Screening for Breast Cancer: A Comparative Review of Guidelines.

Breast cancer is the most common malignancy diagnosed in the female population worldwide and the leading cause of death among perimenopausal women. Screening is essential, since earlier detection in combination with improvements in breast cancer treatment can reduce the associated mortality. The aim of this study was to review and compare the recommendations from published guidelines on breast cancer screening. A total of 14 guidelines on breast cancer screening issued between 2014 and 2022 were identified. A descriptive review of relevant guidelines by the World Health Organization (WHO), the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American College of Obstetricians and Gynecologists (ACOG), the American Society of Breast Surgeons (ASBrS), the American College of Radiology (ACR), the Task Force on Preventive Health Care (CTFPHC), the European Commission Initiative on Breast Cancer (ECIBC), the European Society for Medical Oncology (ESMO), the Royal Australian College of General Practitioners (RACGP) and the Japanese Journal of Clinical Oncology (JJCO) for women both at average and high-risk was carried out. There is a consensus among all the reviewed guidelines that mammography is the gold standard screening modality for average-risk women. For this risk group, most of the guidelines suggest annual or biennial mammographic screening at 40-74 years, while screening should particularly focus at 50-69 years. Most of the guidelines suggest that the age limit to stop screening should be determined based on the women's health status and life expectancy. For women at high-risk, most guidelines recommend the use of annual mammography or magnetic resonance imaging, while the starting age should be earlier than the average-risk group, depending on the risk factor. There is discrepancy among the recommendations regarding the age at onset of screening in the various high-risk categories. The development of consistent international practice protocols for the most appropriate breast cancer screening programs seems of major importance to reduce mortality rates and safely guide everyday clinical practice.

Exploring Perceptions and Practices Regarding Adult Vaccination against Seasonal Influenza, Tetanus, Pneumococcal Disease, Herpes Zoster and COVID-19: A Mixed-Methods Study in Greece.

We aimed to document vaccination coverage for five vaccines, predictors of each vaccine's uptake and attitudes regarding adult vaccination. Adults visiting four pharmacies were randomly invited to participate during summer 2022. Among 395 participants (mean age 51.2 years, range 19-96), vaccination rates were 78.1% for influenza and 25.8% for herpes zoster (≥60 years old), 64.3% for pneumococcal disease (≥65 years old), 33.1% for tetanus, while 11.4% had received two and 74.8% ≥3 COVID-19 vaccine doses. Half of participants (50.1%) voiced some degree of hesitancy, and 1.3% were refusers. The strongest predictor of each vaccine's uptake was doctor's recommendation (OR range 11.33-37.66, p < 0.001) and pharmacist's recommendation (4.01-19.52, p < 0.05), except for the COVID-19 vaccine, where the Attitude Towards Adult VACcination (ATAVAC) value of adult vaccination subscale's score was the only predictor (OR: 5.75, p < 0.001). Regarding insufficient coverage, thematic content analysis revealed seven main themes. Insufficient knowledge, the absence of health professionals' recommendation, perception of low susceptibility to disease, negligence and dispute of vaccine effectiveness were universal themes, whereas safety concerns and distrust in authorities were reported solely for COVID-19 vaccination. Designing public interventions aiming to increase trust in adult vaccination is essential in the aftermath of the COVID-19 pandemic. Health professionals' role in recommending strongly adult vaccination is crucial.

Association of chronic periodontitis with multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Chronic periodontitis (CP) is a multifactorial, chronic inflammatory disease of microbial etiology that manifests as a result of the dysfunction of the immune mechanism, culminating in the destruction of the alveolar bone of the jaws. Multiple sclerosis (MS) is an autoimmune disorder that affects the central nervous system (CNS), leads to demyelination and degeneration of nerve axons and often causes severe physical and/or cognitive impairment. As CP and MS involve inflammatory mechanisms and immune dysfunction, researchers have attempted to study the association between them. AIM: To systematically review the literature on the epidemiological association between CP and MS in adults. METHODS: PRISMA 2020 statement was used in the study protocol. The design was done according to the Cochrane methodology. A comprehensive literature search was performed in PubMed, Scopus and Cochrane databases; a manual search and evaluation of the gray literature was also performed. The meta-analysis was performed by Review Manager (RevMan) 5.4. Odds ratio (OR) with 95% confidence interval (CI) was defined as the effect size of the outcome. Heterogeneity was assessed by Chi-square and I2. The articles evaluated were written in English, without a time limit, concern observational studies (patient-controls) and report the diagnostic criteria of the diseases. Duplicate entries were excluded. To evaluate the reliability of the results of each study, Newcastle-Ottawa Scale (NOS) and GRADE tools were used. Two independent reviewers did all evaluations with a resolution of discrepancies by a third. RESULTS: Meta-analysis included three observation studies examined 3376 people. MS patients are significantly more likely to be diagnosed with CP than healthy controls (OR 1.93, 95% CI 1.54-2.42, p<0.0001). CONCLUSION: A high prevalence of CP was found among MS patients compared with healthy controls. Healthcare professionals should be aware of the association between these pathological entities to provide patients with high-quality care through an effective and holistic diagnostic and therapeutic approach.

