Exploring the Potential Impact of Training on Short-Term Quality of Life and Stress of Parents of Children with Autism: The Integrative Parents' Autism Training Module.

Parents of autistic children experience high levels of parental stress and low quality of life related to the demanding child caring burden they experience. Parent education and training programs are acknowledged to improve parental well-being and reduce parenting stress. In the framework of the Erasmus+ Integrative Autism Parents Training Project (IPAT), we developed the IPAT Training Module based on parents' expressed needs, in order to improve parental quality of life (QoL) and decrease their perceived stress. Sixty-two parents from four countries participated in the IPAT Module Training activity. We used WHOQOL-BREF and Perceived Stress Scale (PSS-10 version) for QoL and stress, respectively, before and after training and a study-specific questionnaire to assess participants' satisfaction. Parents' QoL improved significantly in the environment domain and specific items, while stress levels remained unmodified. Training appeared more advantageous for parents with lower initial QoL and those whose child had been enrolled in a special education program for an extended duration. Parents were quite satisfied, in particular those with lower initial social relationships QoL. Larger studies including a control group are necessary to support preliminary evidence provided by this study, identify additional effect moderators, and disentangle the contribution of different components of the training.

Moral Resilience Reduces Levels of Quiet Quitting, Job Burnout, and Turnover Intention among Nurses: Evidence in the Post COVID-19 Era.

The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single-item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses. This study was not registered.

Association between Organizational Support and Turnover Intention in Nurses: A Systematic Review and Meta-Analysis.

Although recent studies suggest a negative relationship between organizational support and turnover intention among nurses, there has been no systematic review on this issue. The aim of this systematic review and meta-analysis was to synthesize and evaluate the association between organizational support and turnover intention in nurses. The review protocol was registered with PROSPERO (CRD42023447109). A total of eight studies with 5754 nurses were included. All studies were cross-sectional and were conducted after 2010. Quality was moderate in five studies and good in three studies. We found a moderate negative correlation between organizational support and turnover intention since the pooled correlation coefficient was -0.32 (95% confidence interval: -0.42 to -0.21). All studies found a negative correlation between organizational support and turnover intention ranging from -0.10 to -0.51. A leave-one-out sensitivity analysis showed that our results were stable when each study was excluded. Egger's test and funnel plot suggested the absence of publication bias in the eight studies. Subgroup analysis showed that the negative correlation between organizational support and turnover intention was stronger in studies in China and Australia than those in Europe. Organizational support has a moderate negative correlation with turnover intention in nurses. However, data regarding the impact of organizational support on turnover intention are limited. Moreover, our study had several limitations, and thus, we cannot generalize our results. Therefore, further studies should be conducted to assess the independent effect of organizational support on turnover intention in a more valid way. In any case, nursing managers should draw attention to organizational support by developing effective clinical practice guidelines for nurses so as to reduce turnover intention.

Nurses quietly quit their job more often than other healthcare workers: An alarming issue for healthcare services.

AIM: To assess the level of quiet quitting among healthcare workers (HCWs) and identify possible differences between nurses, physicians, and other HCWs. We investigated the impact of sociodemographic variables, job burnout, and job satisfaction on quiet quitting levels. BACKGROUND: The quiet-quitting phenomenon is not new but has been frequently discussed during the COVID-19 pandemic. Interestingly, the level of quiet quitting among HCWs has not been measured yet. METHODS: We conducted a cross-sectional study with a convenience sample. We measured sociodemographic variables, job burnout, job satisfaction, and quiet quitting. We adhered to STROBE guidelines for cross-sectional studies. FINDINGS: Among our sample, 67.4% of nurses were quiet quitters, while the prevalence of quiet quitting for physicians and other HCWs was 53.8% and 40.3%, respectively. Multivariable linear regression analysis identified that the levels of quiet quitting were higher among nurses than physicians and other HCWs. Moreover, greater job burnout contributed more to quiet quitting, while less satisfaction implied more quiet quitting. HCWs who work in shifts and those working in the private sector experienced higher levels of quiet quitting. DISCUSSION: More than half of our HCWs were described as quit quitters. Levels of quiet quitting were higher among nurses. Job burnout and job dissatisfaction were associated with higher levels of quiet quitting. IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY: Measurement of quiet quitting and identification of risk factors are essential to prevent or reduce quiet quitting levels among HCWs. Our study provides information on this field helping managers and organizations to identify quiet quitters within HCWs. Policymakers and managers should develop and implement interventions both at an organizational level and at an individual level.

