Fatigue among Patients with Type 2 Diabetes Mellitus: The Impact of Spirituality and Illness Perceptions.

Type 2 Diabetes Mellitus (T2DM) can cause fatigue, negatively affecting the daily functioning and health of individuals. The purpose of this study was to investigate the impact of spirituality and illness perceptions on fatigue among patients with Type 2 Diabetes Mellitus. In this cross-sectional, descriptive study, 100 patients with Type 2 Diabetes Mellitus completed the Fatigue Assessment Scale, the FACIT Sp-12 scale, and the Illness Perception Questionnaire-Revised assessing fatigue, spirituality, and illness perceptions, respectively. The mean age of the sample was 52.18 ± 15.53 years and 65% were insulin-treated patients. The mean score for the FACIT Sp-12 scale was 31.86 ± 7.7, for the FAS 27.0 ± 7.63, and for the Consequences and Emotional Representations of IPQ-R 25.5 ± 5.3. Statistically negative significant correlations were observed between the FACIT Sp-12 total score and the FAS subscales (r = -0.44 to -0.48, p < 0.01) and positive correlations between the "IP-Consequences and Emotional Representations" subscales and FAS scores. The total score of the FACIT Sp-12 (ß = -0.35) was a negative predictor while Consequences and Emotional Representations (ß = 0.28) were positive predictors of the total FAS Score. Participants scored moderate levels of total fatigue. Spirituality and positive illness perceptions may have a protective effect on the fatigue of patients with Type 2 Diabetes Mellitus.

Investigation of Anxiety and Health Locus of Control in Patients Undergoing Hemodialysis.

INTRODUCTION: Hemodialysis is the most frequent treatment modality for End-Stage Renal Disease (ESRD). However, a number of limitations and modifications accompany this treatment, affecting people's physical and psychological well-being and increasing anxiety symptoms. The aim of this study was to investigate the level of anxiety and health locus of control among dialysis patients. METHODOLOGY: One hundred and five patients on hemodialysis treatment completed a questionnaire with demographic characteristics, the State-Trait Anxiety Inventory and the Multidisciplinary Health Locus of Control Scale. RESULTS: Women had significantly higher levels of state anxiety than men (p = 0.019). Similarly, patients with primary school education had significantly higher trait and total anxiety levels than those with technological education (p = 0.002 and p = 0.033, respectively). Widowed patients exhibited significantly higher state, trait, and total anxiety levels than married (p = 0.032, p = 0.012, and p = 0.012, respectively). Participants who did not do any kind of exercise had significantly higher level of state, trait, and total anxiety than those who did (p = 0.011, p = 0.015, and p = 0.006, respectively). Respondents who did not have any self-care skills had significantly higher level of state, trait, and total anxiety than those who had (p = 0.011, p = 0.015, and p = 0.006, respectively). State, trait, and total anxiety levels were significantly (p ≤ 0.05) correlated negatively with internal locus of control and positively with "chance" locus of control scale. CONCLUSIONS: Hemodialysis patients had increased anxiety symptoms and believed that others had control over their health to a greater extent. Renal professionals need to apply effective interventions to dialysis patients in order to help them gain a better sense of control over their health and reduce anxiety symptoms.

Depressive Symptoms and Anger Expression Among Survivors After Stroke.

INTRODUCTION: Stroke is a frequent cause of death and one of the most common causes of disability and depression in the countries of the Western world. Depression is associated with limited functionality, reduced self-care, and increased mortality in patients with stroke. Anger often occurs in these patients and may disrupt the course of their recovery. AIM: The investigation of the presence of depressive symptomatology, the expression of anger, and the degree of functioning/independence of patients after stroke. METHOD: One hundred and ten patients after stroke completed the Center for Epidemiological Studies-Depression (CES-D) scale, the State-Trait Anger Expression Inventory, and the Barthel Index. RESULTS: Patients who lived alone had a higher depressive symptomatology score than patients who did not live alone (p = 0.009). An increase in the total depressive symptomatology score was related to an increase in the anger expression score (p = 0.011), increase in anger-in score (p < 0.001), increase in anger-out score (p < 0.001), and decrease in anger control score (p = 0.001). Females had lower anger-in scores compared to men (p = 0.029). Individuals with a history of previous stroke had higher anger-out scores compared to people without a history of previous stroke (p = 0.025). An increase in the patient's functional/independence score was associated with an increase in anger control score (p = 0.015). CONCLUSIONS: Early detection and management of depression and anger will facilitate patient's compliance to the rehabilitation program in order to achieve optimal therapeutic results and ensure a better quality of life.

