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Background: The SARS-CoV2 pandemic obligated most of the European countries to implement strict measures and lockdowns to minimize the spread of the virus. Universities closed and on-line classes started. However, COVID-19 epidemic has significant impact on mental health of population. Aim: To assess depression level of nursing students (undergraduate and master) in Greece, Spain and Albania during COVID-19 pandemic as well as to identify possible determinants of depression level. Methods: A multicenter cross-sectional study was conducted between April and May 2020. An on-line questionnaire was used to collect the data. The Patient Health Questionnaire-9 was used to evaluate the depression levels of nursing students. Results: Seven hundred and eighty-seven nursing students participated in the study out of which 83.9% were of female gender, 92.9% single and 94.7% lived with others. One third of the nursing student population experienced mild depression, with higher depression levels noted for Spanish students (59.1%) followed by Albanian (34.5%) and Greek (21.8%) students. Multivariate linear regression analysis identified that Spanish students experienced more depression than Greek and Albanian (p < 0.001). Also, decreased age was associated with increased depression. Conclusion: The impact of lockdown and quarantine on nursing students mental health is clear. Provision of university based mental health interventions should be a priority. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Background: Experiencing the third wave of COVID-19 pandemic, high vaccination coverage by a safe and effective vaccine globally would be a great achievement. Acceptance of vaccination by nursing students is an important issue as they play a decisive role as future professionals in educating patients, counselling, and guiding them to the right clinical decision. Objectives: To explore the intention of nursing students to get vaccinated for SARS-CoV-2 infection and the factors acting either as motivators or as barriers towards vaccination. Design: A multicenter cross-sectional design. Participants: In total 2249 undergraduate nursing students participated. Methods: The study was conducted in 7 universities in participating countries (Greece, Albania, Cyprus, Spain, Italy, Czech Republic, and Kosovo) through a web survey. Data was collected during December 2020–January 2021 in all countries. Results: Forty three point 8% of students agreed to accept a safe and effective COVID-19 vaccine, while the acceptance was higher among Italian students. The factors for intention to get vaccinated were male gender (p = 0.008), no working experience in healthcare facilities during the pandemic (p = 0.001), vaccination for influenza in 2019 and 2020 (p < 0.001), trust in doctors (p < 0.001), governments and experts (p = 0.012), high level of knowledge (p < 0.001) and fear of COVID-19 (p < 0.001). Conclusions: Understanding of factors that influence students' decision to accept COVID-19 vaccination could increase the acceptance rate contributing to a management of the pandemic. © 2021

Recent research evidence has shown that patients with chronic viral hepatitis develop symptoms of anxiety and/or depression, which has a strong impact on their health-related quality of life. This study aimed to assess the levels of anxiety, depression, and health-related quality of life among patients with chronic hepatitis B or C in Greece. It was a cross-sectional study among 111 patients with chronic viral hepatitis, evaluated at a tertiary General Hospital of Athens from March to September of 2014. Anxiety, depression, and health-related quality of life were assessed by the use of specially designed questionnaires. For the comparison between patients' population and general population, a pair-matched population of 111 healthy participants was recruited. Mean age of patients was 44.85 years (SD = 14.4). Fifty-nine patients were infected by hepatitis B virus and 52 by hepatitis C virus. Levels of anxiety and depression were higher among patients than among controls and the overall health-related quality of life was poorer (p

Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004–2015. The research question that guided this review was posed as: “Is there any relationship between leadership style in healthcare settings and quality of care?” Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals. © 2017 by the authors. Licensee MDPI, Basel, Switzerland.

Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA2LEN: Global Allergy and European Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim of this paper is to review current and past EU-funded projects in order to make a summary of their goals and achievements and to suggest future research needs of these European birth cohort networks. © 2012 S. Karger AG, Basel.

This work was supported by Environmental Health Risks in European Birth Cohorts (ENRIECO), a project conducted within the European Union’s Seventh Framework Programme (Theme 6, Environment, including climate change), grant agreement 226285., Vrijheid, M., Casas, M., Bergström, A., Carmichael, A., Cordier, S., Eggesbø, M., Eller, E., Fantini, M.P., Fernández, M.F., Fernández-Somoano, A., Gehring, U., Grazuleviciene, R., Hohmann, C., Karvonen, A.M., Keil, T., Kogevinas, M., Koppen, G., Krämer, U., Kuehni, C.E., Magnus, P., Majewska, R., Andersen, A.-M.N., Patelarou, E., Petersen, M.S., Pierik, F.H., Polanska, K., Porta, D., Richiardi, L., Santos, A.C., Slama, R., Sram, R.J., Thijs, C., Tischer, C., Toft, G., Trnovec, T., Vandentorren, S., Vrijkotte, T.G.M., Wilhelm, M., Wright, J., Nieuwenhuijsen, M.

