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Keywords: osteoporosis; patient preference; burden of disease; quality of life EN osteoporosis patient preference burden of disease quality of life 107 118 12 02/08/23 20230101 NES 230101 Kyriakos Souliotis, SP 1, sp SP 2 sp Christina Golna, SP 2 sp Christina Poimenidou, SP 2 sp Tatiana Drakopoulou, SP 3 sp Memi Tsekoura, SP 2 sp Damon Willems, SP 4 sp Vasileios Kountouris, SP 5 sp Polyzois Makras SP 6 sp SP 1 sp Department of Social and Education Policy, University of Peloponnese, Corinth, Greece; SP 2 sp Research Department, Health Policy Institute, Maroussi, Greece; SP 3 sp Greek Bone Health Association "Petalouda", Perama, Greece; SP 4 sp Market Access Lead, UCB Pharma, Brussels, Belgium; SP 5 sp External Engagement Lead, UCB Pharma, Athens, Greece; SP 6 sp Department of Endocrinology and Diabetes and Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece Correspondence: Kyriakos Souliotis, Email [email protected] Plain Language Summary This study aimed to describe patient-reported health status and quality of life in postmenopausal women with severe osteoporosis in Greece, and to understand patient preferences for osteoporosis therapies. Finally, when participants in this study were asked to select their preferred treatment scenario between two unlabeled anabolic treatments, 70% opted for the scenario that shared treatment characteristics with romosozumab over a scenario that shared treatment characteristics with teriparatide. Around half of participants (58%) would consider their osteoporosis treatment to be effective if it led to a 50% reduction in future fracture risk, 10% would consider their osteoporosis treatment to be effective only if it led to an 80% reduction in risk, and almost 20% only if it led to at least a 90% reduction in risk. [Extracted from the article]

Simple Summary: Increasing screened and linked to care (SLTC) to a hypothetical 100% of eligible high-risk people in Greece leads to a statistically significant reduction in deaths and in total years lost due to lung cancer, when compared with the current SLTC paradigm. Over 5 years, the model predicted a difference of 339 deaths and 944 lost years between the hypothetical and current scenario. More specifically, the hypothetical scenario led to fewer deaths (−24.56%, p < 0.001) and fewer life years lost (−31.01%, p < 0.001). It also led to a shift to lower-stage cancers at the time of diagnosis. This study suggests that applying a 100% screening strategy amongst high-risk adults aged 50–80 would result in additional averted deaths and lung cancer life years lost (LCLYs) gained over 5-years in Greece. (1) Background: Lung cancer causes a substantial epidemiological burden in Greece. Yet, no formal national lung cancer screening program has been introduced to date. This study modeled the impact on lung cancer life years (LCLY) of a hypothetical scenario of comprehensive screening for lung cancer with low-dose computed tomography (LDCT) of the high-risk population in Greece, as defined by the US Preventive Services Taskforce, would be screened and linked to care (SLTC) for lung cancer versus the current scenario of background (opportunistic) screening only; (2) Methods: A stochastic model was built to monitor a hypothetical cohort of 100,000 high-risk men and women as they transitioned between health states (without cancer, with cancer, alive, dead) over 5 years. Transition probabilities were based on clinical expert opinion. Cancer cases, cancer-related deaths, and LCLYs lost were modeled in current and hypothetical scenarios. The difference in outcomes between the two scenarios was calculated. 150 iterations of simulation scenarios were conducted for 100,000 persons; (3) Results: Increasing SLTC to a hypothetical 100% of eligible high-risk people in Greece leads to a statistically significant reduction in deaths and in total years lost due to lung cancer, when compared with the current SLTC paradigm. Over 5 years, the model predicted a difference of 339 deaths and 944 lost years between the hypothetical and current scenario. More specifically, the hypothetical scenario led to fewer deaths (−24.56%, p < 0.001) and fewer life years lost (−31.01%, p < 0.001). It also led to a shift to lower-stage cancers at the time of diagnosis; (4) Conclusions: Our study suggests that applying a 100% screening strategy amongst high-risk adults aged 50–80, would result in additional averted deaths and LCLYs gained over 5 years in Greece. [ABSTRACT FROM AUTHOR]

Purpose: We estimate the association between forgetfulness to take medications as prescribed and polypharmacy and health-related quality of life (HRQoL) among a cohort of patients with hypertension, dyslipidemia or both in Greece during the COVID-19 pandemic. Methods: A telephone survey of 1018 randomly selected adults was conducted in Greece in June 2020. Participants were included in the survey, if they (a) had a diagnosis of hypertension, dyslipidemia or both and (b) were on prescription treatment for these conditions. HRQoL was calculated using the short form (SF) -12 Patient Questionnaire. A multivariable generalized linear regression model (GLM) was used to estimate the association between forgetfulness and polypharmacy and HRQoL, controlling for sociodemographic and health-related covariates. Results: Overall, 351 respondents met the inclusion criteria, of whom 28 did not fully complete the questionnaire (response rate: 92%, n = 323). Of those, 37% were diagnosed with hypertension only, 28% with dyslipidemia only, and 35% with both. Most reported good to average physical (64.1%) and mental health (48.6%). Overall, 25% indicated that they sometimes forget to take their prescribed medications, and 12% took two or more pills multiple times daily. Total HRQoL score was 68.9% (s.d. = 18.0%). About 10% of participants reported paying less attention to their healthcare condition during the pandemic. Estimates of multivariable analyses indicated a negative association between forgetfulness (− 9%, adjusted β: − 0.047, 95% confidence interval − 0.089 to − 0.005, p = 0.029), taking two or more pills multiple times daily compared to one pill once a day (− 16%, adjusted β: − 0.068, 95% confidence interval − 0.129 to − 0.008, p = 0.028) and total HRQoL. Conclusion: Our results suggest that among adult patients with hypertension, dyslipidemia or both in Greece, those who forget to take their medications and those with more complex treatment regimens had lower HRQoL. Such patients merit special attention and require targeted approaches by healthcare providers to improve treatment compliance and health outcomes. [ABSTRACT FROM AUTHOR]

Background: Strict glycaemic control early in the treatment process has been shown to reduce the occurrence of micro- and macro- vascular complications of diabetes in the long-term. Thus, treatment guidelines advise early intensification of treatment to achieve glycaemic control goals. However, evidence in Greece suggests that, despite guideline recommendations, glycaemic control among patients with T2DM remains challenging. This study presents the demographic and clinical characteristics of patients with T2DM in Greece using data from an electronic registry designed specifically for this treatment category and investigates the factors that are independently associated with glycaemic control. Methods: This is a multi-center, observational, cross-sectional study to investigate epidemiological and clinical factors affecting glycaemic control among patients with T2DM in Greece. Data was collected via a web-based disease registry, the Diabetes Registry, which operated from January 1st to December 31st, 2017. Five large specialized diabetes centers operating in Greek hospitals participated in the study. Results: Data for 1141 patients were retrieved (aged 63.02 ± 12.65 years, 56.9% male). Glycaemic control (Hb1Ac < 7%) was not achieved in 57.1% of patients. Factors independently associated with poor glycaemic control were: family history of diabetes [OR: 1.53, 95% CI: 1.06–2.23], BMI score between 25 to 30 [OR: 2.08, 95% CI: 1.05–4.13] or over 30 [OR: 2.12, 95% CI 1.12–4.07], elevated LDL levels [OR: 1.53, 95% 1.06–2.21] and low HDL levels [OR: 2.12, 95% CI: 1.44–3.12]. Lastly, use of injectable antidiabetic agents (in monotherapy or in combination) was less likely to be associated with poor glycaemic control versus treatment with combination of oral and injectable agents [OR: 0.50, 95% CI: 0.24–1.01]. This association was found to be marginally statistically significant. Conclusion: Inadequate lipid control, family history of diabetes and presence of obesity (ΒΜΙ ≥ 30 kg/m2) were associated with poor glycaemic control among study sample, whereas use of injectable antidiabetic agents was less likely to be associated with poor glycaemic control. These findings indicate how complex optimal glycaemic control is, highlighting the need for tailored interventions in high-risk subpopulations with T2DM. [ABSTRACT FROM AUTHOR]