Covid-19 case management in a Greek migrant camp: The Hellenic Red Cross Mobile Health Unit intervention in Nea Malakasa temporary accommodation center.

Introduction: Since the outbreak of the Covid-19 pandemic the scientific community had expressed its concerns about increased transmission of the virus within asylum seeker accommodation centers due to substandard living conditions and poor sanitation. Studies regarding management of Covid-19 cases in such facilities are urgently needed in order to guide international strategies on future pandemics within the humanitarian setting. Our study's paradigm of Covid-19 case management in a Greek migrant camp aims to add on existing data. Data and Methods: A retrospective analysis of epidemiological and demographical data collected as part of a healthcare intervention in a Greek migrant camp during three Covid-19 epidemic waves is presented in this study. Descriptive statistics were generated using STATA 12. Results: During the first wave, the camp's administration adopted a 2-month strict lockdown strategy and no positive cases were recorded. During the second wave, suspected coronavirus cases were referred for PCR testing and, in case of positivity were hospitalized. 3% (n = 28) of the camp's population were referred for PCR, with 1% of the population (n = 10) being tested positive for Covid-19 and admitted to hospital. Close contacts of positive cases were encouraged to comply with non-pharmaceutical interventions and were offered medical care if symptoms developed. During the third epidemic wave, in-camp management was decided by on-site operators, with rapid antigen testing of symptomatic individuals, daily monitoring of positive cases by the medical team and mass screening of their closed contacts. 4% (n = 33) of the camp's residents were tested positive, while none was hospitalized. 19% (n = 148) of the camp's population were considered close contacts, were advised to self-isolate and were offered mass screening with rapid antigen test, from which another 21 positive cases emerged. In total, 7% (n = 54) of the camp population, (n = 21) female adults, (n = 24) male adults and (n = 9) children, were infected with SARS-CoV-2 during the third epidemic wave, with no deaths being recorded. During the study period, only 50 residents had received one dose of Covid-19 vaccines. Conclusion: We recommend an in-camp Covid-19 response featuring regular follow up of positive cases and prompt referral to tertiary centers based on clinical criteria, while overemphasizing the need for equitable access to primary healthcare for asylum seekers in Greece, primarily during the current pandemic. Prolonged camp lockdowns should be avoided as they pose substantial health risks for their vulnerable population.

Care and Safety of Schoolchildren with Type 1 Diabetes Mellitus: Parental Perceptions of the School Nurse Role.

Schoolchildren with type 1 diabetes mellitus (T1DM) need supervision in the management of their disorder by the school nurse, securing proper care and safety in the school environment. The aim of this study was to investigate the parents' perceptions regarding the care and safety of their children with T1DM at school. In this cross-sectional study, 356 parents of children with T1DM attending primary and secondary school (convenience sample) completed the "Parents' Opinions about School-based Care for Children with Diabetes" and the "Safety of children with T1DM at school". The majority (58.8%) noted that their children received some care from a school nurse, less than half (44.6%) declared feeling very safe concerning diabetes care, and 42.5% reported high levels of diabetes management satisfaction. Younger age of the child (p < 0.001), school nurses' advanced diabetic care skills (p < 0.001), existence of school nurse's office (p < 0.05) and higher educational level of the father were positively correlated with higher parental feelings of safety and satisfaction. The presence of a school nurse was associated with higher academic performance (p < 0.001), significantly fewer absences due to the disorder (p < 0.001) and better diabetes management (p < 0.043). The daily presence of a school nurse in school decreases absenteeism, greatly improves school performance and enhances diabetic management of schoolchildren with T1DM.

