A HEALth Promotion and STRESS Management Program (HEAL-STRESS study) for prehypertensive and hypertensive patients: a quasi-experimental study in Greece.

Current hypertension guidelines advocate strategies encouraging healthy lifestyle behaviours. So far, there is a paucity of studies for the efficacy of such multifaceted programmes. The aim of this study is to investigate the efficacy of an 8-week health-promotion programme for lowering blood pressure (BP) in prehypertensive and hypertensive patients in the community. This was a quasi-experimental study using wait-list controls of 548 patients. The intervention group was administered with an 8-week health-promotion intervention. Measurements included home BP, smoking, body mass index (BMI), perceived stress, depression, anxiety and Health Locus of Control. After adjusting for confounders, the intervention group had a significant reduction in both systolic BP (SBP; mean -2.62 mm Hg, 95% confidence interval (CI): -1.29 to -3.96) and diastolic BP (DBP; mean -1.0, 95% CI: -0.93 to -1.9) compared with controls. In all, 14.9% of patients in the intervention group had >10 mm Hg reduction in SBP vs 4.4% in the control group (P<0.001, numbers needed to treat (NNT)=10). With regards to DBP, 21.7% of patients in the intervention group had >5 mm Hg reduction vs 12.5% in the control group (P=0.01, NNT=11). In terms of effect size, moderate-to-large improvements of BMI, perceived stress, anxiety, depression, external and chance Health Locus of Control were recorded. Changes in SBP and DBP were attributed to BMI and depressive symptom reductions, respectively. Comprehensive non-pharmaceutical programmes for BP management are strongly encouraged. Their long-term benefits on cardiovascular morbidity and mortality remain to be established by future research.

Validation of the Greek version of Mini Tinnitus Questionnaire as a Brief Screening Test for Assessment of Tinnitus-related Distress: our experience in 301 adult patients.

OBJECTIVES: Validation of the Greek version of Mini Tinnitus Questionnaire (Mini-TQ-GR) as a Brief Screening Test for Assessment of Tinnitus-related Distress. DESIGN: Questionnaire study. SETTING: 401 General Military Hospital of Athens/Department of Audiology - Neurootology, Athens, Greece. PARTICIPANTS: Three hundred and one participants have anonymously completed the Mini-TQ-GR, comparing it to the Perceived Stress Scale (PSS 14) and Multidimensional Health Locus of Control Scale (MΗLoC) from November 2013 until May 2014. MAIN OUTCOME MEASURE: Mini-TQ-GR, compared to PSS 14 and MΗLoC. RESULTS: Factor analysis, has shown that the Mini-TQ-GR includes three main factors (Distress, Health pre-occupation and Depression), which explains the 59.05% of the total variance. The Cronbach alpha index was 0.865 approaching the respective reliability factor of the original validation (0.9). The test-retest correlation (intraclass correlation coefficient) was 0.9 (P < 0.01), close to the results of the original study (0.89). We found a positive correlation between tinnitus and perceived stress (r = 0.349**) and negative correlation between tinnitus and external locus of control (r = -0.124*, r = -0.198**) (chance, others). CONCLUSIONS: This study demonstrated that the Mini-TQ-GR has good internal consistency and reliability becoming a useful, validated measurement tool for tinnitus-induced distress.

Stress management and sexual health of young adults: a pilot randomised controlled trial.

Young people often experience excessive stress that definitely undermines their sexual life and leads them to adopt risky sexual behaviours. As such, the design and application of a stress management programme in this particular age group is, undoubtedly, a crucial matter. In this parallel randomised controlled trial, 60 psychology students of the Panteion University of Athens, aged 18­20, were randomly assigned to undergo either an 8-week stress management programme (n = 30; diaphragmatic breathing­progressive muscle relaxation and guided imagery, twice a day) or not (n = 30). Self-reported validated measures were used to evaluate stress, stressful life events, health locus of control, general health status, sexual behaviours, sexual desire, satisfaction from sexual life and interpersonal relationships. Between-group analyses revealed statistically significant differences in internal health locus of control and general health evaluation. Within the intervention group analyses showed reductions in BMI, stress, the 'chance' subscale of multidimensional health locus of control (MHLC) and greater satisfaction from sexual life. No other significant change was reported. We deem that our results should encourage relevant future studies.