Does it make sense to use written instruments to assess communication skills? Systematic review on the concurrent and predictive value of written assessment for performance.

OBJECTIVES: To evaluate possible associations between learners' results in written and performance-based assessments of communication skills (CS), either in concurrent or predictive study designs. METHODS: Search included four databases for peer-reviewed studies containing both written and performance-based CS assessment. Eleven studies met the inclusion criteria. RESULTS: Included studies predominantly assessed undergraduate medical students. Studies reported mainly low to medium correlations between written and performance-based assessment results (Objective Structured Clinical Examinations or encounters with simulated patients), and gave correlation coefficients ranging from 0.13 to 0.53 (p < 0.05). Higher correlations were reported when specific CS, like motivational interviewing were assessed. Only a few studies gave sufficient reliability indicators of both assessment formats. CONCLUSIONS: Written assessment scores seem to predict performance-based assessments to a limited extent but cannot replace them entirely. Reporting of assessment instruments' psychometric properties is essential to improve the interpretation of future findings and could possibly affect their predictive validity for performance. PRACTICE IMPLICATIONS: Within longitudinal CS assessment programs, triangulation of assessment including written assessment is recommended, taking into consideration possible limitations. Written assessments with feedback can help students and trainers to elaborate on procedural knowledge as a strong support for the acquisition and transfer of CS to different contexts.

What do we know about written assessment of health professionals' communication skills? A scoping review.

OBJECTIVE: The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals' education. METHODS: Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995-7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics. RESULTS: From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported. CONCLUSION: There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.

Under-Vaccination in Adults: Qualitative Insights Into Perceived Barriers Reported by Vaccine Supporters, Undecided and Refuters.

Although vaccination is one of the most cost-effective ways of preventing disease, vaccine hesitancy has been included among the ten threats of global health. Addressing low adult vaccination rates requires an adequate understanding of people's views. We explored perceived barriers to immunization among under-vaccinated adults to identify potential differences among vaccine supporters, refuters, and those who are undecided. We conducted a multi-center, mixed-methods study at 23 primary care practices in Greece. Each day, we asked three new randomly-selected adult healthcare users who attended the practice over the course of 30 consecutive working days. We used thematic content analysis to analyze their written answers to open-ended questions that addressed reasons for not getting vaccinated. Out of 1571 participants, two-thirds reported they were under-vaccinated as adults, thus accounting for three out of five of the supporters and the vast majority of the undecided and refuters. "Concerns/fears," a "perception of low susceptibility to disease due to good health status," the "absence of healthcare professional's recommendation," and "previous negative experiences" were four themes common to all three groups. Additional barriers reported by supporters and the undecided included "knowledge gaps about the necessity of adult vaccination," "negligence," and lack of "accessibility." Among refuters, additional themes identified were "mistrust in pharmaceutical companies" and "disbelief in vaccine effectiveness." In conclusion, under-vaccination is common, not only among refuters or the undecided, but also among supporters of adult vaccination. We found similarities and differences in under-vaccinated adults' perceived barriers, depending on their individual perspectives. Physicians and public health services should take into consideration the impact of the wide range of attitudes and beliefs in their effort to address the underlying barriers to vaccination compliance as they attempt to increase vaccination coverage in adults.

Understanding what people think and feel about adult vaccinations and the associated barriers in Greece: Development and validation of the attitude towards adult vaccination (ATAVAC) scale.

