Sleep quality and associated factors in the context of COVID-19, among prehospital emergency personnel, in North-Eastern Greece.

BACKGROUND: The stressful conditions that emerged during the Coronavirus disease 2019 (COVID-19) pandemic have had a negative impact on sleep quality in large part of the healthcare worker population. This study aimed to assess the self-reported quality of sleep among members of the Emergency Ambulance Service personnel of the National Emergency Center in the region of Thrace, Northeastern Greece, and to investigate its associations with perceived stress, feelings, and perceptions of well-being during the COVID-19 pandemic. METHODS: The study was conducted from March to May 2021 using an online structured questionnaire, and the collected data included: socio-demographic characteristics, occupational and medical history, distress and mental health issues due to COVID-19 and the following self-administrated instruments: Pittsburgh Sleep Quality Index (PSQI), WHO-5 Well-Being Index (WHO-5), and Perceived Stress Scale-14 items (PSS-14). RESULTS: Among the 74 participants, 71 % were poor sleepers (i.e., PSQI >5). The majority (83 % of the sample) reported feelings of stigma due to their occupation, with the proportion being higher among women (100 % vs 78 % in men, p =0.05) and poor sleepers (95 % vs 65 % in good sleepers, p =0.03). Poor sleepers had significantly lower WHO-5 scores than good sleepers (13.8 ± 4.9 vs 16.9 ± 5.8, p =0.04) and were experiencing significantly more anxiety and/or sadness at the time they answered the questionnaire (69.1 % vs 35.3 %, p =0.02). Perceived stress was significantly positively correlated with the "Latency" dimension of the PSQI (p =0.03). CONCLUSIONS: Poor sleep quality and feelings of stigmatization were prevalent for most of the sample. Poor sleep quality was associated more frequently with reported feelings of stigmatization, anxiety and/or sadness, and impaired well-being. HIPPOKRATIA 2021, 25 (3):126-133.

Measuring authoritarianism in a Greek health care setting.

Few studies have investigated the level of authoritarianism in the area of health. Staff with authoritarian personality may put in danger the quality of health services, especially towards stigmatized groups, such as the mentally ill and HIV positive people or the minority ethnic communities. Authoritarianism Scale (AS) by P. Heaven, is an instrument focusing on the multi-faced nature of authoritarianism and authoritarian behaviors. The aim of this study is to assess the psychometric properties of the Greek Authoritarianism Scale (AS) and to explore authoritarian attitudes of people employed in health services, in Greece. Initially, 600 individuals (health employees and medical students) were enrolled and completed AS. Additionally, 33 postgraduate students completed AS twice, in an interval of 30 days. In order to assess the psychometric properties of AS explanatory factor analysis was performed, which resulted in a 20-items scale and revealed five (5) factors: "Leadership", "Verbal hostility", "Military way of thinking", "Fear-Suspiciousness", "Achievement Motivation". Cronbach's alpha value overall was satisfactory (0.79), while values for every factor separately ranged from 0.55 to 0.76 showing moderate to satisfactory reliability. AS's test-retest reliability was high: ICC showed high to excellent agreement of AS total and factor scores between the two time points. Women and older people were less authoritarian while youngers, students and staff with primary education showed more authoritarianism. Psychiatric staff presents the lowest AS total score comparing to the other specialties. Significant differences in all categories of the sample arose in "Achievement Motivation". Greek version of AS, as evaluated in a Greek health staff sample, revealed interesting differences among participated subgroups and had overall satisfactory reliability. The influence of Authoritarianism on the major issues of our days, such as immigration flows, social and financial crisis, leads to the need of the existence of reliable measures of its assessment.

Validity of the Greek Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) among Greek adolescents.

