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Purpose – Obesity is a significant public health issue. With obesity increasing worldwide, risk factors for obesity need to be better understood and require careful examination. This study aims to examine mental health as a risk factor for obesity using longitudinal data from Australia. Design/methodology/approach – The main identification strategy relies on the recent death of a close friend and a serious injury or illness to a family member as exogenous shocks to mental health. Findings – The authors’ preferred estimates, which account for the endogeneity of mental health, suggest that mental health has a significant negative impact on obesity. This result proves to be robust to a suite of sensitivity checks. Further investigations reveal that poor mental health leads to increased smoking, which also has an effect on obesity. Originality/value – The study’s findings provide a new perspective on how good mental health helps curb obesity.

Prenatal administration of monoclonal antibodies (mAbs) is a strategy that could be exploited to prevent viral infections during pregnancy and early life. To reach protective levels in fetuses, mAbs must be transported across the placenta, a selective barrier that actively and specifically promotes the transfer of antibodies (Abs) into the fetus through the neonatal Fc receptor (FcRn). Because FcRn also regulates Ab half-life, Fc mutations like the M428L/N434S, commonly known as LS mutations, and others have been developed to enhance binding affinity to FcRn and improve drug pharmacokinetics. We hypothesized that these FcRn-enhancing mutations could similarly affect the delivery of therapeutic Abs to the fetus. To test this hypothesis, we measured the transplacental transfer of leronlimab, an anti-CCR5 mAb, in clinical development for preventing HIV infections, using pregnant rhesus macaques to model in utero mAb transfer. We also generated a stabilized and FcRn-enhanced form of leronlimab, termed leronlimab-PLS. Leronlimab-PLS maintained higher levels within the maternal compartment while also reaching higher mAb levels in the fetus and newborn circulation. Further, a single dose of leronlimab-PLS led to complete CCR5 receptor occupancy in mothers and newborns for almost a month after birth. These findings support the optimization of FcRn interactions in mAb therapies designed for administration during pregnancy.

BackgroundSocial cognition helps people to understand their own and others' behavior and to modulate the way of thinking and acting in different social situations. Rapid and accurate diagnoses of neurodegenerative diseases are essential, as social cognition is affected by these diseases. The Revised Self-Monitoring Scale (RSMS) is a scale that detects social-emotional cognition deficits.AimThe aim of the current study is to examine how socioemotional parameters are affected by neurodegenerative diseases and whether the RSMS can discern these disorders based on the socioemotional parameters in the Greek population.Methods/designA total of 331 dementia subjects were included. Mini Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination (Revised, ACE-R) measurements were used in order to assess the cognitive deficits. The Neuropsychiatric Inventory (NPI) was used for the evaluation of the neuropsychiatric symptoms. The RSMS and its two subscales was used in order to detect the socioemotional deficits.ResultsThe RSMS and its two subscales (RSMS_EX and RSMS_SP) can effectively detect neurodegenerative diseases. The RSMS can detect bvFTD in Alzheimer's Disease (AD), AD in a healthy cohort, behavioral variant Frontotemporal Dementia (bvFTD) in a healthy cohort, bvFTD in Parkinson's Disease (PD) and Frontotemporal Semantic Dementia (FTD/SD) in a healthy cohort. It is a useful tool in order to detect frontotemporal dementias. RSMS correlated negatively with the NPI questionnaire total and the subcategories of apathy, disinhibition and eating disorders. The RSMS results are associated with the ACE-R score (specifically verbal fluency).ConclusionsThe RSMS is a helpful tool in order to identify socioemotional deficits in neurodegenerative dementias. It is also a useful scale that can discern bvFTD and svPPA in AD patients. A worse RSMS score correlates with a worse ACE-R and NPI. It seems to be a useful scale that can reliably measure social behavior in non-reversible neurodegenerative disorders, such as AD, FTD (bvFTD, svPPA), PDD and PD. The results also apply to the Greek population.

BackgroundMultiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterized by a broad and unpredictable range of symptoms, including cognitive and sociocognitive dysfunction. Among these social-cognitive functions, moral judgment has been explored in persons with MS (PwMS) using moral dilemmas, where participants must decide whether to sacrifice one person to save a greater number. Opting for such a sacrifice reflects utilitarian reasoning (sacrificing one for the benefit of many is deemed acceptable), while refusing reflects deontological reasoning (such sacrifice is considered morally wrong). Compared to controls, PwMS have been shown to make greater deontological moral choices in such dilemmas.ObjectivesWhile PwMS have demonstrated a higher tendency for deontological moral choices in moral dilemmas compared to controls, the underlying determinants of this reasoning pattern remain unclear. In this project, we aim to investigate cognitive, emotional, and motivational factors that may explain deontological decision-making in MS.Methods and analysisWe will recruit a sample of 45 PwMS and 45 controls aged 18–55 years. The type of response, deontological or utilitarian, to a series of 20 vignettes of moral dilemmas will constitute the primary outcomes. Global cognitive performance, positivity bias, alexithymia and empathy levels as well as emotional reactivity measured by electrodermal activity (EDA) during moral dilemmas will be secondary outcomes.Ethics and disseminationEthics approval was granted by a national ethical committee (CPP Ouest III, national number 2023-A00447-38). The project is sponsored by the ARSEP Foundation. Findings will be presented at national and international conferences, as well as published in peer-reviewed scientific journals.

IntroductionConventional care in Parkinson's disease (PD) faces limitations due to the significant time and location commitments needed for regular assessments, lacking quantitative measurements. Telemonitoring offers clinicians an opportunity to evaluate patient symptomatology throughout the day during activities of daily living.MethodsThe progression of PD symptoms over a two-year period was investigated in patients undergoing traditional evaluation, supplemented by insights from ambulatory measurements. Physicians integrated a telemonitoring device, the PDMonitor®, into daily practice, using it for informed medication adjustments.ResultsStatistical analyses examining intra-subject changes for 17 subjects revealed a significant relative decrease of −43.9% in the device-reported percentage of time spent in “OFF” state (from 36.2 to 20.3%). Following the 24-month period, the majority of the subjects improved or exhibited stable symptom manifestation. In addition to positively impacting motor symptom control, telemonitoring was found to enhance patient satisfaction about their condition, medication effectiveness, and communication with physicians.DiscussionConsidering that motor function is significantly worsened over time in patients with PD, these findings suggest a positive impact of objective telemonitoring on symptoms control. Patient satisfaction regarding disease management through telemonitoring can potentially improve adherence to treatment plans. In conclusion, remote continuous monitoring paves the way for a paradigm shift in PD, focusing on actively managing and potentially improve symptoms control.

The current paper presents the first effort to organize a comprehensive review of the Invasive Alien Species (IAS) of Greece. For this purpose, a database was developed with fields of information on the taxonomy, origin, ecology and pathways of introduction of terrestrial, freshwater and marine species. Our database includes a) taxa in the Union’s list that are present in Greece, b) taxa already present in Greece and considered to be invasive, and c) taxa highly likely to enter Greece in the next 10 years and become invasive. The Database served as the starting point for the compilation of the National List of Alien Invasive Species (HELLAS-ALIENS) in compliance with the EU Regulation 1143/2014. Overall, the HELLAS-ALIENS comprises 126 species, i.e. 32 terrestrial and freshwater plant species, 14 terrestrial invertebrates, 28 terrestrial vertebrates, 30 freshwater fishes and invertebrates and 22 marine species. Terrestrial invertebrates, birds and mammals are mainly of Asiatic origin. Most of the terrestrial plants have their native geographical distribution in the Americas (North and South). Most of the freshwater invertebrates and fishes are of North American origin, while the majority of the marine species are of Indo-Pacific origin. The first records of IAS concern terrestrial plant species, and date back to the 19th century, while those in freshwater and marine ecosystems seem to have been systematically recorded some decades later. Regarding the pathways of introduction, most of the taxa arrived in Greece or are expected to arrive through escape from confinement and unaided. The majority of the terrestrial, freshwater and marine species have been evaluated as of High-risk for the indigenous biodiversity and only 3% of the species listed have been evaluated of Low-risk. Our results provide an important baseline for management and action plans, as required by the priorities set by the European Union through the Biodiversity Strategy for 2030.

