Aggravating factors and assessment tools for Posttraumatic Stress Disorder in children after hospitalization.

Posttraumatic stress disorder (PTSD) is a mental disorder caused by several distressing events that are related with psychotrauma. It is very frequent in childhood and untreated traumatic stress symptoms in children and adolescents often result in debilitating consequences on development with increased risks for a variety of physical and mental disorders. Ιt has been found that PTSD symptoms are reduced as soon as therapeutic interventions have been applied. The aim of the present review was to summarize the available literature regarding aggravating factors associated with the development of PTSD in children after hospitalization and assessment tools for a quick and reliable screening of children who are at risk for developing PTSD. A review of published papers was conducted until April 10, 2019 to identify articles that discuss the aggravating factors and the assessment tools for PTSD in children after hospitalization published in English, German or Greek language. Search was performed on PubMed with the following combination of key-words: "PTSD" and "children" and "hospitalization", using the filters ''human'' and "Publication date from 30/11/2007 to 09/04/2019" and choosing "all fields'' in PubMed Advanced Search Builder. Of the 115 articles reviewed, 16 relevant articles were included, 10 of them referred to the aggravating factors and the remaining 6 were related to the assessment tools. Significant aggravating factors associated with the development of PTSD were: traumatic injuries and illness/ medical-related hospital admission, previous health problems, Pediatric Intensive Care Unit (PICU) hospitalization, attendance at a hospital for child and adolescent psychiatry, female gender and psychotherapy and initial high Posttraumatic Stress Symptoms (PTSS) in parents. As for assessment tools, it was observed that the Child Trauma Screening Questionnaire (CTSQ)-Heart Rate (HR), the alternative PTSD algorithm (PTSD-AA), the Child Stress Disorders Checklist-Short Form (CSDC-SF), the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) model for PTSD symptom categories, the Posttraumatic Stress Disorder Semi-Structured Interview (PTSDSSI), the Preschool Children's Assessment of Stress Scale (PCASS) and the diagnostic interview for children and adolescents (DICA-P) led to the identification of children who were likely to develope or had already developed PTSD symptoms, in the study population wherein each was implemented. The greatest limitation - but also a significant finding - of this review is the scarceness of published studies on this topic. Overall, there is a variety of aggravating factors associated with the development of PTSD in children after hospitalization. Assessment tools should be able to identify immediately the children who are likely to or have already developed PTSD symptoms.

Evidence for respiratory viruses interactions in asymptomatic preschool-aged children

Aim: To prospectively evaluate interferences between viruses of the upper respiratory tract in asymptomatic preschool children. Methods: Nasal-pharyngeal swabs from 233 preschool aged children were prospectively collected over four consecutive time periods, during one school year. The samples were tested using a RT-PCR DNA/RNA microarray system for nine respiratory viruses. Results: Respiratory syncytial virus (RSV) was a predictor of the presence of influenza virus (INFL) (OR: 9.12, CI: 1.52-54.75, p = 0.016), and similarly, INFL predicted the presence of RSV (OR: 4.01, CI: 1.14-14.16, p = 0.030). Also, rhinovirus (RV) was a predictor of adenovirus (ADV) presence (OR: 3.66, CI: 1.10-12.14, p = 0.034), and similarly, ADV predicted the presence of RV (OR: 4.05, CI: 1.02-16.05, p = 0.046). No other significant associations between viruses were observed. Conclusion: Our results indicate that respiratory viruses found in carrier stage in asymptomatic children may interact with other viruses and even facilitate their settling in the upper respiratory tract. The pathophysiological role of these interactions is not yet clear

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Evidence for respiratory viruses interactions in asymptomatic preschool-aged children.

AIM: To prospectively evaluate interferences between viruses of the upper respiratory tract in asymptomatic preschool children. METHODS: Nasal-pharyngeal swabs from 233 preschool aged children were prospectively collected over four consecutive time periods, during one school year. The samples were tested using a RT-PCR DNA/RNA microarray system for nine respiratory viruses. RESULTS: Respiratory syncytial virus (RSV) was a predictor of the presence of influenza virus (INFL) (OR: 9.12, CI: 1.52-54.75, p=0.016), and similarly, INFL predicted the presence of RSV (OR: 4.01, CI: 1.14-14.16, p=0.030). Also, rhinovirus (RV) was a predictor of adenovirus (ADV) presence (OR: 3.66, CI: 1.10-12.14, p=0.034), and similarly, ADV predicted the presence of RV (OR: 4.05, CI: 1.02-16.05, p=0.046). No other significant associations between viruses were observed. CONCLUSION: Our results indicate that respiratory viruses found in carrier stage in asymptomatic children may interact with other viruses and even facilitate their settling in the upper respiratory tract. The pathophysiological role of these interactions is not yet clear.