Despite the unequivocal value of vaccination in reducing the global burden of infectious diseases, the anti-vaccination movement thrives. The vast majority of the existing validated tools explore attitudes regarding vaccination in children. The aim of our study was to develop and validate a scale assessing attitudes towards adult immunisation. This national cross-sectional study included adult healthcare users who visited 23 Greek Primary Healthcare Units. The development of the scale was the result of literature review, semi-structured interviews and pilot testing of its preliminary versions. The initial version contained 15 items measuring respondents' attitudes on a 6-point Likert scale. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales; confirmatory factor analysis was used in the second sample to assess goodness of fit. Moreover, concurrent validity, internal consistency reliability, test-retest reliability and ceiling and floor effects were explored. The total sample consisted of 1,571 individuals. Overall 'Cronbach's alpha' (0.821) indicated good internal consistency. The initial exploratory factor analysis resulted in a three-factor model. The subsequent confirmatory factor analysis indicated that an 11-item version of the scale provided the best fit of the model to the data (RMSEA = 0.050, SRMR = 0.053, TLI = 0.937, CFI = 0.955, AIC = 24,999.949). All subscales ('value of adult vaccination', 'safety concerns' and 'perceived barriers') demonstrated strong concurrent associations with participants' attitudes and behaviour regarding vaccination (p < .001). No ceiling or floor effects were noted for any of the subscales (0.13%, 2.61% and 0.51%; 0.13%, 0.57% and 0.45% respectively). The 11-item ATAVAC scale proved to be a reliable and valid tool, suitable for assessing attitudes towards adult vaccination.

Modeling patients' choice between a primary care physician or a diabetes specialist for the management of type-2 diabetes using a bivariate probit analysis.

AIMS: To determine the prevalence of type-2 diabetes patients that were initially and currently being treated by primary care physicians (PCPs) or diabetes specialists and assess predictors influencing their choice. METHODS: This cross-sectional study was conducted in nine Greek primary healthcare units. Patients' choices were modeled using a bivariate probit analysis. RESULTS: A total of 225 patients participated (84% response rate). Only 15.9% and 11.9% of the respondents acknowledged having chosen a diabetes specialist for their initial or current treatment, respectively. The family history of diabetes in siblings and the screening for diabetic retinopathy during the past year were significantly positively associated with choosing a diabetes specialist (initially p=0.033 or currently p=0.007), and resulted in a statistically significant reduction of the joint probabilities of choosing a PCP by 15.6% and 13.6%, respectively. Younger age (p=0.040), female sex (p=0.017), higher HbA1c (p=0.004), experience of hypoglycemia (p=0.029) and low cardiovascular morbidity index (p=0.016) emerged as important predictors for choosing a diabetes specialist for their treatment. CONCLUSIONS: Our findings provide a better insight in diabetes patients' choices regarding the category of their treating physicians and their predictors. More studies are required to replicate them and identify patient subpopulations that may favor diabetes specialists' guidance.

Exploring primary care physician experiences conducting practice-based research on adult vaccination: a qualitative evaluation study in Greece.

BACKGROUND: Research in primary care is necessary to empower its role in health systems and improve population health. OBJECTIVE: The aim of this evaluation study was to assess the experiences of primary care physicians who participated as researchers in a multi-centre, mixed-methodology study on adult vaccination supported by a newly established practice-based research network. METHODS: Twenty-three physicians participated as researchers, operating in their own practices in 10 different prefectures of Greece. After the completion of the study, they were asked to reflect on their experiences in the research by providing written responses to the questions on the evaluation tool of the study. The open-ended questions were analyzed using thematic content analysis. RESULTS: Mean age of the researchers was 42.9 years old (±3.9, min 35, max 49) and 11 (47.8%) were male. Six themes emerged as beneficial for the participating researchers: (i) raised awareness of patients' needs, (ii) enhancement of clinical practice and services offered, (iii) positive impact on the doctor-patient relationship, (iv) personal satisfaction, (v) enrichment of their curriculum vitae and (vi) improvement of research skills. All researchers were interested in participating in future studies. CONCLUSION: The experience of conducting clinical research on adult vaccination in their own practices within a network was reported to be very rewarding. The benefits gained from their participation could be a valuable tool in promoting research and enhancing the quality of primary health care.

