The impact of delirium on clinical and functional outcomes in hospitalized patients with acute coronary syndrome.

BACKGROUND: Delirium, which is prevalent in critical care settings, remains underexplored in acute coronary syndrome (ACS) patients in the cardiac intensive care unit (CICU). AIMS: To investigate the prevalence and clinical significance of delirium in patients with ACS admitted to the CICU. STUDY DESIGN: A prospective study (n = 106, mean age 74.2 ± 5.7 years) assessed delirium using the confusion assessment method-intensive care unit (CAM-ICU) tool in 21.7% of ACS patients during their CICU stay. Baseline characteristics, geriatric conditions and clinical procedures were compared between delirious and nondelirious patients. The outcomes included in-hospital mortality, 30-day and 6-month mortality, acute adverse events and length of CICU stay and hospital stay (LOS). RESULTS: Delirious patients who were older and had a higher incidence of coronary artery disease underwent more complex procedures (e.g., pacemaker placement). Multivariate analysis identified central venous catheter insertion, urinary catheterization and benzodiazepine use as independent predictors of delirium. Delirium was correlated with prolonged LOS (p < .001) and increased in-hospital, 30-day and 6-month mortality (p < .001). CONCLUSIONS: Delirium in ACS patients in the CICU extends hospitalization and increases in-hospital, 30-day and 6-month mortality. Early recognition and targeted interventions are crucial for mitigating adverse outcomes in this high-risk population. RELEVANCE TO CLINICAL PRACTICE: This study highlights the critical impact of delirium on outcomes in hospitalized patients with ACS in the CICU. Delirium, often overlooked in ACS management, significantly extends hospitalization and increases mortality rates. Nurses and physicians must be vigilant in identifying delirium early, particularly in older ACS patients or those with comorbidities. Recognizing independent predictors such as catheterization and benzodiazepine use allows for targeted interventions to reduce delirium incidence. Integrating routine delirium assessments and preventive strategies into ACS management protocols can improve outcomes, optimize resource utilization and enhance overall patient care in the CICU setting.

The Validation of the COmprehensive Score for Financial Toxicity (COST) Scale in Greek Language.

The aim of this study was to investigate the psychometric properties of the Greek version of FACIT-COST, as well as to assess the levels of financial distress of patients suffering from lung cancer in relation to their quality of life and lung cancer symptom burden. This was a cross-sectional quantitative study. A self-assessment instrument was used to gather the data. The study involved 120 lung cancer patients who were treated using chemotherapy in a day clinic of a General Hospital in Athens. Data were collected with the COST-FACIT-v2 (used to assess the patients' financial toxicity), The 12-item Health Survey (SF-12), and functional Assessment of Cancer Therapy-Lung Symptom Index Questionnaire-7 items-version 4 (FACIT-FACT-LCS). Descriptive statistics as well as exploratory factor analysis performed all the statistical analyses, which were conducted using IBM SPSS Statistics 25 and had p-values with a significance level of 0.05. The majority of the participants were male (68.3%), married or cohabitated (81.3%), and had been diagnosed with microcell cancer (90%). The factor analysis resulted in one factor that interpreted 35% of the total variance. FACT-L (r = 0.365, p < 0.001), physical component SF-12 (r = 0.184, p = 0.045), and mental health component SF-12 (r = 0.268, p = 0.003) were positively correlated to FACIT-OST, as expected. The Greek validated COST-FACIT-v2 is a reliable tool in providing rapid assessment of cancer patients' level of financial distress.

Changes in Smoking Habits in Greece During the Lockdown Measures Due to COVID-19.