Introduction: Rheumatoid Arthritis (RA) is a highly prevalent autoimmune disease associated with joint inflammation and destruction. Treatment for RA, especially with biologic agents (biologics), improves patient functionality and quality of life and averts costly complications or disease progression. Cost of RA pharmaceutical treatment has rarely been reported on the basis of real-world, big data. This study reports on the real-world, big data RA pharmaceutical treatment cost in Greece. Methods: The Business Intelligence database of the National Organization for Healthcare Services Provision (EOPYY) was used to identify and provide analytics on patients on treatment for RA. EOPYY is responsible for funding healthcare and pharmaceutical care services for approximately 95% of the population in the country. ICD-10 codes were applied to identify patients with RA and at least one reimbursed prescription between 1 June 2014 and 31 May 2015. Results: 35,873 unique patients were recorded as undergoing treatment for RA. Total reimbursed treatment cost for the study period was €81,206,363.70, of which €52,732,142.18 (64.94%) was for treatment with biologics. Of that cost, €39,724,489.71 (48.32%) accounted for treatment with anti-TNFs and/or methotrexate/corticosteroids. Conclusion: Real world, big data analysis confirms that the major driver of RA pharmaceutical cost is, as expected, the cost of treatment with biologics. It is critical to be able to match this cost to the treatment outcome it produces to ensure an optimal, no-waste, evidence-based allocation of healthcare resources to need. [ABSTRACT FROM AUTHOR]

In Greece no study has ever been conducted on the prevalence of problem gambling. Therefore, a cross-sectional survey was carried out amid the recession aiming to (1) estimate past year prevalence of problem gambling, (2) explore socio-economic and demographic differences among gamblers and non gamblers, (3) explore socio-economic and demographic differences among gamblers who started gambling prior and during the downturn and (4) identify its risk factors with a special interest in the influence of the recession. To this end, data emanating from a telephone and patron survey were combined. A random and representative sample of 3.404 people participated in the telephone survey and 2.400 in the patron survey. The interview schedule was the same in both studies. The presence of problem gambling was assessed with the Canadian Problem Gambling Index. Information on participants' socio-economic and demographic characteristics as well as their ways of dealing financially with the crisis were collected. Findings indicated that 2.4% of respondents met criteria for problem gambling. Male gender, minority status, living with family of origin, low educational level and low to zero income were found to constitute the risk factors of the disorder. Moreover, having started gambling during the recession increased the odds of suffering from problem gambling; however this finding was gender-specific. Thus, people end up in problem gambling through various pathways, with these trajectories being different for men and women. Any intervention should address the complexity of the issue and be tailored by gender. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis (IPF) is a rare, chronic lung disease with a high mortality rate. IPF affects about 5 million people worldwide with median survival being 2-5 years following diagnosis. Until recently, there was no licensed pharmacologic therapy available for IPF and patients were managed by best supportive care, that includes treatment with pirfenidone. In 2015, nintedanib was approved for the treatment of IPF. This study estimates the reimbursement of nintedanib and its budget impact on the National Organization for Health Care Services Provision (EOPPY). The budget impact of reimbursing nintedanib as part of already available treatment options corresponds to a maximum of 0.13% of annual total pharmaceutical expenditure. Therefore, it has a relatively low impact on the budget of EOPPY, while use of nintedanib was associated with a higher number of acute exacerbation events being avoided, thus providing additional cost savings to EOPPY. [ABSTRACT FROM AUTHOR]

Background: The present study focuses on studying the validity and reliability of the Greek edition of DQOL-BCI. DQOL-BCI includes 15 questions-elements that are evaluated on a 5-grade scale like Likert and two general form-shapes.Methods: The translation process was conducted in conformity with the guidelines of EuroQol group. A non-random sample of 65 people-patients diagnosed with diabetes I and II was selected. The questionnaire that was used to collect the data was the translated version of DQOL-BCI, and included the demographic characteristics of the interviewees. The content validity of DQOL-BCI was re-examined from a team of five experts (expert panel) for qualitative and quantitative performance. The completion of the questionnaire was done via a personal interview.Results: The sample consisted of 58 people (35 men and 23 women, 59.9 ± 10.9 years). The translation of the questionnaire was found appropriate in accordance to the peculiarities of the Greek language and culture. The largest deviation of values is observed in QOL1 (1.71) in comparison to QOL6 (2.98). The difference between the standard deviations is close to 0.6. The statistics results of the tests showed satisfactory content validity and high construct validity, while the high values for Cronbach alpha index (0.95) reveal high reliability and internal consistency.Conclusions: The Greek version of DQOL-BCI has acceptable psychometric properties and appears to demonstrate high internal reliability and satisfactory construct validity, which allows its use as an important tool in evaluating the quality of life of diabetic patients in relation to their health. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patient organization participation in health policy decision making is an understudied area of inquiry. A handful of qualitative studies have suggested that the growing number of patient organizations in Europe and their increasing involvement in policy issues do not result in high political effectiveness. However, existing research is largely country‐specific. Objective: To examine the degree and impact of cancer patient organization (CPO) participation in health policy decision making in EU‐28 and to identify their correlates. Methods: A total of 1266 members of CPOs participated in this study, recruited from a diversity of sources. CPO participation in health policy was assessed with the Health Democracy Index, a previously developed instrument measuring the degree and impact of patient organization participation in various realms of health policy. Additional questions collected information about participants' and the CPO's characteristics. Data were gleaned in the form of an online self‐reported instrument. Results: The highest degree of CPO participation was observed with respect to hospital boards, reforms in health policy and ethics committees for clinical trials. On the contrary, the lowest was discerned with regard to panels in other important health‐related organizations and in the Ministry of Health. The reverse pattern of results was observed concerning the Impact subscale. As regards the correlates of CPO participation, legislation bore the strongest association with the Degree subscale, while organizational factors emerged as the most important variables with regard to the Impact subscale. Conclusions: Research findings indicate that a high degree of CPO participation does not necessarily ensure a high impact. Efforts to promote high and effective CPO participation should be geared towards the establishment of a health‐care law based on patient rights as well as to the formation of coalitions among CPOs and the provision of training to its members. [ABSTRACT FROM AUTHOR]

