Factors Associated With Anxiety and Depression in Persons With Epilepsy (PWE).

INTRODUCTION: Epilepsy is a common neurological disease that is associated with increased morbidity and mortality globally. Persons with epilepsy (PWE) experience a heavy emotional burden mainly due to social stigmatization and limited opportunities in life. The purpose of this study was to explore factors associated with anxiety and depression in PWE. MATERIAL AND METHODS: In the present cross-sectional study, we enrolled 100 PWE who visited outpatient settings in a public hospital for scheduled follow-up. Data collection was carried out by the completion of the Hospital Anxiety and Depression Scale (HADS), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS: Of the 100 participants, the majority were women (65%), below 50 years old (62%), and single (40%). In terms of mental comorbidity, 58% and 48% experienced anxiety and depression, respectively. A statistically significant association was observed between anxiety and age (p = 0.002). Furthermore, a statistically significant association was observed between depression and gender (p = 0.044), age (p = 0.001), marital status (p = 0.036), educational level (p = 0.003), job (p = 0.025), residency (p = 0.041), and whether they went out at night (p = 0.009). CONCLUSION: Identifying factors associated with anxiety and depression is essential for PWE to receive appropriate support.

The Effect of Psychological Resilience and Coping Strategies on Mental Health of Nurses.

INTRODUCTION: Nursing professional is considered to be stressful with impact on nurses' mental health. AIM: The aim of this study was to investigate the effect of coping strategies and psychological resilience on anxiety and depression among nurses. METHODS: In this descriptive and cross-sectional study, 378 nurses from two hospitals (a general and a psychiatric) in Greece completed the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2), the Connor-Davidson Resilience Scale 25 (CD-RISC 25), and the Ways of Coping Questionnaire for evaluating the depression, anxiety, psychological resilience, and coping strategies, respectively. The study was carried out between October and December of 2019. Statistical analysis was performed with JASP version 0.14.01 and significance for all statistical tests was set at 0.05 or less. RESULTS: Psychological resilience was significantly correlated with anxiety (r = -0.127, p = 0.014), Positive approach (r = -0.466, p<0.001), Seeking social support (r = -0.228, p < 0.001), Avoidance/Escape (r = -0.121, p = 0.020). Anxiety was positively correlated with Seeking social support (r = -0.112, p = 0.030), Prayer/Daydream (r = -0.132, p = 0.030), Avoidance/Escape (r = -0.164, p < 0.001), and Assertive problem solving (r =-0.195, p < 0.0010). Psychological resilience, Avoidance, and Assertive problem-solving were significant predictors of increasing of anxiety (ß = -0.128, p = 0.013, ß = 0.130, p = 0.027, ß = 0.131, p = 0.020, respectively). Avoidance (ß = 0.209, p < 0.001) and age (ß = 0.208, p = 0.029) were significant predictors of depression. CONCLUSIONS: Psychological resilience and coping strategies have a significant effect on nurses' mental health.

Anxiety and Depression in Parents of Children Undergoing Hematopoietic Stem Cell Transplant (HSCT).

