Geospatial epidemiology of coronary artery disease treated with percutaneous coronary intervention in Crete, Greece

Coronary artery disease (CAD) constitutes a leading cause of morbidity and mortality worldwide. Percutaneous coronary intervention (PCI) is indicated in a significant proportion of CAD patients, either to improve prognosis or to relieve symptoms not responding to optimal medical therapy. Thus the annual number of patients undergoing PCI in a given geographical area could serve as a surrogate marker of the total CAD burden there. The aim of this study was to analyze the potential, spatial patterns of PCItreated CAD patients in Crete. We evaluated data from all patients subjected to PCI at the island's sole reference centre for cardiac catheterization within a 4-year study period (2013-2016). The analysis focused on regional variations of yearly PCI rates, as well as on the effect of several clinical parameters on the severity of the coronary artery stenosis treated with PCI across Crete. A spatial database within the ArcGIS environment was created and an analysis carried out based on global and local regression using ordinary least squares (OLS) and geographically weighted regression (GWR), respectively. The results revealed significant inter-municipality variation in PCI rates and thus potentially CAD burden, while the degree and direction of correlation between key clinical factors to coronary stenosis severity demonstrated specific geographical patterns. These preliminary results could set the basis for future research, with the ultimate aim to facilitate efficient healthcare strategies planning.

The Effectiveness of Teaching the Teacher Interventions in Improving the Physical Activity among Adolescents in Schools: A Scoping Review.

Physical inactivity is a leading risk factor for global mortality as it increases the risk of non-communicable diseases and decreases overall health. Therefore, increasing physical activity (PA) is strongly recommended, particularly in adolescents. The Teaching the Teachers (TTT) approach is a prominent example of an intervention that could enhance PA levels in adolescents. However, available evidence on the efficacy of TTT interventions in promoting PA among adolescents is either limited or inconclusive. Therefore, a scoping review was conducted to provide an overview of the current state of knowledge regarding the effectiveness of TTT interventions in improving the PA of adolescent students. The PRISMA-Scoping methodology was employed, and articles in the Medline database were searched. We screened 2357 articles for inclusion, and finally included 16 articles. Most articles were conducted in European countries. The TTT interventions appeared to positively affect various aspects of PA. These aspects include support for personal autonomy, intent to engage in PA, improvements in body composition and fitness level, social support, enjoyment of Physical Education (PE), and positive attitudes towards PE. Consequently, policymakers could utilize TTT interventions to improve the physical activity of adolescents, which may reduce the burden of non-communicable diseases and foster healthier societies.

Retroperitoneal Soft Tissue Sarcoma: Emerging Therapeutic Strategies.

Retroperitoneal soft tissue sarcoma (RPS) is a rare and heterogenous disease for which surgery is the cornerstone of treatment. However, the local recurrence rate is much higher than in soft tissue sarcoma of the extremities since wide resection is usually unfeasible in RPS due to its large size, indistinct tumour borders, anatomical constraints and the thinness of the overlying peritoneum. Local recurrence is the leading cause of death for low-grade RPS, whereas high-grade tumours are prone to distant metastases. In recent decades, the role of emerging therapeutic strategies, such as more extended surgery and (neo)adjuvant treatments to improve oncological outcome in primary localised RPS, has been extensively investigated. In this review, the recent data on the evolving multidisciplinary management of primary localised RPS are comprehensively discussed. The heterogeneity of RPS, with their different histological subtypes and biological behaviour, renders a standard therapeutic 'one-size-fits-all' approach inappropriate, and treatment should be modified according to histological type and malignancy grade. There is sufficient evidence that frontline extended surgery with compartmental resection including all ipsilateral retroperitoneal fat and liberal en bloc resection of adjacent organs and structures, even if they are not macroscopically involved, increases local tumour control in low-grade sarcoma and liposarcoma, but not in leiomyosarcoma for which complete macroscopic resection seems sufficient. Additionally, preoperative radiotherapy is not indicated for all RPSs, but seems to be beneficial in well-differentiated liposarcoma and grade I/II dedifferentiated liposarcoma, and probably in solitary fibrous tumour. Whether neoadjuvant chemotherapy is of benefit in high-grade RPS remains unclear from retrospective data and is subject of the ongoing randomised STRASS 2 trial, from which the results are eagerly awaited. Personalised, histology-tailored multimodality treatment is promising and will likely further evolve as our understanding of the molecular and genetic characteristics within RPS improves.