An 8-week stress management program in pathological gamblers: a pilot randomized controlled trial.

Stress plays a major role at the onset and relapse of pathological gambling (PG), but at the same time it can also be the aftermath of gambling behavior, thus revealing a reciprocal relationship. Although the role of stress has been well-documented, there is a paucity of studies investigating the effect of an adjunctive stress management program on PG. In this 8-week parallel randomized waitlist controlled trial pathological gamblers, already in the gamblers anonymous (GA) group, were assigned randomly in two groups, with the intervention group (n = 22) receiving an additional stress management program (consisting of education on diet and exercise, stress coping methods, relaxation breathing -RB- and progressive muscle relaxation -PMR). Self-reported measures were used in order to evaluate stress, depression, anxiety, sleep quality/disturbances, life-satisfaction and daily routine. The statistical analyses for the between group differences concerning the main psychosocial study outcomes revealed a statistically significant amelioration of stress, depression, anxiety symptoms and an increase of life-satisfaction and a better daily routine in participants of the intervention group. We hope that these will encourage researchers and clinicians to adopt stress management in their future work.

Stress management and erectile dysfunction: a pilot comparative study.

Erectile dysfunction (ED) is a complex disorder with various biopsychosocial implications leading the individual into a state of chronic stress that further worsens ED symptoms. The aim of this study is to investigate the effects of a 8-week stress management programme on erectile dysfunction (ED). A convenience sample of 31 newly diagnosed men with ED, aged between 20 and 55 years, was recruited during a period of 5 months to receive either tadalafil (12 patients) or tadalafil and the 8-week stress management programme. Both groups showed statistical significant improvement of both perceived stress and erectile function scores. Men practising stress management showed a statistical significant reduction in perceived stress score compared with men receiving tadalafil alone. No other statistical significant differences were noted between the two groups, although the stress management group showed a lower daily exposure to cortisol compared with the control group after 8 weeks. Finally, perceived stress and cortisol showed some interesting correlations with sexual function measurements. These findings provide important insight into the role of stress management, as part of the recommended biopsychosocial approach, in ED. Future studies should focus on randomised, controlled trials with larger samples and longer follow-up time.

Stress management can facilitate weight loss in Greek overweight and obese women: a pilot study.

BACKGROUND: Stress and negative emotions have been shown to be critical factors in inducing overeating as a form of maladaptive coping in obese people. METHODS: The present study aimed to evaluate the efficacy of an 8-week stress management programme that includes progressive muscle relaxation (PMR) and diaphragmatic breathing on weight loss and eating behaviour in a sample of overweight and obese women who started a weight-loss programme. A total of 34 women with a mean (SD) body mass index of 38.17 (7.19) kg m(-) ² and mean (SD) age 47.35 (11.64) years were recruited from the outpatients Obesity Clinic of a public hospital in Athens. Participants were randomly assigned into a Stress Management (SM) and a control group. Anthropometric measurements were taken before and after the intervention, and the participants completed the following questionnaires: Dutch Eating Behaviour Questionnaire (DEBQ), Eating Attitudes Test (Eat-26), Health Locus of Control (HLC) and Perceived Stress Scale (PSS) before and after the intervention. RESULTS: The findings indicated a significant improvement in weight loss in the SM group [4.44 (0.83) kg] after intervention compared to the control group [1.38 (0.78) kg] (P < 0.05). A higher restrained eating behaviour was observed in the SM group after intervention compared to the control group, although there was no significant difference in perceived stress levels. CONCLUSIONS: The intervention group showed greater weight reduction, possibly because of the stress management programme, and a greater dietary restraint was demonstrated by them compared to the control group. It is likely that stress management could facilitate weight loss in obese women; however, more studies are needed to confirm this hypothesis.

A systematic review of randomized controlled interventions for parents' distress in pediatric leukemia.