INTRODUCTION: During lockdown, people are experiencing higher than usual levels of stress related to social isolation, employment, and finances that may result in lifestyle changes. Here, we aim to assess whether smoking habits changed during the lockdown measures due to coronavirus disease 2019 (COVID-19). METHODS: For the purpose of the survey, an online questionnaire was distributed from the tenth of April to the second of May 2020, among a Greek population, by using an online platform. RESULTS: Two hundred smokers/vapers participated in the present survey (62.5% women, 44% of 36-45 years, 29% of 16-55 years, 15.5% 26-35 years). The daily number of cigarettes smoked before the onset of the COVID-19 pandemic is 15.06 ± 9.84, while during the restrictive measures due to COVID-19, the daily number of cigarettes smoked is 14.52 ± 10.13 (p > 0.05). Vapers consumed an average of 0.54 ± 2.43 mL vapor per day before the COVID-19 pandemic and 0.61 ± 2.81 mL during lockdown. Males smoked more cigarettes per day before (16.31 ± 11.87) and during the lockdown (15.33 ± 12.17) versus females (14.30 ± 8.36) and 14.04 ± 8.70, respectively) (p > 0.05 for both genders). Before versus during the restrictive measures, subjects that were primary school graduates smoked more cigarettes per day (28.00 ± 9.09 and 27.50 ± 9.57, respectively), followed by subjects that were high school graduates (16.90 ± 9.33 and 15.97 ± 9.50, respectively), university graduates (14.17 ± 10.14 and 13.93 ± 10.66, respectively), postgraduates (12.96 ± 9.52 and 12.25 ± 9.90, respectively) and middle school graduates (12.89 ± 8.22 and 14.22 ± 7.93, respectively).The self-reported reason for the change in the mL vaporized and the cigarettes smoked are confinement at home (36.3%), stress about COVID-19 (34.09%), free time (20.45%), boredom (4.54%), stress about the work status (2.27%), and participation in online lucky games (2.27%). DISCUSSION: We did not observe significant differences in the daily consumption of smoke/vaping during the lockdown measures. More studies are needed to assess the long-term effects of the pandemic in smoking habits.

Investigation of the Level of Burnout in Health Care Professionals in COVID-19 Pandemic Conditions.

The coronavirus disease 2019 (COVID-19) pandemic has led to high levels of stress and anxiety for health care professionals. The purpose of this study was to investigate the burnout of health care professionals in COVID-19 pandemic conditions. Quantitative research was performed, and the Copenhagen Burnout Inventory was used to study burnout. The research sample consisted of 360 health care professionals. Health professionals have been found to have fairly high levels of personal burnout, work burnout, and burnout associated with patient interactions. It has also been found that women and health professionals working in department for patients with COVID-19 have significantly greater burnout. However, it was found that age, marital status, years of service, specialty, non-basic degree, and whether they or a first-degree relative had COVID-19 were not correlated to burnout. Given the very high level of burnout among health professionals, it is necessary to develop appropriate strategies to reduce burnout.

Blood, organ and bone marrow donation: Reporting on the attitudes, related to socio-emotional determinants, among nursing students in Greece.

Greece is one of the countries with the lowest occurrence of blood, organ, and bone marrow donors. Sociodemographic and other psycho-emotional features such as self-efficacy seem to be linked to attitudes regarding registering as a donor. The aim of this study was to explore the attitudes of nursing students regarding blood, organ and bone marrow donation and socio-emotional background. The study was conducted among the students of the Nursing Department at the University of Thessaly in Central Greece. An electronic self-administered questionnaire was distributed to 480 students and 345 students (response rate: 71.8%) completed the questionnaire. The questionnaire consisted of socio-demographic information, and six questions, concerning knowledge, attitudes and practices towards blood, organ and bone marrow donation. Emotional Discomfort Scale (EmoD), an 8-item tool was also used in order to identify if emotional discomfort through daily activities influences beliefs and responses of the participants. Only one out of five participants had donated blood voluntarily while those who had been already registered as organ and bone marrow donors were quite few, 1.4% and 6.4% respectively. Moreover, only 15.1% of the participants were aware of the legislative framework concerning organ, tissue and bone marrow donation. Multivariate analysis showed that age, nationality and routine emotional discomfort were determinants of blood and organ donation composite score. The use of EmoD Scale could help professionals in health care and social fields to better screen for emotional complexity to become donor, and act in order to positively alter people's attitudes.