Background: Although the need for integration of mental health services into primary care is well established little has been done. The outbreak of the recession found the Greek mental health system in transition. As a response to the crisis, governments implemented horizontal budget cuts instead of health reforms. This resulted in an unfavorable situation for mental health which was set once again on the sidelines of the health policy agenda. Previous studies suggest that the most prevalent disorders in the years of financial crisis in Greece are depression and anxiety while a general increase of the psychiatric morbidity is observed does not follow the population' needs. Methods: The present descriptive study was carried out between March and June of 2015. A convenience sample of 174 psychiatrists and psychiatry residents who met the inclusion criteria were finally selected to participate. Data were collected by using a 40-items questionnaire consisted of three sections: (a) nine questions about demographics, (b) nine questions pertaining to general aspects of administrative regulations related to primary care, (c) 22 questions about psychiatrists attitudes and perceptions towards their role in primary care. Quantitative variables are expressed as mean values, while qualitative variables as absolute and relative frequencies. Results: The vast majority of participants perceives the public primary care services and mental health services in their community as inadequate and considers psychiatrists' participation in primary care as important in order to improve the detection and management rates of people demonstrating mental health symptoms. They also believe that: (a) primary care practitioners' usually fail to detect the mental health conditions of patients; (b) their participation in primary care will decrease the social stigmatization for mental health conditions; (c) patients receiving pharmaceutical treatment for mental health problems by GPs and other primary care professionals usually fail to comply. Conclusions: Respondents in the present study are receptive to participate in primary care. They believe that their inclusion to primary care will result to decreased social stigmatization for mental health problems, increased patient' access and improved detection and management rates for common mental health conditions. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that Greece is among the European countries with increased trend in HCV prevalence among injecting drug users (IDUs) from 2008 to 2014. Nonetheless, the access of IDUs to treatment for Hepatitis C Virus (HCV) is very limited while the risk of co-infection and transmission remains high. In an effort to better understand the inhibitors to HCV treatment, the present study aimed to investigate the main barriers to access in a sample of IDUs. Methods: The cross-sectional study was carried out between July and September 2015 using a 23-items questionnaire. Participants were recruited from urban primary services, mobile health vans, community health services, day-care centers as well as during street work, located in Athens, Greece. Inclusion criteria were age above 18 years, understanding and speaking Greek sufficiently, HCV diagnosis, intravenous drug use. Data collection was carried out by health professionals of Praksis, a non-governmental organization. For the comparisons of proportions chi-square and Fisher's exact tests were used. Results: The study sample consisted of 101 HCV patients, 68% male. More than 80% of study participants experienced barriers in accessing their doctor and medication during the past 12 months. The most common obstacles in accessing a doctor were "delay in making the appointment and "difficulties in going to the doctor due to health condition or lack of means of transport". Access to physician or medication was not differed according to gender, but significant differences were found according to economic status and health insurance coverage. 56.1% of participants reported loss or treatment delay due to barriers to treatment. The majority of participants had deteriorated financial status, health status, access to health services and medication, higher financial burden for health services, worse mental health and lower adherence to medical instructions in 2015 compared to 2009. Conclusions: The findings from the present study revealed that the vast majority of IDUs experience significant barriers in seeking HCV care in Greece, thus highlighting the need for immediate action in this particular area due to the high risk of co-infection and transmission. [ABSTRACT FROM AUTHOR]

Recently the Norwegian Health Minister ordered the creation of medication-free treatment wards as a result of the lobbying by patients' groups and activists. The idea behind this is that patients should have the right to choose their treatment, but for the first time, with this arrangement, the user/patient does not choose between treatment options; he literally determines by himself what efficacious treatment is. In our opinion this is another step towards a 'reverse stigma' which denies patients the right to be considered as such and eventually kicks them out of the health care system, deprives them of the right for proper treatment and care and instead puts them at the jurisdiction of the much cheaper and ineffective social services. [ABSTRACT FROM AUTHOR]

Since 2009, Greece has experienced a long-lasting socioeconomic crisis that has had substantial consequences on the health and mental health of the population. Unemployment, financial hardship and income loss constitute the hallmarks of the socioeconomic landscape. Consequently, a substantial decline in health and mental health has been documented. Converging evidence corroborates a deterioration of self-rated health, an alarming rise in suicide rates and a gradual increase in the prevalence of major depression. Concomitantly, the healthcare system is on the verge of collapse and the mental healthcare system is incapable of addressing the emerging needs. Therefore, a multifaceted and concerted effort is urgently needed to mitigate the mental health effects of the recession. [ABSTRACT FROM AUTHOR]

Research evidence suggests that access to health care is the key influential factor for improved population health outcomes and health care system sustainability. Although the importance of addressing barriers in access to health care across European countries is well documented, little has been done to improve the situation. This is due to different definitions, approaches and policies, and partly due to persisting disparities in access within and between European countries. To bridge this gap, the Patient Access Partnership (PACT) developed (a) the '5As' definition of access, which details the five critical elements (adequacy, accessibility, affordability, appropriateness, and availability) of access to health care, (b) a multi-stakeholders' approach for mapping access, and (c) a 13-item questionnaire based on the 5As definition in an effort to address these obstacles and to identify best practices. These tools are expected to contribute effectively to addressing access barriers in practice, by suggesting a common framework and facilitating the exchange of knowledge and expertise, in order to improve access to health care between and within European countries. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is one of the top leading causes of death and disability, and its management is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. The study aim was to describe COPD prescribing patterns in Greece by using existing health administrative data for outpatients. Methods: This is a retrospective cross-sectional study based on prescriptions collected by the largest social insurance fund, during the first and last trimester of 2012. Selection criteria were the prescription of specific active substances and a COPD diagnosis. Extracted information included active substance, strength, pharmaceutical form and number of packages prescribed, diagnosis, time of dispensing, as well as insurees’ age, gender, percentage of co-payment and social security unique number. Statistical analysis included descriptive statistics and logistic regression. Results: 174,357 patients received medicines for COPD during the study period. Patients were almost equally distributed between male and female, and age above 55 years was strongly correlated with COPD. Most patients received a long-acting beta agonist plus inhaled corticosteroid combination (LABA +ICS), followed by long-acting muscarinic agonist (LAMA). 63% patients belonging in the 35–54 age received LABA+ICS. LAMA was prescribed more frequently among males and was strongly correlated with COPD. Conclusion: The study provides big data analysis of Greek COPD prescribing patterns. It highlights the need for appropriate COPD classification in primary care illustrating the role of electronic prescribing in ensuring appropriate prescribing. Moreover, it indicates possible gender differences in treatment response or disease severity, and the impact of statutory co-payments on prescribing. [ABSTRACT FROM AUTHOR]

The aim of the study was a cost and clinical effectiveness analysis between moist wound healing dressings and gauze in a homecare set up for the treatment of stage III and IV pressure ulcers up to complete healing. In addition, we assessed the overall economic burden on the Healthcare System. Treatment method for each patient was chosen randomly by using sealed opaque envelopes. The authors monitored the healing progress and recorded treatment costs without interfering with the treatment process. The healing progress was estimated by using surface measurement transparent films. To estimate treatment costs, the authors took into account labor costs, cost of dressings, as well the cost of other materials such as cleansing gauzes, normal saline, syringes, examination gloves, antiseptics and adhesive tape. The patient group under treatment with moist wound healing dressings consisted of 27 men and 20 women aged 75.1 ± 8,6 and had an average ulcer surface of 43.5 ± 30.70 cm2; the patient group under treatment with gauze comprised 25 men and 23 women aged 77.02 ± 8.02 and had an average ulcer surface 41.52 ± 29.41 cm2 ( p = 0.25, 95% CI, Student's t test). The average healing time for the moist wound healing dressings group' was 85.56 ± 52.09 days, while 121.4 ± 52.21 days for the 'gauze group' ( p = 0.0001, 95% CI, Student's t test). The dressing change frequency per patient was reduced in the 'moist wound healing dressings group,' 49.5 ± 29.61, compared with a dressing change frequency per patient of 222.6 ± 101.86 for the 'gauze group' ( p = 0.0001, 95% CI, Student's t test). The use of moist wound healing dressings had a lower total treatment cost of 1,351 € per patient compared with, the use of gauzes (3,888 €). [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the patient-centred care fundamentals in otorhinolaryngology, the service user involvement in mental health, and the use of decision aid for patients who experienced dire side-effects.

