The Relationship Between Quality of Life, Psychological Wellbeing, Satisfaction with Life and Acculturation of Immigrants in Greece.

Few studies have examined the quality of life of immigrants in Greece and its relations to acculturation. This study explored the quality of life, psychological wellbeing and satisfaction with life among Albanian immigrants, Pontic Greeks in comparison to native Greeks. Furthermore, the relationship between quality of life, psychological wellbeing, satisfaction with life and acculturation of Albanian immigrants and Pontic Greeks was investigated. The study was based on 520 participants from broader area of Athens, 58.3% (303 people: 150 men and 153 women) native Greeks, 21.9% (114 people: 57 men and 57 women) Albanian immigrants and 19.8% (103 people: 50 men and 53 women) Pontic Greeks. Quality of life was measured by WHOQOL BREF-while wellbeing was measured with Satisfaction With Life Scale and The Affect Balance Scale. An adapted a version of Vancouver Index of Acculturation was used to assess acculturation of immigrants. The findings indicated three important factors contributed to quality of life and wellbeing of immigrants: ethnicity, heritage dimension of acculturation and gender. Albanian immigrants and Pontic Greeks scored lower on quality of life and satisfaction with life than native Greek.

A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population.

OBJECTIVES: The Maastricht Upper Extremity Questionnaire (MUEQ) is a tool to examine the physical, psychological and environmental risk factors in the work place that may contribute to the prevalence of complaints of arm, neck and shoulder. The aim of this study was to develop a Greek language version of the MUEQ and to assess its psychosocial parameters. METHODS: The MUEQ was translated into the Greek language and culturally adapted. Exploratory factor analysis was used to analyze interrelations among the questionnaire items and for each of the seven domains two factors were given, thus resulting in the identification of a total of 14 factors. RESULTS: The tool was handed out to 455 computer office workers (179 males, 276 females) with a mean age of 37.4 (SD 9.2). Factor analysis and Cronbach's alpha coefficient indicate that the results are generalizable to the population and the total scale has high internal consistency. The results showed that in the last year, 35.8% of respondents experienced upper extremity pain, specifically in the neck or the shoulders. CONCLUSIONS: The Greek version of the MUEQ appears to be a valid tool for the assessment of risk factors related to pain in the upper extremity among Greek computer office workers.

Duloxetine-induced hypomania: case report and brief review of the literature on SNRIs-induced mood switching.

Manic switching during antidepressant treatment has been reported with every class of antidepressant drugs. Serotonin-noradrenaline reuptake inhibitors (SNRIs) have been increasingly used for the treatment of unipolar and bipolar depression and are well tolerated and sufficiently effective because of their dual mechanism of action. A case of duloxetine-induced hypomania in a non-bipolar patient is presented, and a brief review of all cases of SNRIs' induced mania and hypomania has been carried out. The available data suggest that SNRIs, especially venlafaxine, can induce mood switching in patients with bipolar depression and in certain patients with unipolar depression, but the potential of duloxetine and milnacipran to induce manic or hypomanic symptoms cannot be disregarded. Switching appears to be dose-related and treatment initiation with lower doses and upward titration when needed may be preferable in selected cases and may help minimizing the risk of mood switching.

Factor analysis and normative scores of Alcohol Use Disorders Identification Test (AUDIT) in a representative sample of the general population of Greece.

The most widely used screening instrument for alcohol use disorders (AUD) is the Alcohol Use Disorders Identification Test (AUDIT) which, although initially developed for use in primary care, is increasingly used in general population studies. Previous studies that have assessed the screening properties and the factorial structure of AUDIT were mostly based on clinical samples and did not take into consideration the possible differences in AUDIT factorial properties between subgroups according to age, sex and mental health status. Aim of the current study was to explore the distribution of AUDIT and AUDIT-Consumption (AUDIT-C) scores and the factorial structure of AUDIT in subgroups of participants according to sex, age and the presence of mental health disorder. Descriptive statistics and Exploratory/Confirmatory Factor Analysis of AUDIT were extracted in a general population representative sample of 4,894 Greek participants. Different cut-offs are suggested in order to screen 10% of the population with the highest severity of AUD into the aforementioned subgroups. Generally, a cut-off between 10-12 at AUDIT score is suggested for screening the 10% with the highest severity of alcohol use problems in subgroups of frequent alcohol consumers (e.g. younger males) and a cut-off between 4-5 would screen the 5% with the highest severity of alcohol use problems in subgroups of low alcohol-consumers (e.g. older women). A cut-off of 3 in AUDIT-C score is suggested for screening 25% of individuals with the heaviest alcohol consumption. The traditional three-factor model does not explain better the factorial structure of AUDIT compared to the 2-factors model. The AUDIT is a reliable instrument for assessing AUD and heavy alcohol consumption in the Greek general population. Age, sex and the presence of mental health disorders should be taken into consideration when selecting cut-offs for screening purposes in non-clinical samples.

