Validity and reliability of the Greek version of Wijma delivery expectancy/experience questionnaire (Version A) among low-risk pregnant women.

BACKGROUND: Fear of childbirth is a frequent health issue for pregnant women. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely used instrument to measure the fear of childbirth during the antenatal period. The aim of the study was to assess the psychometric properties of the W-DEQ (version A) in a sample of Greek pregnant women. METHODS: Low-risk pregnant women in the second or third trimester of pregnancy (N = 201) were invited to participate in the study and to complete a booklet of questionnaires including the Greek versions of W-DEQ-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Exploratory (EFA) and confirmatory factor analysis (CFA) was performed. RESULTS: The mean age of participants was 34.2 years (SD = 4.3 years). EFA yielded six factors ("Lack of self-efficacy", "Lack of positive anticipation", "Lack of feeling lonely", "Concerns about delivery and losing control", "Calmness", and "Concern for the child") of 33 items of W-DEQ-A. CFA confirmed the multidimensionality of the instrument. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. All factors were significantly correlated with each other, and convergent validity was demonstrated by a significant association with stress, anxiety, and depression among low-risk pregnant women. CONCLUSION: The Greek version of W-DEQ-A proved to be a valid and reliable instrument of fear of childbirth among Greek low-risk pregnant women.

Psychometric properties of the research competencies assessment instrument for nurses (RCAIN) in Greece.

Background and Purpose: Evidence-based practice can improve quality of care and patient and system outcomes. Healthcare professionals need certain research competencies to achieve evidence-based practice. We aimed to evaluate the psychometric properties of the self-reported 19-item Research Competencies Assessment Instrument for Nurses (RCAIN) with Greek. Methods: This cross-sectional study included in total, 520 respondents (within 33 health organizations) who completed the 5-point Likert-type RCAIN as well as the 8-item "Research Utilization by Nurses" that was used to assess construct validity. Expert scholars translated both survey questionnaires into the Greek language. A baseline one-factor model was compared against three-factor model (i.e., knowledge, skills, and application of knowledge and skills) that were developed based on the hypothetical design of the instrument. Results: Participants were females (86.4%) 50 years old or younger (91%). The RCAIN had a Cronbach's alpha coefficient of 0.937 and intraclass correlation coefficient of 0.440 (95% CI 0.403 to 0.480, p < .001). Confirmatory factor analysis revealed a 3-factor solution (i.e., knowledge, skills, application of knowledge & skills). Fit indices for the three-factor model were statistically superior when compared with the baseline model. Reliability and validity of each subscale were acceptable. Further assessment of construct validity using hypothesis testing indicated that there is a statistically significant difference in research utilization by knowledgeable or not participants. Specifically, the effect size between knowledge synthesis and instrumental research use was eta squared = 0.020, meaning that approximately 2.0% of the variance in instrumental research use scores can be explained by knowledge in methods of knowledge synthesis. The predictive validity, based on correlations between the two instruments, showed that increasing levels of instrumental research use were associated with an increasingly positive and statistically significant pattern of correlations. Conclusions: The RCAIN survey is a psychometrically sound tool for nurses. Providers, educators, and health administrators may use it for professional development and improvement of individual research competencies.

Cannabis use during pregnancy and its effect on the fetus, newborn and later childhood: A systematic review.

INTRODUCTION: Cannabis and its derivatives are becoming increasingly popular in women's preferences during pregnancy in order to relieve nausea. The present study examines cannabis use during pregnancy and its effects on the fetus, newborn and later childhood. METHODS: All primary studies were searched in the databases: PubMed, Scopus, Medline during the period June 2019 to August 2020. The keywords used were 'pregnancy', 'pregnant women', 'cannabis', 'marijuana', 'fetus', 'newborn', 'childhood', and combined with 'AND' and 'OR' Boolean operators. Inclusion criteria were: pregnant users of cannabis as the study group and pregnant non-users of cannabis as the control group; the articles could be in English or in Greek. The exclusion criteria were: unpublished studies, reviews, presentations at conferences, and animal studies. RESULTS: From the systematic review of the literature, the study included 13 primary research studies in which it was found that the children of mother-user faced: disorders in the sleep cycle, memory problems, hyperactivity, increased chances of low birth weight, prematurity with lower Apgar score in the 1st and 5th minutes and hospitalization in an NICU, DNA methylation at the position CpG.32, and modifications in the brain, especially in the amygdala. In addition, girls had more aggressive behavior at the age of 18 months, shorter breastfeeding period, and neonatal death. CONCLUSIONS: The use of cannabis during the gestation period by the mother, aggravates the physical and mental development of the fetus, the newborn and the later childhood.