Resilience and Social Support Improve Mental Health and Quality of Life in Patients with Post-COVID-19 Syndrome.

Physical and mental health problems among post-COVID-19 patients are common, even a year after infection. As there is no prior study available, we investigated the impacts of resilience and social support on anxiety, depression, and quality of life among patients with post-COVID-19 syndrome. We conducted a cross-sectional study with a convenience sample. The measures included the demographic and clinical characteristics of patients, the Brief Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Patient Health Questionnaire-4 (PHQ-4), and the EuroQol-5D-3L. The mean age of patients was 44.8 years. The total PHQ-4 score suggested that 32.8% of patients with post-COVID-19 syndrome experienced severe psychological distress, 32.8% experienced moderate distress, 23% experienced mild distress, and 11.5% had no distress. Moreover, 60.7% of patients had anxiety scores of ≥3 and 69.7% had depression scores of ≥3, indicating possible major anxiety or depression disorder. The mean EQ-5D-3L index value was 0.36, and the mean EQ-5D-3L VAS was 54.1. Multivariable analysis identified that resilience and social support reduced anxiety and depression among patients. Also, we found a significant positive relationship between resilience and social support, and quality of life. Our findings suggest that resilience and social support can be protective by reducing anxiety and depression and improving quality of life among patients with post-COVID-19 syndrome. Policymakers should develop and implement healthcare management programs to provide psychological support to these patients.

The Cost and the Value of Stroke Care in Greece: Results from the SUN4P Study.

The aim of this study was to measure the one-year total cost of strokes and to investigate the value of stroke care, defined as cost per QALY. The study population included 892 patients with first-ever acute strokes, hemorrhagic strokes, and ischemic strokes, (ICD-10 codes: I61, I63, and I64) admitted within 48 h of symptoms onset to nine public hospitals located in six cities. We conducted a bottom-up cost analysis from the societal point of view. All cost components including direct medical costs, productivity losses due to morbidity and mortality, and informal care costs were considered. We used an annual time horizon, including all costs for 2021, irrespective of the time of disease onset. The average cost (direct and indirect) was extrapolated in order to estimate the national annual burden associated with stroke. We estimated the total cost of stroke in Greece at EUR 343.1 mil. a year in 2021, (EUR 10,722/patient or EUR 23,308 per QALY). Out of EUR 343.1 mil., 53.3% (EUR 182.9 mil.) consisted of direct healthcare costs, representing 1.1% of current health expenditure in 2021. Overall, productivity losses were calculated at EUR 160.2 mil. The mean productivity losses were estimated to be 116 work days with 55.1 days lost due to premature retirement and absenteeism from work, 18.5 days lost due to mortality, and 42.4 days lost due to informal caregiving by family members. This study highlights the burden of stroke and underlines the need for stakeholders and policymakers to re-organize stroke care and promote interventions that have been proven cost-effective.

Increased Job Burnout and Reduced Job Satisfaction for Nurses Compared to Other Healthcare Workers after the COVID-19 Pandemic.

Nurses experience high levels of job burnout and low levels of job satisfaction, while the COVID-19 pandemic has deteriorated working conditions. In this context, our aim was to compare levels of job burnout and job satisfaction among nurses and other healthcare workers (HCWs) after the COVID-19 pandemic. Moreover, we investigated the influence of demographics and job characteristics on burnout and satisfaction. We conducted a cross-sectional study with 1760 HCWs during June 2023. We used the single-item burnout measure and the "Job Satisfaction Survey". In our sample, 91.1% of nurses experienced high levels of burnout, while the respective percentage for the other HCWs was 79.9%. Nurses' satisfaction was lower than other HCWs. In particular, 61.0% of nurses experienced low levels of satisfaction, while the respective percentage for the other HCWs was 38.8%. Multivariable analysis identified that nurses, HCWs with an MSc/PhD diploma, shift workers, and those who considered their workplace as understaffed had higher burnout score and lower satisfaction score. Our results showed that the nursing profession was an independent factor of burnout and satisfaction. Several other demographic and job characteristics affected burnout and satisfaction. Policy makers, organizations, and managers should adopt appropriate interventions to improve work conditions.

The COVID-19 burnout scale: development and initial validation.