Antioxidant foods consumption and childhood asthma and other allergic diseases: The Greek cohorts of the ISAAC II survey.

BACKGROUND: Antioxidant intake changes have been implicated with the increase in asthma and allergies outcomes, but no clear association has been revealed. In this cross sectional study, the overall effect of antioxidants on asthma and allergic diseases was studied. METHODS: Data from the cohorts of the phase II ISAAC survey (2023 children 9-10 years old) in two metropolitan Greek cities were analysed. Using a semi-quantitative food frequency questionnaire, an Antioxidant Eating Index (AEI, range 0-6) was created with the pro-antioxidant (vegetables, fruits, fresh juice, fish) and the non-antioxidant (meat, burgers) food intake and was evaluated with allergic diseases. Higher values of the score suggest closer to an "antioxidant" and lesser to a "saturated fatty" diet. RESULTS: Prevalence of lifetime and current asthma, current rhinitis and sensitisation were higher in Thessaloniki compared to Athens. The AEI score of the entire cohort was 4.2 ± 1.2 (median 4.0) and was higher in Athens compared to Thessaloniki (4.3 ± 1.2 vs. 4.0 ± 1.2, p=0.001) and in girls than boys (4.3 ± 1.1 vs. 4.0 ± 1.2, p=0.001). AEI was inversely associated with lifetime asthma (OR: 0.87, 95%CI 0.77, 0.99) in either cities independently of other cofounders such as family history, sensitisation, exercise, house smoking, breast feeding, pet or dampness in houses. No association with other allergic disease or sensitisation was detected. CONCLUSION: Antioxidant foods seem to be a non-pharmacological, protective dietary pattern for asthma development in children irrespectively of atopy or heredity; AEI was a rough indicator and the role of antioxidants in allergic diseases is still under consideration.

The association of sedentary lifestyle with childhood asthma. The role of nurse as educator

BACKGROUND: To provide a summary of the existing published knowledge on the association between sedentary lifestyle and childhood asthma. Twelve years ago, the first longitudinal studies carried out in children showed a relationship between physical activity and asthma. Several epidemiological studies confirmed these findings, with sedentary lifestyle predicting the onset of asthma. METHODS: A systematic review of epidemiological studies was conducted within the MEDLINE database. Epidemiological studies on children subjects, published in English were included in the review. A comprehensive literature search yielded 50 studies for further consideration. Following the application of the eligibility criteria, we identified 11 studies. RESULTS: A positive association and an excess risk of asthma during childhood were revealed to sedentary lifestyle. The findings proved the association between childhood asthma and sedentary lifestyle. The correlation between bronchial asthma and sedentary life during childhood and identifying whether preventable or treatable risk factors exist needs to be determined. Further research on the topic is essential for safer and standardised conclusions. Conclusions and practice implication: Asthma can be controlled when managed properly. The role of the nurse as an educator should establish and maintain a relationship with patients in order to help them manage their disease. The steps towards asthma management will help paediatric patients to guide their approach to the condition

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The association of sedentary lifestyle with childhood asthma. The role of nurse as educator.

BACKGROUND: To provide a summary of the existing published knowledge on the association between sedentary lifestyle and childhood asthma. Twelve years ago, the first longitudinal studies carried out in children showed a relationship between physical activity and asthma. Several epidemiological studies confirmed these findings, with sedentary lifestyle predicting the onset of asthma. METHODS: A systematic review of epidemiological studies was conducted within the MEDLINE database. Epidemiological studies on children subjects, published in English were included in the review. A comprehensive literature search yielded 50 studies for further consideration. Following the application of the eligibility criteria, we identified 11 studies. RESULTS: A positive association and an excess risk of asthma during childhood were revealed to sedentary lifestyle. The findings proved the association between childhood asthma and sedentary lifestyle. The correlation between bronchial asthma and sedentary life during childhood and identifying whether preventable or treatable risk factors exist needs to be determined. Further research on the topic is essential for safer and standardised conclusions. CONCLUSIONS AND PRACTICE IMPLICATION: Asthma can be controlled when managed properly. The role of the nurse as an educator should establish and maintain a relationship with patients in order to help them manage their disease. The steps towards asthma management will help paediatric patients to guide their approach to the condition.

Comparison in asthma and allergy prevalence in the two major cities in Greece: the ISAAC phase II survey.

