Sleep quality and associated factors in the context of COVID-19, among prehospital emergency personnel, in North-Eastern Greece.

BACKGROUND: The stressful conditions that emerged during the Coronavirus disease 2019 (COVID-19) pandemic have had a negative impact on sleep quality in large part of the healthcare worker population. This study aimed to assess the self-reported quality of sleep among members of the Emergency Ambulance Service personnel of the National Emergency Center in the region of Thrace, Northeastern Greece, and to investigate its associations with perceived stress, feelings, and perceptions of well-being during the COVID-19 pandemic. METHODS: The study was conducted from March to May 2021 using an online structured questionnaire, and the collected data included: socio-demographic characteristics, occupational and medical history, distress and mental health issues due to COVID-19 and the following self-administrated instruments: Pittsburgh Sleep Quality Index (PSQI), WHO-5 Well-Being Index (WHO-5), and Perceived Stress Scale-14 items (PSS-14). RESULTS: Among the 74 participants, 71 % were poor sleepers (i.e., PSQI >5). The majority (83 % of the sample) reported feelings of stigma due to their occupation, with the proportion being higher among women (100 % vs 78 % in men, p =0.05) and poor sleepers (95 % vs 65 % in good sleepers, p =0.03). Poor sleepers had significantly lower WHO-5 scores than good sleepers (13.8 ± 4.9 vs 16.9 ± 5.8, p =0.04) and were experiencing significantly more anxiety and/or sadness at the time they answered the questionnaire (69.1 % vs 35.3 %, p =0.02). Perceived stress was significantly positively correlated with the "Latency" dimension of the PSQI (p =0.03). CONCLUSIONS: Poor sleep quality and feelings of stigmatization were prevalent for most of the sample. Poor sleep quality was associated more frequently with reported feelings of stigmatization, anxiety and/or sadness, and impaired well-being. HIPPOKRATIA 2021, 25 (3):126-133.

Sociodemographic and clinical characteristics of Roma and non-Roma psychiatric outpatients in Greece.

OBJECTIVE: Differences in psychiatric symptoms are often reported between minority and majority groups. The aim of this study was to compare Roma psychiatric outpatients who are Greek citizens living in Thrace (Greece) with outpatients belonging to the 'majority Greek group' with respect to socio-demographic characteristics, psychopathological symptoms and psychiatric diagnoses. DESIGN: A sample of 122 Roma and 132 majority Greek patients visiting the Outpatient Psychiatric Clinic at the University General Hospital of Alexandroupolis, Greece, were examined with the Structured Clinical Interview for DSM III-R (SCID-I), the International Personality Disorder Examination (IPDE) and the Derogatis Psychiatric Rating Scale (DPRS). Only those with a psychiatric diagnosis were retained in the analyses. The two groups of patients were compared in relation to their socio-demographic characteristics, their diagnoses and their scores on the DPRS symptom dimensions. RESULTS: In comparison to the majority group, Roma patients were younger, more often women, less educated, married, parents of more children, without social security coverage; The Roma group had higher scores on many DPRS symptom dimensions such as somatisation, hostility, sleep disturbance, phobic anxiety, psychoticism, psychomotor retardation, hysterical behaviour and abjection-disinterest. In addition, Roma women presented psychotic and bipolar disorders less often than the majority group women. Symptoms did not differ by ethnic group for those seeking medical certification. CONCLUSION: Roma patients face serious social problems and show greater levels of symptoms than the majority group. The limitations of this include that the sample was not representative of the general psychiatric patient population and language, as well as other cultural and educational barriers, might have obscured important aspects of the Roma people's psychopathology.

[Parenting capacity of mothers with schizophrenia].