BACKGROUND: Research on the pandemic-related burnout has focused on work-related burnout especially among healthcare workers, but not in the general population. AIM: To develop a valid and reliable instrument scale to measure pandemic-related burnout in the general population. METHODS: We took several steps to develop the scale items and achieve content and face validity; literature review, panel of experts, calculation of content validity ratio, and cognitive interviews. We assessed structural and construct validity, and reliability of the COVID-19 burnout scale (COVID-19-BS). RESULTS: Exploratory and confirmatory factor analysis identified three factors for the COVID-19-BS; emotional exhaustion, physical exhaustion, and exhaustion due to measures against the COVID-19. Cronbach's alpha coefficients for the three factors and the COVID-19-BS ranged from 0.860 to 0.921. Kaiser-Meyer-Olkin value was 0.945, and p-value for Bartlett test was <0.001. A significant positive correlation between the three factors and anxiety and depression indicated high concurrent validity. Cohen's kappa ranged from 0.848 to 0.957, while intraclass correlation coefficients ranged from 0.888 to 0.997. CONCLUSIONS: Our findings indicate that the final 3-factor model with 13 items of COVID-19-BS is a brief, easy to administer, valid and reliable scale for assessing COVID-19-related burnout in the general public.

Prevalence and risk factors of adverse effects after the first COVID-19 booster dose: evidence from Greece.

Background: In general, COVID-19 vaccines are safe and effective, but minor adverse effects are common. However, adverse effects have not been measured in several countries including Greece. Objective: To estimate the prevalence of adverse effects after the first COVID-19 booster dose, and to identify possible risk factors. Material and methods: We conducted a cross-sectional study with a convenience sample in Greece during November 2022. We measured several adverse effects after the booster dose, such as fatigue, headaches, fever, chills, nausea, etc. We considered gender, age, chronic disease, self-assessment of health status, COVID-19 diagnóstico, and self-assessment of COVID-19 course as possible predictors of adverse effects. Results: In our sample, 96% developed at least one adverse effect. Half of the participants (50.2%) developed one to five adverse effects, 35.9% developed six to ten adverse effects, and 9.5% developed 11 to 16 adverse effects. Mean number of adverse effects was 5.5. The most frequent adverse effects were pain at the injection site (84.3%), fatigue (70.8%), muscle pain (61%), swelling at the injection site (55.2%), headache (49.8%), fever (42.9%), and chills (41%). Females developed more adverse effects than males (p < 0.001). The prevalence of adverse effects of COVID-19 vaccines was statistically significant and positively associated with the severity of COVID-19 among COVID-recovered individuals (p < 0.05). Moreover, younger age was associated with increased adverse effects (p < 0.001). Conclusions: Almost all participants in our study developed minor adverse effects after the booster dose. Female gender, COVID-19 patients with worse clinical course, and younger individuals experienced more often adverse effects.

Antecedentes: En general, las vacunas COVID-19 son seguras y eficaces, pero son frecuentes los efectos adversos leves. Sin embargo, los efectos adversos no se han medido en varios países, entre ellos Grecia. Objetivo: Estimar la prevalencia de efectos adversos tras la primera dosis de refuerzo de COVID-19 e identificar posibles factores de riesgo. Métodos: Realizamos un estudio transversal con una muestra de conveniencia en Grecia durante noviembre de 2022. Se midieron varios efectos adversos tras la dosis de refuerzo, fatiga, dolores de cabeza, fiebre, escalofríos, náuseas, etc. Consideramos el sexo, la edad, la enfermedad crónica, la autoevaluación del estado de salud, el diagnóstico de COVID-19 y la autoevaluación del curso de COVID-19 como posibles predictores de los efectos adversos. Resultados: En nuestra muestra, el 96% desarrolló al menos un efecto adverso. La mitad de los participantes (50,2%) desarrollaron de uno a cinco efectos adversos, el 35,9% desarrollaron de seis a diez efectos adversos, y el 9,5% desarrollaron de 11 a 16 efectos adversos. La media de efectos adversos fue de 5,5. Los efectos adversos más frecuentes fueron dolor en el punto de inyección (84,3%), fatiga (70,8%), dolor muscular (61%), hinchazón en el punto de inyección (55,2%), cefalea (49,8%), fiebre (42,9%) y escalofríos (41%). Las mujeres presentaron más efectos adversos que los hombres (p < 0,001). La prevalencia de los efectos adversos de las vacunas COVID-19 fue estadísticamente significativa y se asoció positivamente con la gravedad de COVID-19 entre los individuos recuperados de COVID (p < 0,05). Además, la menor edad se asoció con mayores efectos adversos (p < 0,001). Conclusiones: Casi todos los participantes en nuestro estudio desarrollaron efectos adversos menores tras la dosis de refuerzo. El sexo femenino, los pacientes de COVID-19 con peor evolución clínica y los individuos más jóvenes experimentaron efectos adversos con mayor frecuencia.

