Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature.

Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance.

The Relationship between Attitudes toward Death and Emotional Intelligence, Personality, Resilience, and Justice Beliefs: A Cross-Sectional Study of Midwives in Greece.

Midwifery practice inevitably includes miscarriages, stillbirths, and neonatal deaths. The aim of the present study was to investigate the relationship between attitudes toward death and emotional intelligence, personality, resilience, and justice beliefs among midwives in Greece. A descriptive cross-sectional study was conducted from 2020 to 2022 among 348 midwives employed in public hospitals, in regional health authorities, or as independent professionals. Research instruments included the Death Attitude Profile-Revised, the Connor-Davidson Resilience Scale, the Trait Emotional Intelligence Questionnaire-Short Form, the Eysenck Personality Questionnaire, and the Belief in a Just World scale. The results revealed that greater emotional intelligence was significantly associated with higher scores in the escape acceptance subscale. Midwives scored low on the neutral acceptance subscale (2.9 ± 0.8), with the highest score being recorded in the escape acceptance subscale (4.6 ± 1.0), which was significantly associated with greater emotional intelligence. Neuroticism was significantly associated with the death avoidance, approach acceptance, fear of death, and escape acceptance subscales. Finally, the subscale of distributive justice beliefs for self and others was significantly associated with the subscales of death avoidance and approach acceptance. These findings highlight the nuanced perspectives within the healthcare community. As we delve deeper into the complexities of end-of-life care, understanding these diverse attitudes is crucial for providing comprehensive and empathetic support to both patients and healthcare professionals.

Serum Neuron-Specific Enolase as a Biomarker of Neonatal Brain Injury-New Perspectives for the Identification of Preterm Neonates at High Risk for Severe Intraventricular Hemorrhage.

Neonatal brain injury (NBI) is a critical condition for preterm neonates with potential long-term adverse neurodevelopmental outcomes. This prospective longitudinal case-control study aimed at investigating the levels and prognostic value of serum neuron-specific enolase (NSE) during the first 3 days of life in preterm neonates (<34 weeks) that later developed brain injury in the form of either periventricular leukomalacia (PVL) or intraventricular hemorrhage (IVH) during their hospitalization. Participants were recruited from one neonatal intensive care unit, and on the basis of birth weight and gestational age, we matched each case (n = 29) with a neonate who had a normal head ultrasound scan (n = 29). We report that serum NSE levels during the first three days of life do not differ significantly between control and preterm neonates with NBI. Nevertheless, subgroup analysis revealed that neonates with IVH had significantly higher concentrations of serum NSE in comparison to controls and neonates with PVL on the third day of life (p = 0.014 and p = 0.033, respectively). The same pattern on the levels of NSE on the third day of life was also observed between (a) neonates with IVH and all other neonates (PVL and control; p = 0.003), (b) neonates with II-IV degree IVH and all other neonates (p = 0.003), and (c) between control and the five (n = 5) neonates that died from the case group (p = 0.023). We conclude that NSE could be an effective and useful biomarker on the third day of life for the identification of preterm neonates at high risk of developing severe forms of IVH.

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

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

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

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

Temporal Trends in Stillbirth in Greece: A Longitudinal Population-Based Study.