Development and Validation of the CVP Score: A Cross-Sectional Study in Greece.

Although central venous pressure (CVP) is among the most frequent estimated hemodynamic parameters in the critically ill setting, extremely little is known on how intensive care unit (ICU) nurses use this index in their decision-making process. The purpose of the study was to develop a new questionnaire for accessing how ICU nurses use CVP measurements to address patients' hemodynamics investigating its validity and reliability. A cross-sectional study was conducted among 120 ICU nurses from four ICUs of Greece. Based on a comprehensive literature review and the evaluation by a panel of five experts, a new questionnaire, named "CVP Score", was created, having eight items. The construct validity and the reliability of the questionnaire were examined. Half of the study participants (51.7%) worked at a specialized ICU, and they had a mean [±Standard Deviation (SD)] ICU experience of 13(±7.1) years. The estimated construct validity of the newly developed tool was acceptable, while the internal consistency reliability as measured by Cronbach alpha was excellent (0.901). CVP Score had acceptable test-retest reliability (r = 0.996, p < 0.001) and split-half reliability (0.855). The CVP score is a valid and reliable instrument for measuring how critical care nurses use CVP measurements in their decision-making process.

Distance Learning in Nursing Education during the COVID-19 Pandemic: Psychosocial Impact for the Greek Nursing Students-A Qualitative Approach.

(1) Background: The COVID-19 pandemic posed a major threat to global health and on the educational field. The purpose of this study is to identify and illustrate the psychosocial adaptation of nursing students to the sudden and exclusive application of distance learning during the COVID-19 pandemic; (2) Methods: A qualitative interview research has been designed. Two focus groups of seven members each and six individual interviews were conducted in a sample of undergraduate nursing students in Greece from 3 March 2021, to 9 April 2021.; (3) Results: A qualitative thematic analysis of the data identified six themes: 1. Challenges; 2. Concerns; 3. Social changes; 4. Negative Emotions; 5. Evaluation; and 6. Teaching strategies.; (4) Conclusions: During its implementation, it identified gaps and weaknesses in the entire academic community. The study of the psychosocial adaptation of the academic community is considered crucial, as it can highlight the individual difficulties in distance learning and contribute to the improvement of the methods of its the improvement of its methods.

Greek Translation, Cultural Adaptation and Validation of the Mini Sarcopenia Risk Assessment Questionnaire, to Evaluate Sarcopenia in Greek Elderly at a Hospital Setting.

Sarcopenia is a progressive aging syndrome with severe socioeconomic costs. Therefore, the early diagnosis of sarcopenia is required to secure early treatment and to enhance quality of life. The Mini Sarcopenia Risk Assessment (MSRA) questionnaire, which is available in seven-item (MSRA-7) and five-item (MSRA-5) versions, is a sarcopenia screening tool that was translated into Greek, adapted, and validated in this study. The present study was developed in an outpatient hospital setting, from April 2021 to June 2022. The MSRA-7 and MSRA-5 questionnaires were translated backwards and forwards and adapted to the Greek language. To validate the MSRA questionnaire as a pre-screening tool to identify the risk of sarcopenia in the older Greek population, both the MSRA-7 and MSRA-5 versions were correlated with the Greek version of the SARC-F questionnaire, which is a widely accepted and well-known tool used in sarcopenia screening. Ninety elderly subjects aged 65-89 years-old with no mobility impairments participated in this study. The questionnaires' content validity was assessed using the Content Validity Ratio, and the Content Validity Index was calculated for the instrument. The intra-rater reliability was assessed by calculating the Intra-class Correlation Coefficient between the initial assessment and the reassessment of the MSRA questionnaire, which was 0.986, with a 95% Confidence Interval of 0.961-0.995. Concurrent validity was assessed between the Greek MSRA questionnaires and the SARC-F questionnaire using the Spearman's rank correlation coefficient (p). The Greek MSRA-7 questionnaire had a very high correlation with the SARC-F questionnaire (rho = -0.741, p < 0.001), as did the Greek MSRA-5 questionnaire (rho = -0.724, p < 0.001). The proofs of content validity, concurrent validity, and intra-rater reliability provided for the Greek versions of the MSRA, designated them as reliable pre-screening tools for the detection of sarcopenia in the older population and in clinical practice.