Hematopoietic stem cell transplantation (HSCT) is a well-established therapy tool for several malignant and non-malignant diseases. Parents of children undergoing HSCT experience physiological distress for various reasons such as intensive caregiving, potential complications, and medically intensive process. The purpose of this study was to explore anxiety/depression in parents of children who underwent HSCT and the associated self-reported characteristics. METHOD AND MATERIAL: In the present study were enrolled 100 parents of children who underwent HSCT. Data were collected by the completion of the "Hospital Anxiety and Depression Scale (HADs)," which also included parents' characteristics. The statistical significance level was p < 0.05. RESULTS: Of the 100 participants, 81% and 64% of parents experienced anxiety and depression, respectively, based on HADs scores. A statistically significant association was observed between parental anxiety and gender (p = 0.017), frequency of visiting the hospitalized child (p = 0.023), whether they desired family members to remain in hospital (p = 0.033), as well as with the need for participation in daily care (p = 0.023), for help based on personal needs (p = 0.026), for scheduled meetings with parents having same problems (p = 0.006), for contact with hospital after discharge (p = 0.035), and for written information (p = 0.044). In terms of depression, a statistically significant association was observed with difficulties during the hospital stay (p = 0.034), whether they desired other family members to remain in hospital (p = 0.009), as well as with the need for opportunities or time for questions (p = 0.004), for scheduled meetings with parents having the same problems (p = 0.026), and for contact with hospital after discharge (p = 0.038). CONCLUSION: Anxiety and depression were associated with possibility of family members to remain in the hospital as well as with the need for scheduled meetings with parents having the same problems and for contact after hospital discharge. Based on the findings presented, it is suggested that understanding parents' needs and perceptions is fundamental to the development of appropriate interventions that address their worries.

Coping Strategies in Greek Parents of Children with Cancer.

INTRODUCTION: Childhood cancer is a life-threatening, chronic condition and treatment may extent for several years. The diagnosis of cancer in children could stress intensely their parents. AIM: To explore coping strategies utilized by Greek parents who have children with cancer. MATERIAL AND METHODS: Eighty-five parents of children with cancer, admitted for treatment at the in-patient unit of a Paediatric Hospital in Athens completed a questionnaire with demographic and their children's disease related characteristics and the Family Crisis Oriented Personal Evaluation Scale. RESULTS: Sixty mothers (70.6%) and 25 fathers (29.4%) completed the questionnaire. A percentage of 29.4% of the parents included in this study considered themselves anxious. Elementary or secondary school graduates scored higher in Seeking Spiritual Support (p = 0.013). Stay-at-home or unemployed parents scored lower in the subscale of Passive Appraisal (p = 0.012). Parents who were very well informed tended to exhibit more frequently passive appraisal behavior (p = 0.004). Parents whose child had Hodgkin's lymphoma scored higher in the subscale of Acquiring Social Support (p = 0.034). Statistical significance was found between parent's strategies of Seeking Spiritual Support and the gender (girls) (p = 0.036), as well as the treatment problems (p = 0.008) of hospitalized children. CONCLUSIONS: This study may help health professionals understand Greek families' coping strategies when they have a child with cancer. Appropriate knowledge could significantly help them in the field of planning and implementation of personalized care in order to achieve optimal therapeutic outcomes.

Depression and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator in Women.

INTRODUCTION: Cardiovascular disease remains a major cause of morbidity and premature mortality worldwide. The aim of the present study was to investigate the association of atherosclerotic cardiovascular disease (ASCVD) risk estimator with depression in women undergoing cardiological evaluation. MATERIAL AND METHOD: Three hundred women undergoing cardiological evaluation completed the Zung Self-Rating Depression Scale (ZSDS) questionnaire which included women's characteristics. RESULTS: A percentage of 57.4% of our participants exhibited ASCVD risk <5%; while the 18.3% had ASCVD risk between 5% and 7.4%, the 18.3% between 7.5% and 20%, and the remaining 6% > 20%. In terms of depression, 50% of the women had a score of less than 38 (median), according to Zung scale and mean score was 38.4. In addition, 25% of women had a score below 32. These scores indicate low levels of depression in women. Statistically significant higher rates of depression were found in women who were not involved with physical activities (p = 0.030). CONCLUSIONS: The negative impact of depression on the ASCVD risk could potentially be prevented by modifying individuals' behavior with regard to their engagement in physical activity.

Perceived Social Support in Parents of Hospitalized Children During COVID-19.