The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well as at a personal level, for the appropriate management of an older person’s health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes, this is very solid, but in other cases, there is a considerable gap in terms of accurate and well-grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as, for instance, Program of Research on Integration of Services for the Maintenance of Autonomy 7 (PRISMA 7), the gold standard tool of Fried criteria, is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale (CFS) has been validated for translation but not for the capacity to detect frailty. The aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). Seventy-four male and female participants (mean age 80.47 years SD = ±7.45 years, minimum–maximum age = 65–95) have been evaluated for their frailty status using different tools. We observed that the PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥2 and indicates a sensitivity of 88.1% and specificity of 99.9% with a good correlation with SPPB measurements (r = −0.858; p < 0.001). When CFS was validated using SPPB, it demonstrated a very good correlation (r = −0.838; p < 0.001 respectively) as was the case for the modified Fried Criteria (r = −0.725; p < 0.001). All items demonstrated a good correlation between them. We here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek, and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing item 6 of the questionnaire.

Abstract Introduction Functional gastrointestinal disorders (FGID) including impaired rectal evacuation are common in patients with Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). The effect of connective tissue pathologies on pelvic floor function in HSD/hEDS remains unclear. We aimed to compare clinical characteristics and anorectal pressure profile in patients with HSD/hEDS to those of age and sex matched controls. Methods We conducted a retrospective review of all FGID patients who underwent high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) for evaluation of impaired rectal evacuation. Patients with HSD/hEDS were age and sex matched to a randomly selected cohort of control patients without HSD/hEDS. An abnormal BET was defined as the inability to expel a rectal balloon within 2 minutes. Wilcoxon rank sum test and Fisher’s exact test were used to make comparisons and logistic regression model for predictive factors for abnormal evacuation. Results A total of 144 patients (72 with HSD/hEDS and 72 controls) were analyzed. HSD/hEDS patients were more likely to be Caucasian (p

Thrombosis is the most common and a life-threatening complication in patients with Paroxysmal Nocturnal Hemoglobinuria. One-third of patients with PNH experience at least one thromboembolic event during the course of the disease, with thrombosis being the most common cause of death in these patients. The mechanism of thrombosis in PNH is complex and continues to be of great research interest. Since the introduction of C5 complement inhibitors in the treatment of PNH, the incidence of thromboembolic events has decreased substantially. We retrospectively analyzed data concerning the thrombotic episodes of 41 patients with PNH from 14 different national hematology centers in Greece. Sixteen patients (39%) experienced at least one episode of thrombosis, including, seven (43.8%) at diagnosis, seven (43.8%) during the course of the disease and two (12.5%) patients prior to PNH diagnosis. Nearly half of these individuals (n=7, 43.8%) had multiple episodes of thrombosis during the course of their disease. The most common sites of thrombosis were intra-abdominal veins. Three out of 26 patients developed thrombosis while on eculizumab. In none of the 16 patients, the thrombotic event was fatal. Our findings, despite the small number of patients, confirmed that thrombosis continues to be a significant complication of PNH affecting more than one third of the patients.