Recent studies indicate that the pregnancy rates of mothers with schizophrenia do not differ significantly from those of the general population. Mothers' severe mental illness, combined with poor social support and comorbidity, may significantly affect her parenting capacity. However, the poor quality of parenting by psychotic mothers should not be taken for granted, in advance. Some of them may become excellent parents while other may abuse their children and finally lose custody because of this. The parenting capacity is significantly influenced by the existing insight of patient-parent's disease. Assessing the parenting capacity comprises the measurement of insight and of the risk of child abuse as well. Factors associated with increased risk for child abuse are: (a) active psychiatric symptomatology, (b) history of violent behavior in the past, (c) maternal history of abuse during childhood, (d) dangerous domestic environment, (e) stressful events and poor social support to the mother and (f) unrealistic parental expectations. These factors should be assessed both clinically and by using the appropriate psychometric tools. Tools which have been widely used for this purpose are: (a) "Schedule for Assessment of Insight-SAI", (b) "Childhood Trauma Interview", (c) "Home Observation for the Measurement of the Environment Inventory-HOME" and "Home Screening Questionnaire -HSQ", (d) "Parental Stress Inventory-PSI", "Swedish Parenthood Stress Questionnaire-SPSQ", "Arizona Social Support Inventory" (e) "Parent Opinion Questionnaire-POQ". Interventions to ensure a more adequate parenting capacity should be focused on family planning: mothers with severe mental illness have poor knowledge about reproductive and contraception issues. Their pregnancies are mostly not planned. It is important for the family planning to be tailored according to the specific needs of schizophrenic mothers and to take into account the following issues: (a) the severity and the duration/chronicity of the disease, (b) the onset of the disease in relation to the gestational period, (c) the education of mothers with schizophrenia considering their double patient/mother role. An educational program should train the mother to recognize early signs of the disease, comply with medication, increase her empathy towards the baby and reduce any distorted perceptions about it. The treating, assessing, educating and preventing programs and interventions of mental health services should be continuous and supportive.

[Post-stroke depression: recognition and treatment interventions].

Depression is the most common neuropsychiatric complication of a stroke (Post Stroke DepressionPSD) and has been shown to impede the recovery and rehabilitation of these patients. Prevalence rates of PSD vary between 6% and 79%. Direct comparison between studies is limited due to their different methodology. Etiology of PSD is determined by biological and psychosocial factors. Symptoms of PSD appear in three areas: affective, somatic and cognitive. Differential diagnosis includes post-stroke fatigue and pseudo-depressive manifestations of ischemic infarctions (apathy, aprosody, athymhormia, pseudobulbar palsy). Mortality in post-stroke patients is higher than in non-depressed stroke patients and suicide ideation is observed in 6.6-11.3% of stroke patients. Selective serotonin reuptake inhibitors (SSRI) are considered as the first choice treatment of PSD. Other therapeutic approaches include cognitive and functional rehabilitation. PSD is a potentially treatable condition, yet under-diagnosed, and has a negative effect on functional recovery and survival of stroke patients.

Effects of probiotic inclusion levels in broiler nutrition on growth performance, nutrient digestibility, plasma immunoglobulins, and cecal microflora composition.

The aim of this work was to investigate the effect of inclusion levels of a 5-bacterial species probiotic in broiler nutrition. Five hundred twenty-five 1-d-old male Cobb broilers were allocated in 5 experimental treatments for 6 wk. The experimental treatments received a corn-soybean coccidiostat-free basal diet and depending on the addition were labeled as follows: no addition (C), 10(8) cfu probiotic/kg of diet (P1), 10(9) cfu probiotic/kg of diet (P2), 10(10) cfu probiotic/kg of diet (P3), and 2.5 mg of avilamycin/kg of diet (A). Each treatment had 3 replicates of 35 broilers each. Treatment effects on broiler growth performance and biomarkers such as ileal and total tract nutrient digestibility, plasma Ig concentration, and cecal microflora composition were determined. Differences among treatments were considered significant when P < or = 0.05. Overall BW gain was significantly higher in treatment P1 (2,293 g) compared with P2 (2,163 g), C (2,165 g), and P3 (2,167 g), with A (2,230 g) being intermediate and not different from P1. Overall feed conversion ratio values were similar and significantly better for P1 (1.80) and A (1.80) compared with P2 (1.87), C (1.89), and P3 (1.92). Ileal apparent digestibility coefficients (ADC) of CP and ether extract were higher in A. Generally, treatments A and P1 showed an improved total tract ADC for DM, organic matter, ash, ether extract, and AME(n) values. The total tract ADC of CP was higher in P1, C, and P2. There were no differences between treatments regarding plasma Ig in 14- and 42-d-old broilers. Treatments P2 and P3 were effective at beneficially modulating cecal microflora composition. In particular, the lower cecal coliform concentration (log cfu/g of wet digesta) was seen in P2 (6.12) and P3 (4.90) in 14- and 42-d-old broilers, respectively, whereas at 42 d, P3 and P2 had the highest Bifidobacterium (8.31; 8.08) and Lactobacillus concentrations (8.20; 7.86), respectively. It is concluded that probiotic inclusion level had a significant effect on broiler growth responses, nutrient ADC, AME(n), and cecal microflora composition.

Mental health problems in the elderly in residential care in Greece--A pilot study.