Identifying patient-related barriers in hypertension control: a multi-centered, mixed-method study in Greek rural practices.

INTRODUCTION: Treated but uncontrolled hypertension is a worldwide challenge. Exploring patient perspectives in different cultures and contexts could contribute to a more comprehensive understanding of poor blood pressure (BP) control. This study aimed to investigate patients' knowledge and attitudes towards BP management in order to identify possible barriers to achieving effective control. METHODS: A mixed-methods study, using both quantitative and qualitative research methodology, was conducted by 12 general practitioners working in rural areas in five different prefectures in Greece. A 42-item, pre-tested questionnaire was completed by the hypertensive patients who visited the practices and were included among the first 20 patients for 20 consecutive working days. Included participants were patients who (a) had diagnosed hypertension and received BP-lowering medication, (b) were aged over 18 years, (c) had physical and mental ability to participate in an interview, (d) had adequate understanding of the Greek language and (e) provided signed, informed consent. The open-ended questions used to identify the patient-related barriers in hypertension control were analyzed using thematic content analysis. RESULTS: A total of 613 hypertensive patients were recruited (response rate 91%); mean age was 71.5 years (SD 9.4, range 34-100) and 39.5% (242) were male. Uncontrolled BP was found in 41.3% (253), of which 67.6% (171) considered their BP controlled, 18.6% (47) uncontrolled, while 13.8% (35) were unaware of their status. Women were more likely to achieve BP control (OR 1.44, 95% confidence interval 1.04-2.00). As many as 287 (46.8%) patients knew the optimal values for BP. The identified barriers in hypertension control were grouped into six themes: knowledge gaps, intolerance of adverse events, negligence, unmet individual preferences, financial barriers and overtreatment of hypertension. CONCLUSION: Physicians should be aware of the possible disconnection between their patients' perceived and actual BP control, given frequent overestimation of BP control rates and the lack of knowledge of target BP levels. They should bear in mind that covering their patients' knowledge gaps is essential in empowering their patients to get more actively involved in the management of their chronic condition. Simultaneously, physicians should aim to elicit each patient's attitudes, concerns about adverse events, individual preferences, as well as possible financial barriers and negligence, in an effort to actually see the antihypertensive treatment 'through their patients' eyes' and eliminate possible barriers in medication adherence. The provision of patient-centered care remains the gold standard for eliminating patient-related barriers and achieving higher levels of BP control.

Exploring primary healthcare professionals' experiences as educators on safe internet use: a school-based intervention from Greece.

AIM: The objective of this study was to explore the experiences and level of awareness among primary healthcare (PHC) professionals, who were trained and encouraged to participate as educators in a school-based intervention for safe internet use. METHODS: All directors of the PHC centers of the Third Health Authority of the prefecture of Macedonia, Greece were asked to invite their personnel to participate voluntarily in a project on safe internet use. Participants attended a 1-day train-the-trainers course on cyber-safety in order to serve as educators in a school-based intervention in their communities. An evaluation questionnaire was completed anonymously and voluntarily by the professionals 1 month after completion of the school intervention. The answers to the open-ended questions were analyzed using thematic content analysis. RESULTS: Forty-six PHC professionals from 13 PHC centers (response rate 72.2%) were trained. They served as educators to 30 middle schools and 21 high schools, reaching 8053 students, aged 12-18 years, from urban (22.5%), semi-urban (36.3%) and rural areas (41.2%). The experience was evaluated as positive by all 46 professionals, who recognized the following benefits: (i) acquisition of new knowledge on pathological internet use, (ii) ethical reward for raising awareness in students on the potential threats of internet use, (iii) revitalizing effect of the interaction with youth and (iv) reinforcement of cooperation and team spirit. CONCLUSIONS: The combined trainee's and trainer's experience could be rewarding and satisfying, contributing in raising PCH professionals' own awareness on new topics that should be included in their continuous educational agenda. Furthermore, involvement of trained PHC providers as educators in school-based interventions could reinforce their role in health promotion within their communities, both urban and rural.

Raising awareness on cyber safety: adolescents' experience of a primary healthcare professional-led, school-based, multi-center intervention.