BACKGROUND: Variability in the prevalence of allergic diseases has been detected not only between different countries, but also between cities with similar national and different socio-economic or climatic characteristics. The aim of this study was to determine the prevalence of childhood asthma and allergies and which factors are associated with them, in the two largest Greek cities, Athens and Thessaloniki. METHODS: Two thousand and twenty-three Greek 9-10-year-old schoolchildren from Athens (Central Greece) and Thessaloniki (North Greece, more humid), were included in ISAAC-II study. All participants followed the ISAAC-II protocol by questionnaire, skin prick testing and flexural dermatitis examination. RESULTS: Compared with Athens, the prevalence of current wheezing (8.4% vs. 5.7%, p=0.002), lifetime asthma (11.5% vs. 7.7%, p=0.004), atopic current asthma (3.2% vs. 1.6%, p=0.02), allergic rhinitis (8.2% vs. 5.2%, p=0.007), and hay fever (21.7% vs. 12.5%, p<0.001) were higher in Thessaloniki. The overall sensitisation rate was also higher in Thessaloniki than in Athens (25.2% vs. 16%, p<0.001) with more prevalent sensitising due to the perennial allergens (D. pteronyssinus, D. farinae, Alternaria tenuis) and cat dander. Perennial allergens sensitisation was a risk factor for current asthma in both cities. CONCLUSION: A higher prevalence of asthma symptoms, allergic rhinitis, and sensitisation rate was detected in Greek schoolchildren living in Thessaloniki compared to those in Athens. Allergy to mites and mould was more prevalent in Thessaloniki. The more humid weather of Thessaloniki may be implicated.

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.

Parent's adherence to children's home-accident preventive measures.

AIM: To investigate parents' knowledge and practice of preventive measures concerning children's home accidents, as well as the factors affecting adherence. BACKGROUND: Injuries at home constitute the majority of accidental injuries in children aged <6 years old, sometimes with devastating consequences for the child's well-being. Research has concentrated on locating the risk factors and on evaluating the effectiveness of the injury-prevention programmes, but only a few studies have focused on parental knowledge and the application of preventive measures and on how the basic risk factors correlate with parental adherence. METHODS: This was a descriptive study. A sample of 900 parents of children aged 0-6 years, who were guests of kindergartens and day nurseries of the Prefecture of Attica, Greece, and that were randomized geographically by region. Data were collected with an anonymous questionnaire between September 2006 and July 2007. RESULTS: Half of the parents had inadequate adherence to the application of preventive measures for children's accidents at home, while nearly half claimed an information deficit. Accident incidence was 36% lower than when parents claimed to adhere to preventive measures. Higher adherence had fathers of low educational level (P = 0.001), families who had < or =2 bedroom residences (P = 0.001), families who remained in block of flats (P = 0.010) as well as families who had a child with chronic illness (P = 0.012). The study concerns an urban population and does not include parents who lack a sufficient knowledge of the Greek language. CONCLUSION: Parental adherence is of primary importance for decreasing home-accident incidence. Parental education and the adherence gap needs further investigation so as to improve parental application of preventive measures.

Modification of nursing students' performance in blood pressure measurement: an educational retraining programme.

AIM: To assess the procedure for measuring blood pressure (BP) among nursing students after the basic educational programme and after further supplementary training. METHODS: One hundred and fifty nursing students participated in the study, which was divided into two phases. During the first phase, students attended the routine educational programme in respect of the technique of measuring BP in the course of the lesson 'Basic Nursing'. During the next semester (second phase), the same students attended the lesson of 'Internal Medicine Nursing'. In the course of this lesson, a supplementary educational intervention for BP measurement was introduced for the purpose of this study. In order to perform our study, the university's written approval was given. At the end of the second phase, the 150 participants (volunteers) gave their oral consent for the anonymous publication of the results. RESULTS: The results showed an inadequate performance after the basic educational programme, but a significant improvement in the technique of measuring BP after supplementary educational intervention was achieved. This improvement was significant for all the parameters examined. CONCLUSION: Supplementary education of students may be required, as this could significantly improve their technique for the accurate measurement of BP.

Evaluating depression in a sample of children and adolescents with cancer in Greece.

