Length of hospital stay in involuntary admissions in Greece: a 10-year retrospective observational study.

PURPOSE: The treatment of mental disorders has shifted from inpatient wards to community-based settings in recent years, but some patients may still have to be admitted to inpatient wards, sometimes involuntarily. It is important to maintain the length of hospital stay (LoS) as short as possible while still providing adequate care. The present study aimed to explore the factors associated with the LoS in involuntarily admitted psychiatric patients. METHODS: A ten-year retrospective chart review of 332 patients admitted involuntarily to the inpatient psychiatric ward of the General University Hospital of Ioannina, Northwestern Greece, between 2008 and 2017 was conducted. RESULTS: The mean LoS was 23.8 (SD = 33.7) days and was relatively stable over the years. Longer-stay hospitalization was associated with schizophrenia-spectrum disorder diagnosis, previous hospitalizations and the use of mechanical restraint, whereas patients in residential care experienced significantly longer LoS (52.6 days) than those living with a caregiver (23.5 days) or alone (19.4 days). Older age at disease onset was associated with shorter LoS, whereas no statistically significant differences were observed with regard to gender. CONCLUSION: While some of our findings were in line with recent findings from other countries, others could not be replicated. It seems that multiple factors influence LoS and the identification of these factors could help clinicians and policy makers to design more targeted and cost-effective interventions. The optimization of LoS in involuntary admissions could improve patients' outcomes and lead to more efficient use of resources.

The impact of COVID-19 lockdown on air pollution in Europe and North America: a systematic review.

BACKGROUND: Multiple studies report reductions in air pollution associated with COVID-19 lockdowns. METHODS: We performed a systematic review of the changes observed in hazardous air pollutants known or suspected to be harmful to health, including nitrogen dioxide (NO2), nitrogen oxides (NOx), carbon monoxide (CO), sulfur dioxide (SO2), ozone (O3) and particulate matter (PM). We searched PubMed and Web of Science for studies reporting the associations of lockdowns with air pollutant changes during the COVID-19 pandemic in Europe and North America. RESULTS: One hundred nine studies were identified and analyzed. Several pollutants exhibited marked and sustained reductions. The strongest was NO2 (93% of 89 estimated changes were reductions) followed by CO (88% of 33 estimated pollutant changes). All NOx and benzene studies reported significant reductions although these were based on fewer than 10 estimates. About three-quarters of PM2.5 and PM10 estimates showed reductions and few studies reported increases when domestic fuel use rose during COVID-19 lockdowns. In contrast, O3 levels rose as NOx levels fell. SO2 and ammonia (NH3) had mixed results. In general, greater reductions appeared when lockdowns were more severe, as well as where baseline pollutant levels were higher, such as at low-elevation and in densely populated areas. Substantial and robust reductions in NO2, NO, CO, CO2, PM2.5, PM10, benzene and air quality index pollution occurred in association with COVID-19 lockdowns. O3 levels tended to increase, while SO2 and NH3 had mixed patterns. CONCLUSIONS: Our study shows the profound impact of human activity levels on air pollution and its potential avoidability.

Association of lifestyle factors with a high prevalence of overweight and obesity in Greek children aged 10-16 years.

AIM: To investigate the prevalence of overweight, obesity and central obesity in students of primary and secondary education, and the association with lifestyle parameters. METHODS: A total of 3504 students, aged 10-16 years old, from Western Greece participated in this cross-sectional epidemiological study (participation rate: 90%). Demographic, socioeconomic, dietary, physical activity and screen time data were obtained using a questionnaire. Anthropometric measurements were also obtained. Overweight and obesity were estimated using the Centers for Disease Control and Prevention (CDC) and International Obesity Task Force (IOTF) criteria and central obesity using the WHtR ≥0.5 and IDF criteria. RESULTS: The prevalence of overweight and obesity was 19.2% and 12.1% with CDC criteria, respectively, and 20.9% and 7.2%, with IOTF criteria respectively. Central obesity was 31.1 and 32.8% using the Waist-to-Height ratio (WHtR) ≥0.5 and International Diabetes Federation (IDF) criteria respectively. Male gender, small number of meals, breakfast skipping, frequent consumption of school food and sweets and the presence of a computer in children's rooms, were identified as the strongest lifestyle factors affecting weight. CONCLUSION: Overweight, obesity and central obesity rates remain high among children and adolescents in Greece. The identification of risk factors associated with the manifestation of obesity and central obesity, may contribute to the implementation of targeted prevention and treatment interventions.

