A 4.000 € way to improve perceived quality and meet expectations of thyroid cancer patients receiving therapeutic dose of Iodine-131.

BACKGROUND: Thyroid cancer is the most common malignant disease of the endocrine system and radioiodine therapy (RAIT) is still very often used, resulting in patients staying hospitalized for a few days alone and without visitors, augmenting their stress and discomfort. Our objective was to find simple ways of improving RAIT patients' feelings and perceived quality of the nuclear medicine (NM) department services. MATERIAL AND METHODS: We designed a two-year study in order to enhance RAIT patients' perceived quality of the nuclear medicine (NM) department services and expectations' fulfillment. A questionnaire was used in order to capture patients' perceived quality and expectations from their RAIT. RESULTS: 549 replies were collected. Many intrinsic and extrinsic determinants were found to be positively or negatively related to the perceived quality and fulfillment of patients' expectations of receiving RAIT. A 1% increase could be achieved by spending 110 € per RAIT room. CONCLUSIONS: In this article, we present some easily implemented changes in both personnel behavior and room amenities that could, at least in theory and based on our results, offer a 37.9% improvement in RAIT patients' perceived quality and expectations' fulfillment at a cost of 4169 €.

Role of diabetes mellitus in the clinical course and outcome of SARS-CoV-2 infected patients.

PURPOSE: Our aim was to study patients with diabetes mellitus and SARS-CoV-2-infection diagnosed during the first pandemic wave in Greece. METHODS: Cases were retrieved from the national database of SARS-CoV-2 infections. RESULTS: We studied 2624 SARS-CoV-2 infected cases, including 157 with diabetes. Patients with diabetes more often had other comorbidities (68.8 vs. 24.1%; p-value < 0.001). Among patients with diabetes, 149 (94.9%) developed symptomatic disease (COVID-19) compared to 1817 patients (73.7%) without diabetes (p-value < 0.001). A total of 126 patients with diabetes and COVID-19 were hospitalized and 41 died (27.5% case-fatality rate compared to 7.5% among patients without diabetes; p-value < 0.001). Patients with diabetes more often were hospitalized, developed complications, were admitted to the intensive care unit (ICU), received invasive mechanical ventilation, and died compared to patients without diabetes (p-values < 0.001 to 0.002 for all comparisons). Multivariate logistic regression analyses revealed that diabetes, having other comorbidities, and older age were significantly associated with higher risk for hospitalization, ICU admission, invasive mechanical ventilation, and death, and that obesity was significantly associated with higher risk for hospitalization, ICU admission, and mechanical intubation, while female gender protected against these outcomes. CONCLUSION: COVID-19 is associated with increased rates of serious morbidity and adverse outcome in patients with diabetes and represents a severe illness for them.

Device-associated health care-associated infections: The effectiveness of a 3-year prevention and control program in the Republic of Cyprus.

BACKGROUND: Device-associated health care-associated infections (DA-HAIs) are a major threat to patient safety, particularly in the Intensive Care Unit (ICU). This study aimed to evaluate the effectiveness of a bundle of infection control measures to reduce DA-HAIs in the ICU of a General Hospital in the Republic of Cyprus, over a 3-year period. METHODS: We studied 599 ICU patients with a length of stay (LOS) for at least 48 hours. Our prospective cohort study was divided into three surveillance phases. Ventilator-associated pneumonia (VAP), central line-associated blood-stream infections (CLABSI), and catheter-associated blood-stream infections (CAUTI) incidence rates, LOS, and mortality were calculated before, during, and after the infection prevention and control programme. RESULTS: There was a statistically significant reduction in the number of DA-HAI events during the surveillance periods, associated with DA-HAIs prevention efforts. In 2015 (prior to programme implementation), the baseline DA-HAIs instances were 43: 16 VAP (10.1/1000 Device Days), 21 (15.9/1000DD) CLABSIs, and 6 (2.66/1000DD) CAUTIs, (n = 198). During the second phase (2016), CLABSIs prevention measures were implemented and the number of infections were 24: 14 VAP (12.21/1000DD), 4 (4.2/1000DD) CLABSIs, and 6 (3.22/1000DD) CAUTIs, (n = 184). During the third phase (2017), VAP and CAUTI prevention measures were again implemented and the rates were 6: (3 VAP: 12.21/1000DD), 2 (1.95/1000DD) CLABSIs, and 1 (0.41/1000DD) CAUTIs, (n = 217). There was an overall reduction of 87% in the total number of DA-HAIs instances for the period 1 January 2015 to 31 December 2017. CONCLUSIONS: The significant overall reduction in DA-HAI rates indicates that a comprehensive infection control programme can affect DA-HAI rates.