[A proposal for the implementation of Early Intervention in Psychosis (EIP) services in Greece: If not now, when?]

The disorders of the psychosis spectrum, with the most severe being schizophrenia, are prevalent and have a great impact on the patients' quality of life. The purpose of this article is to highlight the need for a novel national strategic approach to the management of psychotic disorders in accordance with the international principles of early intervention. Even though outpatient treatment is considered adequate, there is an urgent need to adopt an early and more comprehensive and effective intervention strategy for young patients with psychosis and their families whose clinical and personal needs are clearly not met by the existing infrastructure of our mental health services. This can be accomplished by the legislation and implementation within the national health system of EIP services which on the one hand actively engage community organizations with the purpose of early identification of cases, reduction of the duration of untreated psychosis and on the other, offer assertive community-based support and treatment, based on a multi-disciplinary community team model. The effectiveness of early intervention in psychosis is supported by evidence provided by 9 international RCTs. The results of these programs indicate a superior effect in indexes of quality of life, retention in treatment, psychopathology, judicious use of medication and return to work/school as well as the patient's effective recovery. International experience (Denmark, Norway, Australia, UK, USA, Canada and Italy) and the corresponding prevention programs emphasize the effectiveness of EIP services and thus the patients' reintegration. However, in contrast to Northern European countries, Southern European countries have not yet incorporated EIP services in their national health system. From a financial perspective, EIP services seem to be cost-effective for the national health system, since the economic burden is compensated in the long term through their qualitative benefits. In Greece, specialized services for those young afflicted for the first time by the most serious of mental disorders are non-existent and no local information exists for the patient's outcome and social integration after a first psychotic-episode nor for the financial burden, placed on mental health services. Overall, the implementation of EIP services is expected to have long-term benefits for our country's National Health System as well as for the patients and their families.

Assessing depression in Greek dementia patients: Which scale to use?

Depression in dementia is known to deteriorate patients' cognitive function and Quality of Life and to increase the burden of care. Although detecting depression in dementia is crucial, there is no gold standard for its screening and diagnosis. We examined the psychometric properties of 3 different scales in detecting depression in dementia. Results will be useful as community services for dementia in the country are developing and the need for reliable detection of depression in dementia patients is urgent. Our sample consisted of 136 Greek dementia patients who consulted a memory clinic. For the diagnosis of depression, DSM-IV criteria for major depression and 3 different depression measures were used: a self-assessment scale (Geriatric Depression Scale; GDS), a caregiver assessment scale (Neuropsychiatric Inventory-Depression; NPI-D) and a clinician rated scale (Cornell Scale for Depression in Dementia; CSDD). For the evaluation of the screening performance of the three depression scales receiver operating characteristic curve (ROC) analysis was applied. The DSMIV criteria served as the gold standard method for the diagnosis of major depression. CSDD showed the best psychometric properties for the diagnosis of depression in dementia. The ROC curve analysis revealed that among the three measures, the CSDD had the wider AUC (0.919), second in the width of the AUC was the GDS (0.871), and last was the NPI-D (0.812). The prevalence of depression ranged from 18.4% according to DSM-IV criteria to 42.6% using the NPI-D. Using the GDS (cut off point: 7/8) and the CSDD (cut off point: 6/7), depression was present in 26.9% and 33.1% of the patients, respectively. Correlations between scales used were significant (r from 0.432 to 0.660; p<0.001). Caregivers tend to report more depressive symptoms in dementia compared to patients' and clinicians' ratings. CSDD should be used in specialized centers, but GDS may be an alternative in patients able to complete the assessment. The need to establish valid criteria for the diagnosis of depression in dementia is urgent.

Sex differences in the prevalence and detection of depressive and anxiety disorders in general health care settings: report from the World Health Organization Collaborative Study on Psychological Problems in General Health Care.

