims to describe the clinical benefit and safety profile of mepolizumab in patients with severe eosinophilic asthma., Results: Compared to the year preceding the initiation of treatment, the annual rate of exacerbations decreased significantly, from 4.3 ± 2.3 to 1.3 ± 1.8; p < 0.0001. Forty-two patients received maintenance dose of oral corticosteroids (OCS) at baseline. From these patients at the end of 1 year of therapy with mepolizumab, 17 patients (40%) had achieved OCS discontinuation. A reduction in the median dose of OCS was also achieved. After 1 year of treatment with mepolizumab, the asthma control test score significantly increased from 16.3 ± 3.7 to 21.2 ± 3.8 (p < 0.0001). This marked clinical improvement was paralleled by a significant reduction of blood eosinophil count. All patients showed a considerable improvement of airflow limitation. In respect to adverse events of treatment with mepolizumab, 19 patients (27%) were recorded to have at least one such occurrence during their 1-year treatment., Conclusions: We have shown that in patients with severe eosinophilic asthma, 1 year of treatment with mepolizumab was safe, resulted in significant reduction of the annual exacerbation rate, reduction (or even discontinuation) of the needed dose of OCS, and improvements of asthma control and lung function., (© 2020 S. Karger AG, Basel.)

Aim: To investigate whether demographic variables and work-related factors predict work motivation in Greek nurses., Background: Nurses' motivation is crucial for an effective health-care system. Herzberg's and Maslow's motivation theories constitute the framework of this study., Method: The sample consisted of 200 nurses from every sector and registration level in a University Hospital in Greece. The response rate was 76%., Instruments: A previously developed and validated questionnaire addressing four work-related motivators (job attributes, remuneration, co-workers and achievements) on a five-point Likert scale., Results: Most participants were women, married, between 36 years and 45 years old and higher education graduates. The highest mean score was recorded for 'achievements' (mean 4.07, SD 0.72), which emerged as the most important motivator. Job satisfaction, work sector and age were statistically significantly related to motivational factors., Conclusions: Nurses placed emphasis on motivators not strictly relating to economic rewards, but which can be seen as intrinsic and could lead to self-actualization., Implications for Nursing Management: The constantly changing health sector requires that human resources and job context be a priority for health administrators. By promoting nurses' satisfaction and efficacy, an improvement in service quality is expected., (© 2012 Blackwell Publishing Ltd.)

Background: COPD is a multicomponent disease and systemic inflammation represents one of the possible mechanisms responsible for its systemic manifestations, including skeletal muscle weakness and cachexia. Fat-free mass index (FFMI) that reflects the skeletal muscle mass, has been shown to be associated with both dyspnoea and exercise capacity. We hypothesized that the multidimensional BODE index, that reflects the multicomponent nature of COPD, might be related to biomarkers of systemic inflammation. We further evaluated associations between FFMI and systemic inflammation., Methods: BODE index and FFMI were calculated in 222 stable COPD patients and 132 smokers or ex-smokers with normal lung function. Systemic inflammation was evaluated with the measurement of leptin, adiponectin, CRP, IL-6, and TNF-α in serum samples of COPD patients., Results: In patients with COPD, both BODE index and FFMI presented significant positive and negative associations respectively with leptin levels (R(2) 0.61 and 0.65, respectively), whereas FFMI presented an additional negative association with the levels of TNF-α (R(2) 0.38). No significant associations were observed in smokers or ex-smokers with normal lung function., Conclusions: Both BODE index and FFMI, are related to the circulating levels of leptin in patients with COPD, suggesting a possible role for leptin in the systemic component of COPD. The additional association of FFMI with TNF-α may further support a role of systemic inflammation in muscle wasting in COPD.