Work place and prevalence of COVID-19 in a rural population in Greece.

INTRODUCTION: Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious global health threat. Many countries including Greece have seen a two-wave pattern of reported cases, with a first wave in spring and a second in autumn of 2020. METHODS: A cross-sectional seroprevalence study was designed to measure the prevalence of IgG antibodies with a quantitative SARS-CoV-2 IgG lab-based serology test, chemiluminescent microparticle immunoassay, against novel coronavirus in rural areas in Greece after the second pandemic wave. The study was conducted on 29 January 2021 in a rural semi-closed area, the municipality of Deskati, prefecture of western Macedonia in Greece after the second pandemic wave. RESULTS: Sixty-nine participants were included in this study. The present study demonstrated a high prevalence of COVID-19 infection (31 of 69 total participants; 45%) and those who were working in the public sector were at higher risk of COVID-19 infection in comparison to their counterparts in private sector (p=0.05364), (relative risk 2.64; 95% confidence interval 1.001-7.086). CONCLUSION: The study presents data showing a high prevalence of herd immunity for COVID-19 in a semi-closed area in Greece. These findings might help to understand the characteristics of this second wave, the behaviour and danger of SARS-CoV-2 in rural areas in Greece and Europe generally.

Level of Knowledge About COPD Among Patients and Caregivers.

Chronic obstructive pulmonary disease (COPD) represents a major health burden worldwide. COPD-specific education may positively affect the emotional distress associated with the disease and may contribute to the patients' poor health-related quality of life. Studies have shown that education regarding COPD is lacking among disease sufferers. The aim of our study was to evaluate the knowledge of COPD among patients and caregivers. We used the Bristol COPD Knowledge Questionnaire in hospitalized and nonhospitalized patients with COPD and other pulmonary diseases, their caregivers, and healthy volunteers. Mean total knowledge score of patients with COPD was 24.27 ± 8.44, of patients with other respiratory diseases 25.53 ± 7.93, of caregivers of patients with COPD 21.80 ± 5.32, of caregivers of patients with other pulmonary diseases 23.50 ± 8.79, and of healthy subjects 25.85 ± 9.27 (p = 0.071). Our data further indicate the lack of knowledge of COPD among patients and their carers and emphasize the need of education programs.

Attitudes and Smoking Prevalence Among Undergraduate Students in Central Greece.

Tobacco smoking is a major public health problem globally. The vast majority of smokers start smoking early. The hazards of smoking depend on a plethora of factors such as the age one starts to smoke, number of cigarettes smoked per day, nicotine, and filter type of the cigarette among other factors. According to the World Health Organization, most tobacco-related deaths occur in low- and middle-income countries. Undergraduate students are an important part of the general population, and their life conditions, smoking rates, and the knowledge, attitudes, and exposure to smoking (including secondhand smoke) are an interesting topic for investigation. The aim of the present study is to investigate undergraduate university students' smoking attitudes as well as the prevalence of smoking and their exposure to secondary smoke. A cross-sectional study was conducted in 600 undergraduate students in Central Greece. Anonymous self-report-adjusted questionnaires were distributed in students of the Technological Educational Institute of Thessaly. The total prevalence of tobacco smoking was 35%, while the majority of the smokers were females (65%). Fifty-three of the participants reported daily exposure to secondary smoke inside their houses, and 45% of them reported daily exposure to secondary smoke in their work.

Greek Nurses' Perception of Hospital Ethical Climate: A Cross-Sectional Study.