The aim of this study is to examine the mental health problems of older adults living in a residential home in a Greek rural area. A sample of 40 residents was compared with 40 matched controls attending a community open care centre for the elderly (OCCE). The following measures were used: Mini International Neuropsychiatric Interview (MINI), Geriatric Depression Screening Scale (GDSS), and the Mini Mental State Examination (MMSE). The group of the residents had a lower educational level and presented with a higher prevalence of depression and suicidality. Suicidal ideation was not significantly correlated to any of the examined independent social or psychological factors and was persistent during a period of two years follow-up. It is possible that, especially in rural areas, admission in the institution is per se a traumatic event precipitating suicidality. The issues of effective psychological care for older adults in residential care are discussed.

Presence of mec genes and overproduction of beta-lactamase in the expression of low-level methicillin resistance among staphylococci.

Detection of methicillin-resistant staphylococci is critical for the management of infected patients in the hospital. A total of 55 nonreplicated clinical isolates of staphylococci (31 Staphylococcus aureus and 24 coagulase-negative staphylococci; CNS) collected during a one-year period and expressing low-level resistance to methicillin (oxacillin MIC of 2-4 mg/l for S. aureus and 0.5-4 mg/l for CNS) were studied. mec determinants and overproduction of beta-lactamase were investigated and pulsed-field gel electrophoresis (PFGE) was applied as a typing method. Twenty-four S. aureus isolates and 19 CNS carried the mecA gene. The presence of mecR1/mecI and blaR1/blaI genes correlated with the expression of low-level methicillin resistance in CNS. Four mecA-negative isolates (2 S. aureus and 2 CNS) overproduced beta-lactamase. PFGE revealed the presence of 2 major clonal types in mecA-positive S. aureus isolates, and 3 in CNS. Low-level methicillin resistance of staphylococci is correlated with the presence of the mecA gene and overproduction of beta-lactamase.

Detection of mecA, mecR1 and mecI genes among clinical isolates of methicillin-resistant staphylococci by combined polymerase chain reactions.

The distribution of the mec genes mecA, mecR1 and mecI that regulate the expression of methicillin resistance was investigated by PCR in 145 staphylococci of hospital origin. Determination of alterations and deletions in parts of the genes was achieved using 11 sets of primers in combined reactions. Methicillin-resistant Staphylococcus epidermidis strains appeared relatively stable, with 57.9% of isolates containing the whole regulatory region. Alterations within the mecA gene were detected more often in other coagulase-negative staphylococci, which also had a higher percentage with deletions of regulatory genes. Among methicillin-resistant S. aureus, a genetically heterogeneous population was identified, with several alterations and deletions of mec genes.

Nonabsorbable antibiotics reduce bacterial and endotoxin translocation in hepatectomised rats.

There is increasing evidence that septic complications, occurring after major hepatectomies, may be caused by gram negative bacteria, translocating from the gut. We investigated in rats, the effect of extended hepatectomy on the structure and morphology of the intestinal mucosa as well as on the translocation of intestinal bacteria and endotoxins. We also examined the effect of nonabsorbable antibiotics on reducing the intestinal flora and consequently the phenomenon of translocation by administering neomycin sulphate and cefazoline. Hepatectomy was found to increase translocation, while administration of nonabsorbable antibiotics decreased it significantly. In addition, hepatectomy increased the aerobic cecal bacterial population, which normalised in the group receiving antibiotics. Among the histological parameters evaluated, villus height demonstrated a significant reduction after hepatectomy, while the number of villi per cm and the number of mitoses per crypt, remained unchanged. Our results indicate that administration of nonabsorbable antibiotics presents a positive effect on bacterial and endotoxin translocation after extended hepatectomy, and this may be related to reduction of colonic bacterial load as an intraluminal effect of antibiotics.

The leading role of hepatitis B and C viruses as risk factors for the development of hepatocellular carcinoma. A case control study.

A double case control study evaluated the role of hepatitis C virus (HCV) and hepatitis B virus (HBV), alcohol drinking, and tobacco smoking as potential risk factors for cepatocellular carcinoma (HCC). Fifty-one patients with HCC, 34 of whom had underlying cirrhosis, were analyzed against 51 hospital controls and 34 patients with cirrhosis, respectively. Sera from patients of all three groups were tested for HBV markers and anti-HCV antibodies. The polymerase chain reaction technique was used to detect HCV RNA in the anti-HCV-positive samples. Alcohol drinking and smoking habits were recorded for all patients. HCC risk was significantly related to the presence of hepatitis B surface antigen (HBsAg) [relative risk (RR) = 18], HCV infection (RR = 8), and alcohol abuse (RR = 4). When the presence of cirrhosis was taken into account, only HBsAg positivity was significantly associated with HCC development (RR = 6.7), indicating that HCV infection and alcohol abuse are related to HCC indirectly through the cirrhotic process. No significant interaction between HCV and HBV infection in the causation of HCC was found. Through the computation of population-attributable risk, it was found that 46% of the HCC cases in Greece could be attributed to HBsAg positivity but only 4% to HCV infection. In conclusion, HBV infection is the major risk factor in the development of HCC in Greece, either by inducing cirrhosis or by direct oncogenic effect. HCV infection is also related to HCC development, albeit indirectly through the cirrhotic process.