Agriculture is widely recognized as a solution to food insecurity and poverty, especially in rural areas. However, 75% of the world’s poor live in rural areas, and agriculture is the primary source of their livelihood. One may wonder if the observed correlation between agriculture and poverty also suggests causation. If that is the case, then what such causal relationship might exist? Is agriculture a vehicle for poverty alleviation or a source of poverty trap? The role of climate change is rather undisputed: associated extreme weather phenomena cause severe negative impacts on agriculture, exacerbating rural poverty. However, climate-smart agriculture (CSA) is acclaimed to potentially reverse the situation by eliminating poverty and food insecurity. Against this backdrop, the paper investigates whether smallholder farmers who adopt CSA could achieve food security and better income. This aim was approached through three key research objectives (i) to examine the effects of climate change on smallholder farmers, (ii) to examine the extent to which smallholder farmers adopt CSA and the barriers to adoption, and (iii) to investigate empirically the effects of CSA practices in terms of food security and poverty alleviation. The Upper West and Upper East regions in Ghana were selected purposively for the case study, and the data collected were analyzed using inferential and descriptive techniques. The results revealed no statistically significant positive relationship between the adoption of CSA with food security and income. Poor socioeconomic and market conditions marred the expected positive effects of CSA, hence the need for the provision of agricultural infrastructures and inputs as well as the creation of market for commodities.

In the mainstream development debate during recent years, among others, there have been two influential camps opposing each other. The first one identifies the environmental context, the “natural” variable, as the ultimate cause that determines the socio-economic development trajectory of a society. The second influential approach argues that “the social” variable (i.e., political institutions) and not “the natural” variable is the sphere in which to look for the main explanatory variables for developmental outcomes. In this paper, we argue that although each approach has its own merits, they equally fail to address hot issues in the realm of economic development. They give an incomplete cause-and-effect picture of the ongoing, complex and vital-for-development processes, and they are equally incapable of identifying plausible explanatory variables regarding developmental successes and failures. Our aim is not to discredit the valuable body of work on either of these approaches, but instead to spark a discussion that would enable more creative, inter- and multidisciplinary research into the missing causal links between the propositions of key authors representing the aforementioned approaches and the fallacies that need to be addressed. Our position is that this is the only path that can lead to a meaningful synthesis capable of paving the way for a breakthrough in development economics and sustainable development studies.

BackgroundThere is consistent evidence that SARS-CoV-2 vaccines have statistical and clinical significant efficacy to prevent incident and severe cases of COVID-19, although different outcomes were analyzed and different risk reductions were observed. However, randomized control trials (RCT) were not designed or powered to assess whether the vaccines prevent deaths, even though this was a secondary or exploratory outcome across many studies. Early real-world observational data suggest that these vaccines are highly effective in reducing hospitalization and all-cause mortality. Our objective is to summarize and appraise-the existing evidence on the efficacy and real-world effectiveness of all SARS-CoV-2 vaccines currently approved for full or limited use to prevent all-cause and COVID-19-attributed mortality.MethodsThe population consists of persons with a record of vaccination status and the outcome of interest. Randomized controlled trials, comparative cohort and case-control studies reporting vaccination with any of the vaccines approved (intervention) will be eligible. The primary outcome will be all cause deaths. COVID-19-attributed deaths and deaths attributable to the vaccination (adverse event deaths) will be secondary outcomes. We will compare deaths occurring in vaccinated persons versus those non-vaccinated or having received placebo. Studies in any language will be eligible. Two independent reviewers will screen for inclusion and assess quality of studies using the Cochrane Risk of Bias 2 and the ROBINS-1 tool, as appropriate. Hazard ratios will be calculated. Assessment of statistical heterogeneity amongst the studies will be done using I2 and prediction intervals, as well as visual inspection of the forest plots. Publication bias will be assessed using a funnel plot and Egger statistical test if we have more than 10 studies in a forest plot. We have followed the PRISMA-Protocol checklist for the current protocol, which is registered at Prospero (York University, CRD42021262211).

