Optimal stump management in laparoscopic appendectomy: A network meta-analysis by the Minimally Invasive Surgery Synthesis of Interventions and Outcomes Network.

BACKGROUND: Laparoscopic appendectomy is the predominant method of treatment of acute appendicitis. There is insufficient evidence on the most effective management of the appendix stump. The aim of this study was to investigate the relative effectiveness and provide a treatment ranking of different options for securing the appendix stump. METHODS: Electronic databases were searched to identify randomized controlled trials comparing ligation methods of the appendix. The primary outcomes were organ/space infection and superficial operative site infection. We performed a network meta-analysis and estimated the pairwise relative treatment effects of the competing interventions using the odds ratio and its 95% confidence interval. We obtained a hierarchy of the competing interventions using rankograms and the surface under the cumulative ranking curve. RESULTS: Forty-three randomized controlled trials were eligible and provided data for >5,000 patients. Suture ligation seemed to be the most effective treatment strategy, in terms of both organ/space infection and superficial operative site infection. Statistical significance was reached for the comparisons of clip versus endoloop (odds ratio 0.56, 95% confidence interval, 0.32-0.96) for organ/space infection; and suture versus clip (odds ratio 0.20, 95% confidence interval 0.08-0.55) and clip versus endoloop (odds ratio 2.22, 95% confidence interval 1.56-3.13) for superficial operative site infection. The network was informed primarily by indirect treatment comparisons. CONCLUSION: The use of suture ligation of the appendix in laparoscopic appendectomy seems to be superior to other methods for the composite parameters of organ/space and superficial operative site infection.

Attitudes towards people with physical or intellectual disabilities among nursing, social work and medical students.

AIMS AND OBJECTIVES: To examine and compare undergraduate healthcare students' attitudes towards people with physical or intellectual disabilities in Greece. BACKGROUND: The experience that people with disabilities have with health care is a complex interaction between their medical condition and the social and physical environment. Attitudes of the nursing and healthcare staff affect the quality of care and people's adaptation to their disability, self-image and rehabilitation outcomes. DESIGN: Descriptive cross-sectional survey. METHODS: Nursing, Social Work and Medicine students (N = 1007, 79.4% female) attending three universities (Athens, Crete) completed during 2014-2016 two standardised scales regarding physical (ATDP-B) and intellectual disability (CLAS-ID). Descriptive and multivariate logistic regression analyses were performed. RESULTS: Attitudes towards people with physical disabilities in Greece (ATDP-B scores) were poor with scores just above the mid-point. Medical studies and higher knowledge and work with individuals with physical disabilities signified marginally more positive attitudes. Gender and age displayed no associations with attitudes. Regarding intellectual disability (CLAS-ID scores), nursing students had slightly less positive attitudes in "Similarity" but more positive attitudes in "Sheltering" subscales. Previous work and contact was related to more favourable and higher age to less favourable "Similarity" and "Sheltering" attitudes. Males had higher "Exclusion" scores. Those who knew people with intellectual disabilities had less favourable "Empowerment" attitudes. Knowledge was related to more positive attitudes in all four CLAS-ID subscales. CONCLUSIONS: Greek health and social care students showed poor attitudes towards people with physical and intellectual disability. RELEVANCE TO CLINICAL PRACTICE: When holding unfavourable attitudes, healthcare professionals become less involved with the people they care for and they do not provide nursing care to the best of their abilities. Undergraduate and continuing education, along with workplace enhancements, should aim to provide high-quality health care to people with disabilities.

Associations of Bullying and Cyberbullying With Substance Use and Sexual Risk Taking in Young Adults.

PURPOSE: This study aims at identifying the sex-stratified associations of involvement in traditional bullying during middle and high school years and in cyberbullying during college years with multiple health risk behaviors in undergraduate students. DESIGN: This cross-sectional analysis draws on the data of the second wave of the LATO study (Lifestyle & Attitudes in a Student Population) in Greece. METHODS: During November and December 2013, 812 second-year undergraduate students (mean age = 19.3 years; girls = 66.1%) provided data on substance use (smoking, alcohol abuse or drunkenness, illegal drug use including marijuana, hashish, and cannabis) and sexual risk taking (paying for sex and not using condoms) and completed the Cyberbullying and its Effects and the Retrospective Bullying Questionnaires. Logistic regression models performed were adjusted for potential confounders. FINDINGS: Both male and female late adolescents who were victims of bullying during middle and high school were less likely to use condoms during college years when compared to uninvolved students. Among males, being a bully or victim at school doubled the odds for past month drunkenness and tripled the odds of paying for sex. Greater likelihood to pay for sex was also evident in bullying victims. Cyberbully or cybervictim male students were more likely to report smoking. In female bullying victims, alcohol abuse associations were somewhat conflicting, with decreased lifetime but increased past month likelihood for drunkenness. CONCLUSIONS: Engagement in bullying and cyberbullying is associated with the manifestation of gender-specific health risk behaviors for the different involvement groups in college students. CLINICAL RELEVANCE: Involvement in bullying and cyberbullying is a major public health concern due to the associations with multiple health risk behaviors. Nurses and healthcare professionals should adopt multifaceted prevention interventions tailored according to bullying status and gender that extend through all educational levels.