It was March 2020 when the World Health Organization declared a global pandemic due to the spread of a virus known as SARS-CoV-2, which started in Wuhan (China) and spread across the world. From that time onward, all governments took specific measures to minimize virus outspread. Human beings faced several challenges in each aspect of life mainly the more vulnerable ones, such as parents with sick children who encountered not only with hospitalization but also with the negative effects posed by pandemic. PURPOSE: Purpose of this study was to explore levels of perceived social support and the associated factors in parents of hospitalized children. METHOD AND MATERIAL: In the study were enrolled 110 parents (30 fathers and 80 mothers) of hospitalized children. Data were collected by the completion of "The Multidimensional Scale of Perceived Social Support (MSPSS)," which included patients' self-reported characteristics. The statistical significance level was p < 0.05. RESULTS: From the 110 participants, 50% scored over 22, 22, and 20 (median) in support from significant ones, family, and friends, respectively. In addition, 25% of parents scored above 25, 25, and 24, respectively. With respect to the possible range of scores (4-28), these values indicate high levels of social support. Statistically significant higher levels of support from significant ones were experienced by parents who desired to be COVID-19 vaccinated (p = 0.019) and had a person at home belonging to a vulnerable group (p = 0.001). In terms of support from family, statistically significantly higher levels had parents who had been COVID-19 vaccinated (p = 0.003), who had not experienced family conflicts during pandemic (p = 0.026), and those who had a person at home belonging to a vulnerable group (p = 0.001). Regarding support from friends, statistically significant levels were experienced by parents who wished to be vaccinated (p = 0.012) and who had not experienced family conflicts during pandemic (p = 0.050). CONCLUSION: Through this unprecedented global health issue, levels of support remained high. Vaccination, having a vulnerable person at home, and intra-family conflicts were associated with support. A better understanding of support in parents with hospitalized children may help in the planning of rational and cost-effective interventions.

Quality of Life in Patients Receiving Medical Cannabis.

INTRODUCTION: Medical cannabis has been used to relieve the symptoms of people with various chronic diseases. Despite of this, it has been stigmatized, even after its legalization in many countries. AIM: The purpose of this study was to investigate the quality of life of patients receiving medical cannabis. MATERIAL AND METHOD: One hundred patients receiving medical cannabis were given (a) a socio-demographic and clinical questionnaire, and (b) the SF-36 Health Survey scale for assessing quality of life. RESULTS: The majority of our patients who received medical cannabis to treat their neurological disorders (58%) reported decrease in their symptoms (96%), better energy and vitality (68%), ability to perform their professional duties (88%), and an improvement in sleeping and appetite (79% and 71%, respectively) after receiving medical cannabis. Our participants exhibited very few restrictions in activities due to emotional difficulties, a moderate general health status as well as moderate vitality and energy. Participants, who reported a longer period of receiving medical cannabis, reported statistically significant more energy and vitality (p = 0.000), but also better mental (p = 0.000) and general health status (p = 0.001). Furthermore, the majority of patients have disclosed medical cannabis use to their family members (85%) and enjoyed their support (93%), but they haven't revealed their medication treatment to their social environment (81%). CONCLUSIONS: Appropriate knowledge could significantly help health professionals in the field of planning and implementation of personalized nursing care in order to achieve optimal therapeutic outcomes.

Quality of Life in Patients Undergoing Percutaneous Coronary Intervention.