Nutritional assessment and quality of life in patients with non-small cell lung cancer undergoing immunotherapy.

BACKGROUND: Patients with metastatic non-small cell lung cancer (NSCLC) often experience severe eating disorders and other problems because of rapid disease progression and various therapies, which significantly affect their quality of life (QoL). AIMS: This study aimed to assess the nutritional status and QoL of patients with NSCLC at the start of immunotherapy and 3 months later. METHODS: This study used a prospective, observational, consecutive sampling approach and was carried out between July 2018 and August 2019. The convenience sample comprised 60 patients treated in the oncology ward and the day care department of a public hospital in Greece. Their nutritional status was assessed using the Mini Nutritional Assessment questionnaire and their QoL using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire and its QLQ-LC13 module. They were evaluated at the start of immunotherapy (phase I) and 3 months later (phase II). FINDINGS: Of the initial 60 patients, 25% had died and 23.3% declined to participate by phase II. Of the 31 patients (51.7%) who completed the study, 64.5% had been assessed as malnourished at phase I; at phase II, this had decreased to 32.3%, so nutritional status appeared to have significantly improved. There were also significant improvements between phases I and II in global health status/QoL, as well as in the physical, roles, emotional and social dimensions. Additionally, all nine symptoms of QLQ-C30 significantly decreased, while the QLQ-LC13 showed significant improvements in dyspnoea, alopecia and pain in parts of the body other than the chest, arm or shoulder. CONCLUSION: Metastatic NSCLC patients' QoL and nutritional status significantly improved after 3 months' immunotherapy.

Perceptions, Knowledge and Attitudes among Young Adults about Prevention of HPV Infection and Immunization.

INTRODUCTION: Human papilloma virus (HPV) is one of the most common sexually transmitted infections and is widely known as the main causative agent for cervical cancer. The aim of this study was to investigate the perceptions, knowledge and attitudes of young Greek adults concerning prevention of HPV infection and HPV immunization. MATERIAL AND METHODS: This constitutes a cross-sectional online survey. A convenience sample of young Greek adults (n = 883) residing in Greece, aged 17 to more than 35 years was surveyed from December 2020 to March 2021. Two validated questionnaires were used to collect data. RESULTS: Participants demonstrated moderate knowledge about HPV infection and vaccination, with a mean knowledge score of 53.26 (SD ± 20.65) and 38.92 (SD ± 17.58), respectively. Cronbach's alpha value was 0.77 and 0.80. Female participants were better informed than males. Approximately 52.3% of respondents had been vaccinated and 65.5% were willing to get vaccinated in the future. Vaccination rate was significantly associated with gender (OR = 11.99; 99% CI = 6.59-21.84), knowledge about the HPV vaccine (OR = 1.04; 99% CI = 1.03-1.04) and age (OR = 0.07; 99% CI = 0.03-0.15). Reasons for vaccine refusal were insufficient information (36.8%) and fear of side effects (19%). Correlates of positive vaccination intention were knowledge about HPV (OR = 1.02; 99% CI = 1.01-1.02). CONCLUSIONS: The findings suggest that the Greek government's continuing HPV promotion efforts and education on the risks of HPV infection among young people are likely to increase vaccination acceptance among this group.

Nursing students, mental health status during COVID-19 quarantine: evidence from three European countries.

BACKGROUND: The SARS-CoV2 pandemic obligated most of the European countries to implement strict measures and lockdowns to minimize the spread of the virus. Universities closed and on-line classes started. However, COVID-19 epidemic has significant impact on mental health of population. AIM: To assess depression level of nursing students (undergraduate and master) in Greece, Spain and Albania during COVID-19 pandemic as well as to identify possible determinants of depression level. METHODS: A multicenter cross-sectional study was conducted between April and May 2020. An on-line questionnaire was used to collect the data. The Patient Health Questionnaire-9 was used to evaluate the depression levels of nursing students. RESULTS: Seven hundred and eighty-seven nursing students participated in the study out of which 83.9% were of female gender, 92.9% single and 94.7% lived with others. One third of the nursing student population experienced mild depression, with higher depression levels noted for Spanish students (59.1%) followed by Albanian (34.5%) and Greek (21.8%) students. Multivariate linear regression analysis identified that Spanish students experienced more depression than Greek and Albanian (p < 0.001). Also, decreased age was associated with increased depression. CONCLUSION: The impact of lockdown and quarantine on nursing students mental health is clear. Provision of university based mental health interventions should be a priority.

Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece.

BACKGROUND: Patients with end-stage renal disease (ESRD) require specialized therapeutic interventions. The decreased renal function that modulates the physiology and presence of comorbidities is often associated with variations in the pharmacological response, thus increasing the risk of adverse drug events or reactions (ADE/ADRs) from co-administered drugs. METHODS: A cross-sectional study to record comorbidities, drug-drug interactions (DDIs), ADE/ADRs in patients with chronic kidney disease of stage five in Greece. The study enrolled 60 patients of mean age 64.8 ± 12.9 years, undergoing hemodialysis three times a week. Demographic and social factors, comorbidities, laboratory test data, medication regimens, DDIs and the reporting of ADE/ADRs were analyzed. RESULTS: Cardiovascular diseases and diabetes were the main comorbidities. In total, 50 different DDIs of various clinical significance were identified. CNS, GI-track, and musculoskeletal-system-related ADE/ADRs were most often reported by patients. ADE/ADRs as clinical outcome from DDIs were associated in 64% of the total identified DDIs. There was a positive trend between number of medications, ADE/ADRs report and DDIs. CONCLUSIONS: The impact of ADE/ADRs in ESRD patients should be always considered. Guidelines as well as continuous training in the context of evidence-based clinical practice by healthcare personnel on therapy administration and prevention of adverse events are important.

Development and Validation of a Questionnaire to Measure Knowledge of and Attitude toward COVID-19 among Nursing Students in Greece.

BACKGROUND: During the COVID-19 pandemic, nursing students have had a key role in supporting the healthcare sector. They can join healthcare professionals in clinical practice or provide information to increase citizens' levels of knowledge and their compliance with the restriction measures. The study aimed to develop and validate a tool to measure knowledge of and attitudes toward COVID-19 among nursing students in Greece. METHODS: A questionnaire was developed through theoretical research and expert consultation. A cross-sectional study was conducted among 348 undergraduate nursing students of the Department of Nursing, Hellenic Mediterranean University, recruited by convenient sampling. Validity and reliability were analyzed. RESULTS: The Kaiser-Meyer-Olkin measure was 0.84, indicating that the sample size was adequate for factor analysis. In addition, the p-value for Bartlett's test of sphericity was <0.001, denoting that the correlation matrix was suitable for factor analysis. The construct validity of the questionnaire was determined through exploratory factor analysis (EFA), which revealed that 16 items lead to four factors: knowledge, attitude toward restriction measures, compliance with them, and volunteering. One of the key findings of this study was that participants preferred to receive information from valid sources rather than social media during the crucial period of the "infodemic". CONCLUSIONS: The questionnaire was shown to have satisfying psychometric properties and, therefore, can be used as a tool in future research in the area of nursing students' knowledge, attitudes, compliance, and volunteering during the COVID-19 pandemic.

The value of the Modified Early Warning Score for unplanned Intensive Care Unit admissions of patients treated in hospital general wards.

AIM: To determine the value of the Modified Early Warning Score (MEWS) for general ward patients and its potential use as an alarm tool for ward nurses. METHODS: A combined prospective-retrospective observational study was conducted with 153 patients in a university hospital (2013-2014). All patients were admitted to the intensive care unit (ICU) from general wards. Parameters retrospectively studied were 5 MEWS values at 4 hourly intervals, up to 20 hours before ICU admission. Parameters prospectively studied were ICU length of stay, ICU mortality, and mortality after ICU discharge. RESULTS: Most frequent severe adverse events were acute respiratory failure (39.9%) and septic shock (20.3%). Modified Early Warning Score increased gradually during the last 20 hours, and most patients remained in the wards, above a cut-off point ≥7 recorded at 4 hours before admission. Significant associations between latest MEWS score and ICU mortality and ICU length of stay were found. MEWS score≥ 7 hours before admission was highly associated with increased ICU and hospital mortality. CONCLUSION: Patient deterioration in general wards can result in severe adverse events. Modified Early Warning Score is a strong predictor of outcome and may be used as a monitoring tool for potentially avoidable deaths and unplanned admissions to ICU.