Psychometric properties of the Greek Version of the Traumatic Event Scale (TES) (Version A) among low-risk pregnant women.

BACKGROUND: The Traumatic Event Scale (TES) is one of the most often used instruments for the assessment of the Posttraumatic Stress Disorder (PTSD) symptomatology during pregnancy which is linked with adverse effects. The aim of the study was to assess the psychometric properties of the TES (version A) in a sample of Greek pregnant women. METHODS: Two hundred one low risk pregnant women in their second or third trimester were invited to participate in the study. Participants completed a number of questionnaires including the Greek versions of TES-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Confirmatory factor analysis (CFA) was conducted in order to test how well the already TES-A five-factor model fits the data from Greece. RESULTS: Participants' average age was 34.2 years (SD = 4.3 years). Through CFA the already five-factor structure of the TES-A (Anticipation of trauma, Intrusion, Avoidance, Resignation, Hyperstimulation) was applied to our sample. All five factors were significantly and positively correlated with each other. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. Relatively convergent validity, all factors of the Greek version of the TES-A were significantly associated with stress, anxiety, depression and coping strategies. CONCLUSION: The Greek version of TES-A is detected to be a valid and reliable instrument of prenatal Posttraumatic Stress Disorder (PTSD) symptomatology among low-risk Greek pregnant women.

The Greek version of the Australian Pelvic Floor Questionnaire: Cross-cultural adaptation and validation amongst women with urinary incontinence.

OBJECTIVES: As in Greek settings there is a need to develop validated patient-reported outcomes (PROs) for pelvic floor dysfunction, this study's aim was to cross-culturally adapt and validate the Australian Pelvic Floor Questionnaire (APFQ) into Greek, a 42-item PRO for routine urogynaecological evaluation of four domains; bladder, bowel, prolapse and sexual function. STUDY DESIGN: Cross-cultural translation was completed through official multistage forward and back-translation process. Validation involved administering the adapted APFQ (APFQ_GR) to women visiting Greek community-based healthcare settings. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was also administered. Comparison between women with and without pelvic floor dysfunction (symptomatic versus control) was also undertaken for exploring discriminatory validity. Test-retest reliability was explored by re-administering APFQ_GR 10-15 days following initial testing and internal consistency was explored against each domain separately as well as total items' score. RESULTS: Greek APFQ translation was successfully performed and piloted to a women sample with varying levels of education for comprehensibility, thus, satisfying the questionnaire's face validity. 100 women (53.7 ± 13.1 years-old) participated in validation, 63 of which predominantly complained of urinary incontinence (UI) and 37 were asymptomatic. There were no ceiling effects. Floor effects were detected for women without symptoms. Moderate to very strong correlations were yielded between APFQ_GR total score and bladder domain, respectively, with ICIQ-UI SF single-item and total score (ρ = 0.403-0.758, p < 0.001), indicating satisfactory criterion-related validity. Moderate correlations were yielded for the sexual function domain with APFQ_GR total score and weaker correlations were found in the other two domains. Independent samples t-test yielded significant differences across the questionnaire's scores (p < 0.001), indicating good discriminatory validity between symptomatic and asymptomatic women. Test-retest reliability was excellent (ICC3,1 = ≥0.998). Internal consistency was very good for each domain and total items' score (Cronbach's α = 0.714-0.924). CONCLUSIONS: The Greek APFQ was proven appropriate, comprehensible, valid and reliable for women with urinary incontinence and can thus, be used across Greek healthcare settings. Prolapse and bowel domains merit further research.