INTRODUCTION: Stillbirths are a major public health issue and a key population health indicator. The aim of this study was to comprehensively investigate and present time trends in stillbirth in Greece. METHODS: Data on all live births and stillbirths were derived from the Hellenic Statistical Authority, covering a 65-year period from 1957 to 2021 and the annual stillbirth rate (SBR) was calculated, defined as the number of stillbirths per 1,000 live births and stillbirths (total births). Trends in the SBR were assessed using joinpoint regression analysis with calculation of the annual percent change (APC) with a 95% confidence interval (95% CI) and level of statistical significance p<0.05. RESULTS: The SBR in Greece, after an initial increasing trend (1957-1965: APC=2.6, 95% CI: 0.5 to 4.7, p=0.016), and an all-time high of 15.8 per 1,000 births in 1966, recorded a four decades period of continuous improvement (1965-2003: APC=3.0, 95% CI: -3.2 to -2.8, p<0.001) and reached a historic low in 2008 (3.3 per 1,000 births) (a decrease by 79%). However, the SBR stagnated at an elevated level during the decade 2006-2016 and showed a steeply upward trend during the most recent period 2016-2021 (APC=7.4, 95% CI: 3.0 to 12.1, p=0.001). In 2021, the SBR was 5.3 per 1,000 births, 60% up from 2008. It was estimated that the SBR improvement for the 1967-2021 period resulted in 50,914 stillbirths averted (7.9 per 1,000 births), but the recent increase in the SBR has led to 1,200 additional fetal deaths (1.0 per 1,000 births) during 2009-2021. CONCLUSION: After an impressive decline for almost four decades the SBR gradually deteriorated during the economic crisis and finally showed an alarming rising trend after 2015, resulting in an increasing burden of fetal deaths in Greece. Further public health interventions are needed to address preventable risk factors and ensure access to optimized antenatal monitoring.

Medication Intake as a Factor for Non-Initiation and Cessation of Breastfeeding: A Prospective Cohort Study in Greece during the COVID-19 Pandemic.

Pharmacological treatment may become a barrier for a mother's breastfeeding goals. We aimed to investigate maternal medication intake as a factor for non-initiation and cessation of breastfeeding and the effect of professional counseling on maternal decision-making. Throughout 2020, 847 women were recruited from five healthcare institutions. Information was gathered prospectively with an organized questionnaire through interview during hospitalization and through telephone at 1, 3 and 6 months postpartum. Results revealed that from the 57 cases of breastfeeding cessation due to medication intake, only 10.5% received evidence-based counseling from a physician. Unfortunately, 68.4% (n = 39/57) of the participants ceased breastfeeding due to erroneous professional advice. The compatibility of medicines with breastfeeding was examined according to the Lactmed and Hale classification systems, which showed discrepancy in 8 out of 114 medicines used, while 17.5% and 13.2% of the medicines, respectively, were not classified. Educational level, employment at six months postpartum, mode of delivery, previous breastfeeding experience, medication intake for chronic diseases, physician's recommendation and smoking before pregnancy were factors significantly correlated with breastfeeding discontinuation due to medication intake. The COVID-19 restrictions protected women from ceasing breastfeeding due to medication intake. Maternal and lactation consultancy should be strictly related to evidence-based approaches.

COVID-19 Vaccination and Related Determinants of Hesitancy among Pregnant Women: A Systematic Review and Meta-Analysis.

Mass vaccination against COVID-19 is necessary to control the pandemic. COVID-19 vaccines are now recommended during pregnancy to prevent the disease. A systematic review of the literature in the electronic databases PubMed and EMBASE was performed and we aimed to investigate the attitude of documents towards COVID-19 vaccination and the prognostic factors of vaccination hesitation. A meta-analysis was also conducted to estimate the overall percentage of pregnant women who were willing to be vaccinated or had been vaccinated against COVID-19. A total of 18 studies were included in the review and meta-analysis. The acceptance rate of vaccination against COVID-19 among pregnant women ranged from 17.6% to 84.5%. The pooled proportion of acceptance of vaccination against COVID-19 in pregnant women was 0.53 (95% CI: 0.44-0.61). Predictors of acceptance of COVID-19 vaccination were older age, White race, occupational status, higher level of education, comorbidities, third trimester of pregnancy, influenza vaccination, knowledge about COVID-19, and confidence that vaccines for COVID-19 are safe and effective. The prevalence of COVID-19 vaccination in pregnant women is low. Targeted information campaigns are needed to increase vaccine education in this population.

Investigation of Healthcare Professionals' Knowledge of Evidence-Based Clinical Practices for Preterm Neonatal Skin Care-A Pilot Study.