Objective. This review aims to summarize the existing evidence concerning interventions towards reducing stress in parents with a child with leukemia and their effect in child and family wellbeing. Methods. A systematic review strategy was conducted using MEDLINE covering the period January 1980 to June 2010. Results. Seven randomized controlled trials met the inclusion criteria including in total 1045 parents participants. A variety of cognitive-behavioral interventions problem-solving skills training programs have been used for managing distress in parents and children. Outcome measures are assessed by self-report, observer report, behavioral/psychological, and physiological measures. The most prominent methodological problems were the marked heterogeneity in stress measurement and the relative absence of proper measurement and adjustment of moderating and mediating factors. The largest effect has been obtained by combined cognitive-behavioral interventions with promising but limited evidence for several other psychological interventions. Conclusions. Recommendations for future RCTs are provided, and particular attention to the quality of trial design and reporting is highlighted.

Exploring the effects of lifestyle, sleep factors and driving behaviors on sleep-related road risk: a study of Greek drivers.

PURPOSE: The present study explored the effect of various lifestyle patterns and sleep-related factors on the sleep-related road risk. Sleep-related factors included daytime sleepiness, drowsy driving and quality/quantify of sleep. METHODS: A sample of 1366 non-professional drivers aged 19-65 was selected from the broader Athens area of Greece, using stratified random sampling. The questionnaire solicited information on the participants' socio-demographic characteristics, driving background, lifestyle patterns, sleep quality and quantity, daytime sleepiness, drowsy driving behavior and sleep-related road risk. RESULTS: Sleep-related road risk was affected by gender, quantity of night sleep and drowsy driving behavior. Drowsy driving behavior was shown to be related to gender, daytime sleepiness, sleep quality and the lifestyle of "amusement". Daytime sleepiness was correlated with sleep quality and the lifestyles of "amusement" and "sport". Finally, sleep quality and quantity were significantly affected by the lifestyles of "amusement" and "yuppies-workaholic". CONCLUSION: The current study has identified a number of risk factors in sleep-related crash risk in the general population of drivers. By raising public awareness the health and safety community can play an important role in reducing, if not preventing, the consequences of this public health problem.

Modelling the factors related to the seatbelt use by the young drivers of Athens.

Road traffic accidents in Greece are one of the major problems of the public health sector and the first cause of death in the ages 18-24. However, there are no records available for defining the determinants of road accidents and seatbelt wearing rates. The main objective of this study is to determine and clarify the relationship between young drivers' intentions (motivation to use/non use seatbelt) and their behaviour (self-reported use). Additionally, the purpose of this study is to evaluate the seatbelt wearing rates among young drivers in relation to their trip-type. The sample consisted of 200 young Greek drivers of both sexes. The statistical analysis included factor analysis and multiple regression analysis. The seatbelt use was measured in relation with seven trip-types. Through factor analysis, a seven factor scale of seatbelt use and a four factor scale of seatbelt non use were created which included Greek young drivers' basic motivations for wearing or not wearing a seatbelt. A model, constructed by the multiple regression analysis, revealed the factors related with the seatbelt use. The factors positively related were 'imitation', 'self-protection', and 'legality'. The factor of 'discomfort' is negatively associated with the seatbelt use. Furthermore, mileage was negatively related with seatbelt use. Finally, some preliminary suggestions on how prevention strategies should be implemented in Greece are discussed.

The impact of young drivers' lifestyle on their road traffic accident risk in greater Athens area.

Young drivers (18-24) both in Greece and elsewhere appear to have high rates of road traffic accidents. Many factors contribute to the creation of these high road traffic accidents rates. It has been suggested that lifestyle is an important one. The main objective of this study is to find out and clarify the (potential) relationship between young drivers' lifestyle and the road traffic accident risk they face. Moreover, to examine if all the youngsters have the same elevated risk on the road or not. The sample consisted of 241 young Greek drivers of both sexes. The statistical analysis included factor analysis and logistic regression analysis. Through the principal component analysis a ten factor scale was created which included the basic lifestyle traits of young Greek drivers. The logistic regression analysis showed that the young drivers whose dominant lifestyle trait is alcohol consumption or drive without destination have high accident risk, while these whose dominant lifestyle trait is culture, face low accident risk. Furthermore, young drivers who are religious in one way or another seem to have low accident risk. Finally, some preliminary observations on how health promotion should be put into practice are discussed.