Level of Awareness Regarding Cervical Cancer Among Female Syrian Refugees in Greece.

Nowadays, prevention, control and treatment of cervical cancer are a worldwide public health priority. Primary objective of this study was to evaluate the level of awareness of female Syrian refugees who have recently settled in Greece regarding the warning signs and the risk factors of cervical cancer. This is a descriptive, cross-sectional study that was conducted in two facilities of the Hellenic Red Cross. The Cervical Cancer Awareness Measure questionnaire was addressed to 176 female Syrian refugees, aged between 18 and 50. Syrian women presented low awareness both for risk factors and warning signs. The most frequently identified warning signs were vaginal bleeding after menopause (44.3%), vaginal bleeding between menstruation (34.1%) and unexplained weight loss (32.4%). Regarding the risk factors' recognition rates, 74.5% considered the existence of many sexual partners as a risk factor and 61.3% the existence of a sexual partner with many previous sexual partners. Older age, a higher level of education and confidence that any potential symptom would be identified were associated with increased awareness. Our findings confirm former published reports that indicate poor awareness regarding cervical cancer among refugee populations. Full compliance with the guidelines of the World Health Organization for a national cervical cancer screening programme is highly advised in Greece and should address the needs of both native and refugee populations. This research is the first one that underlines the need for raising awareness of cervical cancer among female Syrian refugees in Greece by developing health promotion strategies adjusted to their unique cultural needs.

Impact of lockdown on smoking and sleeping in the early COVID-19 presence: Datasets of Greek Adults sample.

The impact of lockdown on life style and behaviour have piqued the interest of people and scientific community, all over the world. It has been demonstrated that in some countries, mandatory stay-at-home limitations and self-isolation measures are linked to an increase in sleeping hours and smoking cigarettes per day. However, these results derive from countries that lockdown had different features and length, and it is possible that society, culture, customs, ecological or other factors may independently or in combination affect life style habits (such sleeping and smoking) in different populations. So, we focus on sleeping and smoking changes in Greek adults during the lockdown of early COVID-19 presence in Greece. Therefore, our aim was to investigate whether lockdown alters smoking and sleeping habits and whether physical activity (PA), gender, age or body mass index (BMI) play a role. The modified online-based Active-Q (Greek version) questionnaire (see Supplementary file 1_Active-Q_modyfied) was used to collect data prior to the COVID-19 pandemic (PRE condition) and during physical distancing and lockdown measures (POST condition). The data period collection was from April 4 to April 19, 2020 (15 days in total) and respondents classified into four PA categories based on their sporting activities (PRE condition), five age categories and four BMI categories, which corresponding to different subgroup. Overall, sleeping hours change (from PRE to POST condition) was 11.80% and smoking cigarettes per day change was 9.35%. However, it appears that between the different subgroups significant differences were also identified.

Breast cancer and social relationship coping efficacy: validation of the Greek version.

The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.

Hyperemesis gravidarum and neonatal outcomes: A systematic review of observational studies.

Hyperemesis gravidarum (HG) is associated with adverse somatic and psychological effects. The impact of HG on neonatal outcomes is debatable given that disagreeing research results have appeared. The objective of this study was to systematically review, according to the PRISMA guidelines, and synthesize the available evidence from observational studies on the relationship between HG and neonatal outcomes. The PubMed, Scopus, and Science Direct databases were systematically reviewed, with the last search carried out in April 2020. The quality of the studies was estimated using the Newcastle-Ottawa Scale (NOS) for non-randomized studies. The databases search yielded 516 studies 15 of which (n = 112.372 HG cases) matched eligibility criteria while the majority of the studies were of moderate quality (n = 12). We observed heterogeneity among the studies regarding the definition of HG and characteristics of the samples. The results of this systematic review suggest that it is still uncertain whether HG has an adverse impact on neonatal outcomes, fact that requires more studies to be conducted.

Data on advanced glycation end-products concentrations and haemodynamic parameters following caffeine and nicotine consumption in nursing students.

This work presents data from a non-invasive interventional trial investigating the early effects of caffeine and nicotine on both the concentrations of advanced glycation end-products (AGEs) and haemodynamic parameters in 178 healthy nursing students aged between 18 and 40. These students were allocated into four groups (A, B, C and D) and the concentrations of AGEs as well as haemodynamic parameters were measured non-invasively using the AgeReader and the Finometer devices, respectively. The haemodynamic parameters that were measured included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, inter-beat interval, stroke volume, cardiac output, ventricular ejection time, total peripheral resistance, ascending aorta impedance and total arterial compliance. According to our protocol, each beverage contained 100 mg of caffeine each cigarette contained 1.5 mg of nicotine. The present data reveal the combined effect of smoke and caffeine consumption to several hemodynamic parameters that may be related to the onset of elevated blood pressure during smoking and following caffeine consumption.

Occupational social class, coping responses and infertility-related stress of women undergoing infertility treatment.

AIM AND OBJECTIVES: The aims of this study were to examine the association between (1) occupational social class and coping responses, (2) coping responses and infertility-related stress and (3) occupational social class and infertility-related distress. BACKGROUND: The coping strategies that individuals use in most of the stressful situations vary according to certain factors, such as, the appraised characteristics of the stressful condition, personality dispositions and social resources. DESIGN: This study was a cross-sectional survey. METHODS: The study involved 404 women undergoing infertility treatment at a public clinic in Athens, Greece. State and trait anxiety (State-Trait Anxiety Inventory), infertility-related stress (Copenhagen Multi-centre Psychosocial Infertility) and coping strategies (Copenhagen Multi-centre Psychosocial Infertility) were measured. RESULTS: Women of low/very low social class reported higher levels of active-confronting coping compared with women of higher social class (p < 0·001). A positive correlation between active-avoidance coping and both state and trait anxiety (r = 0·278 and 0·233, respectively, p < 0·01) was observed. The passive-avoidance coping scale was positively correlated with marital and personal stress (r = 0·186 and 0·146, respectively, p < 0·01). All three kinds of stress (marital, personal and social) were positively correlated with both active-avoidance (r = 0·302, 0·423 and 0·211, respectively, p < 0·01) and active-confronting scale (r = 0·150, 0·211 and 0·141, respectively, p < 0·01). CONCLUSIONS: Infertile women of the lowest social class used more active-confronting coping and more passive-avoidance coping than women of the highest social class. Factors such as low social class and maladaptive coping strategies might contribute to infertility-related stress and anxiety. RELEVANCE TO CLINICAL PRACTICE: Nurses and midwives who work in infertility clinics should aim to identify individuals who are at high risk for infertility stress and adjustment difficulties and they should minimise the identified risk factors for infertility-related stress and strengthen the protective factors.

Oligomenorrhoea in adolescents with type 1 diabetes mellitus: relationship to glycaemic control.

OBJECTIVE: To investigate oligomenorrhoea in adolescents with type 1 diabetes and the possible relationship with glycaemic control. STUDY DESIGN: The study group consisted of 81 female adolescents with type 1 diabetes whose mean age was 15.0 years (range 12-18). The control group consisted of 205 healthy adolescents with a mean age of 15.5 years (range 12-18). Data on menstruation were collected by two parallel self-administered questionnaires. Oligomenorrhoea was defined as having a menstrual cycle longer than 36 days throughout the past year (5-6/year). The metabolic control of diabetes was evaluated by calculating the mean value of HbA1c during the past year. RESULTS: Age of menarche was greater for adolescents with type 1 diabetes (12.2 ± 1.4 vs. 11.7 ± 1.2, p < 0.000) compared to healthy age-matched controls. Logistic regression analysis with oligomenorrhoea as the dependent binary variable revealed an odds ratio equal to 7.8 (95% CI 3.411-17.853) for adolescents with type 1 diabetes (p < 0.000). Finally, a second logistic regression analysis, concerning only adolescents with type 1 diabetes and with the same binary variable, estimated an odds ratio of 4.8 (95% CI 1.784-13.057, p < 0.002) for HbA1c, and an odds ratio of 5.3 (95% CI 1.821-15.130, p < 0.002) for the frequency of hypoglycaemia. CONCLUSION: In adolescents with type 1 diabetes, menarche occurs later and oligomenorrhoea is more frequent. The relative risk of having oligomenorrhoea is greater when there is an increased value of HbA1c or when hypoglycaemia is more frequent.