BACKGROUND: Understanding the relevance of biological and social factors to sex differences in the prevalence and detection of depressive and anxiety disorders has been impaired by the lack of standardized research methods across cultures. METHOD: Prevalence rates of depressive and anxiety disorders were assessed using a 2-stage design from 26,969 patients attending for primary care in 15 centers from 4 continents. Logistic regression analysis was used to examine sex differences in prevalence and detection across centers. RESULTS: Odds ratios for women compared with men of current depression (1.60; 95% confidence interval [CI], 1.37-1.86) and agoraphobia or panic (1.63; 95% CI, 1.18-2.20) were consistent across centers. The odds ratio for generalized anxiety varied among centers: 3 groups of centers were identified with odds ratios of 0.46 (95% CI, 0.27-0.78), 1.34 (95% CI, 1.08-1.66), and 3.09 (95% CI, 1.60-5.89). There was no sex difference in the detection of depressive and anxiety disorders by physicians across centers. CONCLUSIONS: The absence of a sex-by-center effect for current depression and agoraphobia or panic disorder is consistent with biological and psychosocial factors, either interacting or working alone, that have a similar final effect across cultures. It does not support the idea that sex differences in prevalence are caused by local psychosocial factors that vary from country to country. The variation in the odds ratio for generalized anxiety disorder offers some support to the idea that there are local differences between the centers contributing to the sex difference in rates. Patients' sex does not appear to affect the likelihood of current depression and anxiety being detected by primary care physicians.

The burden of caring for patients with dementia and its predictors.

Dementia not only affects patients but also care providers. The assessment of Caregivers' Burden (CB) has grown exponentially in the dementia field, as studies have shown that it is higher in dementia than in other diseases. Dementia care in Greece is different compared to other developed countries, as most of the patients receive care at home from family members. The aim of the present study was to examine the level of burden in Greek caregivers who live in Athens, and its association with patient and caregiver factors. This was a cross-sectional study of 161 primary caregivers of dementia patients living in the community and attending a secondary clinic. CB was assessed with the Zarit Burden Interview (ZBI) and caregivers' depression with the Center for Epidemiological Studies Depression Scale (CES-D). Clinical characteristics of the patients were also assessed using validated scales (cognitive status, functional ability, neuropsychiatric symptoms). In order to find predictors of caregiver Burden, we conducted a 3-step hierarchical regression analysis. Most patients were suffering from Alzheimer's Dementia (n=101; 62.73%) and had moderate and severe dementia according to the MMSE score (mean MMSE=11.50), with patients being unable to perform 2 basic activities of daily living on average. 45 patients (27.95%) had depression according to the CSDD; only 5 patients didn't have any behavioral problem in the NPI, while patients had more than 5 behavioral problems on average. Caregivers were involved in their role for 3.6 years on average and the mean weekly caregiving time was more than 70 hours. Nearly half (n=80; 49.06%) of the 161 caregivers demonstrated high CB (ZBI>40) and nearly one fourth had depression according to the CES-D scale. All blocks of variables entered into the regression model independently predicted caregiver burden's variance (demographics, clinical factors and caregiving characteristics). Lower caregiver's age, high behavioral symptoms of dementia patients and caregivers' depression were found to be independently associated with CB. The final regression model explained 47.2% of the variance in CB. Dementia causes a great burden in caregivers. CB is a complex issue that is associated with several patients and caregivers' factors. The level of CB should be assessed in everyday dementia clinical practice.

Concordance of DSM-IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS-ADR, CIDI and SCAN.

This study was designed to examine the agreement of DSM-IV alcohol and drug use disorder diagnoses generated by three WHO/NIH diagnostic instruments, the AUDADIS-ADR, the CIDI, and the SCAN. This substudy, conducted in three countries, Greece, Luxembourg, and the United States, was part of the larger joint project on diagnosis and classification of mental disorders and alcohol and drug-related problems, which was initiated to evaluate the cross-cultural applicability of the instruments and the criteria. Overall, concordance among the three assessments was good for alcohol and opiate dependence, fair to good for cocaine and sedative dependence, and low for amphetamine dependence. Cannabis dependence concordance was significantly more discrepant than any other substance. Agreement on abuse was low for all substances examined. In addition, the concordance of DSM-IV criteria for each substance was examined. Finally, reasons for discrepancies in responses among assessments were examined, based on discrepancy interview protocol methodology. Further investigation will help to refine these instruments in order to provide a more thorough understanding of alcohol and drug abuse diagnoses.