Effectiveness of maternal vaccination with quadrivalent inactivated influenza vaccine in pregnant women and their infants in 2019-2020.

OBJECTIVES: Influenza is associated with an increased risk for serious illness, hospitalization, and death in pregnant women and young infants. Our aim was to estimate the effectiveness of a quadrivalent inactivated influenza vaccine (QIV) in pregnant women and their infants during 2019-2020. METHODS: A QIV vaccine was offered to pregnant women followed in a maternity hospital. Women were contacted weekly during the influenza season and asked about symptoms. Polymerase chain reaction testing in pharyngeal samples was offered to pregnant women and infants with influenza-like illness. A Bayesian beta-binomial model was used. RESULTS: We studied 636 pregnant women (406 vaccinated and 230 unvaccinated) and 474 infants (281 of mothers vaccinated in pregnancy and 193 of unvaccinated mothers). Using a Bayesian beta-binomial model, it was estimated that influenza vaccination of pregnant women reduced their logit to develop laboratory-confirmed influenza by -4.2 (95% CI -3,7 - 4,7) and the logit of their infants to develop laboratory-confirmed influenza by -4.2 (95% CI -3.6, -4.9). The QIV effectiveness against laboratory-confirmed influenza was 43.5% in pregnant women and 31.4% in infants. CONCLUSION: Maternal influenza vaccination with QIV in pregnancy reduced the odds of pregnant women and their infants to develop influenza. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT04723771.

COVID-19 vaccination significantly reduces morbidity and absenteeism among healthcare personnel: A prospective multicenter study.

AIM: Healthcare personnel (HCP) are prioritized for coronavirus disease 2019 (COVID-19) vaccination to protect them and non-disruptive provision of healthcare services. We assessed the impact of the Pfizer-BioNTech vaccine on morbidity and absenteeism among HCP. METHODS: We studied 7445 HCP in five tertiary-care hospitals in Greece from November 15, 2020 through April 18, 2021. RESULTS: A total of 910 episodes of absenteeism and 9695 days of absence were recorded during the entire study period. Starting from January 4, 2021, 4823/7445 HCP (64.8%) were fully or partially vaccinated. Overall, 535 episodes of absenteeism occurred from January 4, 2021 through April 18, 2021, including 309 (57.76%) episodes among 2622 unvaccinated HCP and 226 (42.24%) episodes among 4823 vaccinated HCP (11.8 versus 4.7 episodes of absenteeism per 100 HCP, respectively; p-value < 0.001). The mean duration of absenteeism was 11.9 days among unvaccinated HCP compared with 6.9 days among vaccinated HCP (p-value < 0.001). Unvaccinated HCP more frequently developed acute respiratory infection, influenza-like illness, and COVID-19 (p-values < 0.001 for all comparisons). Vaccine effectiveness for fully vaccinated HCP was estimated at 94.16% [confidence interval (CI): 88.50%-98.05%) against COVID-19, 83.62% (CI: 73.36%-90.38%) against SARS-CoV-2 infection (asymptomatic or COVID-19), and 66.42% (CI: 56.86%-74.15%) against absenteeism. CONCLUSION: The COVID-19 pandemic had a considerable impact on healthcare workforce. The Pfizer-BioNTech vaccine significantly reduced morbidity, COVID-19, absenteeism and duration of absenteeism among HCP during a period of high SARS-CoV-2 circulation in the community. It is expected that HCP vaccination will protect them and healthcare services and contain healthcare costs.