In this paper we examine the buffering effects of personality traits when people leave their work in later life. Using large-scale panel data for the UK, we show that depending on the exit route and satisfaction related to overall life and the domains of income and leisure, different personality traits act as moderators. Besides augmenting leisure satisfaction for those who hit mandatory retirement, conscientiousness augments life satisfaction for those becoming unemployed. On the contrary, extraversion mitigates satisfaction with life, income, and leisure for those who retire early. This may be an indication that extraverted individuals who tend to be sociable and outgoing may suffer when losing social relationships from their work. At the same time, extraversion may be helpful in augmenting leisure satisfaction for those who stop working for reasons related to ill health or family care. Neuroticism augments income satisfaction for those who become unemployed, which may reflect that people high in neuroticism had a lower "baseline level" of income satisfaction relative to typical individuals so they were not affected as much. Finally, agreeableness mitigates life and leisure satisfaction for those hitting mandatory retirement, as is also the case with openness in terms of income satisfaction.

This paper's aim is to propose a mediation framework and test whether lifestyle choices and social capital are pathways through which locus of control (LoC) affects subjective well-being. Using longitudinal data for Australia, we find that life satisfaction and mental health are explained by direct and indirect effects of LoC. The direct effect is positive, indicating that individuals with an internal LoC have higher levels of life satisfaction and mental health. We also show that physical activity and social interaction are two pathways linking an internal LoC to higher levels of well-being. Our findings provide new insights into the relationship between LoC and subjective well-being and suggest that, if the aim of policy is to improve well-being, the focus should be on enabling people to develop an internal LoC. This may lead to higher well-being both through the identified channels and, more importantly, through the direct channel of LoC.

Health analytics frequently involve tasks to predict outcomes of care. A foundational predictor of clinical outcomes is the medical diagnosis (Dx). The most used expression of medical Dx is the International Classification of Diseases (ICD-10-CM). Since ICD-10-CM includes >70,000 codes, it is computationally expensive and slow to train models with. Alternative lower-dimensionality alternatives include clinical classification software (CCS) and diagnosis-related groups (MS-DRGs). This study compared the predictive power of these alternatives against ICD-10-CM for two outcomes of hospital care: inpatient mortality and length of stay (LOS). Naïve Bayes (NB) and Random Forests models were created for each Dx system to examine their predictive performance for inpatient mortality, and Multiple Linear Regression models for the continuous LOS variable. The MS-DRGs performed highest for both outcomes, even outperforming ICD-10-CM. The admitting ICD-10-CM codes were, surprisingly, not underperformed by the primary ICD-10-CM Dxs. The CCS system, although having a much lower dimensionality than ICD-10-CM, has only slightly lower performance while the refined version of CCS only slightly outperformed the old CCS. Random Forests outperformed NB for MS-DRG, and ICD-10-CM, by a large margin. Results can provide insights to understand the compromise from using lower-dimensionality representations in clinical outcome studies.

Greece is known to be a biodiversity hotspot. Though the plant diversity of Peloponnisos, the southernmost part of the Greek mainland, has been well-studied during the past 200 years, there are still gaps in our knowledge. To this end, the flora of the neighboring mountains Oligirtos and Farmakas was investigated, with a total of 740 and 762 taxa (species and subspecies) recorded, respectively, of which 635 and 756 for the first time. Ten species or subspecies were previously not known from Peloponnisos. Endemics correspond to 10.2% and 8.9% of the total flora and are predominately hemicryptophytes and entomogamous. Almost half of them produce capsules. The number of endemics per 2 × 2 km grid cell reveals that their highest number is found in areas of high elevation, and corresponds to habitats above the tree line, or to the limestone cliffs vegetation. No less than 62 endemic plant taxa of Mt. Oligirtos and 58 of Mt. Farmakas are threatened. A comparison of Mts. Oligirtos and Farmakas with five neighboring mountains shows that elevation correlates positively with the number of regional or bi-regional endemics but not with local or narrow endemics. The importance of mountainous regions for plant conservation is stressed.