Knowledge and attitudes about AIDS of residents of greater Athens.

A prospective research project on health education about AIDS is being conducted in the Greater Athens area. In the first phase of the project, information was collected concerning the knowledge and attitudes about AIDS of a sample of the population. The results indicated that, in general, the population was moderately well informed about AIDS. The population groups who were best informed were the females, those with a higher level of education and a longer period of urban residence, and those in the occupational category merchants/sales personnel. Three attitudinal categories were identified which could be characterized as discrimination, stigmatization and fear of those affected by AIDS. These attitudes were linked respectively to: (1) approval of the enforcement of special measures, (2) stigmatizing of persons, behaviours and districts and (3) fear that AIDS comprises a major social threat. The attitudes expressed by restrictive measures towards those affected and stigmatization were associated with a low level of knowledge about most aspects of AIDS. Health education programmes directed at the population in the districts studied should take into account the findings of this study.

Pattern of treatment among diabetic patients in a sample of urban Greek population.

It is well known that therapeutic habits and diabetic patient's compliance differ substantially between different populations. It is also accepted that if patients are recruited in specialized diabetes centers some important bias is likely to occur, e.g. an excess of insulin-treated subjects. Therefore, population studies are very helpful in order to establish treatment patterns in different populations. A descriptive study was performed during an epidemiological survey conducted on 12,842 randomly selected inhabitants of a suburb of Athens (both sexes, all ages). 509 persons were recorded as known diabetics. Information concerning the type of treatment was collected. Reliable data were available on 490 diabetic individuals. 145 (29.6%) of them were following diet alone, while 270 (55.1%) were receiving antidiabetic tablets and only 75 (15.1%) injected insulin. In patients 40 years old or more (n = 471), the corresponding numbers were 30.1, 56.5 and 13.4% respectively. Thus, it is obvious that insulin-treated patients represent a small percentage of the total diabetic population. It seems that these differences are caused by genetic as well as other factors.

Evidence for an increase in the prevalence of known diabetes in a sample of an urban population in Greece.

It is accepted that the prevalence of known diabetes mellitus has increased in some countries, although the available data are incomplete and sometimes anecdotal. In 1974 a sample of the urban population (n = 21,410) in a suburb of Athens (Greece) was evaluated for the prevalence of known diabetes mellitus. The study was repeated 17 years later in the same area under the same conditions and methodology on 12,836 randomly selected inhabitants (both sexes, all ages). Visiting nurses contacted the inhabitants at home and filled in a questionnaire. The results show a clear increase in diabetes prevalence of the population as a whole (standardized rates: 1974: 2.4% (95% confidence intervals 2.2-2.6%) 1990: 3.1 (2.8-3.4%)). Standardization was done on the basis of data obtained from the same census. The changes were statistically significant in the 50-59, 60-69, and 70-79 age groups (1974: 5.87, 10.98, and 11.41%; 1990: 7.70, 13.68, and 19.52%, respectively). Thus, the prevalence of known diabetes mellitus has considerably increased during the last 17 years in a sample of urban Greek population.

Breast self-examination. Knowledge and behavior of Greek female health care professionals working in primary health care centers.

A comparative correlational study was conducted to examine the knowledge and frequency of breast self-examination (BSE) by Greek health care professionals. A total of 268 women working in primary health care centers constituted the sample. The women were 22-64 years of age. Subjects reported low levels of knowledge about BSE and facts related to breast cancer. Multiple regression analysis showed significant relationships between level of knowledge and profession, number of years of health-related education, and frequency of BSE. The sample's frequency of practice of BSE was limited. Only 34.7% of the participants claimed to practice BSE on a monthly basis. Multiple regression analysis revealed statistically significant correlations between BSE behavior and marital status, professional experience with breast cancer, and level of knowledge. The level of knowledge of the participants is considered to be inadequate, taking into account that they work in settings where primary health care is offered. Courses of preventive medicine and health education should be incorporated in medical and nursing curricula.