INTRODUCTION: Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure to treat coronary artery occlusion. The quality of life (QoL) is a way to measure the impact of illness and additionally its treatments to traditional measures of clinical outcomes. PURPOSE: The aim of the present study was to explore the levels of QoL pre-PCI, 6 and 12 months after PCI, as well as the factors associated with the QoL pre-PCI. METHODS: In the present study, 100 patients undergoing PCI were enrolled. Data were collected through the completion of the SF-36 Health Survey (SF-36), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS: Patients had moderate levels of QoL at baseline, with a median general health score of 45 (IQR: 30-65). A gradual statistically significant increase in scores was observed in all subcategories of the patients' QoL at 6 and 12 months after PCI (p < 0.001). A greater increase in scores was observed in physical functioning, physical role, emotional role and social functionality. In terms of the pre-PCI phase, it was found that physical functionality was statistically significantly associated with educational level (p = 0.005), occupation (p = 0.026) and whether the patients had children (p = 0.041). The physical and emotional role was significantly associated with gender (p = 0.046 and p = 0.040) and educational level (p = 0.030 and p = 0.001). Energy-fatigue was significantly associated with gender (p = 0.001), age (p = 0.028), marital status (p = 0.001), educational level (p = 0.001), whether the patients had children (p= 0.012) and other diseases (p = 0.001). Emotional well-being was significantly associated with family history of coronary artery disease (p = 0.011) and the frequency of physical exercise (p = 0.001). Social functioning was significantly associated with gender (p = 0.033), marital status (p = 0.034) and educational level (p = 0.002). Pain was not found to be significantly associated with patients' demographics. General health was significantly associated with gender (p = 0.003), age (p = 0.043), educational level (p = 0.001), other diseases (p = 0.005) and the frequency of physical exercise (p = 0.001). CONCLUSION: Information about the QoL of PCI and its determinants is important to define an effective and comprehensive care plan.

Measuring Importance of Physical Self-Care Behavior in Patients with Heart Failure: Validation and Reliability Analysis of 14-item IPSC Scale.

INTRODUCTION: Heart failure (HF) is a complex clinical syndrome associated with increased disability, morbidity and mortality globally. HF is characterized by recurrent exacerbations and a high rate of hospital readmissions. Self-care is a crucial component of treatment. The way patients assess the importance of self-care may shed light on planning effective individualized interventions. The aim of this study was to conduct a validity and reliability analysis of the new 14-item IPSC scale, which measures how important HF patients consider their physical self-care behavior (IPSC, Importance of Physical Self-Care). MATERIAL AND METHODS: The 14-item IPSC scale was created by the researchers to explore how important HF patients consider their physical self-care behavior. The validation of the IPSC scale included face and content validity, construct validity, internal consistency, repeatability and discriminant validity. Patients' characteristics were also included. RESULTS: In the present study, 52 hospitalized HF patients were enrolled, of whom 55.8% were female, 34.6% above 70 years old, 48.1% of NYHA class III and 32.7% suffered this illness from 6 to 10 years. The total IPSC score had a possible range of 14-56, with higher scores indicating a low importance of self-care. The descriptive statistics in the IPSC scale showed a mean score of 27.9 ± 4.9 and a median score of 29, indicating that HF patients evaluated self-care behavior as moderately important. All items were found to be statistically significantly correlated with total scale scores (p ≤ 0.05), with correlation coefficients rho > 0.250, indicating moderate to strong correlations and meaning that all items are important in the calculation of the final score (construct validity). The internal consistency of the items that constituted the total score was found to be high (Cronbach's a > 0.7). Furthermore, it was found that scores had high repeatability (p ≤ 0.001 and ICCs > 0.7). Regarding discriminant validity, a statistically significant association was observed between the importance of physical self-care behavior and both years suffering the illness (p = 0.007) and the NYHA class (p = 0.030). CONCLUSION: The 14-item IPSC scale is a reliable instrument that help nurses in clinical settings to gain a better and prompt understanding of the importance which patients invest in their physical self-care behavior.

Managing anxiety disorders with the neuro-biofeedback method of Brain Boy Universal Professional.