The aim of this study is to examine the validity of the Greek version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) in a sample of adolescent pupils. EDE-Q is a self- report instrument that assesses attitudes and behaviors related to Eating Disorders (EDs). A two-stage identification protocol has been applied to the 16 schools that agreed to participate in the present study. Initially, 2058 adolescents, in class under the supervision of one research assistant and one teacher, completed a Questionnaire on socio-demographic data, the Greek EDE-Q-6.0 and the Greek Eating Attitudes Test (EAT-26) while their weight and height were measured. Six-hundred and twenty six participants, who had scores on EAT-26≥20 and/or were underweight or overweight, were considered as "possible-cases" while the remaining 1432 pupils of the sample were thought as "non-possible cases". At the second stage, parents of 66 of the participants identified as possible-cases as well as parents of 72 participants from 358 controls randomly selected from the sample of "non-possible cases" agreed that their children would be examined by means of Best Estimate Diagnostic Procedure. Participants meeting DSM-IV-TR Eating Disorders criteria were identified. Receiver Operating Characteristics (ROC) analysis was applied to reveal EDE-Q's criterion validity. The kappa statistic test was used as measure of agreement between categorical variables at EDE-Q and at interview (the presence of objective binge eating episode, of self-induced vomiting, the use of laxatives and of excessive exercise). The Discriminant and Convergent validity were assessed using the non-parametric Mann-Whitney U test and by means of the Spearman's correlation coefficient, respectively. Nineteen cases of EDs were identified [one case of Anorexia Nervosa (AN), 13 cases of Eating Disorder Not Otherwise Specified (EDNOS), 5 cases of Binge Eating Disorder (BED)]. At the cut off point of 2.6125 on the EDE-Q's global scale the instrument screens with a sensitivity (Se) of 89.5% and a specificity (Sp) of 73.1%, a Positive Predictive Value (PPV) of 34.7% and a Negative Predictive Value (NPV) of 97.8% The same analyses for both sexes revealed a cut-off point of 2.612 for females and of 3.125 for males on the global EDE-Q-6.0 score (Se=84.62%, Sp=73.33% for females and Se=83.33%, Sp= 84.09% for males), yielding a PPV and a NPV of 35.5% and of 96.5% for females and 41.7% and 97.4% for males, respectively. A very low agreement level, between EDE-Q and interview, was observed regarding the presence of objective bulimic episodes (OBEs) [k=0.191 (SE=0.057)] and the unhealthy weight control behaviors [k=0.295 (SE=0.073)]. Positive correlations were found between EAT-26 and EDE-Q-6.0 for both global scale and subscales (rho=0.50-0.57). The results suggest that EDE-Q-6.0, when using its global score, appears to be a proper screening tool for assessing the core psychopathology of eating disorders in community samples in two-stage screening studies since it distinguishes very well the cases from the non-cases. However, the assessment of the presence and frequency of pathological behaviours which characterize EDs appears to be problematic since adolescents, especially the younger ones, misunderstood terms like large amount of food and loss of control or misinterpret the motivation for excessive exercise. Therefore, marked discrepancies were observed between pathological behaviors self-reported at questionnaire and those detected at interview. We may assume that giving participants more information regarding the definition of these concepts may increase the accuracy with which the participants report these behaviors.

Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe?

In most European Union (EU)/European Economic Area (EEA) countries, between 2010 and 2012, reports of new human immunodeficiency virus (HIV) diagnoses among people who inject drugs have been stable or declining. HIV outbreaks in Greece and Romania, first reported in 2011, continue and economic conditions hinder provision of effective response coverage. When measured against some established thresholds, prevention coverage remains inadequate in at least one-third of EU/EEA countries. Urgent consideration to scale up prevention efforts is merited.

[Reliability of the Greek version of the eating disorder examination questionnaire (EDE-Q) in a sample of adolescent students].

The increasing prevalence of Eating Disorders over the last decades generates a growing interest of researchers and health care providers for their early detection through suitable questionnaires. The aim of the present study is to examine the reliability of the Greek version of EDE-Q 6.0 among secondary school adolescents. EDE-Q is a widely used self-report questionnaire that assesses the specific psychopathology of eating disorders. Its 6.0th version consists of 28 items. It yields two types of data: (a) four subscale scores (Restraint, Eating Concern, Shape Concern and Weight Concern) as well as a global score which is the average of the four subscale scores and (b) frequency data on key eating and compensatory behaviors (e.g. binge eating episodes, self-induced vomiting, excessive exercise). The sample comprises 257 secondary school students (133 girls and 124 boys) residents of north Evros-Greece, aged 16.1±1.4 years. The students completed the EDE-Q twice within a median interval of 34 days. In addition, their demographic data were collected and their weight and height were measured. The reliability of the EDE-Q was assessed by means of: (a) its internal consistency which was tested by Cronbach's alpha coefficient for each of the EDE-Q subscales as well as for the global score at both data collection times and (b) its test-retest reliability which was estimated by calculating: (1) intraclass correlation coefficients (ICCs) and Pearson's correlation coefficients (PCCs) for continuous variables (subscales and global score) and (2) Kendal's tau b coefficients for categorical variables (frequency of behavioral features). Cronbach's alphas indicating internal consistency of EDE-Q ranged from 0.71 to 0.91. ICCs and PCCs indicating the test-retest reliability of each subscale and the global score of the questionnaire ranged from 0.55 to 0.70 and from 0.58 to 0.73 respectively. Kendal tau b coefficients indicating the test-retest reliability of items assessing behavioral features ranged from 0.22 to 0.57. All the above correlations that concern the test-retest reliability of the EDE-Q were statistically significant at the 0.001 level. The Greek version of EDE-Q 6.0, standardized in a sample of secondary school students, presents adequate test-retest reliability and internal consistency as well.