Evaluation of a school-based, experiential-learning smoking prevention program in promoting attitude change in adolescents.

INTRODUCTION: School-based tobacco control programs exhibit great variety. Our study aimed to evaluate the effectiveness of an experiential learning smoking prevention program in facilitating knowledge acquisition, forging healthy attitudes, and decreasing intention to smoke. METHODS: A school-based intervention-control study was implemented during the 2016-2017 academic year among middle-school students in Athens, Greece. The experiential learning intervention was delivered using an interdisciplinary approach, bridging excerpts from ancient classical Greek myths, Aesop fables and ancient classical literature (Aristotle, Herodotus, Plutarch, Xenophon, Homer's Epics), with their decoded archetypal symbols applied in a smoking and tobacco control paradigm. An anonymous self-administered questionnaire was used at baseline and at follow-up at 3 months to evaluate program effectiveness. RESULTS: A total of 351 students participated in our study; 181 (51.6%) in the intervention group and 170 (48.4%) in the control group. The mean age of student participants was 13 years (SD=0.96). Students in the intervention group were more likely to improve their knowledge of the adverse effects of smoking, develop attitudes against smoking and report a negative intention to smoke in the first year following the intervention, compared to the control group. CONCLUSIONS: This study provides evidence that school-based experiential learning smoking prevention programs improve smoking-related knowledge, enhance anti-smoking attitudes and reinforce negative intentions toward tobacco products.

Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece.

BACKGROUND: To investigate intention rates to get vaccinated against COVID-19 among healthcare personnel (HCP) in Greece. METHODS: Cross-sectional survey. RESULTS: The response rate was 14.5%. Of 1521 HCP with a known profession, 607 (39.9%) were nursing personnel, 480 (31.6%) physicians, 171 (11.2%) paramedical personnel, 72 (4.7%) supportive personnel, and 191 (12.6%) administrative personnel. Overall, 803 of 1571 HCP (51.1%) stated their intention to get vaccinated while 768 (48.9%) stated their intention to decline vaccination. Most HCP (71.3%) who reported intent to get vaccinated noted contributing to the control of the pandemic and protecting their families and themselves as their reasons, while the most common reason for reporting intent to decline vaccination was inadequate information about the vaccines (74.9%), followed by concerns about vaccine safety (36.2%). Logistic regression analysis revealed that the probability of intending to get vaccinated increased with male gender, being a physician, history of complete vaccination against hepatitis B, history of vaccination against pandemic A (H1N1) in 2009-2010, belief that COVID-19 vaccination should be mandatory for HCP, and increased confidence in vaccines in general during the COVID-19 pandemic. The following factors were associated with a lower intention to get vaccinated: no vaccination against influenza the past season, no intention to get vaccinated against influenza in 2020-2021, and no intention to recommend COVID-19 vaccination to high-risk patients. CONCLUSION: There is an urgent need to built safety perception towards COVID-19 vaccines and raise vaccine uptake rates by HCP, and thus to protect the healthcare workforce and the healthcare services.

Nurses' attitudes and knowledge regarding patient rights: a systematic review.

OBJECTIVE: To synthesize current evidence on nurses' attitudes and/or knowledge on the entire spectrum of patient rights. METHOD: A systematic search of the literature was performed in Web of Science, PubMed, Scopus and CINAHL. Studies were selected according to pre-defined inclusion/exclusion criteria. The Cochrane and PRISMA guidelines, including templates for systematic reviews, were applied. For rigor assessment, the Critical Appraisal Skills Program Qualitative Research Checklist, and the Center for Evidence-Based Management tool were employed. RESULTS: Thirteen studies were included, that exhibited important methodological limitations, such as convenience sampling, mediocre response rates and inadequate instrument validity. Findings indicated: a) low level of awareness regarding patient rights among nurses, b) knowledge discrepancies on specific aspects of patient rights, c) low priority ascribed to a patient's right to access information, and d) insufficient evidence on formal educational sources of knowledge on the topic of patient rights. CONCLUSION: Narrow geographical localization, heterogeneity and methodological limitations render generalizability of the conclusions difficult. Further research based on robust methodology is proposed.