Stroke Patients' Management During COVID-19 Pandemic: Results from the Sun4Patients Web-Based Registry.

Covid-19 pandemic has influenced stroke care in different ways. Recent reports demonstrated a sharp decline in acute stroke admissions worldwide. Even for patients presented to dedicated healthcare services, management at the acute phase may be sub-optimal. On the other hand, Greece has been praised for the early initiation of restriction measures which were associated with a 'milder' surge of SARS-CoV-2 infection. Methods Data derived from a prospective cohort multicenter registry. The study population consisted of first-ever acute stroke patients, hemorrhagic or ischemic, admitted within 48 hours of symptom onset in seven national healthcare system (NHS) and University hospitals in Greece. Two different time periods have been considered, defined as "before Covid-19" (15/12/2019-15/02/2020) and "during Covid-19" (16/02/2020-15/04-2020) era. Statistical comparisons on acute stroke admission characteristics between the two different time periods have been performed. Results This exploratory analysis of 112 consecutive patients showed a reduction of acute stroke admissions by 40during Covid-19 period. No significant differences were observed regarding stroke severity, risk factor profile and baseline characteristics for patients admitted before and during Covid-19 pandemic period. There is a significant delay between symptom onset to CT scan during Covid-19 era compared to the period before pandemic reached Greece (p=0.03). Conclusions The rate of acute stroke admissions has been reduced by 40% during Covid-19 pandemic. Further research is needed to clarify whether the reduction in stroke volume is actual or not and identifying the reasons underlying the paradox.

Psychosocial Predictors of COVID-19 Vaccine Uptake among Pregnant Women: A Cross-Sectional Study in Greece.

An understanding of the factors associated with the COVID-19 vaccine uptake in pregnant women is paramount to persuade women to get vaccinated against COVID-19. We estimated the vaccination rate of pregnant women against COVID-19 and evaluated psychosocial factors associated with vaccine uptake among them. We conducted a cross-sectional study with a convenience sample. In particular, we investigated socio-demographic data of pregnant women (e.g., age, marital status, and educational level), COVID-19 related variables (e.g., previous COVID-19 diagnosis and worry about the side effects of COVID-19 vaccines), and stress due to COVID-19 (e.g., danger and contamination fears, fears about economic consequences, xenophobia, compulsive checking and reassurance seeking, and traumatic stress symptoms about COVID-19) as possible predictors of COVID-19 vaccine uptake. Among pregnant women, 58.6% had received a COVID-19 vaccine. The most important reasons that pregnant women were not vaccinated were doubts about the safety and effectiveness of the COVID-19 vaccines (31.4%), fear that COVID-19 vaccines could be harmful to the fetus (29.4%), and fear of adverse side effects of COVID-19 vaccines (29.4%). Increased danger and contamination fears, increased fears about economic consequences, and higher levels of trust in COVID-19 vaccines were related with vaccine uptake. On the other hand, increased compulsive checking and reassurance seeking and increased worry about the adverse side effects of COVID-19 vaccines reduced the likelihood of pregnant women being vaccinated. An understanding of the psychosocial factors associated with increased COVID-19 vaccine uptake in pregnant women could be helpful for policy makers and healthcare professionals in their efforts to persuade women to get vaccinated against COVID-19. There is a need for targeted educational campaigns to increase knowledge about COVID-19 vaccines and reduce vaccine hesitancy in pregnancy.

Predictors of Seasonal Influenza Vaccination Willingness among High-Risk Populations Three Years after the Onset of the COVID-19 Pandemic.