Evaluation of the efficacy of a probiotic containing Lactobacillus, Bifidobacterium, Enterococcus, and Pediococcus strains in promoting broiler performance and modulating cecal microflora composition and metabolic activities.

The aim of this work was to investigate the efficacy of a new multibacterial species probiotic in broiler nutrition. The probiotic contained 2 Lactobacillus strains, 1 Bifidobacterium strain, 1 Enterococcus strain, and 1 Pediococcus strain. Four hundred 1-d-old male Cobb broilers were allocated in 4 experimental treatments for 6 wk. The experimental treatments received a corn-soybean basal diet and were as follows: "control," with no other additions; "probiotic in feed and water," (PFW) with probiotic administered at 1 g/kg of feed for the whole period and in water on scheduled intervals during the first 4 wk; "probiotic in feed," (PF) with probiotic in feed as in PFW; and "antibiotic," (AB) with addition of avilamycin at 2.5 mg/kg of feed. Salinomycin Na was used as a coccidiostat. Each treatment had 5 replicates of 20 broilers. Treatment effects on parameters of broiler performance and cecal microbial ecology were determined. Broiler BW, feed intake, and feed conversion ratio were determined on a weekly and overall basis. Cecal microflora composition, concentration of volatile fatty acids, and activities of 5 bacterial glycolytic enzymes (alpha-galactosidase, beta-galactosidase, alpha-glucosidase, beta-glucosidase, and beta-glucuronidase) were determined at the end of the experiment. Overall, treatment PFW displayed a growth-promoting effect that did not differ from AB. Overall, feed conversion ratio in treatment AB was significantly better (P < or = 0.01) than the control treatment, whereas treatments PFW and PF were intermediate and not different from AB. Concentrations of bacteria belonging to Bifidobacterium spp., Lactobacillus spp., and gram-positive cocci were significantly (P < or = 0.05) higher in treatments PFW and PF compared with the control and AB treatments. Treatments PFW and PF had significantly higher specific activities of alpha-galactosidase and beta-galactosidase compared with the control and AB treatments. In conclusion, probiotic treatment PFW displayed a growth-promoting effect that was comparable to avilamycin treatment. In addition, treatments PFW and PF modulated the composition and, to an extent, the activities of the cecal microflora, resulting in a significant probiotic effect.

The worldwide obesity epidemic.

The recent World Health Organization (WHO) agreement on the standardized classification of overweight and obese, based on body mass index (BMI), allows a comparable analysis of prevalence rates worldwide for the first time. In Asia, however, there is a demand for a more limited range for normal BMIs (i.e., 18.5 to 22.9 kg/m(2) rather than 18.5 to 24.9 kg/m(2)) because of the high prevalence of comorbidities, particularly diabetes and hypertension. In children, the International Obesity Task-Force age-, sex-, and BMI-specific cutoff points are increasingly being used. We are currently evaluating BMI data globally as part of a new millennium analysis of the Global Burden of Disease. WHO is analyzing data in terms of 20 or more principal risk factors contributing to the primary causes of disability and lost lives in the 191 countries within the WHO. The prevalence rates for overweight and obese people are different in each region, with the Middle East, Central and Eastern Europe, and North America having higher prevalence rates. In most countries, women show a greater BMI distribution with higher obesity rates than do men. Obesity is usually now associated with poverty, even in developing countries. Relatively new data suggest that abdominal obesity in adults, with its associated enhanced morbidity, occurs particularly in those who had lower birth weights and early childhood stunting. Waist measurements in nationally representative studies are scarce but will now be needed to estimate the full impact of the worldwide obesity epidemic.