Health-Related Quality of Life and Social Support of Elderly Lung and Gastrointestinal Cancer Patients Undergoing Chemotherapy.

Introduction: Increasing life expectancy has led to a higher incidence of cancer in the elderly, thus making them vulnerable and worsening their health-related quality of life (HRQoL) and their need for support. Objective: The aim of this study was to examine the HRQoL and social support in elderly Greek lung and gastrointestinal cancer patients undergoing chemotherapy. Methods: This was a descriptive, cross-sectional study of 104 elderly cancer patients, who were receiving chemotherapy in the outpatient department and inpatient ward of a General Hospital in Athens. The data were collected using purposive sampling between December 2019 and May 2020, and included demographic and clinical characteristics, the HRQoL questionnaire, Short Form 36 (SF36), and the Personal Resource Questionnaire (PRQ-2000). Results: The participants' median age was 72 years; the majority were male (62.5%) and had lung cancer (57.7%). The SF36 data revealed a relatively moderate (42.7-62.61) HRQoL in most subscales. The "Pain" subscale recorded the highest score (75.0), and the "social function" subscale the lowest (42.79). The PQR-2000 indicated a satisfactory level of social support (81.65), with values ranging between 48 and 105; married patients with higher education scored more highly (p < .05). Patients aged 65-75 years reported better HRQoL and greater social support than older patients. In addition, patients with their own family and a relatively high income reported better HRQoL and social support compared to single individuals, with low income, who were cared for by their children. Positive and statistically significant (p < .05) correlations were found between the SF36 subscales of role functioning/physical, vitality, general health, emotional well-being and the PRQ-2000. Conclusion: The HRQoL and social support of elderly cancer patients positively affect the course of their health. Healthcare systems and social services should address the multiplying needs of these patients with targeted interventions to support their well-being.

The Impact of GLP1 Agonists on Bone Metabolism: A Systematic Review.

Background and Objectives: The association between diabetes mellitus and increased risk of bone fractures has led to the investigation of the impact of antidiabetic drugs on bone metabolism. Glucagon-like peptide-1 receptor agonists (GLP1RAs) are a relatively novel and promising class of anti-hyperglycemic drugs. In addition to their blood glucose lowering action, GLP1RAs seem to have additional pleiotropic properties such as a beneficial skeletal effect; although the underlying mechanisms are not completely understood. The present systematic review summarizes current evidence about GLP1RAs and their effects on bone metabolism and fracture. Methods: An extensive literature search was conducted based on electronic databases namely, PubMed, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL) through October 2019 to January 2020 for articles related to bone mineral density, diabetes mellitus and GLP1RAs. We included articles published in English. Finally, we included four randomized controlled trials, three meta-analyses, a case-control study and a population-based cohort analysis. Results: Based on the articles included, the animal studies indicated the salutary skeletal effects of GLP1RAs in opposition to what has been commonly observed in human studies, showing that these agents have no impact on bone mineral density (BMD) and the turnover markers. Moreover, it was demonstrated that GLP1 was not associated with fracture risk as compared to other anti-hyperglycemic drugs. Conclusions: Findings from this systematic review have demonstrated the neutral impact of GLP1RAs on BMD. Moreover, further double-blind randomized controlled trials are needed to draw more meaningful and significant conclusions on the efficacy of GLP1RAs on BMD.

Effects of a structured dance program in Parkinson's disease. A Greek pilot study.