Purpose Although safe Internet use is an emerging public health issue, there is a scarcity of published work describing relevant school-based interventions. The objective of this study was to explore the impact of a health professional-led, school-based intervention in raising awareness on cyber-safety in adolescents, Therefore, the aim of this study was to investigate adolescents' evaluation of this school-based intervention, 6 months after its implementation, as well as the impact of adolescents' school class and gender on their evaluation. Methods A student sample was selected using a multistage stratified random sampling technique, according to the location and school grade level (middle, high school). The students - aged from 12 to 18 years old experienced an interactive presentation in their classrooms on the amount of time spent online, the use of social networks and the available support services. An evaluation tool was completed anonymously and voluntarily 6 months after the intervention. Results Four hundred and sixty-two students (response rate 90.7%, 246 middle, 216 high school) completed the evaluation tool. Younger students, especially the ones in the first year of middle school, scored significantly higher in all six parameters used in the evaluation of this intervention compared with all the older participants: (a) they had kept the presented information on Safeline and Saferinternet websites and the helpline Ypostirizo (70.2% vs. 33.7%, p < 0.001) (b) they had already used it (32.5% vs. 12.3%, p < 0.001), (c) they had learned new information on cyber safety (66.4% vs. 34%, p < 0.001), (d) they rated the intervention as more interesting (median 8 vs. 7, p < 0.05), (e) they had reconsidered the way they use Internet (median 7 vs. 6, p < 0.05) and (f) they had changed their cyber behavior (median 7 vs. 5, p < 0.05). Conclusion The active involvement of students in a discussion on cyber-safety based on their experiences was highly evaluated. The impact of the intervention on the youngest students underlines the need for raising awareness on cyber-safety and support services, earlier in the students' life.

Pathological Internet use, cyberbullying and mobile phone use in adolescence: a school-based study in Greece.

Purpose This study investigated the prevalence of Internet addiction (IA) and cyberbullying and examined profiles of adolescents with increased risk to develop pathological behaviors. Methods In this cross-sectional, school-based study, 8053 students of 30 middle and 21 high schools (12-18 years old) were invited to participate, based on a multistage stratified random sampling technique. The Internet aiddiction test (IAT) was used along with information on socio-demographics, Internet activities and cyberbullying experience. Results Five thousand five hundred and ninety students participated (response rate 69.4%). Pathological Internet use (IAT ≥50) was found in 526 (10.1%), while 403 (7.3%) experienced cyberbullying as victims and 367 (6.6%) as perpetrators during the last year. In multivariable models, the odds of IA increased with online hours on mobile phones and Internet use during weekends, Internet café visits, chatrooms usage and engagement in cyberbullying. Cyberbullying victims were more likely to be older, female, Facebook and chatrooms users, while perpetrators were more likely to be male, older Internet users and fans of pornographic sites. A perpetrator was significantly more likely to have also been a victim [odds ratio (OR) = 5.51, confidence interval (CI): 3.92-7.74]. Hours of daily Internet use on a mobile phone was independently associated with IA and cyberbullying (OR) 1.41, 95% CI 1.30, 1.53 and OR 1.11, 95% CI 1.01, 1.21, respectively. Conclusions Cyberbullying is associated with IA and the hours spent online on a mobile phone affected both conditions. The increasing Internet access through mobile phones or other devices should be accompanied by the appropriate education of both parents and adolescents on safe Internet use.

General principles to consider when designing a clinical communication assessment program.

OBJECTIVES: Assessment of clinical communication helps teachers in healthcare education determine whether their learners have acquired sufficient skills to meet the demands of clinical practice. The aim of this paper is to give input to educators when planning how to incorporate assessment into clinical communication teaching by building on the authors' experience and current literature. METHODS: A summary of the relevant literature within healthcare education is discussed, focusing on what and where to assess, how to implement assessment and how to choose appropriate methodology. RESULTS: Establishing a coherent approach to teaching, training, and assessment, including assessing communication in the clinical context, is discussed. Key features of how to implement assessment are presented including: establishing a system with both formative and summative approaches, providing feedback that enhances learning and establishing a multi-source and longitudinal assessment program. CONCLUSIONS: The implementation of a reliable, valid, credible, feasible assessment method with specific educational relevance is essential for clinical communication teaching. PRACTICE IMPLICATIONS: All assessment methods have strengths and limitations. Since assessment drives learning, assessment should be aligned with the purpose of the teaching program. Combining the use of different assessment formats, multiple observations, and independent measurements in different settings is advised.