Background: Biofeedback is a non-invasive therapeutic method used independently or as an adjunct alongside other methods. Objective: This study evaluated the efficacy of biofeedback in the treatment of anxiety disorders. Methods: The sample consisted of 85 individuals with anxiety symptoms who underwent neuro-biofeedback therapy using Brain Boy Universal Professional. Anxiety was assessed by both the Hamilton Rating Scale for Anxiety (HAM-A) and Zung Anxiety Self-Assessment Scale (SAS) before the initiation and after completing ten sessions with biofeedback. Results: Before biofeedback and based on the HAM-A scale, 27.0% of the individuals showed mild to moderate anxiety, 16.5% medium anxiety, and 56.5% severe anxiety. After the completion of biofeedback, 90.6% of the individuals experienced mild to moderate anxiety, 5.9% medium anxiety, and 3.5% severe anxiety. Based on the SAS scale, before biofeedback, 42.4% of the individuals showed minimal to moderate anxiety, 21.2% marked severe anxiety and 36.5% most extreme anxiety. After the biofeedback, 68.2% of the individuals were within a normal range, 27.1% had minimal to moderate anxiety, 4.7% marked severe anxiety, and none in most extreme anxiety. Conclusion: Both HAMA-A and SAS scales showed statistically reduced anxiety levels after biofeedback therapy. Thus, the primary symptom of anxiety can be addressed by the biofeedback method.

Quality of life in diabetic foot ulcer, grade 3: associated demographic factors.

Abstract.

Quality of life of patients with cardiac pacemaker: levels, associated characteristics, and the impact of anxiety and depression.

INTRODUCTION: Implantation of a permanent cardiac pacemaker (PPM) improves recipients' quality of life (QoL). However, psychiatric disturbance may adversely affect QoL and undermine clinical outcomes.

Perceived Social Isolation in Heart Failure.

Patients with heart failure (HF) experience social isolation associated with an increased risk of morbidity, mortality, and elevated health care expenditures. The aim of this study was to evaluate the factors associated with perceived social isolation and to assess the impact of fatigue on social isolation. A total of 100 HF outpatients were enrolled by convenience sampling. Data were collected by completion of the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek), which also included patients' characteristics and their self-report about social isolation. Of the 100 participants (68% men; mean age, 68.6 ± 7.1 years), 78% reported perceiving social isolation. Factors significantly associated with perceived social isolation were female sex (P = .001), New York Heart Association class IV (P = .001), stress about HF (P = .002), paroxysmal nocturnal dyspnea (P = .030), edema in the lower limbs (P = .001), report of receiving many medications (P = .001), change in body image (P = .032), and not following limitations in fluid and sodium intake (P = .001). The MFIS total score determined moderate to high levels of fatigue (median, 70 points; range, 21-105 points). Total fatigue was statistically significantly associated with social isolation as perceived by patients (P = .001). In conclusion, demographic and clinical characteristics as well as fatigue are associated with perceived social isolation. It is essential to evaluate social isolation in routine practice.

Depression Among Hemodialysis Patients: Related Factors and the Impact of Insomnia and Fatigue.

INTRODUCTION: Depression is a commonly experienced psychological disorder among patients undergoing hemodialysis and has a strong association with insomnia and fatigue. The purpose of the present study was to explore the factors related to depression in dialysis patients and the impact of insomnia and fatigue on depression. METHODS: In this cross-sectional study, one hundred (n=100) patients on hemodialysis from one hemodialysis center in Greece participated. Data collection was carried out by interviews using the Zung Self-rating Depression Scale (SDS) for the evaluation of depression; the Athens Insomnia Scale (AIS) for the evaluation of insomnia; the Modified Fatigue Impact Scale (MFIS) for the evaluation of fatigue; and a questionnaire which was created by the researchers. The Kruskal-Wallis, the Mann-Whitney tests, and the Spearman's rho criterion were used to evaluate the relationship between depression score and patient characteristics. Multiple linear regression was performed to assess the effect of characteristics on patients' depression. RESULTS: Statistically significantly high levels of depression were found in patients over the age of 70 years old (p=0.001), in divorced/widowed patients (p = 0.001), in pensioners (p = 0.002), in patients who had other diseases (p = 0.001), in those who felt tired after hemodialysis or at night and those who felt constantly tired (p = 0.001, p = 0.016, and p = 0.001, respectively), in those who had physical and mental fatigue (p = 0.001 and p = 0.001, respectively), in those who had changes in body image (p = 0.009), itching, stiffness, and nausea/vomiting (p = 0.001, p = 0.001, and p = 0.003, respectively), in patients who had restrictions in clothes they could wear (p = 0.001), in patients who had insomnia (p = 0.001), and in patients who did not wish to receive written information about the management of their disease (p = 0.025). A statistically significant positive linear association was detected between physical/mental fatigue and depression levels (rho = 0.824 and rho = 0.746, respectively) and between the score of insomnia and depression levels (rho = 0.707). An increase in fatigue (either physical or mental) and an increase in insomnia score also indicated an increase in depression levels. CONCLUSIONS: The findings of this study showed that depression had a strong association with a variety of demographic factors. Additionally, an increase in fatigue score and an increase in insomnia score indicated an increase in depression levels. Therefore, depression, insomnia, and fatigue should be early assessed and effectively treated by renal professionals in order to improve the quality of life in hemodialysis patients and reduce their morbidity and mortality.