INTRODUCTION: Dance for Parkinson's Disease® (DfPD®) is a structured dance program that has never been evaluated in Greek PD population. This study assesses for the first time the efficacy, safety and feasibility of DfPD® program in Greek PD patients. MATERIAL AND METHODS: A total of 16 early-to-mid-stage PD patients (50% men, aged 56 ± 12) underwent a total of 16 60-min classes of adjusted to Greek music and dance culture DfPD®, twice weekly, over 8 weeks. Assessments were performed at baseline and at the end of the study period and included quality of life (PDQ-8), depressive symptoms (BDI-II), fatigue (PFS-16), cognitive functions (MoCA), balance (BBS) and body mass index (BMI). Safety (possible falls, injuries, muscle soreness or excessive fatigue) and feasibility (technical and financial parameters, willingness for participation and continuation, recruitment rates) were also assessed. RESULTS: Statistically significant improvements were found in quality of life (29 ± 47%, p = 0,020), depressive symptoms (26 ± 52%, p = 0,046), fatigue (13 ± 20%, p = 0,021), cognitive functions (17 ± 23%, p = 0,010), balance (5 ± 4%, p = 0,003) and BMI (2 ± 2%, p = 0,010). No adverse events, high adherence (93,75%) and low attrition (12,5%) rates were reported. CONCLUSION: A twice weekly 60-min DfPD® class for 8 weeks is a safe and feasible non-pharmacological complementary therapeutic intervention for Greek PD patients and may improve their quality of life, depressive symptoms, fatigue, cognitive functions, balance, and BMI. Further research on this intervention is warranted.

Factors associated with social support for family members who care for stroke survivors.

INTRODUCTION: Vascular strokes are a primary cause of long-term disability for adults, with many social consequences for the patient, the family and healthcare systems worldwide. AIM: To investigate the relation between patients' and caregivers' characteristics, as well as burden and depression, and the social support received by carers for stroke victims in Greece. METHOD: Patients and caregivers were recruited from community settings in the Attica region of Greece, using purposive sampling. They completed a set of questionnaires during face-to-face interviews. Correlational and multiple regression analyses were performed to identify factors associated with caregivers' perceptions of social support. RESULTS: In total, 109 dyads of patients and their respective caregivers were recruited. The patients' mean age was 69.3 years, while caregivers' mean age was 58.0 years; 51.4% of patients were males, whereas 67.9% of the caregivers were females. The majority of both patients and caregivers were married, with an annual family income less than €10,000. The level of perceived social support was significantly associated with patients' or caregivers' annual family income, caregivers' working status and the daily caring hours (p < 0.01). Greater perceived support was significantly associated with a lower care burden BCOS (r = 0.29, p < 0.01) and female gender (p = 0.023), but not with the patient's functional level nor with depression (p > 0.05).

Diagnosis, treatment and quality of life in patients with cancer-related lymphedema.

Cancer-related lymphedema is the result of surgical operation or radiation therapy of the corresponding lymph nodes and is due to the obstruction of the lymphatic drainage in the affected area. In lymphedema the lymphatic stasis causes an inflammatory reaction that leads to the proliferation of adipose tissue and fibrosis, resulting in mild to severe permanent swelling of the affected part of the body. It is more often found in the upper extremities of women with breast cancer. It may, however, appear at one or more extremities and may include the corresponding quadrant of the trunk. It may also affect head and neck, breast, genitals and lower extremities, depending on the surgery the patient has undergone. It is often associated with obesity (BMI>40). Early diagnosis and treatment of lymphedema is related with better therapeutic outcome. Women with breast cancer confront more problems with lymphedema than with mastectomy. Its effect on patients' quality of life is relevant to changes in body image, self-esteem, feelings of weakness, fear and anxiety about disease progression, financial costs, and reduced limb function. More recent studies support the effectiveness of contemporary surgical techniques in lymphedema's treatment. In conservative management, CDT remains the treatment of choice and in combination with exercise, weight control programs and self-care training seems to significantly improve patients' quality of life.

Assessment of oncology patients' satisfaction from intravenous chemotherapy.