Enhancing clinical communication in dermatologists: a personalized educational intervention.

OBJECTIVES: Effective communication is a vital component of patient-centered consultations with favorable treatment outcomes. This study aimed in testing the effectiveness of a personalized, communication training program for dermatologists in their practices. METHODS: Fifteen dermatologists were offered the educational intervention NO.TE.S. (Non-Technical Skills). Depending on the dermatologists' needs, seven to nine sessions with a 60-min duration were performed, focusing on: patient-centered care, principles of Neurolinguistic Programming, a guide to the medical interview, principles of motivational interviewing and self-care. After the program's completion, participants completed anonymously an 18-item evaluation questionnaire. RESULTS: All 14 participants would suggest NO.TE.S to a colleague. According to the main themes identified, their participation led to (i) re-consideration of the physician-patient relationship, (ii) more conscious application of the patient-centered model, (iii) improvement in communication skills, (iv) awareness of medical interview guides, (v) increase in self-confidence, and (vi) techniques of self-care. Eleven physicians (78.6%) declared improvement in patients' satisfaction, 14 (100%) in their own satisfaction, seven (50%) in adherence to therapeutic plan and seven (50%) in treatment outcomes. CONCLUSION: The one-to-one coaching is a convenient and well-received personalized means of enhancing clinical communication in dermatologists, leading to more patient-centered medical encounters with better treatment outcomes.

Evaluating the Efficacy of the Feeding Exercise Randomized Trial in Overweight and Obese Adolescents.

BACKGROUND: The Feeding Exercise Trial in Adolescents (FETA) aimed to evaluate whether a community-based, parents-involving, combined physical activity and nutritional education program was effective in improving adiposity profiles in overweight and obese adolescents. METHODS: A total of 181 overweight and obese adolescents aged 13-15 years old were randomized in the three study groups ("Diet & Activity," "Activity," and Control). The Activity intervention included a 45-minute, 3-day per week supervised training program, while the Diet & Activity intervention included a supplementary 15 minutes of group-based sessions attended by the parents. The intervention lasted 3 months and the participants were followed for another 3 months after the intervention. The participants were assessed for anthropometric measures and activity and fulfilled the modified version of the questionnaire "Family Eating and Activity Habits Questionnaire" (FEAHQ). RESULTS: Both "Activity" only and "Diet & Activity" groups reduced significantly (p < 0.001) their mean body mass index (BMI) (-1.1, 95% CI -1.3, -0.8, and -1.4, 95% CI -1.7, -1.2, respectively), waist circumference, systolic and diastolic blood pressure, pulses per minute, and 50 m sprint run test at 3 months, while greater reductions in BMI were observed at 6 months (-2.3, 95% CI -2.6, -2.0, and -3.1, 95% CI -3.3, -2.8). Significant changes in the total FEAHQ score were achieved only in the "Diet & Activity" group both at 3 months and at 6 months. CONCLUSIONS: FETA resulted in significant effects on improving adiposity profiles in overweight and obese adolescents, as well as family activity and feeding habits, maintained at 3 months follow-up.

Hepatitis B Virus Vaccination Coverage in Medical, Nursing, and Paramedical Students: A Cross-Sectional, Multi-Centered Study in Greece.

Students of health professions are at high risk of hepatitis B Virus (HBV) infection during their clinical training. The aim of this cross-sectional, multi-centered study was to investigate the HBV vaccination coverage in Greek medical, nursing, and paramedical students, to look into their attitudes towards the importance of vaccines and to reveal reasons associated with not being vaccinated. A self-completed, anonymous questionnaire was distributed to 2119 students of health professions in Greece, during the academic year 2013-2014. The HBV vaccination coverage of students was high (83%), being higher among medical students (88.1%, vs. 81.4% among nursing and 80.1% among paramedical students; p < 0.001). The vast majority of them (95%) have been vaccinated during childhood. In addition, 30% of the unvaccinated students declared fear over HBV safety. Our results indicate that the healthcare students achieved higher reported immunization rates compared to the currently serving healthcare workers, but also to the students of the last decade. The fact that nursing and paramedical students have lower coverage figures underlines the importance of targeted interventions for the different subgroups of healthcare students in terms of educational programs and screening for HBV markers in order to increase HBV vaccination uptake.