Background: Impaired postnatal growth after chloroform exposure in utero has been observed in rodents without an effect on birth weight. We aimed to study the relationship between exposure to trihalomethanes (THMs) during pregnancy and postnatal weight growth during infancy. Methods: We analysed 2216 mother child pairs recruited in Gipuzkoa, Sabadell, Valencia (Spain, INMA Project, enrolment: 2003-2008) and Crete (Greece, RHEA Study, enrolment: 2007-2008). Drinking water habits and water-related activities ascertained through personal interviews were combined with THM measurements in drinking water to estimate THM exposure through different exposure routes during pregnancy. Weight measurements during the first year of life were used to fit postnatal weight growth curves from birth to one year and to predict weight at six months. Multiple linear regression was used to evaluate the relationship between six months weight gain and interquartile range (IQR) increase in THM exposure adjusting for confounders. Results: Average weight gain at six months ranged from 4325 g (Gipuzkoa) to 4668 g (Crete). Median residential THM levels ranged from 1 mu g/1 (Crete) to 117 mu g/I (Sabadell). No significant association was observed overall (24.4 g [95% CI -78.8, 30.0] for an IQR increase in total residential uptake). A negative relationship was observed in Sabadell (148 g [95% CI 282, -13.7]) for an IQR increase in ingestion THM uptake. Conclusions: No consistent evidence of an association between THM exposure during pregnancy and postnatal growth was observed. The novelty of the hypothesis and the negative trend observed in the region with the highest levels warrants the replication in future studies. (C) 2014 Elsevier Inc. All rights reserved.

AimTo compare blood pressure reactions (BPR) of infants to mild stress for evidence of adverse cardiovascular effects of passive exposure to tobacco smoke during pregnancy and early infancy. MethodsAn observational field study conducted in Crete. We compared 4- to 6-month olds of lifelong nonsmokers minimally (controls, n=9) or frequently exposed to tobacco smoke (passive smokers; n=10) with those born to habitual smokers (n=6). Smoke exposure was verified biochemically (urine cotinine each trimester and at study). We recorded beat-to-beat blood pressure (BP) during brief repositioning manoeuvres performed during a daytime nap and analysed BPR (% change in BP during head-up tilt) for associations with maternal and infant cotinine. ResultsWe observed a 20-fold difference between BPR of infants of controls versus passive smokers - exceptional given number of infants ( error/confidence level 90%). The BPR declined linearly as the infant’s (but not mother’s) cotinine level rose (p=0.04), indicating abnormal BPR was caused mainly by postnatal smoke exposure. Infants of active smokers differed from those of passive smokers. ConclusionCardiovascular effects of passive smoking by a newborn infant manifest early on and are exceptionally strong. They can be largely avoided by keeping the home smoke rigorously free.

Evidence-based practice (EBP) is an approach that influences healthcare worldwide. Systematic research in the relevant biomedical literature was conducted using the Medline-Pubmed interface until August 2012. Six studies were included in the review. All of these studies had a cross-sectional study design, and 4 of them conducted a postal survey, using different questionnaires for data collection purposes. This review supports previous literature suggesting that community nurses have a positive attitude toward EBP. However, although EBP implementation is considered to be a professional imperative, the integration of recent evidence into clinical practice seems to be a cumbersome process. © 2013 Copyright Taylor and Francis Group, LLC.

Estimating within-city variability in air pollution concentrations is important. Land use regression (LUR) models are able to explain such small-scale within-city variations. Transparency in LUR model development methods is important to facilitate comparison of methods between different studies. We therefore developed LUR models in a standardized way in 36 study areas in Europe for the ESCAPE (European Study of Cohorts for Air Pollution Effects) project.Nitrogen dioxide (NO2) and nitrogen oxides (NOx) were measured with Ogawa passive samplers at 40 or 80 sites in each of the 36 study areas. The spatial variation in each area was explained by LUR modelling. Centrally and locally available Geographic Information System (GIS) variables were used as potential predictors. A leave-one out cross-validation procedure was used to evaluate the model performance.There was substantial contrast in annual average NO2 and NOx concentrations within the study areas. The model explained variances (R2) of the LUR models ranged from 55% to 92% (median 82%) for NO2 and from 49% to 91% (median 78%) for NOx. For most areas the cross-validation R2 was less than 10% lower than the model R2. Small-scale traffic and population/household density were the most common predictors. The magnitude of the explained variance depended on the contrast in measured concentrations as well as availability of GIS predictors, especially traffic intensity data were important. In an additional evaluation, models in which local traffic intensity was not offered had 10% lower R2 compared to models in the same areas in which these variables were offered.Within the ESCAPE project it was possible to develop LUR models that explained a large fraction of the spatial variance in measured annual average NO2 and NOx concentrations. These LUR models are being used to estimate outdoor concentrations at the home addresses of participants in over 30 cohort studies. © 2013 Elsevier Ltd.

Objectives: To investigate the effects of postoperative intensive glycemic control on patient outcomes. Background: Ineffective perioperative glycemic control has been associated with high mortality and morbidity rates among cardiac surgery patients. Methods: 212 cardiac surgery patients were allocated by a quasi-experimental design to: a) a control group (. n = 107) with targeted blood glucose levels 161-200 mg/dl or b) a therapy group (. n = 105) with blood glucose target 120-160 mg/dl. We compared the two groups on their mortality, length of stay, duration of intubation, incidence of severe hypoglycemia and frequency of postoperative infections. Results: The mean postoperative blood glucose levels were significantly lower for the therapy group compared with the control group (153.9 mg/dl vs. 173.9 md/dl, p < 0.001). The intensive glycemic control was strongly associated with decreased in-hospital mortality (7 deaths/105 patients for the control group vs. 1 death/105 patients for the therapy group; p = 0.033). We did not identify any statistically significant associations regarding the other patient outcomes. Conclusions: This randomized quasi-experimental trial found lower in-hospital mortality with more intense blood glucose control. Effective postoperative glycemic control did not affect the other studied patient outcomes. © 2013 Elsevier Inc.

Current evidence provides contradictory results in regards to the associations of breastfeeding or early introduction of cow's milk and formula with the development of type 1 diabetes (T1D). The aim of this systematic review was to evaluate the type of feeding, duration of breastfeeding, time of introduction of formula or cow's milk, and the potential impact on developing T1D. The literature search was conducted based on the standards outlined in the MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies and yielded a total of 161 studies, 28 of which were included in this review. Twenty seven of the included studies were case-control and one was a prospective cohort study. Eight of the studies indicated breastfeeding has a protective role against the development of T1D. Seven additional studies emphasized that a short period or absence of breastfeeding could be a risk factor for T1D development. The results of this systematic review indicate a short duration and/or a lack of breastfeeding may constitute a risk factor for the development of T1D later in life. © 2012 International Life Sciences Institute.

Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations and estimating individual exposure for participants of cohort studies. Within the ESCAPE project, concentrations of PM2.5, PM2.5 absorbance, PM10, and PMcoarse were measured in 20 European study areas at 20 sites per area. GIS-derived predictor variables (e.g., traffic intensity, population, and land-use) were evaluated to model spatial variation of annual average concentrations for each study area. The median model explained variance (R2) was 71% for PM2.5 (range across study areas 35-94%). Model R2 was higher for PM2.5 absorbance (median 89%, range 56-97%) and lower for PMcoarse (median 68%, range 32- 81%). Models included between two and five predictor variables, with various traffic indicators as the most common predictors. Lower R2 was related to small concentration variability or limited availability of predictor variables, especially traffic intensity. Cross validation R2 results were on average 8-11% lower than model R2. Careful selection of monitoring sites, examination of influential observations and skewed variable distributions were essential for developing stable LUR models. The final LUR models are used to estimate air pollution concentrations at the home addresses of participants in the health studies involved in ESCAPE. © 2012 American Chemical Society.

Background: Our aim was to assess second-hand smoke (SHS) exposure in hospitality venues after the smoke-free legislation implemented in September 2010 in Greece and to compare with when a partial ban was in place and in 2006 when no ban was in place. Methods: Hospitality venues were prospectively assessed for their indoor concentrations of particulate matter (PM 2.5) during the partial ban phase (n=149) and the complete ban phase (n=120, 80% followed up), while overall and matched by venue comparisons were also performed (no ban vs. partial ban vs. complete ban). Comparisons with previously collected data in 2006 when no ban was in place also was performed. Results: Indoor air levels of PM2.5 attributable to SHS dropped following the transition from a partial to a complete ban by 34% (137μg/m3 vs. 90μg/m3, p=0.003). This drop was larger in bars (from 195μg/m3 to 121μg/m3), than in cafes (124μg/m3 vs. 87μg/m3) or restaurants (42μg/m3 vs. 39μg/m3). PM2.5 concentrations between 2006 (no ban) and the partial ban of 2010 were also found to decrease by 94μg/m3; however, among matched venues, the levels of indoor air pollution were not found to change significantly (218μg/m 3 vs. 178μg/m3, p=0.58). Comparing the 2010 complete ban results (n=120) with previously collected data from 2006 when no ban was in place (n=43), overall PM2.5 concentrations were found to fall from 268μg/m3 to 89μg/m3, while a matched analysis found a significant reduction in PM2.5 concentrations (249μg/m 3 vs. 46μg/m3, p=0.011). Conclusion: The complete ban of smoking in hospitality venues in Greece led to a reduction in SHS exposure, in comparison to when the partial ban or no ban was in place; however, exposure to SHS was not eliminated indicating the need for stronger enforcement. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

Compliance with laws making certain environments smoke free has focused mainly on smokers behavior, while the role of non-smokers has scarcely been investigated. Our cross-sectional study interviewed 4043 adults (2037 smokers and 2006 non-smokers) in the general population of Greece during April 2009. Non-smokers reported that they would actively work for compliance with the law. The non-smokers were older, more educated (odds ratio, OR 1.4), and were more likely to be annoyed by the smell of environmental tobacco smoke (OR 2.4) or report that it irritates their eyes (OR 1.8). Policymakers should evaluate how non-smokers could actively support smoke-free laws through reporting of violations using media campaigns that inform them of their rights, and other measures. © 2011 Macmillan Publishers Ltd.

Recent findings suggest a significant association between the antioxidant status of pregnant women and of their children during the first years of life and the development of allergic disease during childhood. The aim of this review was to identify all studies that estimated the effect of intake of antioxidants in pregnant women and their children on the development of allergic disease during early childhood. A systematic review was conducted of epidemiological studies featuring original peer-reviewed data on the association between dietary antioxidant status and allergic disease during childhood. A systematic search was performed following the Meta-analysis of Observational Studies in Epidemiology Guidelines. A comprehensive search of the literature yielded 225 studies, 18 of which were selected for the extraction of results and were related to antioxidant status and allergic disease. The systematic review included five prospective cohort studies, four cross-sectional studies, and nine case-control studies. Eight studies reported an important association between antioxidant status and asthma onset during childhood. Similarly, wheezing and eczema were studied as an outcome in six and in five studies, respectively. Recent observational studies suggest that a higher intake of antioxidant vitamins, zinc, and selenium during pregnancy and childhood reduces the likelihood of childhood asthma, wheezing, and eczema. © 2011 International Life Sciences Institute.

Background: It is proven that early admission to hospital contributes significantly to the successful management of acute myocardial infarction (AMI). Aim: This study aimed to examine the factors associated with delayed hospital arrival among patients with AMI. Methods: A cross-sectional study among 477 AMI patients was conducted during a 2-year period in two large tertiary hospitals in Greece. Structured face-to-face interviews were conducted and information regarding their socio-demographic characteristics, medical history and factors that might be correlated with delayed hospital arrival were collected. Results: The main factors that were found to be correlated with delayed hospital arrival among AMI patients were the absence of companion/attendant/escort present during the AMI [odds ratio (OR) 2.1, 95% confidence interval (CI) 0.98-4.4, P=0.049], previous medical history of diabetes mellitus (OR 3.4, CI 1.6-7.2, P=0.002), absence of dyspepsia (OR 9.2, CI 3.6-23.3, P

Aims and objectives: To identify the factors that might affect the length of stay in the intensive care unit (ICU-LOS) among cardiac surgery patients. Background: ICU-LOS forms an important factor for assessing the effectiveness of the provided nursing care. A number of factors can be accused for increasing patient hospitalization. The nursing workload (NWL), among others, was found to play a significant role as it is closely associated with the quality of care. Design: An observational cohort study among 313 consecutive patients who were admitted to the cardiac surgery intensive care unit of a general, tertiary hospital of Athens, Greece from November 2008 to November 2009. Methods: Data collection was performed by using a short questionnaire (for basic demographic information) and two instruments, the Nursing Activities Score (NAS) and the logistic EuroSCORE, for assessing the NWL and the perioperative risk for each patient respectively. Results: ICU-LOS of more than 2 days increased with age and was more common among females (p < 0·001 and p = 0·02, respectively). Multivariate logistic regression analysis revealed a positive association between increased perioperative risk and the increased ICU-LOS [odd ratio (OR) 1·9, 95% confidence interval (CI) 1·0–3·5, p = 0·04], while patients with a first day NAS of more than 61·6% had an almost 5·2 times greater probability to stay in the cardiac surgery unit for more than 2 days (OR 5·2, 95% CI 3·0–8·8, p < 0·001). Conclusions: Increased level of NWL and patient perioperative risk are closely associated with increased ICU-LOS. Relevance to clinical practice: The correlation between patient perioperative risk and ICU-LOS encourages the early identification of high-risk patients for prolonged hospitalization. Furthermore, the relationship between NWL and ICU-LOS allows the early identification of these patients with the use of an independent nursing tool. © 2011 The Authors. Nursing in Critical Care and 2011 British Association of Critical Care Nurses.

Objectives: Exposure to disinfection by-products (DBPs) during pregnancy has been associated with adverse birth outcomes. We evaluated exposure to DBPs through ingestion, inhalation and dermal absorption among pregnant women in Crete, in relation to birth weight and gestational age. Methods: The mother-child birth cohort in Crete ('Rhea' study) enrolled 1359 pregnant women at the third month of pregnancy (2007-2008), residents in the prefecture of Heraklion. Exposures were assessed through three questionnaires administered during pregnancy requesting extensive information on personal water-related habits. Tap water samples were collected in representative mother homes on the basis of detailed water distribution patterns, and were analysed for major DBPs including trihalomethanes (THMs). Logistic and linear regression models were applied. Results: Pregnant women reported a high consumption of bottled water at home (76%) and work (96%). More than half the women (59%) washed dishes by hand, nearly all women (94%) took showers rather than baths (1%), and only 2% attended a swimming pool. THM levels were low (

Endotracheal suctioning is a common aspect of nursing care to mechanicallyventilated patients. The aim of this study was to investigate the effects of two suctioning techniques on oxygen saturation (SaO2) and the amount of drained secretions. A quasi-experimental study of 103 mechanically-ventilated patients was conducted from two tertiary hospitals in Greece. Two suctioning techniques were applied to each patient: with normal saline instillation and without. Normal saline instillation was associated with increased secretions' weight (p

Aim: To translate into Greek and validate the chronic liver disease questionnaire (CLDQ). Methods: Two hundred and six consecutive adult patients with the diagnosis of a chronic liver disease from 2 general hospitals in Athens were enrolled in the study from May to September 2008. In order to assess their quality of life (QOL) the CLDQ was applied. The instrument was translated from English, back translated and reviewed in focus groups within the framework of a large multicenter study. The measurements that were performed included: 2 independent sample t tests, oneway analysis of variance, reliability coefficients, explanatory factor analysis using a varimax rotation and the principal components method. Results: One hundred and twenty five (61%) patients were men, half were aged 40-59 years and > 33% were > 60 years old. Among the patients, 48 (23%) were hospitalized and 97 (47%) were cirrhotic according to the Child-Pugh score. The internal consistency of the Greek CLDQ version using Cronbach's alpha coefficient was found to be 0.93. Exploratory factor analysis identified 7 domains accounting for 65% of the variance of CLDQ items and only partially overlapping with those found in the original version. The area under the receiver operating characteristics curve was calculated at 0.813 and the logistic estimate for the threshold score of 167.50 provided a sensitivity of 74.3% and a specificity of 71.6% for the model. Conclusion: Our data confirmed the validity of the Greek version of the CLDQ in identifying the QOL among patients with chronic liver disease. © 2010 Baishideng.

The importance of education in the development of nursing as a profession and as a science has been emphasized over the last decade. Therefore, this article aims to highlight the current situation of undergraduate and postgraduate nursing education in Greece and to propose directions for its improvement. Undergraduate nursing education in Greece is two dimensional. Prospective students can obtain a degree as a registered nurse through both university-based degree studies and Technological Educational Institute (TEI) studies that differ significantly in both the provision of clinical experience and theoretical background due to their different course curricula and teaching staff. University graduates are provided with a better theoretical background while TEI graduates are usually better in clinically skills, even though both programmes lead to professional registration and are in accordance with European Union directives. Postgraduate studies in nursing science are mainly organized by the University of Athens, but recently joint postgraduate degrees of other university departments and TEIs, are possible. Changes that will lead to one common undergraduate nursing education leading to registration as a registered nurse, and organized in such a way that will reduce the gap between theory and practice is a proposal that is gradually gaining acceptance by the profession. However, the development of a single nursing degree in Greece is complex, and close cooperation between the government and the professional authorities is essential. © 2009 Elsevier Ltd. All rights reserved.

We aimed to provide a summary of the existing published knowledge on the association between adverse birth outcomes and the development of wheezing during the first two years of life. We carried out a systematic review of epidemiological studies within the MEDLINE database. Epidemiological studies on human subjects, published in English, were included in the review. A comprehensive literature search yielded 72 studies for further consideration. Following the application of the eligibility criteria we identified nine studies. A positive association and an excess risk of wheezing during the first two years of life were revealed for adverse birth outcomes. © 2009 by the authors.