A comparative online survey on the intention to get COVID-19 vaccine between Greek and Cypriot healthcare personnel: is the country a predictor?

Vaccine hesitancy amongst healthcare personnel (HCP) is a critical issue. The aim was to explore the factors that determine the intention to opt for COVID-19 vaccine among HCP from two southern European countries. An anonymous online self-administered survey using Google Forms has been conducted between December 1st to December 15th, 2020 among the HCP in Greece and the Republic of Cyprus. A total of 2,238 HCPs participated in the study (1,220/54.5% from Republic of Cyprus and 1,018 from Greece). Overall 1,082 (48.3%) stressed their intention to get vaccinated (64.4% for Greece and 34.9% for Republic of Cyprus). The main reasons for those who intend to get the COVID-19 vaccine include self (94.2%), family (98.7%), and patients protection (95.2%) as well as mitigation of COVID-19 pandemic (95.4%). The multivariate logistic regression that was performed for the total sample revealed that the following variables were significantly associated with an increased probability to get vaccinated against COVID-19: being a physician, a member of the nursing personnel, paramedical staff, working in Greece, age, the belief that influenza vaccination should be mandatory for HCP, and the rating of the overall management of COVID-19 pandemic in the country and from the public hospitals. Physicians were more likely to get vaccinated against COVID-19 than other HCP. The age was a predictor of COVID-19 uptake intention in the Republic of Cyprus. The belief that there was a successful management of the COVID-19 pandemic contributed to the intention to COVID-19 vaccination uptake.

When Multidrug-Resistant Organism (MDRO)-Positive ICU Patient Isolation and Cohorting Is Not Feasible, What Comes Next?

Background The need for the implementation of an infection prevention strategy that included patient isolation and a cohorting procedure emerged in our ICU. Yet, isolation, as well as cohorting, were not feasible due to certain barriers associated with a high colonization pressure, open-plan ICU, inadequate bed separation, a limited number of isolation rooms, and nursing shortage. Despite these limitations, we tried to upgrade our ICU's infection prevention efforts by developing the "universal use of contact precautions approach" for infection prevention and control for all the patients with and without multidrug-resistant organisms (MDROs), cohorting, and single room isolation. The study aimed to evaluate the effectiveness of our approach. Methods A prospective cohort study using surveillance screening cultures for Methicillin-resistant Staphylococcus aureus (MRSA) and MDROs for a period of 18 weeks from October 1, 2018, to January 31, 2019. The main purpose of the approach was to isolate all patients (regardless of their MDRO/MRSA status) in their own bed space as if they were in an isolation room for the entire duration of their ICU hospitalization, in such a way as to prevent horizontal transmission of infection (infection acquisition) in our open-plan ICU.  Results Seventy-eight patients were admitted to our ICU for a total of 942 patient-days; a total of 432 swabs were collected during the study period. A total of 17 (21.8%) patients were admitted with a pre-existing infection while two (2.5%) patients acquired an infection during their ICU stay (one with Acinetobacter baumannii andone with Pseudomonas aeruginosa; 1.28 acquisition per 1000 patient-days). No transmission was documented for Klebsiella pneumoniae, Enterococcus faecalis, and Staphylococcus aureus. Conclusions Our MDRO acquisition rates suggested that the implementation of our infection control strategy potentially prevents the horizontal transmission of pathogens in an open-plan ICU, despite the high colonization pressure and the lack of isolation and cohorting procedures.

Association Between Upper Respiratory Tract Viral Load, Comorbidities, Disease Severity, and Outcome of Patients With SARS-CoV-2 Infection.