BACKGROUND: Several studies have found that serious illness increases the risk of depression. One of the most common psychiatric disorders related to the diagnosis and treatment of cancer is depression. AIM: The aim of the present study was to investigate the rate of depression in children with cancer compared with that in healthy children. PATIENTS AND METHODS: The present study is an ongoing prospective study. The research group consisted of 80 children with cancer followed up by an oncology inpatient clinic of a Greek Children's hospital. The control group consisted of 84 healthy children. After parental consent was obtained, data were collected using the Children's Depression Inventory (CDI) and a socio-demographic data form. RESULTS: At the time that this study was carried out, neither the research group nor the control group suffered from depression. In particular, there was no statistically significant difference between the two groups with respect to symptoms of depression (mean = 5.88 for children with cancer vs. mean = 7.23 for healthy children, U = 3013, P = 0.25). CONCLUSIONS: Our findings suggest that the children in this study with malignancies did not have higher depression scores than their healthy peers, although many previous surveys confirm that children with cancer are at high risk for depression.

Changes in children's fatigue during the course of treatment for paediatric cancer.

BACKGROUND: Fatigue is described as one of the most distressing symptoms of cancer therapy; yet it has received limited clinical attention. Children are suffering from a symptom that is under-diagnosed during their treatment. AIM: The aim of this study is: (a) to assess the change in fatigue scores during cancer treatment according to children's perspectives, and (b) to describe the possible causes of fatigue from children's points of view. SAMPLE AND METHODS: The present study is part of an ongoing prospective study. The research group consisted of 40 (n = 40) children aged 7-12 years with cancer who are being followed up in the oncology clinic of a Greek children's hospital. After parental consent was obtained, data were collected using the Child Fatigue Scale and a sociodemographic data form. RESULTS: The children with cancer reported a statistically significant increase in fatigue scores during their treatment (F = 6.846, P = 0.003). Gender was the only demographic factor associated with a significant increase in the fatigue scores (F = 4.857, P = 0.034). CONCLUSIONS: Cancer treatment was found significantly to increase children's fatigue levels. Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by children with cancer during their treatment.

Job-related stress among nursing personnel in Greek dialysis units.

The purpose of this study was to describe specific work-related factors that contribute to increased levels of stress experienced by nursing personnel, and to compare their impact on nurses and assistant nurses who work in Dialysis Units (DU) to those who work in Peritoneal Dialysis Units (PDU) in Greece. The sample of the study consisted of 682 members of nursing personnel working in DU and in PDU in Greek Hospitals. The collection of data was done by means of a questionnaire. The latter included questions about the motivation of nursing personnel for having chosen to work in these units along with questions about the stress factors related to the patients and their care, the role of the nurse in the unit, and the working conditions. According to the results of the study, the percentage of nursing personnel working in DU or PDU by their own choice was 71% and 8.3% respectively, whereas the rest of the staff were placed there irrespective of their preferences, by the Administrators. Among nursing personnel who had chosen to work in DU, the reported motives that contributed to their decision were the absence of a night shift (27.8%), and working in a closed unit. The main motive that incited nursing personnel to work in PDU was the acquisition and the application of specialized knowledge. The percentage of nursing personnel working in DU that expected high levels of job satisfaction was 77%, whereas the corresponding percentage for nursing personnel working in PDU was 65%. However, only 44% and 37% of the nursing personnel working in DU and PDU reported high levels of job satisfaction. The most important stressors related: i) To the patient: were the risk of contamination (79% DU, 84% PDU) and the death of a patient (77% DU, 80% PDU). 2) To the role of nursing personnel in the unit: were increased responsibilities (65% DU, 37% PDU), low involvement of the nursing personnel in decision making (58% DU, 54% PDU), and low professional status of nursing personnel. 3) To the working conditions: were the shortage of nursing personnel (74% DU, 99% PDU), limited material (74% DU, 57% PDU), the closed environment (75% DU, 64% PDU) and the daily work routine (78% DU, 61% PDU). In conclusion, we can say that working in DU and PDU provokes increased stress in nursing personnel, even though the implicated stress factors differ between these units.

Psychosomatic nursing assessment of psychiatric patients.

This article presents the results of a research study on 547 mental patients testing a form of nursing assessment of mental patients in psychiatric and in general hospitals, as a means to assess their nursing needs and as a basis for planning, implementation and evaluation of their personalized holistic nursing care. The study showed that more depressive than schizophrenic patients went to the general hospital for help. The reverse was observed in the psychiatric hospital. The psychological nursing needs of the patients were significantly correlated with their somatic nursing needs. The psychological as well as the somatic nursing needs of the patients were significantly correlated with sex, age, somatic health state and mental health state in general, and not with their concrete psychiatric diagnosis. It is concluded that the psychiatric nursing assessment should be oriented towards the investigation of the patient's psychosomatic nursing needs rather than be based on his medical diagnosis.