Concordance between ICD-10 alcohol and drug use disorder criteria and diagnoses as measured by the AUDADIS-ADR, CIDI and SCAN: results of a cross-national study.

Agreement between the AUDADIS-ADR, CIDI and SCAN in case identification for ICD-10 alcohol and drug use disorders and diagnostic criteria was investigated in three countries, Luxembourg, Greece and the US. Overall, agreement for ICD-10 dependence diagnoses between the three instruments was fair to good for alcohol, opioids and cocaine, but generally lower for dependence diagnoses for other substance. In contrast, concordance between instruments for harmful use diagnoses was extremely poor for all substances. Implications of these major findings are discussed in terms of the relationship between prevalence, reliability and concordance and indications and cautions regarding cross-instrument comparisons.

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Greece: the transition to community care.

The system of psychiatric care in Greece is described. It was based until recently on overcrowded, large asylums inhabited by chronic mental patients. The mental health system was highly centralized, with an uneven distribution of both facilities and manpower. Out-patient and rehabilitation facilities were particularly scarce. Recent reforms funded by both the Greek State and the Social Fund of the EC are outlined. These changes started in the late Seventies and are aimed at creating a comprehensive system of community-oriented mental health care. The new system is gradually being deployed, and it is expected that in the following years it will effectively cover the needs of the whole country.

Evaluation of dangerousness of Greek mental patients.

There is a diachronic interest on the evaluation of the risk of violence by mental patients.Difficulties that have been underlined concern the definition of the term dangerousness and the different methods of approaching it. Accurate risk assessments are particularly important for psychiatric patients, with history of violence, in indoor care. The accuracy of predictions can better determine the patients designated as "at risk" for violence and avoid false designations. The aim of this study was to investigate the probability of patients, from several psychiatric units, to become violent after their discharge and over the next three years. We also investigate the predictive validity and accuracy of the HCR-20 in relation to post-discharge outcomes. Two hundred ninety five (295) psychiatric patients, from several psychiatric units, were assessed with the HCR-20, PCL: SV and GAF scales at discharge (using case file data, interviews with the patients and the clinicians of the units, and also information from the collateral informants) and were monitored for violent episodes over the following three years. The study was conducted in two phases: 1st phase: During the last week before discharge. 2nd phase: Every six months, over the following three years. Both the HCR-20 and PCL: SV scales and their subscales are significant predictors of readmission, suicide attempts and violent behavior. The GAF scale had a low positive correlation with the HCR-20 scale. A number of other variables such as duration of hospitalization, previous violent acts, diagnosis, gender, marital status, socioeconomic status, number of previous hospitalizations, were statistically related with failure of re-integration in the community. The results provide a strong evidence base that the HCR-20 is a good predictor of violent behavior in psychiatric patients, following their discharge from psychiatric wards in Greece, and hence can be used by clinicians in routine clinical practice.

[A study of the effectiveness of a group-based cognitive-behavioral parent training program].

The role of the family in the development of the child as well as the quality of the parent-child relationship and its effect in the social, mental and cognitive development of the child has been the focus of attention of many sciences and scientists and it has been discovered that many parents are not well prepared to do their best for their children. The parent training programmes are willing to partly give a solution to this with their preventive role. In recent years, the effectiveness of the parent training programmes, which are offered to "high risk" parents, has been the focus of a big amount of research, meta-analyses and reviews. A smaller amount concerns the effectiveness of the universal programmes which are offered to the parents of the general population. The effectiveness of a ten-meeting structured group parent training programme of cognitive-behavioral approach, which had been offered to mothers of the general population, was researched in the present study. It aimed to research the effectiveness of the specific programme in the children's behavior and the subjective perception of the functionality of the family of the mothers who chose to participate in and completed the programme (n=56, experimental group/participants), compared to those who chose not to (n=113, control group/non participants). The mothers of the two groups were mothers with children aged between 2 and 12 and filled in the Family Adaptation and Cohesion Scales, FACES-III and the Questionnaire of Inter-personal and Cross-personal Adaptation, before (Phases A) and after (Phases B) the programme. The two groups were fully matched and did not present any significant difference regarding their demographic characteristics. During both Phases A and B of the training programme participants and non-participants expressed a high degree of satisfaction by the functionality of their family and did not differentiate significantly in the evaluation of the existent family cohesion and adaptability, the type of the family based on the cohesion and adaptability and the general type of family based on the functionality. In addition, while the children of the participants were, before the start of the programme, in a significantly disadvantaged position compared to the children of the non-participants, after the end of the programme, they were significantly improved, decreasing the negative symptoms and behaviors. This particular parent training programme of cognitive-behavioral approach, as well as other programmes which belong to the same theoretical direction, could contribute to the prevention of the behavior problems and the promotion of the mental health.