BACKGROUND: There is limited information on the association between upper respiratory tract (URT) viral loads, host factors, and disease severity in SARS-CoV-2-infected patients. METHODS: We studied 1122 patients (mean age, 46 years) diagnosed by polymerase chain reaction (PCR). URT viral load, measured by PCR cycle threshold, was categorized as high, moderate, or low. RESULTS: There were 336 (29.9%) patients with comorbidities; 309 patients (27.5%) had high, 316 (28.2%) moderate, and 497 (44.3%) low viral load. In univariate analyses, compared to patients with moderate or low viral load, patients with high viral load were older, more often had comorbidities, developed Symptomatic disease (COVID-19), were intubated, and died. Patients with high viral load had longer stay in intensive care unit and longer intubation compared to patients with low viral load (P values < .05 for all comparisons). Patients with chronic cardiovascular disease, hypertension, chronic pulmonary disease, immunosuppression, obesity, and chronic neurological disease more often had high viral load (P value < .05 for all comparisons). In multivariate analysis high viral load was associated with COVID-19. Level of viral load was not associated with any other outcome. CONCLUSIONS: URT viral load could be used to identify patients at higher risk for morbidity or severe outcome.

Nursing quality indicators for adult intensive care: A consensus study.

BACKGROUND: The selection of quality indicators demonstrating the efficiency and relevance of nursing practice in patient outcomes in the intensive care unit remains a challenge. AIM: The aim of this study was to develop a set of potential quality indicators to quantify nursing care provided to critically ill patients through a consensus method. DESIGN: This was a three-phase study including a European survey of intensive care unit (ICU) nurses (phase one) followed by a two-phase face-to-face consensus meeting of experts from Cyprus. METHOD: Two distinct panels of experts were asked to rate each quality indicator using a 4-point Likert scale in phases one and two. The level of consensus was set at 60%. In phase three, scores of the content validity index for items and scales were considered for the final selection of quality indicators. RESULTS: The phase one survey included 139 ICU nurses from 13 European countries, and phases two and three included seven ICU experts from Cyprus. "Consensus in" was achieved for 12 items at the end of phase two. Three of the quality indicators were significantly different by country: (a) falls (P = .006), (b) accidental removal of nasogastric tube (P < .001), and (c) accidental removal of intravascular catheters (P < .001). Only falls was significantly correlated with higher academic qualifications of the participants (P = .002). CONCLUSIONS: Fifteen items have been identified as potential indicators for adult ICU nursing quality. These need to be prospectively studied to determine the extent to which they can accurately capture nursing care quality in this setting. RELEVANCE TO CLINICAL PRACTICE: The study provides a set of relevant quality indicators. A nursing set for the ICU may serve as the basis for nursing management and facilitate the strategy dedicated to the vision of health care quality assurance.

Closing the gap: The effect of an evidence-based intervention in increasing COPD nurses' knowledge.

BACKGROUND: Chronic obstructive pulmonary diseases (COPD) is the leading cause of respiratory failure and is associated with high morbidity and mortality rates. Nurses play a vital role in ensuring effective, safe, and person-centered care in COPD. AIM: To assess the effect of an evidence-based intervention in increasing the COPD knowledge in a sample of care nurses, staffing public primary, and secondary healthcare services infrastructures and hospitals. METHODS: An intervention that entailed a combination of an educational program and the use of an educational algorithm based on the Global Strategy for the Diagnosis, Management, and Prevention of COPD was performed. RESULTS: At the baseline, the mean total percentage of correct answers was very low (52.74%) as opposed to the other time intervals in which there was a huge increase after the session that was maintained 3 and 6 months later. The highest effect in the total knowledge score was attributed to the educational session followed by the use of the educational algorithm. CONCLUSION: The effect of the intervention on the mean score of correct answers was very strong, which is confirmed by the consistency of the high performance of nurses after 3 and 6 months, respectively.

Transmission dynamics of SARS-CoV-2 within families with children in Greece: A study of 23 clusters.