The Convention on Biological Diversity (CBD) pathways classification framework used in the implementation of the European Union’s (EU) Regulation 1143/2014 on invasive alien species (IAS Regulation) has recently been adopted by the European Alien Species Information Network (EASIN), the official information system supporting the implementation of the IAS Regulation. In the current paper, the result of an alignment of the primary introduction pathways of all alien plants in Europe included in the EASIN catalogue is presented, based on the CBD framework. In total, 6,250 alien plant taxa (marine plants excluded), both alien to Europe (native range outside Europe) and alien in Europe (native range partially in Europe) are reported. Altogether 5,175 plant taxa had their primary introduction pathway aligned based on the CBD framework, while for the rest the pathway remains unknown. In addition, the taxonomy, year and country of its first record in the wild are provided for each taxon. Our analyses reveal that the main primary introduction pathways of alien plants into Europe are linked to accidental escapes from ornamental and horticultural activities. Northwestern European countries seem to act as the main gateway areas of alien plants into Europe. Recent first observations of new alien taxa growing spontaneously exhibit a contemporary accelerating trend for plants alien to Europe, particularly linked to ornamental and horticultural activities. On the other hand, the number of new plants alien in Europe seems to have stabilized over the last few decades. The present work can assist in the prioritization of introduction pathways control, with the target of slowing down the rate of alien plants introductions into Europe, following also the requirements of the IAS Regulation.

Subjective well-being measures are gaining recognition as important determinants of health outcomes. This paper examines whether life satisfaction matters for healthcare usage in the older population and, if so, what might help explain this relationship. To that end, we develop a mediation framework and test whether lifestyle choices and social capital are pathways through which life satisfaction at baseline influences subsequent healthcare usage. Using Heckman's approach to correct for sample selection bias, we find that those high in life satisfaction may need less outpatient care. We also show that this effect is explained by increased physical activity.

Abstract In patients with myelodysplastic syndrome (MDS), the prognostic significance of chromosome 17 abnormalities has not yet been fully elucidated, except for isochromosome 17q that has been characterized as an intermediate risk abnormality in the Revised International Prognostic Scoring System (IPSS‐R). To further characterize the prognostic significance of chromosome 17 abnormalities we analyzed the hematologic and prognostic characteristics of 548 adult patients with MDS treated with 5‐azacytidine through the Hellenic 5‐azacytidine registry and found 32 patients with a chromosome 17 abnormality (6 with i[17q], 15 with ‐17, 3 with add[17p] and the rest with other rarer abnormalities, mostly translocations). The presence of a chromosome 17 abnormality was correlated with poor prognostic features (high IPSS, IPSS‐R, and WPSS scores) and a low overall survival rate (15.7 vs 36.4 months for patients without chromosome 17 abnormalities, Kaplan–Meier, Log Rank P

Background: 5-azacytidine (5-AZA) improves survival of patients with higher-risk myelodysplastic syndromes (MDSs) and oligoblastic acute myeloid leukemia (AML); however, predictive factors for response and outcome have not been consistently studied. Methods: This study of the Hellenic MDS Study Group included 687 consecutive patients with higher-risk MDS and oligoblastic AML treated with 5-AZA. Results: The International Prognostic Scoring System (IPSS) revised version (IPSS-R), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0 or 1 versus ⩾2) and baseline serum ferritin (SF) levels > 520 ng/ml were shown to independently predict response to 5-AZA. In the survival analysis, the IPSS and IPSS-R risk classification systems along with the ECOG PS and SF levels > 520 ng/ml proved to be independent prognosticators for overall survival (OS), as well as for leukemia-free survival (LFS). Next, we built new multivariate models for OS and LFS, incorporating only ECOG PS and SF levels besides IPSS or IPSS-R risk classification systems. Thereby, the new modified IPSS and IPSS-R risk classification systems (H-PSS, H-PSS-R) could each discriminate a low, an intermediate and a high-risk patient group regarding OS and LFS. The H-PSS and H-PSS-R proved to be better predictors of OS than their previous counterparts as well as the French prognostic score, while the most powerful OS predictor was the new, H-PSS-R system. Conclusions: ECOG PS and SF levels > 520 ng/ml independently predict response to 5-AZA, OS and LFS. Their incorporation in the IPSS and IPSS-R scores enhances these scores’ predictive power in 5-AZA-treated higher-risk MDS and oligoblastic AML patients.