Background: Despite the documentation of addressing healthcare disparities in detection and treatment of cancer and health outcomes for cancer patients, the inequalities persist. Cancer patients of several vulnerable groups suffer disproportionally the effect of economic crisis on health and healthcare. Patients & Methods: A cross sectional survey was carried out between July and October 2014 in order to assess the cancer patients' barriers to healthcare access. A total of 426 cancer patients, members of cancer patient organization participated in the study. Data were collected by using an online, self reported questionnaire evaluating three main areas: healthcare access (7 items), economic status and financial burden of the disease (17 items) and the alteration on several aspects related to the disease (8 items) from 2009 to 2014. Results: Approximately 31% of cancer patients reported that they faced barriers to healthcare access for cancer treatment during the last 12 months. The main barriers included long waiting time for a medical appointment (51%) and inability to visit a private physician due to the incapability to pay the out of pocket cost (44%). One in four patient encountered obstacles in medication access which resulted to treatment delay (46%), worsened health status (96%) and increased out of pocket costs (39%). Conclusions: Results suggest that there are vulnerable groups among cancer patients in Greece who suffer disproportionally more the impact of economic crisis on health and healthcare. Healthcare reforms and targeted interventions should be implemented in order to effectively address the inequities in access for cancer patients. [ABSTRACT FROM AUTHOR]

Cancer accounts for approximately 13 % of all deaths worldwide. Development of stratification biomarkers, for cancer screening, diagnosis, monitoring, and treatment optimization, is a vital concept to facilitate disease prevention and drug development. The advent of stratified medicine should result in the safer, more effective use of therapeutic drugs to treat cancer, and in reducing the cost associated with inappropriate therapeutic regimens; however, many barriers delay the use of biomarkers in drug development and clinical practice. Since the incorporation of biomarkers in clinical practice might have additional initial costs, the question arises regarding whether the improvement in outcomes is reached at a realistic additional cost. This review presents an overview of economic issues surrounding biomarkers in cancer treatment optimization. [ABSTRACT FROM AUTHOR]

The article discusses various topics published within the issue including the development of a tool for evaluating patients' communication patterns, the patients' perspective on physician behaviours during end-of-life communication and the ways biosample donors conceptualize their donation.

Background The present study's aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. Methods Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation. Results Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health. Conclusions Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices. [ABSTRACT FROM AUTHOR]

The latest regulatory change in the distribution system of biologic disease-modifying, antirheumatic drugs limited their sale only through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (NHS) hospitals, adding to the complexity of access to effective treatment for rheumatoid arthritis (RA) in Greece. The aim of this paper was to assess the barriers to access RA treatment, by recording patients', rheumatologists' and EOPYY pharmacists' experiences. One twenty-three patients, 12 rheumatologists and 27 pharmacists from Athens and other urban areas in Greece participated in the study. Three types of standardized questionnaires were used to elicit information from each group of respondents using the method of personal interview for patients and the method of postal survey for doctors and pharmacists. During the last year, 26 % of patients encountered problems in accessing their rheumatologist and 49 % of patients experienced difficulties in accessing their medication. Ninety-two percent of rheumatologists and 96 % of pharmacists confirmed that patients experience difficulties in accessing RA medication. The most commonly reported reasons for reduced access to medical treatment were travel difficulties and long distance from doctor's clinic, as well as delays in booking an appointment. The most frequently reported barriers to access pharmaceutical treatment were difficulties in the prescription process, distance from EOPYY pharmacies and medicine shortages in NHS hospitals. The study showed that RA patients are facing increased barriers to access timely and effective treatment. Redesign of the current system of distribution ensuring the operation of additional points of sale is deemed necessary. [ABSTRACT FROM AUTHOR]

Background Maternal depression has a negative impact on both the mother and child's physical and mental health, as well as impairs parenting skills and pediatric health care utilization. The pediatricians' role in identification and management of maternal depression is well established. Although it can be successfully and easily treated, maternal depression remains under-recognized and under-treated. Despite the heightened emphasis, there is lack of interventions to pediatricians in order to improve detection and management of maternal depression. Methods To address this gap, an educational intervention based on the 'Health Belief Model' was developed, implemented, and evaluated. The present quasi-experimental study, aimed to assess the pediatricians' knowledge, self-efficacy, beliefs, and attitudes toward maternal depression at baseline and post-intervention measurements. A total of 43 randomly selected primary care pediatricians residing in Athens completed a 59-item survey by mail in 2011. Pediatricians in the intervention group received a toolkit about the recognition and management of maternal depression, while pediatricians in the control group received a leaflet about mental health. Descriptive statistics, t test, chi-square, Fisher's exact test, and analysis of variance were used for the statistical analysis. Results Post-intervention measurement revealed differences at a statistical significance level between the two groups, in the following variables: beliefs, attitudes, self- efficacy, perceived barriers, and management practices of maternal depression. Furthermore, at post-measurement, pediatricians in the intervention group demonstrated increased perceived responsibility and increased self-efficacy for detection and referral of maternal depression. Conclusions Educational interventions to pediatricians seem to be beneficial for the improvement of the pediatricians' knowledge, self-efficacy, and attitudes regarding maternal depression. Studies using large, representative population samples are needed to provide evidence if the training interventions to pediatricians for maternal depression are translated to changes in their clinical practice and improved the patients' health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The quest of specialized oncology services represents an inelastic need for cancer patients that often leads to traveling in order to receive adequate care. The present survey assesses patient geographic mobility to access services for the prevention and treatment of neoplasmatic diseases in Greece, a country where the National Health System is characterized by severe misdistribution of oncology-specific resources. Methods: Based on data from the National Statistical Service for 1999-2005 (last available), we estimated geographic mobility as the difference between oncology patients residing in a specific region and those receiving care in National Health System (NHS) facilities located in the region, for the ten administrative districts of Greece. Especially for Attica, we performed a sub-analysis according to cancer diagnosis. Results: The most significant mobility is towards Attica, where patients receiving care within the region outnumber the patients actually residing by 48.9% annually, on average. Positive flows are also observed towards Macedonia (8.4%) and Epirus (7.8%). Negative flows are recorded in all remaining regions, the highest noticed in Sterea (−76.2%), Ionian Islands (−63.3%), Aegean Islands (−45.2%), and Thessaly (−37.3%). The largest flow towards Attica is for cases of malignant neoplasms of the skin, uterus, male genital organs, and for Hodgkin's lymphomas. Conclusions: Misallocation of oncology-specific resources creates 'two-tier' cancer patients based on ability to pay for traveling/accommodation. The severity and the consequences of the disease necessitate a bold approach to resource allocation and the establishment of integrated patient support networks that ensure all cancer patients are offered equal opportunities to effective treatment. [ABSTRACT FROM AUTHOR]

We assessed the vaccination effectiveness (VE) of a COVID-19 booster vaccine dose and the association between morbidity and absenteeism with COVID-19 booster vaccine receipt among healthcare personnel (HCP) in 2022–2023 in Greece. We followed 5752 HCP from November 14, 2022 through May 28, 2023 for episodes of absenteeism. Absenteeism for non-infectious causes, pregnancy leave, or annual leave was not recorded. Full vaccination was defined as a primary vaccination series plus one booster dose within the past six months. Multivariable regression models were used to estimate the association of full COVID-19 vaccination with the outcomes of interest. A total of 1029 episodes of absenteeism occurred during the study period (17.9 episodes per 100 HCP). The mean duration of absence per episode was 5.2 days, and the total duration of absence was 5237 days. COVID-19 was diagnosed in 736 (12.8 %) HCP, asymptomatic SARS-CoV-2 infection in 62 (1.1 %) HCP, and influenza in 95 (1.7 %) HCP. Overall, COVID-19, influenza, and asymptomatic SARS-CoV-2 infection accounted for 71.5 %, 9.2 %, and 6.0 % of episodes of absenteeism, respectively. Multivariable regression models indicated that fully vaccinated HCP were absent from work for shorter periods [adjusted odds ratio (aOR): 0.42; 95 % confidence interval (CI): 0.21–0.83], were less likely to develop COVID-19 [aOR: 0.37; 95 % CI: 0.17–0.81)], and were more likely to develop an asymptomatic SARS-CoV-2 infection (aOR: 5.90; 95 % CI: 1.27–27.45). The adjusted full VE against COVID-19 was 62.8 % (95 % CI: 18.6 %-83.0 %). COVID-19 remains a significant cause of morbidity and absenteeism among HCP. Full COVID-19 vaccination status conferred significant protection against COVID-19 and was associated with shorter periods of absence from work. [ABSTRACT FROM AUTHOR]

The article offers information on increased public involvement while making health policies. Topics discussed include patients participating in decision making related to health, papers concerning research on mental health by achieving better data in care homes and optimal care with health literacy for patients.