There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection clustering within families with children. We aimed to study the transmission dynamics of SARS-CoV-2 within families with children in Greece. We studied 23 family clusters of coronavirus disease 2019 (COVID-19). Infection was diagnosed by reverse-transcriptase polymerase chain reaction in respiratory specimens. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values. There were 109 household members (66 adults and 43 children). The median attack rate per cluster was 60% (range: 33.4%-100%). An adult member with COVID-19 was the first case in 21 (91.3%) clusters. Transmission of infection occurred from an adult to a child in 19 clusters and/or from an adult to another adult in 12 clusters. There was no evidence of child-to-adult or child-to-child transmission. In total 68 household members (62.4%) tested positive. Children were more likely to have an asymptomatic SARS-CoV-2 infection compared to adults (40% vs 10.5%; P = .021). In contrast, adults were more likely to develop a severe clinical course compared with children (8.8% vs 0%; P = .021). In addition, infected children were significantly more likely to have a low viral load while adults were more likely to have a moderate viral load (40.7% and 18.6% vs 13.8% and 51.7%, respectively; P = .016). In conclusion, while children become infected by SARS-CoV-2, they do not appear to transmit infection to others. Furthermore, children more frequently have an asymptomatic or mild course compared to adults. Further studies are needed to elucidate the role of viral load on these findings.

Nurses attitudes and knowledge regarding patient rights: a systematic review / Atitudes e conhecimentos dos enfermeiros em relação aos direitos do paciente: uma revisão sistemática / Actitudes y conocimientos de las enfermeras sobre los derechos de los pacientes: una revisión sistemática

ABSTRACT Objective: To synthesize current evidence on nurses' attitudes and/or knowledge on the entire spectrum of patient rights. Method: A systematic search of the literature was performed in Web of Science, PubMed, Scopus and CINAHL. Studies were selected according to pre-defined inclusion/exclusion criteria. The Cochrane and PRISMA guidelines, including templates for systematic reviews, were applied. For rigor assessment, the Critical Appraisal Skills Program Qualitative Research Checklist, and the Center for Evidence-Based Management tool were employed. Results: Thirteen studies were included, that exhibited important methodological limitations, such as convenience sampling, mediocre response rates and inadequate instrument validity. Findings indicated: a) low level of awareness regarding patient rights among nurses, b) knowledge discrepancies on specific aspects of patient rights, c) low priority ascribed to a patient's right to access information, and d) insufficient evidence on formal educational sources of knowledge on the topic of patient rights. Conclusion: Narrow geographical localization, heterogeneity and methodological limitations render generalizability of the conclusions difficult. Further research based on robust methodology is proposed.

RESUMO Objetivo: Sintetizar as evidências atuais sobre as atitudes e/ou conhecimentos dos enfermeiros sobre todo o espectro dos direitos do paciente. Método: Uma busca sistemática da literatura foi realizada na Web of Science, PubMed, Scopus e CINAHL. Os estudos foram selecionados de acordo com critérios de inclusão/exclusão pré-definidos. As diretrizes Cochrane e PRISMA, incluindo modelos para revisões sistemáticas, foram aplicadas. Para uma avaliação rigorosa, foram utilizados o Critical Appraisal Skills Program Qualitative Research Checklist e a ferramenta do Center for Evidence-Based Management. Resultados: Foram incluídos 13 estudos que exibiram limitações metodológicas importantes, como amostragem por conveniência, taxas de resposta medíocres e validade inadequada do instrumento. Os resultados indicaram: a) baixo nível de consciência sobre os direitos do paciente entre os enfermeiros, b) discrepâncias de conhecimento sobre aspectos específicos dos direitos do paciente, c) baixa prioridade atribuída ao direito do paciente de acessar informações, e d) evidências insuficientes sobre fontes de conhecimento educacionais formais sobre o tema dos direitos do paciente. Conclusão: A localização geográfica estreita, a heterogeneidade e as limitações metodológicas dificultam a generalização das conclusões. Outras pesquisas baseadas em metodologia robusta são propostas.