Factors Associated With Fatigue in Patients Undergoing Hemodialysis.

Background and objective Fatigue is frequently experienced by patients undergoing hemodialysis and it has a negative effect on their quality of life. The aim of this study was to investigate the factors associated with fatigue in patients undergoing hemodialysis. Methods In this quantitative cross-sectional study, 100 patients on hemodialysis participated. Fatigue was evaluated via the Modified Fatigue Impact Scale (MFIS). Participants also completed a questionnaire about demographics and clinical characteristics. The Kruskal-Wallis test, the Mann-Whitney U test, and Spearman's rho criterion were used to assess the association between fatigue score and patient characteristics. Multiple linear regression was performed to assess the effect of the characteristics on patients' fatigue. Results Statistically significant high levels of physical or mental fatigue were found in older patients (p=0.001 and p=0.001), divorced/widowed patients (p=0.001 and p=0.014), those who had children (p=0.019), those who had primary education (p=0.015), those who were not informed about their health problems (p=0.003 and p=0.006), those who had comorbid diseases (p=0.001 and p=0.001), those who believed that regular information did not help to reduce stress (p=0.005 and p=0.004), patients who had insomnia (p=0.001 and p=0.001), patients who felt tired after hemodialysis (p=0.001 and p=0.001), those who thought they had a change in body image (p=0.001 and p=0.001), those who often felt stiffness (p=0.001 and p=0.001), those who sometimes felt nausea (p=0.015 and p=0.038), and those who had limitations in the clothes they could wear (p=0.001 and p=0.001). Conclusions The findings of this study showed that physical or mental fatigue had a strong association with advanced age, comorbidities, marital status, level of education, inadequate information about the disease, insomnia, and change in body appearance. Hence, renal professionals need to properly educate dialysis patients on the complicated nature of fatigue in order to manage it effectively and improve their physical, cognitive, and social wellbeing.

Depression, Adherence, and Functionality in Patients Undergoing Hemodialysis.