This study aimed to examine Greek nurses' perceptions about hospital ethical climate and to investigate the possible difference of those perceptions regarding their demographic and work-related characteristics. The cross-sectional study design was employed in this study in which 286 nurses and nurse assistants participated. Data were collected by a sheet containing demographic and work-related characteristics and the Greek version of the Oslons' Hospital Ethical Climate Scale. IBM Statistical Package for Social Sciences 25 was used in data analysis. Frequencies, means, percentages, and standard deviations summarized the data. For the statistical differences, parametric tests were performed. Independent Samples t and Pearson correlation analysis were used to determine the relationship between the ethical climate of the hospital and the nurses' characteristics. The p-values 0.05 were considered statistically significant. The mean age of the nurses was 44 years (SD: 8.5 years; range 24-66 years). The majority of them were women (77.3%). A percent of 57.7% of the sample was married. Most positive perceptions were concerning managers (4.01) following by peers (3.82), patients (3.69), hospitals (3.29) while the least positive perceptions of the ethical climate were concerning the physicians (3.16). The factors associated with hospital ethical perception were: working experience and responsible position. The highest score of ethical climate reported to managers subscale, while the minimum score was related to physicians. In general, Greek nurses reported positive perceptions regarding hospital ethical climate. The positive ethical climate is associated with a better working environment, fewer nurses' experience of moral distress, fewer chances for nursing turnover, high quality of nursing care, and fewer errors in nursing practice.

The Effect of Spirituality on Illness Perceptions in Patients Undergoing Hemodialysis : Spirituality and Health.

The aim of this study was to assess the effect of spirituality on illness perceptions of Greek patients on hemodialysis. The cross-sectional study design was employed for this purpose. The sample comprised of 367 patients on hemodialysis. Data were collected via a three-part questionnaire consisting of a sheet containing demographic and clinical information, the Illness Perceptions Questionnaire, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12). Data were processed with SPSS V.21, descriptive as well as inferential statistics were applied. The significant level was set at 0.05; 62.1% of the patients in the sample were men and 37.9% women. Their ages ranged from 18 to 92 years old, with an average of 61.80 years old. The findings of the research showed that the spirituality score both total and the subscales leads to a decrease illness perceptions score, meaning that patients perceive the disease as less threatening. The overall score of the Illness Perceptions Questionnaire was above the median, which means that patients perceive their condition as quite threatening. Overall, individual spirituality has a positive impact on the way patients perceive their condition.

Compliance of Bronchial Asthma Patients' with the Mediterranean Diet : Compliance with the Mediterranean Diet in Asthma Patients.

INTRODUCTION: Asthma is considered the most common chronic disease that affects survival and quality of life. An astringent regulatory factor of asthma is the Mediterranean diet. Nutrition, however, seems to be of great importance in the onset and outcome of the disease as many ingredients and eating habits that may improve or exacerbate the condition of the patient. PURPOSE: The present study aimed to investigate dietary habits in patients with bronchial asthma and their compliance with the Mediterranean diet. MATERIAL AND METHODS: The study included 60 patients with bronchial asthma, 47 women (71% of the total) and 17 men (28.3%). All patients completed a questionnaire with sociodemographic questions, a medical history (years of diagnosis, exacerbations, hospitalizations, medication), and spirometry results (FEV1, FVC, FEV1/FVC, PEF, FEF25-75). Asthma control was evaluated with the Asthma Control Test (ACT). Conformity to the Mediterranean diet was assessed using the MEDLIFE index (Mediterranean lifestyle) questionnaire. Statistical analysis of the data was done using the SPSS 23.0 statistical package by applying the Inductive Analysis, which included the Pearson correlation coefficient (r), the t-test for independent samples, and the variance analysis (one-way ANOVA). RESULTS: There was a significant negative correlation of last year hospitalizations with the MEDLIFE questionnaire scale (r = -0.522, p = 0.009) and a significant negative correlation of last year's exacerbations with the ACT scale. We observed a significant negative correlation of hospitalizations in the last year with the ACT scale (r = -0.505, p = 0.012) and a significant statistical relationship of long acting ß2 agonist + steroid with the MEDLIFE scale (p = 0.046). CONCLUSION: The level of compliance with the principles of the Mediterranean diet leads to a reduction in hospitalization. The optimal asthma control is associated with a reduction of exacerbations and asthma control is associated with reduced hospitalizations. Those receiving beta2 + steroid show higher levels of compliance with the principles of the Mediterranean diet.

