Pythagorean Self-Awareness Intervention Promoted Healthy Dietary Patterns, Controlled Body Mass Index, and Reduced Self-Reported Stress Levels of Primary School Children: Α One-Arm Pilot Study.

Stress is common in childhood and an important factor that affects behavior later in adulthood. The aim of this study was to assess the effects of the Pythagorean Self-Awareness Intervention (PSAI), a holistic "cognitive reconstruction" technique to assess primary school children's stress levels, adherence to the Mediterranean diet, and body mass index. Secondary outcome measures included relations with peers, sleep, and hair cortisol concentrations. This one-arm pilot study took place in a primary school, from February to June 2019. Participants were 32 pupils attending the second grade of primary school who received the 8-week PSAI to adopt healthy behaviors and lifestyle. Self-report measures were applied for the evaluation of various variables at the beginning and the end of the eight-week intervention. There were statistically significant reductions in stress levels (p = 0.00), nightmares' frequency (p = 0.00), body mass index (p = 0.03), and bully scale (p = 0.00), and improvement in Mediterranean diet quality (p = 0.00). Hair cortisol concentrations increased (p = 0.02). The social scale significantly increased. Bedtime remained the same after the intervention. This pilot trial showed that the PSAI promoted healthy dietary patterns, controlled children's body mass index, and reduced their self-reported stress levels. Further research on the implementation of this holistic program on children is suggested, in well-powered randomized controlled trials.

The Effect of Pythagorean Self-Awareness Intervention on Stress and Mental Health Characteristics of Civil Servants in Crete, Greece.

Evidence is limited regarding the effects of holistic programs on work-related stress, anxiety, and depressive symptomatology. This study aimed to evaluate the effects of the Pythagorean Self-Awareness Intervention (PSAI) on stress and mental health characteristics of civil servants in Crete, Greece. This was a single arm interventional study with PSAI outcome evaluation. Validated, self-reported scales were used to assess stress and mental health characteristics (PSS, DASS, UCLA, RSE, and STAXI). Hair samples were obtained to measure cortisol concentrations as a biological stress marker. Paired-samples t-test or Wilcoxon tests were used to evaluate pre- and post-intervention measures. Overall, 48 civil servants (56.3% women, mean age 51 years) participated in the study. Statistically significant reductions were observed in all self-reported stress scales (p < 0.05). Although hair cortisol decreased, this difference was not statistically significant (p = 0.109). Statistically significant improvements were also observed on depressive symptomatology (p < 0.001), self-esteem (p < 0.001), loneliness (p < 0.001), self-efficacy (p = 0.002), and anger (p = 0.017). The PSAI appeared beneficial with respect to all self-reported outcomes. Larger studies including control groups and further follow-up evaluations are needed to ascertain these findings.

Validation of the Greek Version of the State Shame and Guilt Scale (SSGS).

Both shame and guilt are self-conscious negative emotions claiming self-representations and self-awareness. Growing evidence indicates that these pessimistic emotions are associated to stress and stress-related disorders. The aim of this study was to translate and investigate the validity and reliability of the State Shame and Guilt Scale (SSGS) in a Greek adult population sample. A total of 181 adults (63% women) participated in the study. To validate the SSGS, correlations with the Depression Anxiety Stress Scales (DASS) and the Perceived Stress Scale (PSS) were also examined. Exploratory factor analysis was used to examine the factors of the Greek version of the SSGS. In addition, for greater validity, comparisons were made according to sex, marital status and level of education. The reliability assessment revealed that the index of internal consistency (Cronbach's alpha) was above the acceptable margin (0.7) for the three subscales (shame; 0.717, guilt; 0.770, pride; 0.874). The Greek version of the 15-item State Shame and Guilt Scale (SSGS) demonstrated good psychometric properties and could be proven useful for the assessment of shame, guilt, and pride.

Post-traumatic Stress Disorder as a Risk Factor for the Development of Risky Behavior Among Adolescent Offenders: A Systematic Review.

The purpose of this research study was to obtain greater insight into the associations of post-traumatic stress disorder (PTSD) and trauma-exposed experiences with the development of offending behavior in adolescents. Using the PubMed and Scopus databases, we performed a systematic review of recent cross-sectional studies between 2016 and 2022, investigating the associations of PTSD and trauma with the social and mental behavior of adolescents. Fifty-three articles were initially identified. Due to duplication, eight articles were excluded, leaving 45 remaining articles. In addition, 34 articles were excluded due to year of publication, review, abstract, or irrelevant title. Seven articles were included in this systematic review after excluding the remaining due to different study types or samples. Included studies primarily examined the associations of PTSD symptomatology and expression of externalizing symptoms with risky behavior and the commission of a crime. The strongest outcomes were increased levels of violent behavior, violent delinquency, and total risk in correlation with PTSD symptoms, emotional numbing, use of drugs, and in some cases maltreatment. The results of the systematic review suggest that PTSD symptoms and risky behavior, which can be also fueled by maltreatment activities in the family circle, are associated with criminal behavior. Future research is needed to confirm these findings.

Burnout in General Surgeons. A Systematic Review.

Occupational burnout is particularly widespread amongst surgical professionals. During the past 10 years, both the awareness and the ability to reliably measure and classify "burnout" in medical professionals have increased. The purpose of this systematic review was to summarize the current evidence on the burnout levels of general surgeons. Online searches were carried out using the scientific search engines PubMed, Embase, Cinahl, and Google scholar, from 2010 to 2020, before the COVID-19 pandemic. Articles that met the inclusion criteria were critically evaluated using the critical appraisal skills programme (CASP) tool. Five studies pertaining to 669 subjects were included in this review. As expected, "burnout syndrome" was mainly due to the exhaustive and demanding conditions of working life and was strongly observed in general surgeons. The incidence of the burnout syndrome increased with their years of service, compromised their quality of life, and had detrimental effects on their mental and physical health. Personal achievements and emotional satisfaction were protective for the occurrence of the syndrome. We conclude that valid recognition and prevention of the burnout syndrome are necessary. Further research is needed to manage this phenomenon within the healthcare settings and the surgical departments.

Mindfulness and Academic Performance of College and University Students: A Systematic Review.

Higher education's expectations place demands on students' attainment, leading them to experience stress and anxiety, which negatively affect their academic improvement and life satisfaction. The aim of this systematic review was to investigate (a) if mindfulness as an inner ability is related to academic attainment, through dependent variables, including compassion, engagement, stress or anxiety state, depression, self-efficacy, mindfulness's facets (non-reactivity, acting with awareness) and (b) if mindfulness-based interventions positively affect the academic performance of college and university students. The systematic review was conducted in accordance with the PRISMA statement. PubMed, Web of Science, and Cochrane Library Wiley were screened to identify studies published relevant to the topic. In total, 568 papers were retrieved in the initial search. Five papers met the eligibility criteria and were included in the systematic review: a randomized controlled trial, a non-randomized controlled trial, a quasi-experimental study, a quantitative exploratory pilot study, and a longitudinal randomized controlled study. Most interventional studies revealed a non-significant direct effect of practicing mindfulness technique on academic attainment. Further research, especially randomized controlled trials are necessary to clarify the effect of mindfulness on academic performance of college and university students.

How Does Meditation Affect the Default Mode Network: A Systematic Review.

This article provides a systematic review of studies evaluating the effect of meditation on the Default Mode Network (DMN). The review was conducted according to PRISMA guidelines. A literature search of PubMed, Scopus, and Embase was conducted up to June 2020. Search terms included default mode network or DMN and meditation.A total of 306 articles were identified, of which 16 controlled trials with a total of 853 experienced (in Mindfulness, Samatha, Raja Yoga, Transcendental Meditation, Vipassana, Insight meditation Theravada tradition) and non-experienced mediators were finally included in this systematic review. The results showed that meditative interventions affect the operation of DMN and there are differences in functional connectivity between networks. Further research should be undertaken to establish meditation as an effective intervention strategy for well-being.

Brain Activity of Professional Dancers During Audiovisual Stimuli Exposure: A Systematic Review.

Many studies have shown the effect of dance to the brain. It seems that long-term practice modulates brain plasticity and visuomotor skills, as it activates the Action Observation Network (AON). The aim of this systematic review was to evaluate potential differences in the brain activity (visuomotor skills) between professional dancers and non-dancer adults, measured by electroencephalography (EEG), during the observation of an individual who is dancing (video dance stimuli). This literature search was conducted from February to June 2022, according to the PRISMA guidelines, in the PubMed database using advanced search, mesh terms, and extensive manual search. The included articles were published in English. Specifically, case-control studies were selected, which used healthy adults, professional dancers, and non-dancers as participants, who were exposed to video dance clips and measured by EEG. The articles were excluded if they were based on different type of study, unhealthy population, control group with athletic background, different type of stimuli (rhythmic), or different type of task and procedure. The ratings of quality of evidence were conducted using the Joanna Briggs Institute's (JBI) critical appraisal tool. Five case-control studies were included with 193 participants in total, 87% females. The participating groups of professional dancers (n = 12-25) had mean age 25.14 years, with at least 9-19 years of professional training, whereas control groups had the same sample size, mean age of 24.14 years, and no experience in dancing. Most of the studies presented high methodological quality. All studies showed significant differences in dancers' brain activity, especially regarding the visuomotor skills. The results showed faster activation of AON demonstrated by higher P300 at the frontocentral regions and increased sensitivity of the occipital temporal cortex. Dancers could cope easier with familiar-unfamiliar and effortful-effortless movements. They also demonstrated faster alpha band peak frequency, stronger synchrony over the bands theta, beta, gamma during the audiovisual stimuli, and the ability to encode faster the visual information. The results demonstrate that dancers had better visuomotor skills suggesting dance-enhanced neuroplasticity, as professional dancers processed their actions easier. Dance, which includes visuomotor tasks, could help in prevention, therapy, and rehabilitation of neurodegenerative diseases or movement disorders.

Validation of the Greek Version of Social Appearance Anxiety Scale in Adolescents and Young Adults.

Many people are worried about their social appearance. The fear of negative evaluation and judgment regarding one's look in social circumstances is referred to as social appearance anxiety. Social appearance anxiety belongs to social anxiety. The aim of the present study was to validate the Social Appearance Anxiety Scale (SAAS) in the Greek language and to examine its psychometric properties. An online survey was conducted in a Greek population sample of adolescents and young adults aged 18 to 35 years. The survey instruments included the Social Appearance Anxiety Scale, the Social Physique Anxiety Scale (SPAS), 2 subscales of Multidimensional Body-Self Relations Questionnaire Appearance Scale (MBSRQ), the Appearance Schemas Inventory-Revised Scale (ASI-R) and the Depression Anxiety Stress Scale (DASS). A total of 429 respondents participated in this research. The statistical analysis showed that the Greek version of the SAAS has good psychometric properties. The internal consistency of questions within the SAAS was 0.942. Positive correlations were found between SAAS and SPAS, the overweight preoccupation subscale of MBSRQ, the ASI-R and the DASS, while negative correlations were observed between SAAS and the appearance evaluation subscale of MBSRQ and age. The results of this study suggest that the Greek version of SAAS can be used as a reliable and valid instrument in the Greek population.

Stress and Well-Being of Greek Primary School Educators: A Cross-Sectional Study.

The teaching profession has always been challenging, while for various reasons the magnitude of observed stress in teachers has been continually growing over time. This study was conducted to demonstrate the relevance of stress in this professional group and to generate evidence for the benefit of primary school teachers and, indirectly, their pupils. To this end, we examined a large number of school teachers in a descriptive cross-sectional study. The survey comprised 786 primary school instructors aged 21 to 65 years, 646 women (82.2%) and 140 males (17.8%), and was performed from March to October 2022. Participants were asked about their gender, age, marital status, place of domicile, satisfaction with their income, whether their income met their needs, number of children, whether they cared for a person with a disability, work experience, alcohol use, eating patterns, and their height and weight for computation of their Body Mass Index (BMI). The survey included the Teacher Subjective Well-being Questionnaire (TSWQ), the Perceived Stress Scale (PSS), the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ), and the Pittsburgh Sleep Quality Index (PSQI). The results showed that there were significant differences between the two sexes in age, marital status, work experience, smoking, alcohol use, and eating breakfast. Furthermore, there were significant differences between the two sexes in BMI, PSS Total, Dietary Health Choice, Harm Avoidance and Total HLPCQ. The variance of PSS Total was predicted by Sex, Teacher Efficacy, Total PSQI, Dietary Health Choice, organized physical exercise, social support and mental control, and Total HLPCQ. Between teacher efficacy, school connectedness, teacher well-being, organized physical exercise, social support and mental control, Total HLPCQ and PSS Total, the correlation coefficients were negative and significant at the <0.05 level. Between Total PSQI and PSS Total, the correlation coefficient was positive and significant at the <0.05 level. Between teacher efficacy, school connectedness and teacher well-being, organized physical exercise, social support and mental control, Total HLPCQ and Total PSQI, the correlation coefficients were negative and significant at the <0.05 level. In summary, we demonstrated that Greek primary school teachers experience significant stress, which is intertwined with their way of life, and reflected in significant decreases in their sense of well-being, quality of sleep, and overall life satisfaction, as well as in their standards of teaching.

Reliability and validity of the Dyadic Coping Inventory for Financial Stress in Greek couples.

Financial stress can negatively affect a couple's relationship. The Dyadic Coping Inventory for Financial Stress (DCIFS) instrument assesses the way couples cope with financial stress. This study sought to validate the Dyadic Coping Inventory for Financial Stress (DCIFS) in Greek. The sample included 152 Greek couples (mean age: 42.82 ± 11.94). Confirmatory factor analyses provided support for delegated dyadic coping and evaluation of dyadic coping. Confirmatory Factor Analysis results supported a 33-item version consisting of the following subscales for both men and women: Stress Communication by Oneself and by Partner, Emotion and Problem-Focused Supportive Dyadic Coping (DC) by Oneself and by Partner, Negative DC by Oneself and by Partner, Emotion and Problem-Focused Common DC, and Evaluation of DC. The Dyadic Coping Inventory questionnaire and Perceived Stress Scale were used to assess the criterion validity of DCIFS.

Educational Stress among Greek Adolescents: Associations between Individual, Study and School-Related Factors.

Greek adolescent students experience high levels of educational stress during the school period. In this cross-sectional study, we examined various factors associated with educational stress in Greece. The study was conducted using a self-report questionnaire survey in Athens, Greece, between November 2021 and April 2022. We studied a sample of 399 students (61.9% females; 38.1% males, with a mean age of 16.3 years). We found that several factors, such as age, sex, study hours, and health status of the adolescents, were associated with the subscales of the Educational Stress Scale for Adolescents (ESSA), Adolescent Stress Questionnaire (ASQ), Rosenberg Self-Esteem Scale (RSES), and State-Trait Anxiety Inventory (STAI). Older age, female sex, family status, parental profession, and the number of study hours were positively associated with the amount of stress, anxiety and dysphoria-related symptoms reported by the students, including pressure from studying, worry about grades, and despondency. Future research studies are needed to aid specialized interventions for adolescent students to effectively deal with their academic challenges.

Strong Correlations between Social Appearance Anxiety, Use of Social Media, and Feelings of Loneliness in Adolescents and Young Adults.

Social appearance anxiety is a type of social anxiety that is associated with body image perception and exacerbated by the use of social media, leading to feelings of loneliness. The purpose of this cross-sectional study was to examine the relations between social appearance anxiety, use of social media, and feelings of loneliness in Greek adolescents and young adults. The sample of the research consisted of 632 participants, 439 women (69.5%) and 193 men (30.5%), aged 18-35 years. The Social Appearance Anxiety Scale (SAAS), the Social Media Disorder Scale (SMDS), and the UCLA Loneliness Scale were the instruments used. Data collection was performed online, via Google forms. Multiple regression analyses were performed and demonstrated a significant positive correlation between the Social Appearance Anxiety Scale and the UCLA Loneliness Scale scores. The feeling of loneliness was predicted by the social appearance anxiety score (p < 0.0001). On the other hand, there was a significant negative correlation between the Social Appearance Anxiety Scale and the Social Media Disorder Scale scores (p = 0.002), suggesting that social media use may exacerbate appearance anxiety and, hence, loneliness. The findings suggest that there may be a complex, vicious reverberatory cycle between appearance anxiety, use of social media, and feelings of loneliness in some young people.

Reliability and Validity of the Educational Stress Scale for Adolescents (ESSA) in a Sample of Greek Students.

This research outlines the initial validation of a new instrument to quantify academic stress, the Educational Stress Scale for Adolescents (ESSA). A total of 399 students (61.9% females, 38.1% males), with a mean age of 16.3 years, participated in the research protocol. Cronbach's α for the total 16-item ESSA scale was 0.878, suggesting good reliability. Cronbach's α for each one of the five components were statistically positively significant. The Greek version of the Educational Stress Scale for Adolescents (ESSA) can be utilized as a valid tool to measure the perceived educational stress in adolescents.

Measuring Adolescent Chronic Stress: A Review of Established Biomarkers and Psychometric Instruments.

Adolescence is a period of stressful physiological and psychosocial changes. Exposure to chronic stress can cause specific structural and functional changes in an organism, which can be appraised objectively. Some of these alterations are an expected reaction of the body in its attempt to adapt to a stressful situation, while others are signs of possible disease development. The aim of this review was to present the most widely used methods of stress evaluation in adolescence research. Primary biomarkers associated with different biological systems, such as the stress hormones glucocorticoids, and catecholamines, as well as the available methods of extraction and assessment of each biomarker, are presented. This work also includes secondary outcomes, which can also provide an estimation of an individual's stress level. Also, most available psychometric instruments of stress, constructed to address specifically this period of life, are presented and discussed. In addition, this paper addresses possible confounding factors that may affect stress measurements, which should be taken under consideration when conducting stress research. To objectively evaluate stress, it is of great importance for a researcher to be familiar with the condition under examination and its representative stress indices. Adequate evaluation of adolescents with the selection of proper psychometric tests and biological markers can help design targeted interventions aiming to prevent or reverse the effects of physical and mental stressors that occur during adolescence, effects that can be carried into adulthood with detrimental consequences.

The Effect of Pythagorean Self-Awareness on Heart Rate Variability, Perceived Stress and Behavior of Preschool Children.

Stress is associated with unhealthy habits and non-communicable diseases. It is also linked to communicable diseases due to its impact on immune function. These can be prevented through intervention programs in schools. The aim of this study was to examine the effect of the simplified Pythagorean Self-Awareness Intervention on heart rate variability (HRV) parameters, perceived stress and behaviors of preschool children. The sample of the study consisted of 45 preschool students. A "one group (double) pretest­posttest design" was used, to allow for comparisons of the measurements before and after the intervention. Students were assessed via two questionnaires ("Perceived Stress Scale for Children" (PSS-C) and "Checklist for Screening Behavioral Problems in Preschool Children") and a photoplethysmographic (PPG) device. The intervention lasted 9 weeks and included practicing of the Pythagorean Self-awareness techniques and the adoption of healthy behaviors. The results showed no statistically significant differences between the two pretests (p > 0.05 for all comparisons) and statistically significant differences between the second pretest and posttest ("Perceived Stress Scale for Children", (PSS-C) p < 0.0001, "Checklist for Screening Behavioral Problems in Preschool Children" p < 0.0001 and two indices of PPG device: heart rate mean, p < 0.0001, low frequency/very low frequency, p = 0.034). In conclusion, the Pythagorean Self-Awareness Intervention had a beneficial effect on the sample of preschool students examined, as the results showed an improvement in the perceived stress and the HRV parameters tested, and in engaging healthier behaviors, findings that indicate a relaxed psychologic state and a healthier lifestyle.

The prognostic role of micronutrient status and supplements in COVID-19 outcomes: A systematic review.

Micronutrients constitute an adjuvant treatment for respiratory viral infections. Since there is no effective antiviral therapy for COVID-19 yet, adjuvant intervention for the survival of critically ill patients may be significant. Search of the PubMed, CINAHL and Cochrane databases was carried out to find human studies investigating the prognostic role of micronutrient status and the effects of micronutrient supplementation intervention in COVID-19 outcomes of adult patients. Patients with certain comorbidities (diabetes mellitus type 2, obesity, renal failure, liver dysfunction etc.) or pregnant women were excluded. 31 studies (27 observational studies and 4 clinical trials) spanning the years 2020-2021, pertaining to 8624 COVID-19 patients (mean age±SD, 61 ± 9 years) were included in this systematic review. Few studies provided direct evidence on the association of serum levels of vitamin D, calcium, zinc, magnesium, phosphorus and selenium to patients' survival or death. Vitamin D and calcium were the most studied micronutrients and those with a probable promising favorable impact on patients. This review highlights the importance of a balanced nutritional status for a favorable outcome in COVID-19. Micronutrients' deficiency on admission to hospital seems to be related to a high risk for ICU admission, intubation and even death. Nevertheless, evidence for intervention remains unclear.

Pythagorean Self-Awareness Intervention for Multiple Sclerosis Patients: A Quasi-Experimental Pragmatic Trial.

OBJECTIVE: Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system affecting patients' well-being and quality of life. Pythagorean Self-Awareness Intervention (PSAI) is a novel non-pharmaceutical intervention with significant benefits both in MS and other chronic diseases. In this study, the longstanding effectiveness of PSAI was investigated. METHOD: This was a two-arm quasi-experimental pragmatic trial in relapsing-remitting MS patients (23 in the PSAI and 21 in the control group). PSAI patients received an 8-week training period and then they performed PSAI at home for another 16 weeks. Assessments took place at baseline, 8 weeks, and 24 weeks. These included cognition, fatigue, perceived stress, and hair cortisol. RESULTS: Significant group × time interactions favoring PSAI were found during the first 8-week period for information processing speed, fatigue, and perceived stress. However, only verbal memory was found to be significantly improved in the PSAI group during the 24-week follow-up period. There were no significant group × time differences with respect to hair cortisol. No side effects were noted and compliance was excellent. CONCLUSIONS: PSAI was mostly effective during the first 8-week training period. Its benefits worn out during the non-training period, albeit we observed a delayed significant improvement of verbal memory. Our findings will help to further refine the technique, either by extending the training period and/or by including booster sessions, throughout the PSAI treatment. This study provided Class III evidence for PSAI.

A Biofeedback-Assisted Stress Management Program for Patients with Irritable Bowel Syndrome: a Randomised Controlled Trial.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects the functionality and quality of life of the affected persons. There is a well-established detrimental reciprocal relationship between stress and IBS. In this randomised controlled trial, IBS patients were randomly assigned to an 8-week biofeedback-assisted stress management intervention group (n=24) or a control group (n=22). Psychometric measures were performed at baseline and following intervention to assess perceived stress, health locus of control and depressive symptoms. In patients of the intervention group, perceived stress and symptoms of depression were significantly decreased, while the sense of control over health was increased. The intervention program was beneficial to the health and quality of life of individuals with IBS. Future randomised controlled studies with larger samples and longer follow-up are required to establish the effectiveness of stress-management techniques in functional gastrointestinal disorders.

Studying Depression, Anxiety, Distress and Somatisation in a Community Sample of 2,425 Adults in Greece.

A growing part of the literature has focused on depression, anxiety, distress and somatisation. Identifying their prevalence and populations at risk is essential to form relevant interventions. The aim of this study was to examine the prevalence and associated factors of distress, depression, anxiety, and somatisation in a community adult sample in Greece. Participants were recruited from two Greek cities; Giannitsa in the northern area and Athens in the southern area of the country, and completed sociodemographic assessments, as well as the 4-Dimensional Symptom Questionnaire (4-DSQ), a self-reported instrument assessing depression, anxiety, distress, and somatisation. A total of 2,425 adults, females (60.1%) and males (39.9%), 18 to 84 years of age (mean age±SD, 46.98±9.57 years) participated in the study. Mental health symptoms were reported by 10.8% for depression, 12% for anxiety, 13% for distress and 5.3% for somatisation. Females scored higher than males in anxiety, distress, and somatisation (p=0.000 in all cases), while there were no significant sex differences in depression (p=0.593). Statistically significant associations were found between age and depression, anxiety and distress (p=0.000 in all cases), since those between 18-34 years of age had higher scores than the older age groups in all variables. Higher scores of depression, anxiety and distress were reported by students and unemployed participants (p=0.000 in all cases) than participants with other occupations. This study mapped several sociodemographic groups with worse mental health. Studies in representative population samples are needed to guide public health interventions to improve the well-being of high-risk populations.