Stress and coping strategies in the general population of Greece and Cyprus in response to the COVID-19 pandemic: A cross-sectional study.

The COVID-19 pandemic and the lockdown policy had a profound psychological impact on the general population worldwide. The aim of this study was to assess the level of stress and coping strategies used during the initial stage of the COVID-19 outbreak and their association. Secondary aims were to a) identify the most important coping strategies and b) investigate predictors of stress. A cross-sectional study was conducted by using an anonymous online questionnaire. The study was carried out from April 23 to May 4 2020. A snowball sampling method was conducted to recruit potential participants from the general population of Greece and Cyprus. Participants over 18 years old who were familiar with the Greek language were included. The psychological impact was assessed by the Impact of Event Scale-Revised (IES-R). Coping strategies were assessed using 15 statements detected from a review of the literature. Participants were asked to rate each one of the coping strategies according to how important it was to them, on a four-point likert scale. The sample consisted of 3941 participants (74.2% women, N=2926), with a mean age of 36.9 years old. The most important coping strategies adopted were 1) "Dealing the situation with a positive attitude" (96.5%), 2) "Follow strict personal protective measures" (95,9%), 3) "Acquiring knowledge about coronavirus" (94.6%), 4) "Engaging in health-promoting behaviors" (89.6%), 5) "Limiting the time spent on media" (75.5%). The highest and positive coefficients were recorded for the association of IES-R scales with 1) "Talking with family and friends to reduce stress", 2) "Seeking help from a mental health professional", 3) "Limiting the time spent on media", 4) "Relieving and managing emotions", 5) "Practicing relaxation techniques". 26.5% showed severe psychological impact. Conclusion: Addressing stress levels with the use of functional coping strategies can be beneficial to protect the general population from adverse psychological outcomes.

Laser-patterned paper-based flow-through filters and lateral flow immunoassays to enable the detection of C-reactive protein.

We report the use of a laser-based fabrication process in the creation of paper-based flow-through filters that when combined with a traditional lateral flow immunoassay provide an alternative pathway for the detection of a pre-determined analyte over a wide concentration range. The laser-patterned approach was used to create polymeric structures that alter the porosity of the paper to produce porous flow-through filters, with controllable levels of porosity. When located on the top of the front end of a lateral flow immunoassay the flow-through filters were shown to block particles (of known sizes of 200 nm, 500 nm, 1000 nm and 3000 nm) that exceed the effective pore size of the filter while allowing smaller particles to flow through onto a lateral flow immunoassay. The analyte detection is based on the use of a size-exclusive filter that retains a complex (∼3 µm in size) formed by the binding of the target analyte with two antibodies each of which is tagged with different-sized labels (40 nm Au-nanoparticles and 3 µm latex beads), and which is larger than the effective pore size of the filter. This method was tested for the detection of C-reactive protein in a broad concentration range from 10 ng/ml to 100,000 ng/ml with a limit-of-detection found at 13 ng/ml and unlike other reported methods used for analyte detection, with this technique we are able to counter the Hook effect which is a limiting factor in many lateral flow immunoassays.

Capillary-based reverse transcriptase loop-mediated isothermal amplification for cost-effective and rapid point-of-care COVID-19 testing.

As the SARS-CoV-2 pandemic continues to spread, the necessity for rapid, easy diagnostic capabilities could never have been more crucial. With this aim in mind, we have developed a cost-effective and time-saving testing methodology/strategy that implements a sensitive reverse transcriptase loop-mediated amplification (RT-LAMP) assay within narrow, commercially available and cheap, glass capillaries for detection of the SARS-CoV-2 viral RNA. The methodology is compatible with widely used laboratory-based molecular testing protocols and currently available infrastructure. It employs a simple rapid extraction protocol that lyses the virus, releasing sufficient genetic material for amplification. This extracted viral RNA is then amplified using a SARS-CoV-2 RT-LAMP kit, at a constant temperature and the resulting amplified product produces a colour change which can be visually interpreted. This testing protocol, in conjunction with the RT-LAMP assay, has a sensitivity of ∼100 viral copies per reaction of a sample and provides results in a little over 30 min. As the assay is carried out in a water bath, commonly available within most testing laboratories, it eliminates the need for specialised instruments and associated skills. In addition, our testing pathway requires a significantly reduced quantity of reagents per test while providing comparable sensitivity and specificity to the RT-LAMP kit used in this study. While the conventional technique requires 25 µl of reagent, our test only utilises less than half the quantity (10 µl). Thus, with its minimalistic approach, this capillary-based assay could be a promising alternative to the conventional testing, owing to the fact that it can be performed in resource-limited settings, using readily available apparatus, and has the potential of increasing the overall testing capacity, while also reducing the burden on supply chains for mass testing.