Psychometric properties of WHOQOL-BREF in clinical and health Greek populations: incorporating new culture-relevant items.

Τhe present study examines main psychometric properties of the World Health Organisation (WHO) quality of life (QoL) instrument, the WHOQOL-BREF with the inclusion of four national items. Participants were 425 adult native Greek speaking, grouped into patients with physical disorders, psychiatric disorders and healthy individuals. Participants were administered WHOQOL-BREF and 23 national items, the General Health Questionnaire (GHQ-28) and the Life Satisfaction Index (LSI). Confirmatory factor analysis produced acceptable fit values for the original model of 26 items within the four WHOQOL domains: physical health, psychological health, social relationships and environment. Testing for the fit of national items within this model, the results indicated four new items with the most satisfactory fit indices and were thus included forming a 30-items version. The national items refer to: (a) nutrition, (b) satisfaction with work (both loaded in the physical health domain), (c) home life and (d) social life (both loaded in the social relationships domain). Statistical tests were applied to the 26- and 30-items versions producing satisfactory results, with the 30-items version showing slightly better values. Furthermore, results on the 30-items version included: (a) internal consistency, which was found satisfactory, with alpha values ranging from α=0.67-0.81, while the inclusion of new items produced higher alpha values in physical health and social relationships domains, (b) construct validity with good item-domain correlations, as well as strong correlations between domain scores, (c) convergent validity, which was very satisfactory, showing good correlations with GHQ-28 and LSI, (d) discriminant validity, showing instrument's ability to detect QoL differences between healthy and unhealthy participants, and between physically ill and psychiatric patients, and (e) test-retest reliability, with ICC scores in excess of 0.80 obtaining for all domains. The WHOQOL-BREF Greek version was found to perform well with sick and healthy participants, demonstrating satisfactory psychometric properties. Use of the instrument may be recommended for clinical and general populations, for service or intervention evaluation, as well as for cross-cultural clinical trials.

Mental pain and suicide risk: application of the Greek version of the Mental Pain and the Tolerance of Mental Pain scale.

According to Shneidman's theory, mental pain or "psychache", which refers to an endopsychic painful experience consisted of excessively felt negative feelings, is a key component to the understanding of suicidal behaviour, as to its psychological features. Shneidman himself supported that 'suicide is caused by psychache', more precisely suicide occurs when a person can no longer tolerate this pain. Findings of previous studies have shown that mental pain is an independent predictive factor for suicidal behaviour. In the present study we evaluated the psychometric properties of the Greek version of the Mental Pain Scale (MPS) and the Tolerance for Mental Pain Scale (TMPS) ina non clinical sample consisted of 112 participants (73 female and 39 male). Moreover, we explore the relationships between mental pain, depression, and suicide risk and for the first time the effect of the tolerance for mental pain on depression and suicide risk. We hypothesized that both the level of mental pain and the degree of tolerance for mental pain would predict suicide risk, independently of the level of depression. Both MPS and TMPS appear to have satisfactory to high levels of internal consistency, test-retest reliability, and concurrent validity. Suicide risk was correlated to mental pain, tolerance for mental pain, and depression. Multiple regression analysis showed that mental pain and tolerance for mental pain have a significant contribution to suicide risk, independently of depression, confirming our hypothesis.Using an additional multivariate regression with the factors extracted from MPS and TMPS as independent variables, we found that especially 'loss of control' of mental pain and the ability to 'contain the pain' contribute uniquely to suicide risk. Our findings offer support to the hypothesis that mental pain is a clinical entity distinct from depression with a specific and important contribution to the suicide risk.Depression alone is not enough to cause suicide. The mental pain construct, although related to depression,could shed light on the comprehension of the human experience that leads to suicide. Relieving mental pain may constitute a distinct and important treatment goal, along with the remission of depression and despair, so that the person can maintain control and contain all the distressing events that comprise the painful experience. Both MPS and TMPS appear to be valid and reliable tools for the assessment of mental pain and its tolerance, respectively. They could also be employed in further investigation on the role of specific aspects of the mental pain experience in suicidal behaviours.