Gender differences in the prevalence and clustering of multiple health risk behaviours in young adults.

AIMS: To estimate the sex-stratified prevalence and clustering of 14 behavioural and metabolic health risk factors in emerging adulthood. BACKGROUND: The high prevalence and the clustering of risk factors multiply health consequences and increase the threat to the future health and quality of life of young adults. DESIGN: Descriptive cross-sectional study. METHODS: During November-December 2012, we assessed 14 lifestyle characteristics of 1058 1st year university students' that were classified as: healthy (score = 0), unhealthy (score = 1) and high-risk unhealthy (score = 2). We subsequently created a Multiple Health Risk Behaviours Index by summing the score of each behaviour adjusted to 0-100. RESULTS: Only 0·3% of the students had one risk behaviour and 21·3% (male: 31·5%; female: 12·6%) had ≥10 of 14. Male students had higher risk index score. In adjusted regression analyses, female students had higher odds of reporting healthier behaviours in oral hygiene (tooth brushing), red meat and junk food consumption, binge drinking, cannabis/hashish/marijuana use and lower number of sexual partners and Body Mass Index. Male students reported higher physical activity. No statistically significant gender differences were noted for screen time/sedentary behaviours, condom use, smoking, sunburns, breakfast and fruit and vegetable consumption. CONCLUSION: Although health-compromising behaviours are highly prevalent in both men and women, they are gender-related, with males engaging in more health risk behaviours than females. Preventive interventions may need to focus on gender-informed approaches when targeting multiple health risk behaviours.

Development of the Social Capital Questionnaire in Greece.

The Greek version of the social capital questionnaire (SCQ-G) was evaluated in a sample of 521 adults drawn from three different urban areas in Greece. Exploratory factor analysis followed by multi-trait scaling yielded six factors: Participation in the Community, Feelings of Safety, Family/Friends Connections, Value of Life and Social Agency, Tolerance of Diversity, and Work Connections. The factor solution is similar to the patterns identified originally in Australia and the US. Variations suggest that social capital does not share the same structure in different countries. The SCQ-G is a useful scale to measure individual-level social capital in Greece. Social capital measurement tools should be validated in each cultural or national setting in which they are used.

Factors associated with the attitudes and expectations of patients suffering from beta-thalassaemia: a cross-sectional study.

Regular transfusions and iron chelation therapy have transformed the life expectancy of homozygous beta-thalassaemia patients, so that it can now be considered a chronic condition. A health questionnaire survey of all adults suffering from beta-thalassaemia major receiving treatment on the Island of Crete, Greece was carried out with the aim of ascertaining the factors that are associated with their attitudes and expectations. The responses of 67 of the 72 patients, aged 18-45 years, were analyzed using Principal Component Analysis to extract three component indicators (Adaptability, Optimism and Pessimism Indicators), which reflected their attitudes towards life and two component indicators (Healing and Therapy Indicators) that reflected their expectations from life. These were then tested against the respondents' socio-demographic characteristics, their health status and satisfaction with the services. It was found that the Optimism Indicator was associated with a positive comparative assessment of health status, while the Adaptability Indicator was associated with a positive subjective assessment of health status. The Adaptability Indicator was also higher in those satisfied with the services but it was lower in the best-educated group. The pessimism indicator was associated with a negative comparative assessment of health status and with the lowest level education. The expectation indicators showed an interaction with gender and other parameters such as admission to hospital. The relationship between the attitudes and the expectations of patients suffering from a chronically disability condition and specific experiences during their treatment regimens raises several issues related to the need for better health education and psychological support of the group of patients, as well as issues related to the communication skills of the staff caring for them.