The Effect of Emotional Intelligence on Caring Behaviors Among Psychiatric Nurses in Greece : Emotional Intelligence and Caring Behaviors in Mental Healthcare.

The effect of emotional intelligence in the field of mental health is of particular interest, as it is an intensely emotional field. The nursing staff has as an object the healthcare of people with mental problems, where emotions and their management are key factors. The purpose of this study was to investigate the levels of emotional intelligence and caring behaviors among mental health nurses as well as the correlation between these variables. In this cross-sectional study, 191 nurses completed the tools Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) and the Caring Behaviors Inventory-24 scale (CBI-24) for assessing the degree of emotional intelligence and caring behaviors, respectively. Demographic and job characteristics were recorded. Results: The results showed that the majority of participants were female and the average age was 44.69 years. According to the total but also the individual scoring of the TEIQue-SF, emotional intelligence was found to be at a relatively high level (total mean: 4.92) and was associated directly (r = 0.448, p < 0.001) with the frequency of caring behaviors of the CBI-24 which was found to be at a fairly high level (total mean 5.08). The study findings showed that as the overall emotional intelligence increased, the frequency of occurrence and the importance of behavioral behaviors increased.

Increased Body Mass Index (BMI) and Sunscreen Use Are Associated with Inadequate Vitamin D Status in Greek Adults in Winter : BMI, Sunscreen Use and Vitamin D Status in Greek Adults.

Vitamin D deficiency is common even in sunny countries like Greece, especially during winter and is associated with skeletal disorders and additionally with increased risk for chronic diseases and adipose metabolic diseases such as obesity and diabetes. The purpose of this pilot study was the determination of vitamin D status in Greek adults and the investigation of possible correlation with lifestyles and somatometric characteristics. The study was conducted during winter and included 36 members (20 women and 16 men) of a university community in central Greece (latitude 39.6° North). Their age was 36.2 ± 16.3 years, body mass index (BMI) 26.4 ± 4.8 (women 26.6 ± 5.6, men 26.3 ± 3.8), and waist circumference 85.7 ± 13.3 cm (women 81.5 ± 13.0, men 90.7 ± 12.4) (mean ± SD). Mean serum 25(OH)D concentration was 20.1 ± 7.3 ng/mL (women 19.7 ± 7.6, men 20.7 ± 7.1). More than half of the participants had 25(OH)D levels below the 20 ng/mL (50 nmol/L) threshold of deficiency. There was a significant negative association between the use of sunscreen during summer and serum 25(OH)D concentrations during winter and a significant positive association between physical exercise and serum 25(OH)D. Levels of 25(OH)D tended to decrease with increasing BMI in persons with a BMI over 25.0. There is a high prevalence of vitamin D insufficiency in Greek adults during winter. Serum 25(OH)D levels in winter are positively associated with exercise and negatively associated with high BMI and the use of sunscreen during summer.

Calprotectin in Lung Diseases.

Calprotectin (CLP) is a heterodimer formed by two S-100 calcium-binding cytosolic proteins, S100A8 and S100A9. It is a multifunctional protein expressed mainly by neutrophils and released extracellularly by activated or damaged cells mediating a broad range of physiological and pathological responses. It has been more than 20 years since the implication of S100A8/A9 in the inflammatory process was shown; however, the evaluation of its role in the pathogenesis of respiratory diseases or its usefulness as a biomarker for the appropriate diagnosis and prognosis of lung diseases have only gained attention in recent years. This review aimed to provide current knowledge regarding the potential role of CLP in the pathophysiology of lung diseases and describe how this knowledge is, up until now, translated into daily clinical practice. CLP is involved in numerous cellular processes in lung health and disease. In addition to its anti-microbial functions, CLP also serves as a molecule with pro- and anti-tumor properties related to cell survival and growth, angiogenesis, DNA damage response, and the remodeling of the extracellular matrix. The findings of this review potentially introduce CLP in daily clinical practice within the spectrum of respiratory diseases.

Vaccination Coverage of the Elderly in Greece: A Cross-Sectional Nationwide Study.

Vaccines are important for older adults, and the morbidity and mortality of vaccine-preventable diseases among older adults are high. There are limited data on vaccination coverage among elderly people in Greece. The aim of this observational study was to record the vaccination coverage for vaccines recommended by the National Vaccination Program in Greece for the elderly people ≥60 years old. Two hundred general practitioners (GPs) around the country from the primary healthcare system were invited to "participate," and one hundred fifty from them participated in the present study. The GPs were selected using geographically stratified random sampling methodology. Two thousand and seventy-two participants participated in the present study: of which, 1043 were males and 1029 were females. The mean age of the participants was 73.3 years, and 83% vaccination coverage for flu vaccine, 49.5% for conjugate pneumococcal vaccine, and 23.5% for polysaccharide pneumococcal vaccine were recorded. In addition, the vaccination coverage for herpes zoster vaccine was 20%, while very low percentages were recorded for diphtheria, tetanus, pertussis, and polio vaccine for adults. We found significant gaps in vaccination coverage, especially with regard to pneumococcal, herpes zoster, and tetanus. On the contrary, influenza vaccination coverage was satisfactory.

Blood donation knowledge and attitudes among undergraduate health science students: A cross-sectional study.

Awareness towards blood donation can be empowered by health professionals' role-modelling. We aimed to assess knowledge and attitudes among Greek undergraduate medical laboratory students. A questionnaire was distributed to 330 students (response rate: 88.7%). Overall, 24% had donated blood at least once, with males 4.62 times more likely to be donors. Voluntary, non-remunerated blood donors were more likely to be repeaters. A quarter of all students were inclined to offer blood for monetary reward, with men more prone to accept payment. There is a need to campaign health science students during formal education through need-based as well as altruistic 'smart' messages.

Organ donation knowledge and attitudes among health science students in Greece: emerging interprofessional needs.

BACKGROUND: The impact of presumed consent on donation rates has been widely debated. In June 2013 Greece adopted a 'soft' presumed consent law for organ and tissue donation, where relatives' approval is sought prior to organ removal. AIMS: To report on the knowledge, attitudes and concerns of undergraduate students, enrolled in three health science disciplines, in regards to organ donation and presumed consent. METHODS: Undergraduate junior and senior health science students [medical (MS), nursing (NS) and medical laboratory students (MLS)] were recruited from higher education settings in Thessaly, Greece. Dichotomous questions, previously used, were adopted to assess knowledge, attitudes and concerns towards organ donation, together with questions regarding the recent presumed consent legislation. RESULTS: Three hundred seventy-one out of 510 students participated in the study (response rate: 72.7%). Only 3.6% of NS, 8.7% of MS and 3.2% of MLS carried a donor card. Although over 78% in all groups knew that it was possible to leave kidneys for transplant after death, only 10% to 39% considered themselves well-informed. NS were more likely to consider opting-out (21.5%), followed by MLS (17.9%) and MS (10.9%). Respondents were more likely to refuse organ removal upon death when expressing one of the following views: a) opposing a system making it lawful to take kidneys from an adult who has just died, unless forbidden while alive [Odds ratio (OR) 95% Confidence Interval (CI): 2.96 (1.48-5.93), p=0.002], b) worrying about their kidneys being removed after death [OR, 95% CI: 3.37 (1.75-6.49), p=<0.001] and c) believing that an intact body was needed after death [OR, 95% CI: 4.23 (2.15-8.31), p<0.001]. CONCLUSION: Health science students, soon to become healthcare professionals, demonstrated limited awareness in regards to the newly reformed organ donation system. Identified knowledge deficits and concerns could have far-reaching implications in terms of conveying a clear message and shaping the public's stand. The feasibility and effectiveness of a joint inter-professional curriculum on organ and tissue donation issues across all three health science disciplines, addressing common themes and concerns deserves further study.

Investigation of admission serum creatinine as a predictor of hospital length of stay in triple-vaccinated COVID-19 inpatients.

BACKGROUND: This study assessed the association between admission kidney function and the duration of hospitalization in triple-vaccinated coronavirus disease 2019 (COVID-19) inpatients during the omicron surge in Larissa, central Greece. METHODS: Regression analysis was used to estimate the effect of kidney function biomarkers on hospital length of stay (LoS) within a dataset from a cohort of 51 subjects. RESULTS: Sex- and age-adjusted admission serum creatinine was associated with hospital LoS (p=0.034). CONCLUSIONS: Serum creatinine concentration on admission should be further evaluated as a possible clinical predictor of hospital LoS among triple-vaccinated COVID-19 inpatients both at the country and global level.

Pneumococcal and Influenza Vaccination Coverage in Patients with Heart Failure: A Systematic Review.

Background/Objectives: As heart failure (HF) patients face increased vulnerability to respiratory infections, optimizing pneumococcal and influenza vaccination coverage becomes pivotal for mitigating additional health risks and reducing hospitalizations, morbidity, and mortality rates within this population. In this specific subpopulation of patients, vaccination coverage for pneumococcal and influenza holds heightened significance compared to other vaccines due to their susceptibility to respiratory infections, which can exacerbate existing cardiovascular conditions and lead to severe complications or even death. However, despite the recognized benefits, vaccination coverage among HF patients remains below expectations. The aim of the present systematic review was to assess the vaccination coverage for influenza and pneumococcus in HF patients from 2005 to 2023 and the vaccination's effects on survival and hospitalizations. Methods: The authors developed the protocol of the review in accordance with the PRISMA guidelines, and the search was performed in databases including PubMed and Scopus. After the initial search, 851 studies were found in PubMed Library and 1961 in Scopus (total of 2812 studies). Results: After the initial evaluation, 23 publications were finally included in the analysis. The total study population consisted of 6,093,497 participants. Regarding the influenza vaccine, vaccination coverage ranged from low rates of 2.5% to very high rates of 97%, while the respective pneumococcal vaccination coverage ranged from 20% to 84.6%. Most studies demonstrated a beneficial effect of vaccination on survival and hospitalizations. Conclusions: The present systematic review study showed a wide variety of vaccination coverage among patients with heart failure.

Validity and Reliability of the Greek Version of Adult Vaccine Hesitancy Scale in Terms of Dispositional Optimism in a Community-Dwelling Population: A Cross-Sectional Study.

Vaccine hesitancy is an important public health issue referring to concerns about the safety and efficacy of vaccination. Within a framework, this study aimed to assess the cultural adaptation, validity, and reliability of the Greek version of the adult Vaccine Hesitancy Scale (aVHS) as well as to identify the determinants of vaccine hesitancy among a large regional population in central Greece. A cross-sectional study was conducted enrolling 300 adults who had received primary healthcare services in the Health Centers and Local Health Units of the Magnesia Region from October to December 2022. The aVHS and the Life Orientation Test-Revised (LOT-R) were used to identify vaccine hesitancy and the dispositional level of optimism, respectively. For survey translation, the procedure of forward and backward translation was followed. Also, the aVHS was tested in a pilot study with a sample of 18 responders. Construct validity and internal consistency reliability were investigated via exploratory and confirmatory factor analysis and Cronbach's alpha coefficients, respectively. Simple and multiple linear regression analysis were used to determine predictors for vaccine hesitancy. Factor analyses indicated that the aVHS comprises two constructs ("lack of confidence" and "risk perception") explaining 68.9% of the total variance. The Cronbach's alpha of the total scale was 0.884, indicating its high internal consistency. Participants who lived in rural areas, had a lower annual income, and reported a lower level of optimism showed a higher lack of confidence in vaccination. On the other hand, people aged above 45 years old who had graduated from high school or elementary school and were unemployed showed greater aversion to the risks of side effects. Finally, certain socio-demographic characteristics were associated with vaccine hesitancy. Our data suggest that the aVHS is a valid and reliable instrument for measuring vaccine-related attitudes and perceptions in Greek society, providing meaningful insight into designing vaccination-related preventive interventions in the community.