RESUMEN Objetivo: Sintetizar la evidencia actual sobre las actitudes y/o conocimientos de las enfermeras sobre todo el espectro de los derechos del paciente. Método: Se realizó una búsqueda sistemática de la literatura en Web of Science, PubMed, Scopus y CINAHL. Los estudios se seleccionaron de acuerdo con criterios de inclusión/exclusión predefinidos. Se aplicaron las guías Cochrane y PRISMA, incluidas las plantillas para revisiones sistemáticas. Para una evaluación más rigurosa, se emplearon el Critical Appraisal Skills Program Qualitative Research Checklist y la herramienta del Center for Evidence-Based Management. Resultados: Se incluyeron trece estudios, que exhibieron importantes limitaciones metodológicas, como muestreo por conveniencia, tasas de respuesta mediocres y validez inadecuada del instrumento. Los hallazgos indicaron: a) bajo nivel de conciencia sobre los derechos del paciente entre las enfermeras, b) discrepancias de conocimiento sobre aspectos específicos de los derechos del paciente, c) baja prioridad atribuida al derecho del paciente a acceder a la información, y d) evidencia insuficiente sobre fuentes formales de conocimiento educativo sobre el tema de los derechos del paciente. Conclusión: La estrecha localización geográfica, la heterogeneidad y las limitaciones metodológicas dificultan la generalización de las conclusiones. Se propone más investigación basada en una metodología robusta.

Children and Adolescents With SARS-CoV-2 Infection: Epidemiology, Clinical Course and Viral Loads.

BACKGROUND: There is limited information on severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection in children. METHODS: We retrieved data from the national database on SARS-CoV-2 infections. We studied in-family transmission. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values. RESULTS: We studied 203 SARS-CoV-2-infected children (median age: 11 years; range: 6 days to 18.4 years); 111 (54.7%) had an asymptomatic infection. Among the 92 children (45.3%) with coronavirus disease 2019 (COVID-19), 24 (26.1%) were hospitalized. Infants <1 year were more likely to develop COVID-19 (19.5% of all COVID-19 cases) (P-value = 0.001). There was no significant difference between viral load and age, sex, underlying condition, fever and hospitalization, as well as between type of SARS-CoV-2 infection and age, sex, underlying condition and viral load. Transmission from a household member accounted for 132 of 178 (74.2%) children for whom the source of infection was identified. An adult member with COVID-19 was the first case in 125 (66.8%) family clusters. Child-to-adult transmission was found in one occasion only. CONCLUSIONS: SARS-CoV-2 infection is mainly asymptomatic or mild during childhood. Adults appear to play a key role in spread of the virus in families. Most children have moderate or high viral loads regardless of age, symptoms or severity of infection. Further studies are needed to elucidate the role of children in the ongoing pandemic and particularly in light of schools reopening and the need to prioritize groups for vaccination, when COVID-19 vaccines will be available.

Influenza vaccination policies for health workers in low-income and middle-income countries: A cross-sectional survey, January-March 2020.

INTRODUCTION: The World Health Organization (WHO) recommends vaccination of health workers against influenza, but uptake in low-resource settings remains low. To complement routine global data collection efforts we conducted a detailed survey on influenza vaccination policies for health workers in low-income and middle-income countries (LMICs) in early 2020. METHODS: Health worker vaccination policy data were collected via a web-based survey tool sent to Expanded Programme on Immunization managers or equivalent managers of all eligible countries. High-income countries and countries with active civil war were excluded from the participation. The survey was sent by email to 109 LMICs in all WHO Regions to invite participation. Data were analyzed by World Bank income category and WHO Region. Statistical methods were applied to assess mean vaccination rates across countries. RESULTS: Sixty-eight (62%) out of 109 invited LMICs were studied. Thirty-five (51.5%) reported to have a policy for influenza vaccination of health workers. Vaccinations were voluntary in 23 countries (66%), mandatory in 4 (11%), while in 8 countries (23%) mixed vaccination policies existed. A mechanism to estimate vaccine uptake existed in 26 countries (74%). Low-income and African Region countries were less likely to have influenza vaccination policies for health workers (p-values < 0.001 and 0.009, respectively). The most common reason for not having a vaccination policy for health workers was influenza not being a priority (48.5%). CONCLUSIONS: Despite policies being in place in more than half LMICs studied, gaps remain in translating vaccination policies to action, particularly in low-income and African Region countries. To optimize the operationalization of policies, further research is needed within countries, to enable evidence-based introduction decisions, categorization of health workers for vaccination, identification of factors impacting effective service delivery, strengthening monitoring and estimation of vaccination uptake rates and ensure sustainability of funding.