Low seropositivity for SARS-CoV-2 antibodies among healthcare workers after the first COVID-19 pandemic wave in Greece.

OBJECTIVES: To estimate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity among healthcare workers (HCWs) in Greece and to identify high-risk groups in healthcare facilities. STUDY DESIGN: The study design used in this study is a nationwide cross-sectional study. METHODS: Data were collected from 1 June to 9 July 2020. HCWs in the Greek National Health System were offered a free SARS-CoV-2 IgG antibody test, regardless of symptoms. RESULTS: Overall, 379 of 57,418 HCWs (0.66%, 95% confidence interval [CI]: 0.59-0.73) were positive for SARS-CoV-2 antibodies. The adjusted overall seroprevalence was 0.43% (95% CI: 0.35-0.51). We found that HCWs in non-reference hospitals for COVID-19 (odds ratio [OR]: 1.81, 95% CI: 1.23-2.64; P = 0.002) and reference hospitals for COVID-19 (OR: 1.66, 95% CI: 1.06-2.58; P = 0.03) were more likely to be seropositive than HCWs in primary care centres. Regarding professions, nurses (OR: 1.45, 95% CI: 1.07-1.98; P = 0.02), physicians (OR: 1.43, 95% CI: 1.06-1.93; P = 0.02), and administrative, cleaning and security staff (OR: 1.50, 95% CI: 1.09-2.06; P = 0.01) had a statistically higher chance of having a positive serology than laboratory employees. CONCLUSIONS: The adjusted overall seroprevalence found in this study indicates a very low prevalence of SARS-CoV-2 among HCWs in Greece. This result is in line with the low incidence of COVID-19 during the first wave of the pandemic and is a direct benefit from the early implementation of lockdown.

Seroprevalence of SARS-CoV-2 antibodies and associated factors in healthcare workers: a systematic review and meta-analysis.

BACKGROUND: Healthcare workers (HCWs) represent a high-risk population for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). AIM: To determine the seroprevalence of SARS-CoV-2 antibodies among HCWs, and identify the factors associated with this seroprevalence. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were applied for this systematic review and meta-analysis. Databases including PubMed/MEDLINE and preprint services (medRχiv and bioRχiv) were searched from inception to 24th August 2020. FINDINGS: Forty-nine studies including 127,480 HCWs met the inclusion criteria. The estimated overall seroprevalence of SARS-CoV-2 antibodies among HCWs was 8.7% (95% confidence interval 6.7-10.9%). Seroprevalence was higher in studies conducted in North America (12.7%) compared with those conducted in Europe (8.5%), Africa (8.2) and Asia (4%). Meta-regression showed that increased sensitivity of antibody tests was associated with increased seroprevalence. The following factors were associated with seropositivity: male gender; Black, Asian and Hispanic HCWs; work in a coronavirus disease 2019 (COVID-19) unit; patient-related work; front-line HCWs; healthcare assistants; shortage of personal protective equipment; self-reported belief of previous SARS-CoV-2 infection; previous positive polymerase chain reaction test; and household contact with suspected or confirmed cases of COVID-19. CONCLUSION: The seroprevalence of SARS-CoV-2 antibodies among HCWs is high. Excellent adherence to infection prevention and control measures; sufficient and adequate personal protective equipment; and early recognition, identification and isolation of HCWs infected with SARS-CoV-2 are imperative to decrease the risk of SARS-CoV-2 infection.

Polytrauma: Treatment, Cost, and Associated Factors.

Trauma is a multifactor problem with economic, social, and political burdens. In this article, we estimate its economic extension. This 3-yr study includes 69 patients above 14 yr of age, who experienced multiple traumatic injuries. We review their economic impact on the National Health System of Greece. Mean patient age is 38.91 yr, and most are male (85.5%), nonsmoking (69.6%), and without open fractures (78.3%). As a result of their injuries, most patients (76.8%) stayed in the intensive care unit (ICU), underwent surgery (76.8%), were transfused (68.1%), and became infected (63.8%). Mean cost was 16,365.65€, median cost 10,399.07€, minimum value 554.17€, and maximum value 89,243.52€. Of the 69 patients, 12 died. The number of polytrauma patients is relatively small compared to the total amount of patients in hospital care, but their impact on health services is very high. Patients admitted to the ICU are at great risk of infection, which can almost triple financial cost and increase hospital stay.

The Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire: cultural adaptation and validation of the Greek version.