Background  Patients undergoing hemodialysis face multiple problems such as difficulties in performing daily activities, low functional capacity, non-adherence to the hemodialysis regimen, and depressive symptoms that lead to poor health outcomes. The present study aimed to assess the levels of depression, adherence, and functionality in patients undergoing hemodialysis, as well as the association between the above variables. Materials and methods In this cross-sectional study, 100 patients undergoing hemodialysis from a private hospital in Athens participated. Data were collected via the Zung Self-Rating Depression Scale, the Barthel Scale/Index, and the Greek Simplified Medication Adherence Questionnaire-Hemodialysis for the evaluation of patients' depression, functionality, and adherence to hemodialysis regimen, respectively. In addition, sociodemographic and clinical characteristics were recorded. The study was conducted during the period of December 2020 to February 2021. IBM SPSS Statistics for Windows, Version 25.0 (Released 2017. IBM Corp., Armonk, New York) was used for the statistical analysis of the data. The statistical significance level was set up at 0.05. Results Of the patients, 50% scored < 38 (possible range 20-80) in the scale pof depression, and 25% of patients scored < 34. Regarding adherence, the median value was 7 (IQR: 7-7) while 77% scored 7 (possible range of 0-8). Regarding functionality, mild dependence (score 91-99) was referred by 77% of the participants, moderate dependence (score 61-90) by 17%, and severe dependence (score 21-60) was referred by 6% of the patients. A statistically significant negative association emerged between depression and functionality (r= -0.342, p=0.001) while no significant association arised between depression and adherence (r= 0.021,p=0.836) as well as between adherence and functionality (r = 0.078, p = 0.439). Statistical significantly higher scores of depression were seen in women (ß = 3.65, p = 0.001) and elderly >70 years old (ß = 3.51, CI=0.09-6.93, p = 0.044). Statistically significantly lower functionality were referred by patients >70 years old (ß = -13.58, CI: -21.68-5.49, p = 0.001) and by patients with high depression score (ß= -0.62, 95% CI: -1.06-0.20, p = 0.005). Conclusion Patients experienced moderate to low levels of depression and high levels of adherence and functionality. The higher the functionality scores, the lower the depression scores. Demographic characteristics, such as age and gender, seem to be significant predictors of depression and functionality.

Factors Associated With Insomnia in Patients Undergoing Hemodialysis.

INTRODUCTION: Insomnia is the most common sleep disorder among patients on hemodialysis and has a strong relation with fatigue, depression, low immune system, increased risk of cardiovascular problems, and low quality of life. The aim of this study was to explore the factors associated with insomnia in patients undergoing hemodialysis.  Methods: In this cross-sectional study, 100 patients on hemodialysis (75 males and 25 females) from a hemodialysis center in Greece were included. Insomnia was assessed via the "Athens Insomnia Scale (AIS)" and a questionnaire about demographic and clinical characteristics. The Kruskal-Wallis, Mann-Whitney tests, and Spearman's rho criterion were used to evaluate the association between insomnia score and patients' characteristics. Multiple linear regression was performed to assess the effect of characteristics on patients' insomnia. RESULTS: Statistically significantly high levels of insomnia were found in patients over the age of 60 years (p = 0.002), in divorced/widowed patients (p = 0.007), in patients who had comorbid diseases (p = 0.001), in patients who felt tired after hemodialysis (p = 0.001), in those who had continuous fatigue (p = 0.001) and change in body image (p = 0.003), in those who often had itching (p = 0.007) and stiffness in joints (p = 0.001) and in patients who had limitations in the clothes they could wear (p = 0.001). CONCLUSIONS: The findings of this study showed that insomnia had a strong association with increased age of patients, comorbidities, fatigue, change in body appearance, pruritus, and limitation in clothes they could wear. Therefore, there is a necessity for early assessment of sleep quality and effective treatment of sleep disorders in hemodialysis patients in order to reduce morbidity and mortality and improve the quality of their life.

Depression in Male Inmates.

Introduction: The prevalence of psychiatric morbidity is high among incarcerated individuals. Severe mental disorder is five to ten times higher among prisoners compared to the general population. Several factors are held to be responsible for the high prevalence of depression in prison: mainly poor living conditions (narrow room, loss of privacy), limited interpersonal relationships, and lack of mental health access. Inmates are at increased risk of all-cause mortality, suicide, self-harm, violence, and victimization while those with mental disorders are involved in conflicts and are more likely to be charged with prison rules. Purpose: To explore depression among male inmates. Methods and material: In the study, 101 male inmates were enrolled. Data were collected by the completion of a "self-rating depression scale (SDS)-Zung" which included participants' characteristics. The statistical significance level was p < 0.05. Results: Of the 101 participants, 51.4% of inmates were under 40 years old, 54.5% were married, 45.6% had been convicted of homicide and 38.6% had a life sentence. Normal depression levels were experienced by 62.4% of the participants, while 21.8% were mildly depressed, 14.9% were moderately depressed and 1.0% severely depressed. Foreign prisoners had statistically significant higher scores of depression compared to Greeks (median 48 vs. 45, p = 0.012); those suffering from a chronic disease compared to those who did not (median 48 vs. 45, p = 0.038); those who had spent time in solitary confinement compared to those who had not (median 46 vs. 43.5, p = 0.038) as well as those who had not considered harming themselves compared to those who had thought of it (median 46 vs. 44, p = 0.017). Conclusion: Given that prison populations are marginalized and deprived of the rights that people in the community benefit from, establishing the prevalence of depression in male inmates and its associated characteristics may help to formulate recommendations for future prison health care services. Clinical, research, and policy efforts are needed to improve prison mental health.