History and therapeutic properties of Hypericum Perforatum from antiquity until today.

The St. John's wort has been recently one of the most popular therapeutic means that may be easily found in health food stores in various forms, such as capsules, liquid extracts, oils,ointments and others. The St. John's wort is not, however, a new pharmaceutical aid. The herb has a long and particular background as an antidepressant, anti-septic, anti-inflammatory,expectorant and tonic for the immune system, used for its alleviating properties. In fact, some of the previous reports on the herb's use originate from the Greek herbalist of the 1st AD century,Pedanios Dioskourides, as well as from his contemporary physicians, respectively Greek and Roman, Galinos and Plenius. In the treatise, Paracelsus (1493-1541 AD), the famous Swiss alchemist and physician,has been also mentioned to be using the St. John's wort. The historians consider that the name of the St. John's wort was given to it by the first Christians, who noticed that the plant blossomson about the 24th of June, the Saint John's-the Baptist's birthday, who was decapitated. In our times, and mainly in the USA, the UK and Germany, the St. John's wort has been extensively usedfor the treatment of mild and moderate depression. According to researchers, the St. John's wort has an action equivalent to amitryptilline, fluoxetine and maprotiline, and is clearly more activethan placebo. Experimental protocols have been also in progress on the St. John's wort therapeutic action against diseases of our times, such as cancer, AIDS and hepatitis. According to what iswidely supported, the St. John's wort is considered as bridge between the conventional and the alternative medicine. The St. John's wort pharmacodynamics as well as pharmacokinetics have beenalso extensively studied. The probable mechanism of the St. John's wort action is the suspension of monoaminoxidase (MAO) and the suspended reuptake of serotonine. Using the St. John's wort weopen the wide sphere of natural therapies. Such an extended approach may lead us to an increasing evaluation of our natural sources. Preserving what we have and renewing what we have destroyedis our only hope for the future of humanity, our planet and all the living organisms.

[Change of atmosphere in patients' family after attending rehabilitation programs].

Contemporary research had confirmed the opinion that an unstable familial environment, with expressed negative affects of healthy members, contributes to negative prognosis of patients. Rehabilitation Programs can contribute to reverse this negative atmosphere in families of mentally ill patients. In own research have participated 48 patients and their carers from different settings in the Athens area. We used validated scales (Family Atmosphere Scale, Family Burden Scale and Family Rituals Scale). The measurement took place before and after the participation in the rehabilitation program. We had a 90% follow up rate. Family's climate, measured with all three scales, showed a statistically significant improvement after the end of the rehabilitation program. The burden was the same for mothers and fathers. The diagnosis and the previous therapeutic methods had an influence on the outcome. Current research verifies the positive outcome of rehabilitation programs in the overall improvement of family's atmosphere. Early or simultaneous provision of systemic therapy has a positive affect. Other variables like sex, age, education, profession, socioeconomic status, years of illness, hadn't any significant influence.

Impact of an anesthesia discharge scoring system on postoperative monitoring after circumcision in children: a randomized trial.

BACKGROUND: Ambulatory surgery in children, combined with new anesthetic methods, leads to shorter hospital stays and an increase in patient and parental satisfaction. AIM: Aim of the study was to determine the feasibility and safety of transferring children directly to the ward without a previous stay in a post anesthesia care unit (PACU), after undergoing circumcision for phimosis under regional anesthesia and non-opioid analgesia. METHODS: 187 healthy children undergoing circumcision were studied in a randomized manner. After surgery, children who met predefined inclusion criteria in the operating room were randomly assigned to one of two groups. Children in the first group (Group A) bypassed the PACU and were admitted directly to the ward, after undergoing assessment using the White and Song scoring system. Children in the second group (Group B) were first transferred to a PACU and then to the ward. The children in Group A who did not meet the criteria of the White and Song scoring system represent the level of risk associated with direct transfer to the ward and no PACU stay. Recovery in the PACU and the ward, parental satisfaction, number of readmissions and the number of parental contacts for medical problems after discharge were recorded and compared between the two study groups. RESULTS: 157 children were randomly assigned into two groups (79 children in Group A and 78 in Group B). Demographic data, the duration of surgery, and recovery in the PACU or the ward were similar for the two groups. No readmissions were observed and most parents were very satisfied with the procedure. CONCLUSION: Children undergoing circumcision do not routinely require admission to a PACU and if the appropriate criteria are met, it is safe to transfer them directly to the ward.