AIM: To adapt cross-culturally the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) for use in Greek patients with atrial fibrillation (AF) and to evaluate its psychometric properties. METHODS: Professional translators were involved in the inverse translation procedure. Twenty patients with AF participated in the cultural adaptation procedure. One hundred two consecutive patients participated in the validation process that included reliability (internal consistency, test-retest reliability) and validity assessment (face validity, construct validity). RESULTS: Greek AFEQT showed high internal consistency (Cronbach's alpha for overall scale: 0.97, subscales: Symptoms: 0.90, Daily Activities: 0.93, Treatment Concern: 0.91, Treatment Satisfaction: 0.83) and test-retest reliability (Spearman's rho: 0.99, p <0.001, Wilcoxon's test, p =0.959). Face validity was rated with a median of 7 by the patients. Finally, Greek AFEQT showed appropriate construct validity of demonstrating adequate convergent validity with the moderate to strong correlations of AFEQT domains with the Physical and Mental Component Summaries of SF-12 (Spearman's rho: 0.53-0.78, p <0.001). CONCLUSIONS: The Greek version of AFEQT has shown good psychometric properties and can be a useful tool in future studies on the quality of life of patients with AF. Hippokratia 2016, 20(4): 264-267.

Health Professionals' knowledge and attitude towards the Umbilical Cord Blood donation in Greece.

BACKGROUND/AIM: In the last years a major emphasis is laid on the Allogeneic Transplantation of Blood Stem Cells from the Umbilical Cord Blood with a simultaneous development of Umbilical Cord Blood bank. The attitude and knowledge of Health Professionals is vital to the success of this attempt as it affects significantly the promotion of Umbilical Cord Blood donation. The aim of present study is the examination of Health Professionals' knowledge and attitudes towards Umbilical Cord Blood in Greece. MATERIAL AND METHODS: The study was conducted from April 25th 2012 to May 7th 2012. The sample consisted of 109 Health Professionals from 3 provincial hospitals and 2 hospitals in Thessaloniki. In order to collect the data, a questionnaire was used. The questionnaire was designed by the researcher and a group of experts to serve the mission of the present study. From the 130 questionnaires sent, 109 were completely answered (response rate 84%). RESULTS: Of those who participated to the research, 23.9% were physicians, 34.9% were midwives, and 34.8% were nurses. As far as the Health Professionals' knowledge on the Umbilical Cord Blood is concerned, only 15.6% of the participants declared to be quite or well informed on the collection methods and the usage of Umbilical Cord Blood. The vast majority of the participants (89%), declared that a well-organized program on a continual training is very essential. 93.5% of the participants declared that in the last 5 years received no or very little training regarding the collection, storing and transplantation of Umbilical Cord Blood. CONCLUSIONS: Although according to a relevant research health professionals are considered by the public as the most credible source of information about Umbilical Cord Blood, their level of knowledge on the usage and storing of Umbilical Cord Blood is inadequate. The present study indicates the necessity of creation or reinforcing of effective programs of continual training with the use of technology (i.e. Internet).

Characteristics of dog bites among nursing students and knowledge about their emergency management.

BACKGROUND: Dog bites represent a significant health concern leading to a variety of consequences. Nursing students should be appropriately educated in order to manage and help prevent such injuries. AIM: This paper is the first to report the lifetime experience and characteristics of dog bites among Greek nursing students and their knowledge in managing the above injuries. METHODS: A cross-sectional quantitative study was performed using an anonymous questionnaire distributed to first and fourth year nursing students from April though June 2009. A knowledge score based on key questions was set on a scale from 0 to 7, to assess their competence on bite injuries management. RESULTS: Of 237 nursing students recruited, 56 (23.6%) had experienced a dog bite. Men outnumbered women as dog bite victims [n = 15 (39.5%) vs. n = 41 (20.6%), P = 0.012]. Mean age at the attack was 11.1 (standard deviation = 5.6) years and legs sustained the majority of injuries (n = 31; 55.4%). Most bites (n = 39; 69.9%) involved a dog known to the victim, were provoked (n = 30; 53.6%) and occurred in a public place (n = 35; 62.5%). Ten (17.9%) of the victims sustained a moderate or severe injury. The majority (67.9%) of students answered correctly to less than or equal to three out of seven key knowledge questions. After multiple linear regression analysis, previous educational course attendance was the only factor associated with increased score (b = 0.48, standard deviation = 0.17, 95% confidence interval = 0.12-0.84, P = 0.009). CONCLUSIONS: Dog bites were common and presented characteristic patterns among nursing students, but knowledge in their management was suboptimal. Improved education should be provided during undergraduate studies.