Age at menarche and menstrual irregularities of adolescents with type 1 diabetes.

STUDY OBJECTIVE: The aim of the study was to investigate the age at menarche and menstrual irregularities in adolescents with type 1 diabetes. DESIGN: This was an aged-matched, controlled study. SETTING: The study was done in the diabetes center of a children's hospital in Athens and in high schools in major regions of central Greece. PARTICIPANTS: The study involved two groups: a group of 100 female adolescents, 12 to 18 years of age, with type 1 diabetes; and a control group of 225 healthy adolescents, matched for age. MAIN OUTCOME MEASURES: The relationship between age at menarche and menstrual irregularities was studied. RESULTS: The mean age at menarche differed significantly in the two groups (P=0.000). In particular, the mean age at menarche in the study group was 12.2 years (+/- 1.4) and in the control group it was 11.7 years old (+/- 1.2). The mean age of menarche was older in the subgroup of adolescents who had received a diagnosis of diabetes before the age of 10 than it was in those diagnosed after the age of 10. CONCLUSIONS: Menarche was observed to be delayed in adolescents with type 1 diabetes who had been diagnosed before the age of 10 in comparison with those diagnosed after the age of 10. Menstrual irregularities were found to be more common in adolescents with type 1 diabetes than in healthy ones.

Undergraduate nursing students' level of assertiveness in Greece: a questionnaire survey.

BACKGROUND: A number of studies of nursing and midwifery have found stress and bullying to be frequent problems. Those suffering from bullying and stress need to have high levels of assertiveness to resist and to cope successfully. Hence, it was considered vital to assess the assertiveness level of nursing students throughout their training curriculum. METHODS: The study population was composed of nursing students in different semesters at one school in Central Greece (n=298) who agreed to complete a questionnaire on assertiveness level assessment, which had been translated into Greek and adapted to this population. All students present in class completed the questionnaire, representing 80% of the total population of active students. Mean assertiveness scores between semesters were compared by ANOVA and comparisons between the responses of the first semester students and responses of advanced semester students were done by Pearson's chi square. RESULTS: The main finding of this study was that the assertiveness levels displayed by students increase slightly in advanced semesters by comparison to those displayed by first-semester students. CONCLUSIONS: Assertive behavior should be encouraged through learning methods. Nurses should preferably obtain this training throughout their studies. Instructors have an essential role in the improvement and achievement of assertiveness training curriculums for undergraduate nursing students.

Greek nursing students' immunization coverage: data from central continental Greece.

Nursing students are at risk of acquiring vaccine-preventable diseases. To estimate the vaccination rates for nursing students, a cross-sectional survey was conducted in a major district of central continental Greece with an anonymous and self-administered questionnaire in a sample of 432 nursing students (the response rate was 97%). The eligible nursing students completed the questionnaire after informed consent was obtained. The vaccination rates of the nursing students ranged from 65.2% for the oral polio (SABIN) vaccine and 65.7% for the hepatitis B virus vaccine to 74.6% for the diphtheria-tetanus-pertussis (DTP) vaccine. The parents' level of education did not correlate with the students' underimmunization. The t-test showed that the senior students were more knowledgeable about the compulsory vaccines. Almost half of the nursing students were somewhat satisfied with the available information on vaccination, while 9.5% were not at all satisfied and 38.5% were underimmunized. The proportion of male students who had completed the SABIN and DTP vaccination schedules was higher compared to the female students. More health education programs could increase the vaccination rates among nursing students.