High-risk populations are at increased risk of severe influenza-related illness, hospitalization, and death due to influenza. The aim of our study was to assess the willingness of high-risk populations to take the influenza vaccine for the 2022-2023 season, and to investigate the factors associated with such willingness. We conducted a cross-sectional study in Greece in September 2022 using a convenience sample. We considered demographic characteristics, COVID-19-related variables, resilience, social support, anxiety, depression, and COVID-19-related burnout as potential predictors. Among participants, 39.4% were willing to accept the seasonal influenza vaccine, 33.9% were unwilling, and 26.8% were hesitant. Multivariable analysis identified that increased age and increased family support were associated with increased influenza vaccination willingness. Moreover, participants that have received COVID-19 booster doses were more willing to accept the influenza vaccine. In contrast, adverse effects because of COVID-19 vaccination and exhaustion due to measures against COVID-19 reduced influenza vaccination willingness. We found that the intention of high-risk populations to receive the influenza vaccine was low. Our study contributes to an increased understanding of the factors that affect vaccination willingness. Public health authorities could use this information to update vaccination programs against influenza. Emphasis should be given on safety and effectiveness issues.

Seasonal Influenza Vaccine Intention among Nurses Who Have Been Fully Vaccinated against COVID-19: Evidence from Greece.

Seasonal influenza continues to be a significant public health issue causing hundreds of thousands of deaths annually. Nurses are a priority risk group for influenza vaccination and a high vaccine uptake rate among them is crucial to protect public health. Thus, the aim of our study was to estimate the levels of influenza vaccine acceptance, as well as its determinants, among nurses for the 2022/2023 season. We conducted a cross-sectional study with a convenience sample in Greece. We collected data via an online survey in September 2022. Most of the nurses in the study possessed a MSc/PhD diploma (56.2%) and had previously been infected by SARS-CoV-2 (70.3%). Among nurses, 57.3% were willing to accept the influenza vaccine, 19% were hesitant, and 23.7% were unwilling. Older age, higher levels of perceived support from significant others, and higher COVID-19-related physical exhaustion were positively related to influenza vaccination intention. In contrast, more side effects because of COVID-19 vaccination and higher levels of exhaustion due to measures taken against COVID-19 were negatively associated with vaccination intention. Since the influenza vaccination acceptance rate among nurses was moderate, policymakers should develop and implement measures tailored specifically to nurses in the context of the COVID-19 pandemic to decrease vaccine hesitancy.

Predictors of second COVID-19 booster dose or new COVID-19 vaccine hesitancy among nurses: A cross-sectional study.

AIMS AND OBJECTIVES: To assess the levels of second COVID-19 booster dose/new COVID-19 vaccine hesitancy among nurses and explore the potential predictors of vaccine hesitancy. BACKGROUND: COVID-19 full vaccination seems to be highly effective against highly contagious variants of SARS-CoV-2. Healthcare workers are at high-risk group since they have experienced high levels of COVID-19-associated morbidity and mortality. DESIGN: An on-line cross-sectional study was carried out in Greece in May 2022, using a self-administered questionnaire. METHODS: The study population included nurses in healthcare services who were fully vaccinated against COVID-19 at the time of study. We considered socio-demographic characteristics, COVID-19-related variables, and attitudes toward COVID-19 vaccination and pandemic as potential predictors of vaccine hesitancy. We applied the STROBE checklist in our study. RESULTS: Among 795 nurses, 30.9% were hesitant toward a second booster dose or a new COVID-19 vaccine. Independent predictors of hesitancy included lower educational level, absence of a chronic condition, good/very good self-perceived physical health, lack of flu vaccination during 2021, front-line nurses that provided healthcare to COVID-19 patients, nurses that had not been diagnosed with COVID-19 and nurses that had at least one relative/friend that has died from COVID-19. Moreover, increased compliance with hygiene measures, increased fear of a second booster dose/new COVID-19 vaccine and decreased trust in COVID-19 vaccination were associated with increased hesitancy. CONCLUSIONS: Our study shows that a significant percentage of nurses are hesitant toward a second booster dose/new COVID-19 vaccine. This initial hesitancy could be a barrier to efforts to control the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: Nurses' role during the COVID-19 pandemic is essential since they are the front-line healthcare workers empowering the public with their passion and empathy. There is a need to communicate COVID-19 vaccine science in a way that is accessible to nurses in order to decrease COVID-19 vaccine hesitancy. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Quiet Quitting among Nurses Increases Their Turnover Intention: Evidence from Greece in the Post-COVID-19 Era.