Neonatal skin care practices are considered crucial for a neonate's survival and are closely related to healthcare professionals' (HPs) knowledge and skills in delivering scientifically valid neonatal care interventions. In this descriptive cross-sectional pilot study, conducted in 2022, we aimed to assess HPs' basic theoretical knowledge of neonatal vernix caseosa, skin microbiota, and bathing as well as knowledge regarding evidence-based clinical practices (referred to as "clinical knowledge") for preterm neonatal skin care. Eligible participants were neonatologists, pediatricians, obstetricians, midwives and nurses working in the Greek setting. The research instrument was an online questionnaire designed by the research team. Finally, 123 HPs took part in the study. The theoretical, clinical and total knowledge scores were all significantly associated with age, healthcare profession and the sources used for education. Participants' theoretical and clinical knowledge scores were compared and found not to differ significantly (p = 0.566). A significant and positive correlation was found between theoretical and clinical knowledge scores. Thus, it is concluded that HPs should be updated with the latest evidence-based knowledge and clinical guidelines in order to provide neonatal skin care with high-quality standards.

Frequency and Determinants of Breastfeeding in Greece: A Prospective Cohort Study during the COVID-19 Pandemic.

Breastfeeding is considered to be the cornerstone of child health. In Europe however, overall breastfeeding rates remain low. The present study aimed at estimating the frequency of breastfeeding in Greece during the COVID-19 pandemic period and comparing findings with the latest national study in order to identify a potential impact of the pandemic. Additionally, possible correlations of socio-cultural and demographic characteristics with breastfeeding indicators were investigated. This prospective cohort study included 847 women from five tertiary maternity hospitals, between January and December 2020. Data were collected by a structured questionnaire via interview during hospitalization and via telephone in the first, third and sixth month postpartum. Results showed that all breastfeeding indicators improved over the last three years. Full breastfeeding reached 7.2%, contrary to 0.78% of the latest national study at six months postpartum. Employment, marital status, educational level, mode of delivery, type of maternity hospital, body mass index before pregnancy, previous breastfeeding experience of the mother and infant's birth weight correlated significantly with breastfeeding indicators at different time periods. The COVID-19 pandemic seems to have favorably influenced breastfeeding initiation and duration in Greece due to lockdowns, home confinement and teleworking.

EU ambition to build the world's leading bioeconomy-Uncertain times demand innovative and sustainable solutions.

This article outlines the current context and the development of the European Bioeconomy Strategy. It analyses the current situation, challenges and needs for EU action and concludes with the next steps that the European Commission will undertake to review and update the Bioeconomy Strategy. Bioeconomy offers great opportunities to realising a competitive, circular and sustainable economy with a sound industrial base that is less dependent on fossil carbon. A sustainable bioeconomy also contributes to climate change mitigation, with oceans, forests and soils being major carbon sinks and fostering negative CO2 emissions. The EU has invested significantly in research and innovation in this field and the European Commission is committed to lead on European bioeconomy strategy.

Attitudes and behaviours of Greeks concerning blood donation: recruitment and retention campaigns should be focused on need rather than altruism.

BACKGROUND: Blood supplies in Greece are insufficient to meet the high transfusion needs arising from car accidents and treatment of thalassaemia. This study was designed to determine Greeks' opinions about blood donation, in order to identify the reasons for the lack of motivation to donate and allow experts to establish better recruitment campaigns for the enrichment of the donor pool, based on our findings. MATERIALS AND METHODS: The opinions of randomly selected Greek citizens (n=800) about volunteer blood donation were assessed by means of a standardised, anonymous questionnaire. The results were analysed using the χ(2) test and Spearman's correlation coefficient. RESULTS: With regards to attitudes towards intention to donate, only 7.1% were indifferent, while 88.0% of the individuals believed that donating blood was an "offer". Reasons for not donating mainly involved safety (36.0%) and fear (24.0%), whereas need (77.9%) was the most fundamental positive motivation. Of the people enrolled in the present study, 10.0% were active donors, 31.3% occasional donors, 15.0% rare donors and 36.6% non-donors. DISCUSSION: The considerable percentages of occasional and rare donors in comparison with the low proportion of active donors in the Greek donor pool indicates that "need" is a more important motivation for blood donation than altruism in Greece. These results could be useful for establishing advertising campaigns on blood donation and for a more direct approach to the population, aiming for a change in mentality in favour of active blood donation.