Dynamic Risk Stratification for Predicting Treatment Response in Differentiated Thyroid Cancer.

Prognosis in Differentiated Thyroid Cancer (DTC) patients is excellent, but a significant degree of overtreatment still exists because of the inability to accurately identify small patient cohorts who experience a more aggressive form of the disease, often associated with certain poor prognostic factors. Identifying these cohorts at an early stage would allow patients at high risk to receive more aggressive treatment while avoiding unnecessary and invasive treatments in those at low risk. Most risk stratification systems include age, tumor size, grade, presence of local invasion, and regional or distant metastases. Here we discuss these common factors as well as their association with treatment response, but also other upcoming markers including histology and multifocality of primary tumor, dose administered and preparation method for Radioiodine Therapy (RAI), Thyroglobulin (Tg), Anti-thyroglobulin Antibodies (Tg-Ab) levels both at initial management and during follow-up, and the presence of previously existing benign thyroid disease. In addition, we examine the role of remnant size and avidity as well as surgeons' experience in performing thyroidectomies with recurrence rate, discussing its impact on disease prognosis. Our results reveal that treatment response has a statistically significant association with histology, T and M stages, surgeons' experience, Tg levels and remnant score both during RAI and follow up and Tg-Ab levels during follow-up whole body scan (WBS).

Data on advanced glycation end-products concentrations and haemodynamic parameters following caffeine and nicotine consumption in nursing students.

This work presents data from a non-invasive interventional trial investigating the early effects of caffeine and nicotine on both the concentrations of advanced glycation end-products (AGEs) and haemodynamic parameters in 178 healthy nursing students aged between 18 and 40. These students were allocated into four groups (A, B, C and D) and the concentrations of AGEs as well as haemodynamic parameters were measured non-invasively using the AgeReader and the Finometer devices, respectively. The haemodynamic parameters that were measured included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, inter-beat interval, stroke volume, cardiac output, ventricular ejection time, total peripheral resistance, ascending aorta impedance and total arterial compliance. According to our protocol, each beverage contained 100 mg of caffeine each cigarette contained 1.5 mg of nicotine. The present data reveal the combined effect of smoke and caffeine consumption to several hemodynamic parameters that may be related to the onset of elevated blood pressure during smoking and following caffeine consumption.

The Importance of an Active Case Detection (ACD) Programme for Malaria among Migrants from Malaria Endemic Countries: The Greek Experience in a Receptive and Vulnerable Area.

Greece has been malaria-free since 1974. In October 2011, following an outbreak of 36 locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases. We evaluated the PACD program for the years 2012-2017 using indicators such as the number of locally acquired cases, the detection rate/sensitivity and the timeliness of diagnosis and treatment. We visited each migrant home every 7-15 days to screen migrants for malaria symptoms, performing Rapid Diagnostic Tests (RDTs) and blood smears on symptomatic patients. We estimated: (i) the number of malaria cases detected by the PACD, divided by the total number of reported malaria cases during the same period among the same population; (ii) the time between onset of symptoms, diagnosis and initiation of treatment. The total number of migrants who were screened for malaria symptoms for the years 2012-2017 was 5057 with 84,169 fever screenings conducted, while 2288 RDTs and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reported in 2012 and 2015, respectively. Sensitivity of PACD ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness between diagnosis and treatment initiation was 0 h. The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction.