Exploring Perceptions and Practices Regarding Adult Vaccination against Seasonal Influenza, Tetanus, Pneumococcal Disease, Herpes Zoster and COVID-19: A Mixed-Methods Study in Greece.

We aimed to document vaccination coverage for five vaccines, predictors of each vaccine's uptake and attitudes regarding adult vaccination. Adults visiting four pharmacies were randomly invited to participate during summer 2022. Among 395 participants (mean age 51.2 years, range 19-96), vaccination rates were 78.1% for influenza and 25.8% for herpes zoster (≥60 years old), 64.3% for pneumococcal disease (≥65 years old), 33.1% for tetanus, while 11.4% had received two and 74.8% ≥3 COVID-19 vaccine doses. Half of participants (50.1%) voiced some degree of hesitancy, and 1.3% were refusers. The strongest predictor of each vaccine's uptake was doctor's recommendation (OR range 11.33-37.66, p < 0.001) and pharmacist's recommendation (4.01-19.52, p < 0.05), except for the COVID-19 vaccine, where the Attitude Towards Adult VACcination (ATAVAC) value of adult vaccination subscale's score was the only predictor (OR: 5.75, p < 0.001). Regarding insufficient coverage, thematic content analysis revealed seven main themes. Insufficient knowledge, the absence of health professionals' recommendation, perception of low susceptibility to disease, negligence and dispute of vaccine effectiveness were universal themes, whereas safety concerns and distrust in authorities were reported solely for COVID-19 vaccination. Designing public interventions aiming to increase trust in adult vaccination is essential in the aftermath of the COVID-19 pandemic. Health professionals' role in recommending strongly adult vaccination is crucial.

Stress, Professional Burnout, and Employee Efficiency in the Greek National Organization for the Provision of Health Services.

BACKGROUND: Workplace stress and burnout in the Greek healthcare system had been considered severe even before the high pressure of the COVID-19 pandemic. We aimed to investigate occupational quality of life and burnout effects on workplace errors among the administrative staff in the Greek healthcare system. METHODS: We enrolled 120 administrative healthcare employee participants between April and May 2019. Occupational burnout was assessed using the Maslach Burnout Inventory-Human Services Survey and the Hospital Anxiety and Depression Scale. FINDINGS: Inadequate staffing, a low sense of well-being, exhaustion, and low family income were associated with workplace errors. Increased workload and staff shortages were associated with occupation related quality of life. CONCLUSIONS: Targeted interventions supporting healthcare staff mental health are warranted. APPLICATION TO PRACTICE: Wellness and professional burnout can affect professional efficiency and are associated with workplace errors in the healthcare sector. Targeted interventions are warranted to support the mental health of healthcare staff during work and to prevent incidents of post-traumatic stress. Shortages of staffing may lead to an increase in the cost of the provided services.

The Impact of Change Management in the Greek National Health System: A Quantitative Study.

INTRODUCTION:  Serious changes took place in Greece due to the economic crisis of 2008, which led to significant changes in Greece's health sector. The reforms and changes that were made to the National Health System (NHS) aimed to improve it, provide quality services to its users, and adapt it to Greece's new external environment. The aim of this study was to assess the management of these changes by the leadership of the NHS and to examine their effectiveness. MATERIAL AND METHODS: The survey was based on quantitative research methods, using a questionnaire as a research tool. The sample population comprised employees of a tertiary-care public hospital in northern Greece. RESULTS:  We recruited a sample size of 100 participants for the survey. The questionnaire's Cronbach's alpha was equal to 0.724. The overall change management was moderate, and Greece's NHS did not follow a specific change-management model that provided principles facilitating the success of the effort. The most serious problems identified by using the questionnaire were the following: the changes were not structured and clear, the management set unrealistic goals and objectives, the changes to the NHS were made without the appropriate financial support, and there is uncertainty about the future of health care in Greece. CONCLUSION: The present study showed that changes cannot be made randomly; rather, they require careful planning and organization. Further changes, continuous feedback, and development are required to improve the status of Greece's healthcare system.

Development and Validation of the Life for Low Vision Questionnaire (LIFE4LVQ) Using Rasch Analysis: A Questionnaire Evaluating Ability and Independence.

Low vision (LV) has a substantial impact on an individual's daily functionality and patient-reported outcome measures (PROMs) are increasingly incorporated into the evaluation of this problem. The objective of this study was to describe the design of the new "Life for Low Vision Questionnaire (LIFE4LVQ)", as a measure of daily functionality in LV and to explore its psychometric properties. A total of 294 participants completed the LIFE4LVQ and the data were subjected to Rasch analysis to determine the psychometric properties of the questionnaire, including response category ordering, item fit statistics, principal component analysis, precision, differential item functioning, and targeting. Test-retest reliability was evaluated with an interval of three weeks and intraclass correlation coefficients (ICC) were used. The correlation between the questionnaire score and Best Corrected Visual Acuity (BCVA) was examined using Spearman's correlation coefficient. Rasch analysis revealed that for most items the infit and outfit mean square fit values were close to 1, both for the whole scale and its subscales (ability and independence). The separation index for person measures was 5.18 with a reliability of 0.96, indicating good discriminant ability and adequate model fit. Five response categories were found for all items. The ICC was 0.96 (p < 0.001; 95% CI, 0.93-0.98), suggesting excellent repeatability of the measure. Poorer BCVA was significantly associated with worse scores (rho = 0.559, p < 0.001), indicating excellent convergent validity. The functional, 40-item LIFE4LVQ proved to be a reliable and valid tool that effectively measures the impact of LV on ability and independence.

Breaking Bad News During the COVID-19 Pandemic: A Systematic Review of the Literature.

The aim of the present review was to extend research by reviewing international research regarding the communication between oncologists and oncology patients and the communication of bad news to oncology patients during the COVID-19 pandemic. Following the PRISMA guidelines a review of the literature was performed by searching PubMed, Scopus, and EMBASE bibliographic databases from inception to October 10, 2022. The search was limited to articles written in English. Two reviewers independently completed title and abstract, full-text screening, and data extraction. A total of five studies were deemed eligible for this systematic review. A narrative synthesis was undertaken. Of these five articles, three referred to the communication of bad news to patients by medical oncologists during the COVID-19 pandemic, whereas the remaining two referred to the transmission of bad news to patients by surgeons during the pandemic. The COVID-19 pandemic and the social distancing measures imposed caused radical changes in the forms of communication in medical environments. The challenges faced by the oncologist in breaking bad news to cancer patients are highlighted in this systematic review, and the need for physician preparation prior to communication with the patient is emphasized. Overall, new studies are needed on the effects of distance communication on both health professionals and patients. New studies are also needed that would explore the perceptions of physicians and patients in Greece.

Mortality and morbidity from infectious and non-communicable diseases in Greece during Axis/Nazi military occupation (1941-1944).

Greece has been severely damaged by the Second World War and the subsequent military occupation of the country by the Axis forces headed by Nazi Germany. The Greek society and economy were dislocated as a result of plundering of the country's vital resources, as well as enforced payments, instead paid to the occupying forces. The dramatic food shortages and famine appeared plaguing especially large cities. There is very limited information on the trends of mortality and morbidity (1941-1944) at a national level. The morbidity and mortality statistics of the General Statistical Service of Greece were assessed and the incidence morbidity and mortality rates have been calculated. As denominator population we used the population of Greece according to 1940 census. The morbidity due to exanthematic typhus, typhoid fever, dysentery and meningitis has been elevated over the period 1940-1944. An elevated specific mortality due to tuberculosis, malaria and typhoid fever was observed over the period 1940-1941. Regarding non-communicable diseases, the mortality due to hemorrhagic stroke was increased after 1940. In conclusion, we found that the Axis/Nazi military occupation of Greece had considerable health effects on infectious diseases and hemorrhagic stroke mortality. Deaths ostensibly due to infectious diseases (e.g. tuberculosis or malaria), were expedited by the hunger famine of the period under investigation. With regard to the elevated mortality due to hemorrhagic stroke, we believe that the stressful events of occupation and famine have triggered increased psychosocial stress which in turn may have increased the risk of hemorrhagic stroke mortality during the period of Axis/Nazi occupation of Greece.

Views and Experiences of Health Service Users in Greece During 2012-2018.

During the period of 2012-2018, a series of reforms took place in the Greek health care system. These reforms focused on both the health expenditure and the efficiency and quality of health services provided. In this qualitative study, we examined whether these improvements were visible to health service users based on their personal experiences with the health care system, using thematic content analysis to evaluate the research data. The results indicated that the reforms did not meet the original objectives in several fields such as primary health care, health expenditure streamlining, health service affordability, and confidence in the health care system and professionals. Further interventions are required to improve the status of the Greek health care system.

Intake and adequacy of the vegan diet. A systematic review of the evidence.

BACKGROUND: Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations. METHODS: A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included. RESULTS: Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower (0.24-0.49 µg, recommendations are 2.4 µg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B1, Β6, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load. CONCLUSIONS: Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.

Nationwide Survey in Greece about Knowledge, Risk Perceptions, and Preventive Behaviors for COVID-19 during the General Lockdown in April 2020.

BACKGROUND: The aim of this study was to investigate the knowledge, attitudes, and practices of the Greek general population toward coronavirus disease 2019 (COVID-19) during the lockdown period in April 2020, to examine factors associated with misperceptions and to determine behavioral patterns that may require interventions. METHODS: A cross-sectional study of the general Greek population (N = 1858) was conducted. A geographically stratified cluster sampling was implemented. A questionnaire was composed consisting of 35 questions. Data collection took place from 15 April to 2 May 2020. A random-digit dialing survey was conducted by 29 interviewers. RESULTS: The majority of respondents (62.7%) answered ≥12/17 questions correctly. Participants aged 18-44 years, male gender, specific occupations (freelancer, unemployed, housewife, retiree) and those who sought information about COVID-19 from less than two sources received lower aggregated scores on knowledge questions. Regarding attitudes toward future vaccination, 18.9% declared that were against it, while 81.1% that they may consider or will be vaccinated. About 40% were not using a face mask and only 42% washed their hands appropriately. CONCLUSION: Adjusting information campaigns targeting especially people below 45 years of age can help to sensitize them and realise their role to control the spread. Further targeted surveys are needed to adjust/design prevention campaigns.

Exploring primary healthcare professionals' experiences as educators on safe internet use: a school-based intervention from Greece.

AIM: The objective of this study was to explore the experiences and level of awareness among primary healthcare (PHC) professionals, who were trained and encouraged to participate as educators in a school-based intervention for safe internet use. METHODS: All directors of the PHC centers of the Third Health Authority of the prefecture of Macedonia, Greece were asked to invite their personnel to participate voluntarily in a project on safe internet use. Participants attended a 1-day train-the-trainers course on cyber-safety in order to serve as educators in a school-based intervention in their communities. An evaluation questionnaire was completed anonymously and voluntarily by the professionals 1 month after completion of the school intervention. The answers to the open-ended questions were analyzed using thematic content analysis. RESULTS: Forty-six PHC professionals from 13 PHC centers (response rate 72.2%) were trained. They served as educators to 30 middle schools and 21 high schools, reaching 8053 students, aged 12-18 years, from urban (22.5%), semi-urban (36.3%) and rural areas (41.2%). The experience was evaluated as positive by all 46 professionals, who recognized the following benefits: (i) acquisition of new knowledge on pathological internet use, (ii) ethical reward for raising awareness in students on the potential threats of internet use, (iii) revitalizing effect of the interaction with youth and (iv) reinforcement of cooperation and team spirit. CONCLUSIONS: The combined trainee's and trainer's experience could be rewarding and satisfying, contributing in raising PCH professionals' own awareness on new topics that should be included in their continuous educational agenda. Furthermore, involvement of trained PHC providers as educators in school-based interventions could reinforce their role in health promotion within their communities, both urban and rural.

Raising awareness on cyber safety: adolescents' experience of a primary healthcare professional-led, school-based, multi-center intervention.

Purpose Although safe Internet use is an emerging public health issue, there is a scarcity of published work describing relevant school-based interventions. The objective of this study was to explore the impact of a health professional-led, school-based intervention in raising awareness on cyber-safety in adolescents, Therefore, the aim of this study was to investigate adolescents' evaluation of this school-based intervention, 6 months after its implementation, as well as the impact of adolescents' school class and gender on their evaluation. Methods A student sample was selected using a multistage stratified random sampling technique, according to the location and school grade level (middle, high school). The students - aged from 12 to 18 years old experienced an interactive presentation in their classrooms on the amount of time spent online, the use of social networks and the available support services. An evaluation tool was completed anonymously and voluntarily 6 months after the intervention. Results Four hundred and sixty-two students (response rate 90.7%, 246 middle, 216 high school) completed the evaluation tool. Younger students, especially the ones in the first year of middle school, scored significantly higher in all six parameters used in the evaluation of this intervention compared with all the older participants: (a) they had kept the presented information on Safeline and Saferinternet websites and the helpline Ypostirizo (70.2% vs. 33.7%, p < 0.001) (b) they had already used it (32.5% vs. 12.3%, p < 0.001), (c) they had learned new information on cyber safety (66.4% vs. 34%, p < 0.001), (d) they rated the intervention as more interesting (median 8 vs. 7, p < 0.05), (e) they had reconsidered the way they use Internet (median 7 vs. 6, p < 0.05) and (f) they had changed their cyber behavior (median 7 vs. 5, p < 0.05). Conclusion The active involvement of students in a discussion on cyber-safety based on their experiences was highly evaluated. The impact of the intervention on the youngest students underlines the need for raising awareness on cyber-safety and support services, earlier in the students' life.

Pathological Internet use, cyberbullying and mobile phone use in adolescence: a school-based study in Greece.

Purpose This study investigated the prevalence of Internet addiction (IA) and cyberbullying and examined profiles of adolescents with increased risk to develop pathological behaviors. Methods In this cross-sectional, school-based study, 8053 students of 30 middle and 21 high schools (12-18 years old) were invited to participate, based on a multistage stratified random sampling technique. The Internet aiddiction test (IAT) was used along with information on socio-demographics, Internet activities and cyberbullying experience. Results Five thousand five hundred and ninety students participated (response rate 69.4%). Pathological Internet use (IAT ≥50) was found in 526 (10.1%), while 403 (7.3%) experienced cyberbullying as victims and 367 (6.6%) as perpetrators during the last year. In multivariable models, the odds of IA increased with online hours on mobile phones and Internet use during weekends, Internet café visits, chatrooms usage and engagement in cyberbullying. Cyberbullying victims were more likely to be older, female, Facebook and chatrooms users, while perpetrators were more likely to be male, older Internet users and fans of pornographic sites. A perpetrator was significantly more likely to have also been a victim [odds ratio (OR) = 5.51, confidence interval (CI): 3.92-7.74]. Hours of daily Internet use on a mobile phone was independently associated with IA and cyberbullying (OR) 1.41, 95% CI 1.30, 1.53 and OR 1.11, 95% CI 1.01, 1.21, respectively. Conclusions Cyberbullying is associated with IA and the hours spent online on a mobile phone affected both conditions. The increasing Internet access through mobile phones or other devices should be accompanied by the appropriate education of both parents and adolescents on safe Internet use.

Internet addiction in Greek medical students: an online survey.

OBJECTIVE: The authors investigated the prevalence of Internet addiction (IA) in undergraduate medical students to identify possible associations with sociodemographics and Internet habits. METHODS: All students at the Aristotle University of Thessaloniki School of Medicine, Greece, were invited to complete the online Internet Addiction Test (IAT) along with sociodemographics and preferences on Internet activities. RESULTS: The authors received 585 responses after three reminders (23.5 % response rate). Mild IA was found in 24.5 %, moderate in 5.4 %, and severe in 0.2 %. In multivariable analysis, the odds to develop IA were increased with visits in Internet cafes (Odds Ratio [OR] 3.49, 95 % Confidence Interval [CI]: 1.45, 8.46), the use of Facebook (OR 2.43, 95 % CI: 1.35, 4.38), Twitter (OR 2.45, 95 % CI: 1.37, 4.39), and online games (OR 1.95, 95 % CI: 1.29, 2.94). Using e-mails seemed to be protective against IA (OR 0.59, 95 % CI: 0.37, 0.94). CONCLUSION: This is the first IA prevalence study in a European medical school. Early-detection systems and other ways to help students with pathological behaviors should be developed.

Greek version of the Internet Addiction Test: a validation study.

The aim of this project was to translate, culturally adapt and validate the Internet Addiction Test (IAT) in Greek adults. Twenty-one post-graduate medical students participated in the cultural adaptation procedure and 151 both post- and under-graduate medical students in the validation process. The internal consistency shown by a Cronbach's alpha was 0.91. Two-week test-retest reliability was rtt = 0.84, p < 0.001. Face validity was affirmed by 83.6 % of the students. In terms of convergent validity, the hours of daily internet use were positively correlated with IAT score (rho = 0.48, p < 0.001). Moreover, IAT scores were higher in students that reported use of online gambling (40.5 vs 29.2, p = 0.004), pornographic sites (36.5 vs 28.0, p = 0.003) and online games (35.6 vs 28.2, p = 0.009). Exploratory factor analysis revealed three interpretable factors for the IAT, "Psychological/Emotional Conflict", "Time Management" and "Neglect Work", that showed good internal consistency and concurrent validity, explaining 55.3 % of the variance. The Greek version of IAT has shown good psychometric properties, comparable with the original IAT and the previously published translated versions, and can be a useful tool in future studies on internet addiction.