Occupational accidents in Greek Armed Forces in Evros County.

AIM: The purpose of this study was to investigate risk factors for occupational accidents and the relationship between perceived and actual risk of occupational accidents in Greek soldiers. METHOD: A case-control study was conducted of military personnel in Evros county in Greece. Cases (n = 250) were defined as enlisted personnel having had an accident at work and the control series (n = 300) comprised of a simple random sample, stratified by age from the army population. RESULTS: Conscripted soldiers (OR = 3.8, 2.21 to 6.58, p < 0.001) and professional soldiers (OR = 2.2, 1.28-3.75, p = 0.004) had higher frequency of occurrence of accidents in comparison to army officers. The degree of risk perception due to electrical hazards (OR = 2.8, 1.81-4.18, p < 0.001), lighting (OR = 2.6, 1.74-3.97, p < 0.001), falls (OR = 2.9, 1.61-5.13, p < 0.001) and inadequate safety signs (OR = 3.3, 1.99-5.49, p < 0.001) were associated with increased occurrence of accident. Regression analysis demonstrated a significant relationship between the accident and the age, time of service in the present unit, specialty, level of education, years of service and the overall military training. CONCLUSION: This study highlights the increased likelihood of occupational accidents among military personnel with lower rank and lower level of education, less working experience (fewer years of service) and less military training (conscripted and professional soldiers). The existence of occupational accidents in the workplace, civilian or military, creates the need for the adoption of policies for the protection of workers and the organization of occupational preventive services.

Factors associated with delayed hospital arrival among patients with acute myocardial infarction: a cross-sectional study in Greece.

BACKGROUND: It is proven that early admission to hospital contributes significantly to the successful management of acute myocardial infarction (AMI). AIM: This study aimed to examine the factors associated with delayed hospital arrival among patients with AMI. METHODS: A cross-sectional study among 477 AMI patients was conducted during a 2-year period in two large tertiary hospitals in Greece. Structured face-to-face interviews were conducted and information regarding their socio-demographic characteristics, medical history and factors that might be correlated with delayed hospital arrival were collected. RESULTS: The main factors that were found to be correlated with delayed hospital arrival among AMI patients were the absence of companion/attendant/escort present during the AMI [odds ratio (OR) 2.1, 95% confidence interval (CI) 0.98-4.4, P = 0.049], previous medical history of diabetes mellitus (OR 3.4, CI 1.6-7.2, P = 0.002), absence of dyspepsia (OR 9.2, CI 3.6-23.3, P < 0.001) and nausea/vomiting symptoms (OR 16.9, CI 4.1-69.1, P < 0.001), and also being at a distance of more than 10 km from the hospital (OR 19.6, CI 5.4-70.6, P < 0.001). CONCLUSION: A number of factors that might delay hospital arrival among patients with AMI should be taken into account in healthcare service planning. Health policy actions that will improve the accessibility to healthcare services, the restructuring of the Greek primary healthcare system and the provision of effective patient education by nurses could reduce the pre-hospital delay. LIMITATIONS: The study was conducted in two hospitals which limits the generalization of the findings. Also, the onset of AMI symptoms relied on self-report by the patients.

The effectiveness of a disaster training programme for healthcare workers in Greece.

BACKGROUND: Recent natural disasters have made disaster training a public priority. Multiple methods of disaster preparedness training have been established in hospitals worldwide. Nevertheless, researchers have not yet discovered the most effective method for training hospital personnel in the area of disaster preparedness. AIM: The aim of this study is to test the hypothesis that a brief educational intervention would improve hospital staff knowledge about the hospital disaster plan and procedures. METHODS: A quasi-experimental design was used. The intervention group included 56 professionals and the comparison group included 35 professionals in Greece. The intervention group attended a 5-h course that addressed the basic principles of hospital disaster management. A structured questionnaire was used to estimate the participants' changes in knowledge. Repeated measures analysis of variance (ANOVA), t-test, one-way ANOVA and chi-square test were used to analyse the data. RESULTS: The intervention resulted in a significant improvement in knowledge. The mean score was significantly higher immediately after the intervention programme [86; standard error (SE): 2] than before (44.5; SE: 1.7) (P<0.001). The mean score 1 month later was significantly lower (77.2; SE: 2.3) than that immediately after the intervention programme (P<0.001), but significantly higher than the mean score before the intervention programme (P<0.001). Participants in the control group achieved a score of 40 (SE: 2.4), which was significantly lower than the scores of the intervention group after the course (P<0.001). CONCLUSION: The disaster training course had a great benefit for the participants. This study suggests that a brief educational intervention is beneficial, but more must be done.