Quality of Life and Self-care Activities in Diabetic Ulcer Patients, Grade 3: Gender Differences.

Introduction: Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus associated with increased morbidity and mortality and diminished quality of life (QoL). This study aimed to explore the effect of gender differences on QoL and adherence to self-care activities. Methods: In this cross-sectional study, we enrolled 135 male and 135 female patients with DFU. Data was collected using the Short Form Health Survey (SF-36) and a questionnaire that measured self-care activities (Diet, Exercise, Blood Examination, and Foot Check). Data analysis was performed using SPSS version 20. Results: In terms of QoL, male participants had moderate to high levels in the categories of energy/fatigue, emotional well-being, social functioning, and bodily pain, whereas they had low levels in physical functioning, physical role, and emotional role. Female patients had moderate QoL in the categories of energy/fatigue and social functioning, whereas they had low QoL in physical functioning, physical role, emotional role, emotional well-being, and bodily pain. Finally, regarding general health, male participants had moderate QoL and females had moderate to low QoL. Both males and females had low adherence to exercise and high in blood-examinations. For both genders, adherence to exercise had a statistically significant association with all sub-categories of QoL apart from those of role (physical and emotional). Conclusion: It is essential for health care professionals to provide gender-specific approaches in treatment of ulceration.

Patient Perceptions and Quality of Life in Pacemaker Recipients.

Quality of life (QoL) reflects the multidimensional impact of a clinical condition and its treatment on patients' daily lives. Although permanent cardiac pacemakers (PPMs) have made a significant contribution to the improvement of patients' QoL, patients' perceptions remain crucial after implantation. Hence, the present study was carried out to explore the QoL and the associated perceptions of PPM patients. A total of 150 PPM patients were enrolled. Data were collected using the Short Form-36 (SF-36) health survey, which also included patients' characteristics. The statistical significance level was set at p < 0.05. The physical health score as measured by SF-36 was 42.9 ± 19.5 points, and the mental health score was 54.1 ± 26.6 points. Study participants had higher scores in emotional well-being (66.5 ± 18.8 points), and the lowest scores were in physical functioning (22.5 ± 10.7 points). The level of information about PPM was associated with physical role (p = 0.005), emotional role (p = 0.004), emotional well-being (p = 0.001), social functioning (p = 0.002), and general health (p = 0.001). Attendance at follow-up was associated with physical role (p = 0.015), emotional role (p = 0.014), social functioning (p = 0.003), and general health (p = 0.016). The belief that the device prevents disease deterioration was associated with physical role (p = 0.005), emotional role (p = 0.001), energy/fatigue (p = 0.010), emotional well-being (p = 0.004), social functioning (p = 0.001), pain (p = 0.005), and general health (p = 0.001). Dependency on the device was associated with energy/fatigue (p = 0.006), emotional well-being (p = 0.001), and social functioning (p = 0.002). Social difficulties due to the device were associated with emotional well-being (p = 0.001), social functioning (p = 0.001), pain (p = 0.001), and general health (p = 0.004). Family support was associated with emotional role (p = 0.023) and general health (p = 0.036), while pain was associated with information about the family (p = 0.001). In conclusion, the present findings regarding factors associated with QoL provide key opportunities for interventions aimed at facilitating positive adjustments after PPM implantation.