Simple Summary: Clear cell renal cell carcinoma (ccRCC) is the most common form of renal cancer. Currently, treatment of metastatic ccRCC (mccRCC) is challenging despite the use of modern immunotherapy options. In order for the patient to receive the most effective treatment among the available pharmaceutical agents, there is a constant need for biomarkers that can predict therapeutic efficacy. The present study investigates changes in the mRNA expression of genes related to inflammation and immunity in patient blood. By using machine learning approaches, several changes in mRNA expression levels were observed in patients who had clinical benefit from the treatment compared to patients with progressive disease. Collectively, our results show that gene expression can be used to classify these samples with high accuracy and specificity. Clear cell renal cell carcinoma (ccRCC) is the most common renal cancer. Despite the rapid evolution of targeted therapies, immunotherapy with checkpoint inhibition (ICI) as well as combination therapies, the cure of metastatic ccRCC (mccRCC) is infrequent, while the optimal use of the various novel agents has not been fully clarified. With the different treatment options, there is an essential need to identify biomarkers to predict therapeutic efficacy and thus optimize therapeutic approaches. This study seeks to explore the diversity in mRNA expression profiles of inflammation and immunity-related circulating genes for the development of biomarkers that could predict the effectiveness of immunotherapy-based treatments using ICIs for individuals with mccRCC. Gene mRNA expression was tested by the RT2 profiler PCR Array on a human cancer inflammation and immunity crosstalk kit and analyzed for differential gene expression along with a machine learning approach for sample classification. A number of mRNAs were found to be differentially expressed in mccRCC with a clinical benefit from treatment compared to those who progressed. Our results indicate that gene expression can classify these samples with high accuracy and specificity. [ABSTRACT FROM AUTHOR]

Background: Adherence to medication in chronic conditions may be influenced by interventions from pharmacists. This study aimed to assess the impact of guidance and reminders from pharmacists on adherence to medication for hypertension, dyslipidemia, and chronic venous circulation disorders (CVCD) in Greece.Methods: The prospective CONCORD study aimed to record and report on change in self-reported adherence to medication following pharmacist reminders amongst a cohort of adult patients, diagnosed with at least one or a combination of these health conditions. All study participants were regular patients of a network of pharmacies in Attica and southern Greece. Pharmacists were trained to provide adherence reminders over 4 months. Impact on self-reported adherence of the intervention was reported at baseline and again in month 4.Results: Of the 1146 participants, 48% were men and 60% were aged 55– 74 years. Among them, 23.7% were diagnosed with hypertension, 16.5% with dyslipidemia, 3% with CVCD, 42.5% with hypertension and dyslipidemia, 3.1% with hypertension and CVCD, 2.6% with dyslipidemia and CVCD, and 8.6% with dyslipidemia, hypertension, and CVCD. In month 4 vs month 0, patients were less likely to forget to take their prescribed medications (p< 0.001), to be careless about their medications during the last 30 days (p< 0.001), and to temporarily discontinue their medications without prior doctor's advice (p< 0.001). Patients with CVCD were more prone to lower self-reported adherence compared to patients who were not diagnosed with CVCD or a combination of conditions that included CVCD.Discussion: Reminders and advice from pharmacists resulted in higher adherence to medication amongst participants in month 4 versus month 0.Conclusion: Pharmacist-enabled interventions, including reminders and advice, following targeted training, may positively impact on patient medication adherence in chronic health conditions.Plain Language Summary: This study aimed to measure the impact of reminders and advice on adherence to medication provided by private pharmacists to patients with hypertension, dyslipidemia, and/or chronic venous circulation disorders (CVCD) in Greece. Patients were asked to self-report adherence to medication at months 0 and 4, following advice and reminders received from trained pharmacists. Self-reported adherence was significantly improved at month 4 vs month 0 across our sample. Our study showed that pharmacist-enabled interventions, following targeted training, can quickly and significantly improve adherence to medication in patients with chronic diseases in Greece. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the impact of social distancing interventions in Greece and to examine what would have happened if those interventions had not been implemented. A dynamic, discrete time, stochastic individual-based model was developed to simulate coronavirus disease 2019 (COVID-19) transmission. The model was fitted to the observed trends in COVID-19 deaths and intensive care unit (ICU) bed use in Greece. If Greece had not implemented social distancing interventions, the healthcare system would have been overwhelmed between March 30 and April 4. The combined social distancing interventions and increase in ICU beds averted 4360 (95% credible interval: 3050, 5700) deaths and prevented the healthcare system from becoming overwhelmed. The quick and accurate interventions of the Greek government limited the burden of the COVID-19 outbreak. • Without the social distancing (SD) interventions, the healthcare system would have been overwhelmed by early April. • The early implementation of the SD interventions prevented 4360 (95% credible interval: 3050, 5700) deaths by April 27. • Any interventions to boost health care capacity, without the simultaneous of SD interventions, would not have been effective. • The decision of the Greek government to launch early SD measures resulted in limiting the burden of the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including patient involvement in mental health care, an assessment of a two-state process for health care research prioritization, and intervention for family carers of people with dementia.

There has been much discussion on the devastating impact of austerity and the continuing economic crisis on the health system in Greece during the last few years, but little on the underlying reasons responsible for the continued failure to reform it. What is not widely known is that with the first "memorandum" in 2012 between Greece and the European Union (EU), the Law 4052/2012 [[5]] reformed the geographic areas of the YPE in a more rational way (Fig. During the latter, what should be the "typical" way of managing the Ministry of Health, Greece experienced 26 changes of person in the position of Minister of Health with a mean 18.4 ± 11.4 (3.1-47.4) months of service in office. [Extracted from the article]

Background: Only a handful of studies have explored the effect of the financial crisis on public attitudes to mental illness. Aims: This study examines changes in lay attitudes to depression and psychiatric medication between 2009 and 2014 in Attica region. Furthermore, it explored a potential interaction with employment status. Methods: Data were drawn from two surveys conducted in 2009 and 2014 using the same sampling procedure, interview mode, and survey instrument. Specifically, a random and representative sample of 586 people was recruited in 2009 and of 604 in 2014. Attitudes to depression were measured by the Personal Stigma subscale of the Depression Stigma Scale and attitudes to psychiatric medication by a self-constructed scale with good psychometric properties. Data collection occurred via telephone. Results: There has been no overall change in lay attitudes to depression. Nonetheless, a positive change was recorded with regard to the belief that depression is a sign of personal weakness and a negative change with respect to people with depression being dangerous. Attitudes to psychiatric medication have worsened during the study period. Employment status was not found to interact with the survey year. Conclusion: Anti-stigma efforts should be tailored on counteracting the dangerousness stereotype, while they should prioritize targeting attitudes to psychiatric medication [ABSTRACT FROM AUTHOR]

• The prevalence of depression is alarmingly high among people with low income. • The income-depression association is stronger in men than in women. • Income is strongly and independently associated with suicidality only among men. • Financial difficulties influence depression but not suicidality. The interplay between objective and subjective measures of economic hardship on influencing mental health has not been explored during a period of enduring recession. The present study aims to fill this gap by investigating the relationship between income and economic difficulties in evoking major depression and suicidality in Greece, while taking into consideration gender differences. A random and representative sample of 2188 adults participated in a telephone survey in 2013 (response rate = 81%). Major depression and suicidality were assessed with the pertinent modules of SCID-IV; while financial difficulties were measured by the Index of Personal Economic Distress. Information on confounder variables was also gleaned. Income exerted an independent effect on major depression (OR = 0.37, 95%CI = 0.22–0.63), which was more pronounced among men than women. On the contrary, financial difficulties exerted a strong and independent effect on depression (OR = 1.16, 95%CI = 1.13–1.2). Income was found to bear a strong association with suicidality only among men; whereas financial difficulties were unrelated in both genders. Subjective and objective indices of economic hardship exert a differential impact on mental health outcomes amid recession. Gender-sensitive policies and interventions should be geared towards softening the social effects of the recession in the country. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial resistance (AMR) is a major public health threat worldwide. Greece has the highest burden of infections due to antibiotic-resistant bacteria among European Union/European Economic Area (EU/EEA) countries. One of the most serious AMR threats in Greece is hospital-acquired infections (HAIs) with limited treatment options (LTO) caused by resistant gram-negative pathogens. Thus, this study sought to estimate the current AMR burden in Greece and the value of reducing AMR to gram-negative pathogens for the Greek healthcare system. Methods: The current model was adapted from a previously published and validated model of AMR to investigate the overall and AMR-specific burden of treating the most common HAIs with LTO in Greece and scenarios to demonstrate the benefits associated with reducing AMR levels from a third-party payer perspective. Clinical and economic outcomes were estimated over a 10-year time horizon; life years (LYs) and quality-adjusted life years (QALYs) were calculated over a lifetime (based on the annual number of infections over 10 years) at a willingness-to-pay of €30,000 per QALY gained and a 3.5% discount rate. Results: In Greece, the current AMR levels in HAIs with LTO caused by four gram-negative pathogens account for > 316,000 hospital bed days, €73 million in hospitalisation costs, and > 580,000 LYs and 450,000 QALYs lost over 10 years. The monetary burden is estimated at €13.9 billion. A reduction in current AMR levels by 10–50% results in clinical and economic benefit; 29,264–151,699 bed days may be saved, leading to decreased hospitalisation costs (€6.8 million–€35.3 million) and a gain in LYs (85,328–366,162) and QALYs (67,421–289,331), associated with a monetary benefit of between €2.0 billion and €8.7 billion. Conclusion: This study shows the substantial clinical and economic burden AMR represents to the Greek healthcare system and the value that can be achieved by effectively reducing AMR levels. [ABSTRACT FROM AUTHOR]

The recognition of cardiovascular disease (CVD) as a “male” privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies. [ABSTRACT FROM AUTHOR]

We estimated vaccine effectiveness (VE) of full (booster) vaccination against severe outcomes in hospitalized COVID-19 patients during the Delta and Omicron waves. The study extended from November 15, 2021 to April 17, 2022. Full vaccination was defined as a primary vaccination plus a booster ≥ 6 months later. We studied 1138 patients (mean age: 66.6 years), of whom 826 (72.6 %) had ≥ 1 comorbidity. Of the 1138 patients, 75 (6.6 %) were admitted to intensive care unit (ICU), 64 (5.6 %) received mechanical ventilation, and 172 (15.1 %) died. There were 386 (33.9 %) fully vaccinated, 172 (15.1 %) partially vaccinated, and 580 (51 %) unvaccinated patients. Unvaccinated patients were absent from work for longer periods compared to partially or fully vaccinated patients (mean absence of 20.1 days versus 12.3 and 17.3 days, respectively; p-value = 0.03). Compared to unvaccinated patients, fully vaccinated patients were less likely to be admitted to ICU [adjusted relative risk (ARR: 0.49; 95 % CI: 0.29–0.84)], mechanically ventilated (ARR: 0.43; 95 % CI: 0.23–0.80), and die (ARR: 0.57; 95 % CI: 0.42–0.78), while they were hospitalized for significantly shorter periods (ARR: 0.79; 95 % CI: 0.70–0.89). The adjusted full VE was 48.8 % (95 % CI: 42.7 %-54.9 %) against ICU admission, 55.4 % (95 % CI: 52.0 %-56.2 %) against mechanical ventilation, and 22.6 % (95 % CI: 7.4 %-34.8 %) against death. For patients with ≥ 3 comorbidities, VE was 56.2 % (95 % CI: 43.9 %-67.1 %) against ICU admission, 60.2 % (95 % CI: 53.7 %-65.4 %) against mechanical ventilation, and 43.9 % (95 % CI: 19.9 %-59.7 %) against death. Full (booster) COVID-19 vaccination conferred protection against severe outcomes, prolonged hospitalization, and prolonged work absenteeism. [ABSTRACT FROM AUTHOR]

Introduction: Hospital-acquired infections (HAIs) and growing antimicrobial resistance (AMR) represent a significant healthcare burden globally. Especially in Greece, HAIs with limited treatment options (LTO) pose a serious threat due to increased morbidity and mortality. This study aimed to estimate the clinical and economic value of introducing a new antibacterial for HAIs with LTO in Greece. Methods: A previously published and validated dynamic model of AMR was adapted to the Greek setting. The model estimated the clinical and economic outcomes of introducing a new antibacterial for the treatment of HAIs with LTO in Greece. The current treatment pathway was compared with introducing a new antibacterial to the treatment sequence. Outcomes were assessed from a third-party payer perspective, over a 10-year transmission period, with quality-adjusted life years (QALYs) and life years (LYs) gained considered over a lifetime horizon. Results: Over the next 10 years, HAIs with LTO in Greece account for approximately 1.4 million hospital bed days, hospitalisation costs of more than €320 million and a loss of approximately 403,000 LYs (319,000 QALYs). Introduction of the new antibacterial as first-line treatment provided the largest clinical and economic benefit, with savings of up to 93,000 bed days, approximately €21 million in hospitalisation costs and an additional 286,000 LYs (226,000 QALYs) in comparison to the current treatment strategy. The introduction of a new antibacterial was linked to a monetary benefit of €6.8 billion at a willingness to pay threshold of €30,000 over 10 years. Conclusion: This study highlights the considerable clinical and economic benefit of introducing a new antibacterial for HAIs with LTO in Greece. This analysis shows the additional benefit when a new antibacterial is introduced to treatment sequences. These findings can be used to inform decision makers to implement policies to ensure timely access to new antibacterial treatments in Greece. Plain Language Summary: Antimicrobial resistance is a major issue for the Greek healthcare system. The overuse of antibacterial agents contributes to the growing resistance levels, making currently available treatment options less effective. As a result, there is an imperative need to address antimicrobial resistance in Greece. This study developed a mathematical model to investigate the clinical and economic benefits of introducing a new antibacterial to current treatment practice. The model uses regression equations to describe the relationships between inputs and outputs from a published and validated model, which describes the transmission and treatment of infections. The model is used to estimate the impact of a new treatment in Greece, considering differing treatment sequence scenarios. The largest health and financial benefits were seen when a new antibacterial was introduced at first line prior to currently used treatments. Over 10 years, savings of up to 93,000 hospital bed days and €21 million in hospitalisation costs could be achieved, as well as a gain of 286,000 patient life years and 226,000 patient quality-adjusted life years (QALYs), a measure of a patient's quality and length of life, over their remaining lifetime. The introduction of a new antibacterial into the current treatment pathway resulted in an overall monetary benefit of €6.8 billion over 10 years, when additional QALYs are valued at €30,000. This study demonstrates considerable health economic benefits of introducing a new antibacterial in Greece and can help inform decision makers when developing a national action plan to combat resistance and improve access to treatments. [ABSTRACT FROM AUTHOR]