PURPOSE: To assess patient satisfaction from chemotherapy and investigate the effect of demographic factors, disease symptoms and treatment on satisfaction. METHODS: A non-randomized cross-sectional survey was conducted on a sample of 100 patients undergoing chemotherapy at "Metaxa" Cancer Hospital, Piraeus, Greece for 6 months. A demographic data questionnaire, a Cancer Treatment Satisfaction Questionnaire (CTSQ) and visual analog scales were used to evaluate pain, anxiety, fatigue, and nausea while presence or absence of vomit were also assessed. RESULTS: The majority of the patients in the sample were men (51%), with a mean age of 58.5 ± 10.82 years. The mean value of expectations from treatment was 60.55, from treatment's satisfaction was 75.86 and from feelings about treatment's side effects was 44.56. The most serious symptoms were fatigue and anxiety (7.2 ± 1.95 and 6.71 ± 2.5, respectively). Statistical tests have shown that sub-dimensions of CTSQ are associated with pain, anxiety, fatigue, and nausea. CONCLUSIONS: Generally, chemotherapy meets patients' expectations with cancer. Symptoms such as fatigue, anxiety, pain, and nausea affect their satisfaction. Treatment's satisfaction can be improved by evaluating symptoms, which will lead to appropriate interventions.

The Effects of Patients' and Caregivers' Characteristics on the Burden of Families Caring for Stroke Survivors.

BACKGROUND: Vascular strokes are the leading cause of long-term disability for adults. They impose high levels of burden on the patient, the family, and national healthcare systems worldwide. This study aimed to assess the effects of patients' and caregivers' characteristics on the perceptions of burden in families caring for a loved one living with stroke in Greece. METHODS: Using purposive sampling, 109 dyads of patients and their respective caregivers were recruited from the Attica region. Patients completed a questionnaire that included personal characteristics and the Barthel Index, while caregivers completed a set of questionnaires-personal characteristics, revised Bakas Caregiving Outcomes Scale (BCOS), Personal Resource Questionnaire (PRQ 2000), and Center for Epidemiological Studies-Depression (CES-D). RESULTS: Caregiving burden was linked to both patients' and caregivers' characteristics. A patient's educational level, the number of family members living in the same house, the existence of equipment and facilities in the house, and the duration of provided care were associated with perception of greater burden. Regarding caregivers' characteristics, those in good health had a significantly lower perception of burden. Higher PRQ 2000 scores were significantly associated with higher BCOS scores (less burden), and higher CES-D scores were significantly associated with lower BCOS scores (more burden). CONCLUSION: Caring for a loved one affected by stroke places a considerable burden on the caregiver. Systematic assessment and intervention strategies can help to identify caregivers at risk so that suitably targeted assistance may be provided.

Factors Affecting State and Trait Anxiety of Relatives of Hospitalized Patients.

Introduction: Hospitalization is a stressful event for both patients and relatives. The aim of the study was to explorefactors affecting state and trait anxiety of relatives of hospitalized patients. Methods: In this cross-sectional study, was enrolled a convenience sample of 222 relatives of hospitalized patients in a public hospital in Athens, Greece. Data were collected by the completion of State-Trait Anxiety Inventory (STAI) which also included participants' characteristics. Data were analyzed using SPSS version 25, while the statistical significance level was P < 0.05. Results: Of the 222 relatives, 72 were men and 150 women. The average state and trait anxiety score was 45.6 and 42, respectively, within the possible range of scores (20-80) thus indicating moderate levels of anxiety. Moreover, state and trait anxiety was statistically significantly associated with gender, degree of information of patient's health, whether they had readjusted family responsibilities, whether they had financial worries, whether they experienced uncertainty about future and finally whether they were anxious about their ability to respond to patients care. Conclusion: Factors associated with relatives' anxiety were gender, information regarding patient's health, family responsibilities, financial worries, uncertainty and anxiety to respond to patients' care. These factors need to be evaluated when planning psychological intervention to alleviate this emotional burden.

Determinants of Health Promotion Behaviors among Family Caregivers of Stroke Survivors.