Prevalence and Risk Factors of Overweight and Obesity among Adolescents and Their Parents in Central Greece (FETA Project).

The increasing obesity trend in adolescence is a public health concern. The initial phase of Feeding Exercise Trial in Adolescents (FETA) aimed in investigating the prevalence of overweight and obesity in adolescents and their parents and in identifying associated factors among parents' and adolescents' demographics, eating habits, and parental style. The sample consisted of 816 adolescents, aged 12-18 years old, and their parents from 17 middle and high schools in Larissa, central Greece. During school visits, anthropometric measurements were performed along with examination of blood pressure. The students completed the study tool that comprised of demographics and the modified versions of Parental Authority Questionnaire (PAQ), the Parent-Initiated Motivational Climate Questionnaire-2 (PIMCQ-2) and the Family Eating and Activity Habits Questionnaire (FEAHQ). Their parents completed a questionnaire with demographics, anthropometrics and FEAHQ. Normal Body Mass Index was found in 75.2% of the adolescents, 2.6% of the adolescents were underweight, 18% overweight and 4.2% obese. Regarding the parents, 76.3% of the fathers and 39.2% of the mothers were overweight or obese. The logistic regression analysis revealed that, overweight or obesity in adolescence was associated with gender (boy), maternal overweight or obesity, lower maternal educational level, eating without feeling hungry, eating in rooms other than kitchen and having a father that motivates by worrying about failing. A significant proportion of adolescents and their parents are overweight or obese. Future interventions should focus both on the parents and children, taking into account the role of parental authority style, in preventing adolescents' obesity.

Internet addiction in Greek medical students: an online survey.

OBJECTIVE: The authors investigated the prevalence of Internet addiction (IA) in undergraduate medical students to identify possible associations with sociodemographics and Internet habits. METHODS: All students at the Aristotle University of Thessaloniki School of Medicine, Greece, were invited to complete the online Internet Addiction Test (IAT) along with sociodemographics and preferences on Internet activities. RESULTS: The authors received 585 responses after three reminders (23.5 % response rate). Mild IA was found in 24.5 %, moderate in 5.4 %, and severe in 0.2 %. In multivariable analysis, the odds to develop IA were increased with visits in Internet cafes (Odds Ratio [OR] 3.49, 95 % Confidence Interval [CI]: 1.45, 8.46), the use of Facebook (OR 2.43, 95 % CI: 1.35, 4.38), Twitter (OR 2.45, 95 % CI: 1.37, 4.39), and online games (OR 1.95, 95 % CI: 1.29, 2.94). Using e-mails seemed to be protective against IA (OR 0.59, 95 % CI: 0.37, 0.94). CONCLUSION: This is the first IA prevalence study in a European medical school. Early-detection systems and other ways to help students with pathological behaviors should be developed.

Determinants of patients' attitudes toward patient-centered care: a cross-sectional study in Greece.

OBJECTIVE: The aim of this study was to investigate - for the first time in Greece - patients' attitudes toward patient-centered care, by identifying the impact of socio-demographic factors, health condition, social support and religious beliefs. METHODS: 454 Hospitalized patients were interviewed on the first day of their scheduled admission, answering demographic questions and the following questionnaires: Patient-Practitioner Orientation Scale (PPOS), Autonomy Preference Index (API), Short Form SF-12v2 Health Survey, God Locus of Health Control (GLHC) and Perceived Available Support (PAS). RESULTS: Mean PPOS and API scores were: PPOS Sharing 3.4 (sd=0.69), Caring 3.99 (sd=0.76), API Information-Seeking 88.32 (sd=9.35) and Decision-Making 51.19 (sd=9.27). Higher desire for information was associated with younger age, more years of education, weaker spiritual faith in healing and worse subjective health status. Higher expectations for caring physicians were correlated with older age, more years of education, higher perceived social support and weaker spiritual faith in healing. CONCLUSION: Age, years of education, health status, social support and religious beliefs are determinants of patient-centered attitudes. PRACTICE IMPLICATIONS: Patients expect to be informed, although they do not equally want to be involved in decision-making. Religious faith and perceived social support should be taken into consideration to further understand patients' needs.