Introduction: The stigma of mental illness and the ensuing social exclusion are due to the lack of knowledge on the causality of mental illness. Aim: The purpose of this study was to record the stigmatic attitudes of health professionals towards depression, patients suffering from it and the available therapeutic approaches. Material and Methods: The sample of the study included 609 health professionals working in the General Hospital of Corinth. The collection of the empirical material was performed using an anonymous questionnaire. The statistical analysis was performed with the statistical program SPSS 17.0. Results: Although the health professionals showed more optimistic attitudes towards the abilities of the mentally ill, they seem to maintain stereotypes, proving that stigmatization of the mentally ill and prejudice around mental illness continue to exist. Participants identified psychosocial and psychotherapeutic interventions as the most effective forms of therapy, such as supportive social destination (74.4%), healthy eating and physical activity (67.9%), psychoanalysis (60.6%), relaxation techniques (60.5%) and counselling (53.2%), recording ambivalent attitudes towards psychiatric medicines, questioning their effectiveness. The economic crisis has had a direct impact on health professionals as well burdened their psyche (78.3%) and created problems in everyday work (86.7%). Conclusion: Health professionals must be protagonists, free from the stigma attached to mental illness as only in this way will they be able to transmit optimism and feelings of acceptance. [ABSTRACT FROM AUTHOR]

We assessed the impact of COVID-19 vaccination status and time elapsed since the last vaccine dose on morbidity and absenteeism among healthcare personnel (HCP) in the context of a mandatory vaccination policy. We followed 7592 HCP from November 15, 2021 through April 17, 2022. Full COVID-19 vaccination was defined as a primary vaccination series plus a booster dose at least six months later. There were 6496 (85.6 %) fully vaccinated, 953 (12.5 %) not fully vaccinated, and 143 (1.9 %) unvaccinated HCP. A total of 2182 absenteeism episodes occurred. Of 2088 absenteeism episodes among vaccinated HCP with known vaccination status, 1971 (94.4 %) concerned fully vaccinated and 117 (5.6 %) not fully vaccinated. Fully vaccinated HCP had 1.6 fewer days of absence compared to those not fully vaccinated (8.1 versus 9.7; p-value < 0.001). Multivariable regression analyses showed that full vaccination was associated with shorter absenteeism compared to not full vaccination (OR: 0.56; 95 % CI: 0.36–0.87; p-value = 0.01). Compared to a history of ≤ 17.1 weeks since the last dose, a history of > 17.1 weeks since the last dose was associated with longer absenteeism (OR: 1.22, 95 % CI:1.02–1.46; p-value = 0.026) and increased risk for febrile episode (OR: 1.33; 95 % CI: 1.09–1.63; p-value = 0.004), influenza-like illness (OR: 1.53, 95 % CI: 1.02–2.30; p-value = 0.038), and COVID-19 (OR: 1.72; 95 % CI: 1.24–2.39; p-value = 0.001). The COVID-19 pandemic continues to impose a considerable impact on HCP. The administration of a vaccine dose in less than four months before significantly protected against COVID-19 and absenteeism duration, irrespective of COVID-19 vaccination status. Defining the optimal timing of boosters is imperative. [ABSTRACT FROM AUTHOR]

• We assessed the impact of Pfizer-BioNTech vaccine on HCP morbidity and absenteeism. • We found 11.8 absenteeism episodes per 100 unvaccinated and 4.7 per 100 vaccinated HCP. • The mean duration of absence was 11.9 days in unvaccinated and 6.9 days in vaccinated HCP. • Vaccine effectiveness was 94.16% against COVID-19 and 66.42% against absenteeism. • Vaccination significantly reduced morbidity, COVID-19, absenteeism and duration of absenteeism. Healthcare personnel (HCP) are prioritized for coronavirus disease 2019 (COVID-19) vaccination to protect them and non-disruptive provision of healthcare services. We assessed the impact of the Pfizer-BioNTech vaccine on morbidity and absenteeism among HCP. We studied 7445 HCP in five tertiary-care hospitals in Greece from November 15, 2020 through April 18, 2021. A total of 910 episodes of absenteeism and 9695 days of absence were recorded during the entire study period. Starting from January 4, 2021, 4823/7445 HCP (64.8%) were fully or partially vaccinated. Overall, 535 episodes of absenteeism occurred from January 4, 2021 through April 18, 2021, including 309 (57.76%) episodes among 2622 unvaccinated HCP and 226 (42.24%) episodes among 4823 vaccinated HCP (11.8 versus 4.7 episodes of absenteeism per 100 HCP, respectively; p-value < 0.001). The mean duration of absenteeism was 11.9 days among unvaccinated HCP compared with 6.9 days among vaccinated HCP (p-value < 0.001). Unvaccinated HCP more frequently developed acute respiratory infection, influenza-like illness, and COVID-19 (p-values < 0.001 for all comparisons). Vaccine effectiveness for fully vaccinated HCP was estimated at 94.16% [confidence interval (CI): 88.50%-98.05%) against COVID-19, 83.62% (CI: 73.36%-90.38%) against SARS-CoV-2 infection (asymptomatic or COVID-19), and 66.42% (CI: 56.86%-74.15%) against absenteeism. The COVID-19 pandemic had a considerable impact on healthcare workforce. The Pfizer-BioNTech vaccine significantly reduced morbidity, COVID-19, absenteeism and duration of absenteeism among HCP during a period of high SARS-CoV-2 circulation in the community. It is expected that HCP vaccination will protect them and healthcare services and contain healthcare costs. [ABSTRACT FROM AUTHOR]

Introduction: In 2009 and 2010, Athens, Greece experienced a hepatitis C virus (HCV) and a Human Immunodeficiency Virus (HIV) outbreak among People Who Inject Drugs (PWID), respectively. The HCV outbreak was not detected, while that of HIV was identified in 2011. The integrated HIV-interventions, launched in early 2012, managed to reduce directly the HIV incidence and indirectly the HCV incidence. This study aims to assess what would have been the course of the HIV outbreak and its associated economic consequences if the 2009 HCV outbreak had been detected and integrated interventions had been initiated 1- or 2-years earlier. Methods: The model was calibrated to reproduce the observed HIV epidemiological and clinical parameters among PWID of Athens, Greece. We examined the effect of the 1- or 2-years earlier detection scenarios, the 1-year later detection, the non-detection scenario, and compared them to the status quo scenario. Results: Cumulative HIV cases, under the status-quo scenario during 2009‐2019, were 1360 (90% Credible intervals: 290, 2470). If the HCV outbreak had been detected 1- or 2- years earlier, with immediate initiation of integrated interventions, 740 and 1110 HIV cases could be averted by 2019, respectively. Regarding the costs, if there was an efficient notification system to detect the HCV outbreak 1 or 2 years earlier, 35.2–53.2 million euros could be saved compared to the status quo by 2019. Conclusions: If the HCV outbreak had been detected and promptly addressed, the HIV outbreak would have been prevented and 35.2–53.2 million euros could have been saved. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore factors that influence individuals' attitudes towards mandatory vaccination in Greece. Methods: A nationally representative cross‐sectional telephone survey was conducted via a random multistage selection process in October 2019 in Greece. The survey was designed to obtain information about whether vaccination should be mandated or not among adults 18 years of age or older. A multivariable logistic regression model was used to estimate the association between individuals' sociodemographic, contextual and clinical characteristics, utilization, satisfaction, and trust in the healthcare system and providers and their preference over mandatory vaccination. Results: A total of 901 participants fully completed the survey (response rate 90%‐901/1001). About 85% of the respondents supported mandatory vaccination. Individuals who used preventive services more often compared to those who never or rarely used such, those who reported increased trust in official healthcare authorities' guidelines and recommendations compared to those who reported no trust and those who had underage children living in the household were significantly more likely to support mandatory vaccination. No differences were observed for sociodemographic factors and mandatory vaccination support. Conclusion: This survey revealed that most Greek citizens support mandatory vaccination, which was critically affected by the utilization of preventive services and trust in healthcare authorities. Our results suggest that healthcare policy interventions should promote mandatory vaccination through multi‐level initiatives to improve healthcare providers' and the general public's understanding of the value of vaccination. [ABSTRACT FROM AUTHOR]

Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active rheumatoid arthritis (RA). In Greece, it is mandatory that all infusions are administered in a hospital setting; therefore, they are strongly correlated with the system's capacity in terms of resources. The objective of this paper was to assess the capacity of the Greek National Health System (NHS) hospitals to meet current/projected demand for iv treatment of RA patients. Semi-qualitative interviews on the basis of a strictly structured questionnaire were conducted with the Heads of all NHS RA infusion sites to record available resources, service utilization and ability to meet current/projected demand. Out of 31 NHS infusion sites, 28 responded (90.3%). On average, 41.6% of Greek NHS RA patients are treated with a biologic agent and 61.5% of respondents stated that available resources are insufficient to meet current demand. The most important constraints in selection order were as follows: space (93%), staff (89.5%), equipment (61.5%) and working hours (57%). Fifty-six percent of respondents stated that they may decline treatment to patients due to constraints. Overall, respondents estimated that the number of iv patients could be increased by 104%, were there no capacity constraints. An important proportion of the estimated 40.000 RA patients in Greece, for whom iv biologic treatment in the hospital setting is essential for disease control, may be declined treatment due to constraints in RA-specific resources. Rationalization and reallocation of NHS resources is required to ensure equity in access to effective treatment for all RA patients. [ABSTRACT FROM AUTHOR]

Objectives: To explore rates and factors associated with mandatory vaccination support overall and intentions to get vaccinated specifically for COVID‐19 among individuals in Greece. Methods: Using data from a nationally representative cross‐sectional survey conducted in October 2020 among 855 adults (≥18 years) in Greece, we estimated support rates for mandatory vaccination and respondents' intention to get vaccinated for COVID‐19 as well as associations thereof with individual sociodemographic, clinical and contextual characteristics. Results: About 74% of respondents supported mandatory vaccination and 62% intended to get vaccinated for COVID‐19. The most prevalent reasons against COVID‐19 vaccination were safety concerns related to the duration of clinical trials and potential side effects. Individuals who reported increased trust in healthcare authorities' recommendations, who revealed that their trust in the State increased due to the way the COVID‐19 pandemic was handled, who used preventive services more often, and those with higher income were more likely to both support mandatory vaccination and to indicate intention to get vaccinated for COVID‐19. Participants with worse or better self‐reported health status (compared to average), younger adults, and females were less likely to intend to get vaccinated for COVID‐19. Conclusion: The survey revealed that the majority of the Greek citizens favour mandatory vaccination overall and intend to get vaccinated for COVID‐19, driven mostly by utilization of preventive services and trust in healthcare authorities. However, intention to get vaccinated for COVID‐19 was lower relative to mandatory vaccination support. This suggests a need to intensify evidence‐based yet simplified messaging by esteemed healthcare providers to inform the public on the risks and benefits of vaccines. [ABSTRACT FROM AUTHOR]

The present study aims to explore the economic distress and pertinent coping strategies in families with a member suffering from a severe mental illness. Furthermore it endeavors to gauge the impact of illness burden and that of the Greek recession on economic distress, while disentangling their contribution. In total, 190 key relatives of people with severe mental illness were recruited from community mental health services in the region of Attica. Relatives completed a self-reported questionnaire consisting of the Index of Personal Economic Distress, the Family Burden scale and the Family Rituals scale. Information on financial strategies for tackling recession and income loss due to the recession was also gleaned. Regarding economic distress, only 15% had frequent difficulty meeting routine financial demands in their household. The preponderant strategy was spending savings (56.8%). Income category and spending less on basic needs were the main predictors of economic distress. Objective poverty indices rather than burden predicted economic distress to a greater extent. [ABSTRACT FROM AUTHOR]

Background: Population movements have been increasing over the past years in Europe due to socioeconomic factors, global turbulence and conflicts, especially in the area of Middle East. The presence of migrant populations in Europe challenges health systems due to increased requirements for health care provision. However, to date there is limited published data on the burden of disease among this population (in Greece and elsewhere). Our objective was to record burden of disease of undocumented migrants hosted in a Detention Center and therefore generate data for migrant and public health planning.Methods: Epidemiological data have been collected for 4756 male migrants hosted in a Detention Center from mid 2013 to mid 2015. Of them, 1427 have used health services in the Center, which maintained a detailed record of their medical history and tests.Results: The majority of the study population was aged between 18 and 40 years old. Among those who used health services, most suffered from respiratory (45.6%) and digestive (30.1%) diseases. Injury, poisoning and other external causes accounted for 19.6% of service use, diseases of the skin and subcutaneous tissue for 18.7%, and factors affecting health status and contact with health services for 16.7%. Prevalence of communicable diseases was 15.9% amongst migrants randomly tested.Conclusion: Systematic screening and monitoring of diseases and use of health services by migrants in detention centers allows for an evidence based understanding of the burden of disease related to these populations and the investment required to effectively manage it, thus providing critical input to appropriate health planning. Surveillance for communicable diseases amongst migrants in detention centers would also allow for a true picture of the impact of their presence on public health indicators and help address related prejudices and stigma. [ABSTRACT FROM AUTHOR]

Background: Single-incision laparoscopic surgery (SILS) is a new technique that aims to minimize abdominal wall trauma and improve cosmesis. Concerns have been raised about the risk of trocar-site hernia following SILS. This study aims to assess the risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery, and investigate whether current evidence is conclusive.Methods: We performed a systematic search of MEDLINE, AMED, CINAHL, CENTRAL, and OpenGrey. We considered randomized clinical trials comparing the risk of trocar-site hernia with SILS and conventional laparoscopic surgery. Pooled odds ratios with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method. Trial sequential analysis using the Land and DeMets method was performed to assess the possibility of type I error and compute the information size.Results: Twenty-three articles reporting a total of 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% CI 1.25-4.50, p = 0.008). There was no evidence of between-study heterogeneity or small-study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O'Brien-Fleming α-spending boundaries at 1137 patients, suggesting that the evidence of higher risk of trocar-site hernia with SILS compared to conventional laparoscopic surgery can be considered conclusive.Conclusions: Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Introduction Preventive gynaecological examinations ( PGEs) are the main means of monitoring gynaecological cancers across the developed world. The purpose of this study was to investigate the perceptions and attitudes of women of a regional municipality of Greece, regarding preventive gynaecological examinations amid economic crisis. Material and methods The study included 360 women aged 20-70 years, who lived in an urban area of Greece. A specialised, valid and anonymous questionnaire that included questions about perceptions and attitudes regarding preventive gynaecological examinations was used. The data analysis was performed using the statistical package spss 21. Results It was found that women who lived in less developed areas had had lower educational levels and higher abstinence rates from medical examinations. The main source of information about sexually transmitted diseases was their social circle (48%), but the gynaecologist is the one preferred (54.8) to inform about preventive gynaecological examinations. Thirty per cent of the participants had never have a mammogram, while 33.9% of the sample did not show the same result, although considered the Pap test necessary. The main cause of women's abstention of preventive gynaecological examinations is the financial crisis. Conclusions The current financial crisis has negatively affected the women's ability to afford gynaecological examinations. Therefore, it is necessary to inform the population about the necessity of preventive gynaecological examinations starting from school age and at the same time, health information and promotion campaigns should be launched at a national level. [ABSTRACT FROM AUTHOR]