PURPOSE: To record the health promotion behaviors of family caregivers of stroke survivors, as well as potential determinants that could affect these behaviors. METHODS: A cross-sectional study was carried out through home visits in the Attica region using the convenience sampling method. The studied population included 109 survivors who had suffered a stroke and experienced functional problems, and their 109 primary caregivers, who were family members, lived in the same house and were fully responsible for their care. The dependent variables were the caregivers' health promotion behaviors, while the independent variables were the survivors and caregivers' demographic characteristics, survivors' functional capacity, depression, social support and changes in caregivers' lives from caring. RESULTS: Better health promotional behaviors were associated with the following: patient having advanced age and a high level of functionality, caregivers assessing their own state of health as "good", greater social support, a higher educational level and a higher income level. In addition, more hours of patient care were associated with a less healthy lifestyle for caregivers. CONCLUSIONS: Promoting the health of family caregivers of stroke survivors is crucial for both survivors and caregivers. For this reason, it is of great importance to detect factors that affect the health promotion behaviors of caregivers in order to carry out appropriate interventions and improve their quality of life.

Intervention for symptom management in patients with malignant fungating wounds - a systematic review.

PURPOSE: To identify the latest data on interventions in the management of malignant fungating wounds (WFWs). METHODS: A systematic review has been conducted to explore the original research about symptom management of malignant fungating wounds. Keywords and time constraints were used for the period 2008-2017 using the online Medline database (NCBI) with combined inclusion and exclusion criteria. RESULTS: Eleven original research studies met the inclusion criteria. Nine of them referred to the use of materials and methods for managing the main symptoms which are malodour, exudate, pain and bleeding. An improvement in symptoms was observed in the involving intervention studies. According to the results, odor and exudates were significantly decreased by the use of honey and silver dressings. Wound cleaning with saline or tap water and the use of metronidazole had also positive results. Pain management was performed by the systematic use of opioids and the administration of an additional dose prior to the dressing change. CONCLUSION: Patients with MFWs need a holistic treatment approach. They often seek late for health services and professional help. The disease is already locally advanced and a variety of symptoms leads to suffering and low quality of life. The effective management of symptoms by health professionals is vital to support patients in advanced disease. The need for constant briefing and updating of knowledge is imperative.

Factors Associated with Anxiety and Depression among Family Caregivers of Patients Undergoing Palliative Radiotherapy.

OBJECTIVE: The family caregivers of patients receiving palliative care experience high levels of anxiety and depression. The aim of the present study was to investigate the factors associated with family caregivers' anxiety and depression when caring for patients with advanced cancer in Greece. METHODS: The sample consisted of 100 patients undergoing palliative radiotherapy and their respective caregivers. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the MD Anderson Symptom Inventory. Their respective caregivers completed the Oberst Caregiving Burden Scale, the Bakas Caregiving Outcomes Scale, and the HADS. Correlational and multiple regression analyses were conducted to identify potential predictors of anxiety and depression. RESULTS: The majority of patients were male (63.0%), whereas the majority of their caregivers were female (76.0%). The mean ages of patients and caregivers were 63.9 ± 10.8 and 53.3 ± 12.6 years, respectively. Caregiving anxiety and depression were associated with patients' variables, such as gender (P < 0.0005), primary cancer (P = 0.008), and past surgery (P = 0.002), and caregiver's variables, such as gender (P = 0.001), co-residence (P = 0.05), previous care experience (P = 0.04), and means of transport (P = 0.038). In multiple regression analyses, caregiving anxiety and depression were significantly predicted by caregivers' and patients' characteristics, in a model that accounted for 48% of the anxiety variance (P < 0.0005) and 39% of the depression variance (P < 0.0005). CONCLUSION: The caregivers who experienced more anxiety and depression shared the following traits: they were women, cared for men with lung cancer, cared for patients not undergoing surgery, lived together, were younger, went to the hospital by private means of transport, had previous care experience, and perceived an increased degree of general burden. Further investigation of the factors that may affect caregivers' psychological state is required to better identify parameters that may predict it.