Beta-thalassaemia and the prevalence of HCV viraemia.

Twenty-four serum samples from multitransfused patients with beta-thalassaemia major and fourteen positive control samples, (eight haemodialysis patients and six sporadic cases of HCV infection) were selected as anti-HCV-positives by a second-generation ELISA, a confirmatory test (Abbott), and an immunoblot assay (INNO-LIA HCV AbIII, Omicron Medical). Subsequently, by means of the nested polymerase chain reaction technique (PCR), using the set of PT1-4 primers, the RNA of the virus was detected in a total of 29 samples: 22 out of 24 patients with beta-thalassaemia and 7 out of 14 from the control group were positive for the RNA of the virus. The findings show that there is a statistically significant prevalence [chi2 = 6.344, P < or = 0.02] of HCV viraemia in the population of beta-thalassaemia major in Greece, as compared with the positive control group.

Isolation and characterization of a novel 20-kDa sulfated polysaccharide from the extracellular slime layer of Staphylococcus epidermidis.

Slime-producing coagulase-negative staphylococci have emerged as important pathogens especially in immunocompromised hosts and patients with implanted devices. Although the extracellular slime layer is considered an important virulence factor, the chemical composition of the slime polysaccharide(s) remains unknown. The crude slime product derived from two reference Staphylococcus epidermidis strains (ATCC 35983 and 35984) and two clinical isolates was found to contain protein (11-20.5%), hexosamines (8-19%), neutral sugars (12.2-14%), phosphates (4-9.5%), uronic acids (1-13%), and small amounts of sulfates (0.5-3%). Preparative anion-exchange chromatography separated a main carbohydrate component which was isolated by combined chromatographies on DEAE-Sephacel and Sepharose CL-6B. HPLC and electrophoreses on polyacrylamide gel and cellulose acetate membrane revealed the presence of one species of low-sulfated polysaccharide with a relative molecular mass of 20-kDa. Chemical analyses of the polysaccharide showed that it is rich in glucosamine (46%) and neutral sugars (30-34%) with small amounts of sulfates (5.7-6.5%) and glucuronic acid (2.9-3.4%). Ten percent of the glucosamine is sulfated at the amino group. The neutral monosaccharides present are glucose, fucose, and xylose with glucose as the predominant one. It is estimated that the polysaccharide consists of 61-65 molecules of glucosamine (6-7 of which are N-sulfated), 30-35 neutral monosaccharides, 3-4 molecules of glucuronic acid, and 1-3 of fucose and xylose. Isolation and characterization of such a polysaccharide from the extracellular slime layer of S. epidermidis has not been previously reported. Its role to pathogenicity remains to be elucidated.

A retrospective study of Pseudomonas aeruginosa isolation from clinical sources.

The incidence of Pseudomonas aeruginosa recovery from blood, urine and other clinical specimens as well as its resistance to various antimicrobials during a 5-year period (1982 to 1986) are reported. The susceptibility patterns to newer antipseudomonad agents of 100 randomly selected P. aeruginosa clinical strains isolated in 1987 is also presented. Our results show an overall P. aeruginosa isolation incidence of 10.6%, with its resistance to routinely used antibiotics being high but relatively low to the newer agents which have not been used extensively in our hospital.

Central venous catheter replacement with the aid of wire introducer in patients receiving total parenteral nutrition: short report.

During a 1-year period, 24 of 71 patients receiving total parenteral nutrition, underwent replacement of their central venous catheter (CVC) for presumed CVC sepsis or catheter malposition with the use of a wire inducer, according to the Seldinger technique. Catheters were defined as sterile when cultures of both the catheter tip and the peripheral blood were negative, contaminated when culture of the tip was positive whereas the peripheral blood culture(s) was either sterile or positive with different bacteria than those obtained from the tip culture, and septic when cultures from the catheter tip and peripheral blood grew identical microorganisms. Among 19 catheters with suspected sepsis, six were sterile, ten contaminated and three septic. Guidewire catheter replacement was easily and safely performed, and succeeded in sterilizing all contaminated catheters but only one of three septic catheters.