As turnover intention is a strong determinant of actual turnover behavior, scholars should identify the determinants of turnover intention. In this context, the aim of this study was to assess the effect of quiet quitting on nurses' turnover intentions. Additionally, this study examined the impact of several demographic and job characteristics on turnover intention. A cross-sectional study with 629 nurses in Greece was conducted. The data were collected in September 2023. Quiet quitting was measured with the "Quiet Quitting" scale. In this study, 60.9% of nurses were considered quiet quitters, while 40.9% experienced high levels of turnover intention. Multivariable regression analysis showed that higher levels of quiet quitting increased turnover intention. Moreover, this study found that turnover intention was higher among females, shift workers, nurses in the private sector, and those who considered their workplace understaffed. Also, clinical experience was associated positively with turnover intention. Since quiet quitting affects turnover intention, organizations, policymakers, and managers should address this issue to improve nurses' intentions to stay at their jobs.

The quiet quitting scale: Development and initial validation.

Introduction: COVID-19 pandemic causes drastic changes in workplaces that are likely to increase quite quitting among employees. Although quiet quitting is not a new phenomenon, there is no instrument to measure it. Objective: To develop and validate an instrument assessing quiet quitting among employees. Methods: We identified and generated items through an extensive literature review and interviews with employees. We carried out the content validity by content experts and we calculated the content validity ratio. We checked face validity by conducting cognitive interviews with employees and calculating the item-level face validity index. We conducted exploratory and confirmatory factor analysis to investigate the quiet quitting scale (QQS) factorial structure. We checked the concurrent validity of the QQS using four other scales, i.e., Copenhagen burnout inventory (CBI), single item burnout (SIB) measure, job satisfaction survey (JSS) and a single item to measure turnover intention. We estimated the reliability of the QQS measuring Cronbach's alpha, McDonald's omega, Cohen's kappa and intraclass correlation coefficient. Results: After expert panel review and item analysis, nine items with acceptable corrected item-total correlations, inter-item correlations, floor and ceiling effects, skewness and kurtosis were retained. Exploratory factor analysis extracted three factors, namely detachment, lack of initiative and lack of motivation, with a total of nine items. Confirmatory factor analysis confirmed this factorial structure for QQS. We found statistically significant correlations between QQS and CBI, SIB, JSS and turnover intention confirming that the concurrent validity of the QQS was great. Cronbach's alpha and McDonald's omega of the QQS were 0.803 and 0.806 respectively. Conclusion: QQS, a three-factor nine-item scale, has robust psychometric properties. QQS is an easy-to-administer, brief, reliable and valid tool to measure employees' quiet quitting. We recommend the use of the QQS in different societies and cultures to assess the validity of the instrument.

Post-COVID-19 Syndrome and Related Dysautonomia: Reduced Quality of Life, Increased Anxiety and Manifestation of Depressive Symptoms: Evidence from Greece.

Background: Post-COVID-19 syndrome affects a significant number of SARS-CoV-2 infected individuals, even in asymptomatic cases causing several neurological and neuropsychiatric symptoms and signs. Materials and Methods: An online cross-sectional study with a convenience sample was conducted in Greece from November 2022 to January 2023. We measured the demographic and clinical characteristics of patients with post-COVID-19 dysautonomia in terms of the quality of life with the EQ-5D-3L, and anxiety and depressive symptoms by employing Patient Health Questionnaire-4. Results: The study population included 122 patients with post-COVID-19 syndrome. One out of four patients (27.8%) manifested post-COVID-19 dysautonomia, while the mean duration of COVID-19 symptoms was 11.6 months. Anxiety and depressive symptoms were worse after the post-COVID-19 syndrome (p<0.001 in both cases). A statistically significant reduction in quality of life was observed among patients after the post-COVID-19 syndrome (p<0.001 for both EQ-5D-3L index value and EQ-5D-3L VAS). Post-COVID-19 dysautonomia increased depression symptoms after developing the post-COVID-19 syndrome (p=0.02). We found a negative relationship between the duration of COVID-19 symptoms and the quality of life (p<0.001). Moreover, our results showed that depressive symptoms were more common among females after the post-COVID-19 syndrome (p=0.01). Also, the quality of life was lower among females than males (p=0.004 for EQ-5D-3L index value, and p=0.007 for EQ-5D-3L VAS). Conclusions: Our results suggest that post-COVID-19 syndrome causes a tremendous impact on the patients' quality of life and mental health. In addition, we found that the groups most psychologically affected were patients with post-COVID-19 dysautonomia, females, and patients with a longer duration of symptoms. Policy makers should assign priority rights to vulnerable groups in future psychiatric planning. Policy measures should focus on the mental health of post-COVID-19 patients who seem to be particularly vulnerable.