Conflict management in public hospitals: the Cyprus case.

BACKGROUND: Conflict among health-care personnel has been identified as an issue within health-care settings around the world. AIM: To investigate the existence and management of conflict among health-care personnel in public hospitals in Cyprus; to assess the factors leading to conflict among staff members; to evaluate the consequences of conflict arising; and to consider the management strategies. METHODS: A self-administered questionnaire was completed by a random sample of 1037 health-care professionals in all (seven) state-run hospitals in Cyprus in 2008. RESULTS: Mean age of respondents was 41 years, and 75% were female. Sixty-four per cent of respondents reported that they had never been informed about conflict management strategies, with physicians being the least informed as the relative percentage was 79.8% (χ(2) = 33, P < 0.001). Sixty per cent of health-care professionals reported conflict at work with other health-care personnel one to five times per week, and 37% of the respondents stated that they devote 90 min (mean value) from work during their shift in conflict resolution, meaning that managing conflicts may absorb 19% of working time daily. The majority of respondents agreed that organizational problems and communication gaps were the main issues creating conflict. Avoidance and collaboration were the preferable strategies for conflict resolution, used by 36.6% and 37.5% of the respondents, respectively. CONCLUSION: Better communication, fair management practices and clear job descriptions and expectations may be needed in order to facilitate change and reverse the negative atmosphere that exists. Further education in conflict management for physicians, nurses and their managers may also be needed.

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

BACKGROUND: Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care. AIM: The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children. PATIENTS AND METHODS: The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP). RESULTS: Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 +/- 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses (P < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses (P = 0.047). Across the sample, females hold significantly more positive attitudes than males (F = 9.5, P = 0.002), while age did not have any significant effect. CONCLUSIONS: Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.

Greek students' knowledge and sources of information regarding sex education.

BACKGROUND: Human sexuality is a complex part of life and is considered a multidimensional phenomenon. Therefore there is an increased need for adequate and comprehensive sex education, especially for teenagers and young adults. AIM: The main aim of the study was to evaluate the level of students' sexual knowledge, as well as to identify their sources of information regarding sexual life and reproduction. POPULATION AND METHOD: A cross-sectional study using a designed self-report questionnaire was performed. The study population consisted of 936 students who were attending 10 high schools and four medical schools in Attica. Data were collected after obtaining permission from the Pedagogic Institute of the Greek Ministry of Education. FINDINGS: The main sources of students' sexual information about reproduction were friends (29.1%) and parents (24.0%), whereas school was reported by 14.3% of them. The preferred sources of information, according to students' perceptions, were sex education specialists (65.6%), followed by school (39.1%), parents (32.2%) and friends (27.7%). CONCLUSIONS: The importance of school, peer and parent support upon adolescents' sexual life was revealed by the results of the study. Students' knowledge level on sex topics is not satisfactory and therefore there is a need for sex education specialists and special courses regarding sex education in Greek schools.

A study comparing tolerability, satisfaction and acceptance of three different techniques for esophageal endoscopy: sedated conventional, unsedated peroral ultra thin, and esophageal capsule.

Three methods of esophagoscopy are available until now: sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. The three methods carry comparable diagnostic accuracy and different complication rates. Although all of them have been found well accepted from patients, no comparative study comprising the three techniques has been published. The aim of this study was to compare the three methods of esophagoscopy regarding tolerability, satisfaction, and acceptance. Twenty patients with large esophageal varices and 10 with gastroesophageal reflux disease were prospectively included. All patients underwent consecutively sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. After each procedure, patients completed a seven-item questionnaire. The total positive attitude of patients toward all methods was high. However, statistical analysis revealed the following differences in favor of esophageal capsule endoscopy: (i) total positive attitude has been found higher (chi(2)= 18.2, df = 2, P= 0.00), (ii) less patients felt pain (chi(2)= 6.9, df = 2, P= 0.03) and discomfort (chi(2)= 22.1, df = 2, P= 0.00), (iii) less patients experienced difficulty (chi(2)= 13.7, df = 2, P= 0.01), and (iv) more patients were willing to undergo esophageal capsule endoscopy in the future (chi(2)= 12.1, df = 2, P= 0.002). Esophageal capsule endoscopy was characterized by a more positive general attitude and caused less pain and discomfort. Sedated conventional endoscopy has been found more difficult. More patients would repeat esophageal capsule endoscopy in the future. Patients' total position for all three available techniques for esophageal endoscopy was excellent and renders the observed advantage of esophageal capsule endoscopy over both sedated conventional and unsedated ultrathin endoscopy a statistical finding without a real clinical benefit.