COVID-19 Vaccine Uptake among Healthcare Workers: A Systematic Review and Meta-Analysis.

The vaccine-induced immunity of healthcare workers (HCWs) is crucial to controlling the COVID-19 pandemic. Therefore, we conducted a systematic review and meta-analysis to assess the COVID-19 vaccine uptake among HCWs worldwide and to identify predictors of vaccination. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL, and medRxiv up to 25 August 2022. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We found 25 studies including 491,624 vaccinated HCWs, while the full sample included 555,561 HCWs. The overall proportion of vaccinated HCWs was 77.3%. Vaccine uptake for studies that were conducted in North America (85.6%) was higher than the proportion for studies that were conducted in Asia (79.5%), Europe (72.8%), and Africa (65.6%). The overall prevalence of COVID-19 vaccine uptake was 83.6% and 77.4% for physicians and nurses, respectively. Older age, white race, physicians' profession, seasonal influenza vaccine, direct COVID-19 patient care, and confidence in COVID-19 vaccine safety and effectiveness were positive predictors of vaccine uptake, while history of SARS-CoV-2 infection was a negative predictor. Deep understanding of the factors that influence HCWs' decisions to receive a COVID-19 vaccine is critical to implementing tailored communication strategies for HCWs who are at risk for not getting vaccinated.

Predictors of Real-World Parents' Acceptance to Vaccinate Their Children Against the COVID-19.

Background: As the COVID-19 pandemic continues to threaten public health, the vaccination of children against the disease appears to be a key factor to control the pandemic. Our aim was to investigate the prevalence of parents who have vaccinated their children against the COVID-19 and the factors influencing this decision. Materials and Methods: We conducted a web-based cross-sectional study in Greece during the first week of September 2021. The study questionnaire was distributed through social media and a convenience sample was obtained. Only parents with children aged 12-17 years old could participate in the study. We collected socio-demographic data of parents and we measured their attitudes towards vaccination and COVID-19 pandemic. Results: Study population included 656 parents. Regarding vaccination, 27.1% of parents had their children vaccinated against the COVID-19, while almost all children had a complete vaccination history (98.9%). The most important reasons for decline of COVID-19 vaccination were doubts about the safety and effectiveness of COVID-19 vaccines (45.3%) and fear of side effects (36.6%). Regarding the information about the COVID-19 vaccines, parents showed more trust in family doctors than in scientists and the government. We found that increased parents' age, increased trust in COVID-19 vaccines, and positive attitude of parents towards vaccination had a positive effect on children's vaccination. Conclusions: Understanding the factors influencing parents' decision to vaccinate their children against the COVID-19 is crucial to increase the COVID-19 vaccination coverage rate. Implementation of public health policies is necessary to spread knowledge about COVID-19 vaccines and to regain vaccine confidence.

Predictors of Willingness of the General Public to Receive a Second COVID-19 Booster Dose or a New COVID-19 Vaccine: A Cross-Sectional Study in Greece.

Given the concerns of waning immunity from the primary COVID-19 vaccines and the first booster dose, we conducted an online cross-sectional study in May 2022 to investigate willingness to receive a second COVID-19 booster dose or a new COVID-19 vaccine and its associated factors. Overall, 62% of the participants were willing to be vaccinated, 25.8% were unsure, and 12.3% were unwilling to be vaccinated. The main reasons against accepting a second COVID-19 booster dose/new COVID-19 vaccine were concerns about the side effects and the effectiveness and the opinion that further vaccination is unnecessary. Males, younger individuals, participants without a previous COVID-19 diagnosis, and those with good/very good self-perceived physical health were significantly more frequently willing to receive a second COVID-19 booster dose or a new COVID-19 vaccine. Additionally, increased fear of the COVID-19, increased trust in COVID-19 vaccinations, and decreased fear of a second booster dose or a new COVID-19 vaccine was associated with increased willingness. Our results show some hesitancy and unwillingness toward further COVID-19 vaccination and indicate that the fear of COVID-19 and trust in COVID-19 vaccination affects public opinion.