Correlation between the Personal and Social Performance scale (PSP) and the Positive and Negative Syndrome Scale (PANSS) in a Greek sample of patients with schizophrenia.

BACKGROUND: Psychosocial dysfunction is one of schizophrenia's core features, often leading to a deprecation of independent living and significant failure to maintain a competent quality of life. Cognitive and occupational performance as well as psychosocial functioning is moreover recognized as determinants of treatment response. Therefore, the elaboration of measures regarding social performance besides scales that assess psychopathology is essential. The Personal and Social Performance (PSP) scale has been found to be as much valid as reliable for assessing social functioning in the acute and stable stage of schizophrenia. The aim of this study was to estimate the correlation between the PSP and Positive and Negative Syndrome Scale (PANSS) (convergent validity) in patients with schizophrenia during routine clinical practice. METHODS: A longitudinal study with a six-month follow-up is presented. Correlation between the PSP scale and the Positive and Negative Syndrome Scale (PANSS) was conducted in a Greek sample of 2010 patients with schizophrenia in outpatient setting in two successive visits. PANSS and PSP scales were used for the assessment of psychopathological symptoms and social and personal functioning. RESULTS: The PSP subscales scores were well correlated with each other with Spearman correlation coefficients (r) ranging from 0.56 to 0.76 on both visits in three out of the four main areas, whereas in the category of "disturbing and aggressive behavior" the correlations were lower but still significant. Furthermore, total PSP score showed high association to PANSS total score in the first (r = -0.59) as well as in the second visit (r = -0.50). Regression analysis showed that one point decrease of PANSS's total score is associated with a 0.42 points increase on the PSP scale. PSP and PANSS scales exhibited high convergent validity. CONCLUSIONS: The PSP could provide additional valuable information in the assessment of schizophrenia related social functioning and treatment response.

Exploring the Psychological Impact of Quarantine: An Investigation into Eating Patterns, Emotions, and Loneliness During the COVID-19 Pandemic in Greece.

PURPOSE: The implementation of quarantine measures in response to the COVID-19 pandemic presented challenges linked to adverse psychological effects, notably affecting individuals' eating patterns. This study aimed to investigate the eating patterns of individuals during lockdowns compared across sex, age, and income levels, and examine the influence of positive and negative emotions, as well as loneliness, on these patterns. METHODS: A cross-sectional online study was conducted with 450 participants (aged 18-74 years old). One questionnaire about demographics, the Demographic Questionnaire, and three validated self-report scales (Eating Attitudes Test, comprising the Dieting, Bulimia, and Food Preoccupation, and Oral Control subscales, the Modified Differential Emotions Scale, and the UCLA Loneliness Scale) were employed. Convenience and snowball sampling were used. The data were collected between April and May 2021, primarily through social media platforms, such as Facebook, Instagram, and Twitter. The survey questionnaire was shared via these platforms and users could answer if they wanted. Also, they were asked to send the questionnaire to their close contacts. Additionally, the survey questionnaire was distributed face-to-face to 80 participants. The statistical analyses included linear regression and mediation analyses. RESULTS:  Abnormal eating patterns (e.g. eating behaviors that tend to have signs of diet such as constant avoidance of fattening foods, the individual's involvement with becoming leaner, extreme control or preoccupation with food, overeating and purging methods) were identified in 25% of the 450 participants participated in this survey, aged 18-74 years. Moderate levels of negative/positive emotions and loneliness were predominantly reported. Female sex was significantly associated with abnormal eating patterns (p=0.010), particularly dietary behaviors (p=0.029). Negative emotions (p=0.032) and loneliness (p=0.001) emerged as predictive factors for overall eating patterns and bulimic behaviors. Negative emotions exhibited a direct correlation with eating patterns, while loneliness played a significant mediating role (p=0.032). Furthermore, the association between negative emotions and bulimia was partially mediated by loneliness (p=0.018). CONCLUSIONS: This study underscores the pivotal roles of negative emotions and loneliness in shaping eating patterns during quarantine. Multilevel public health interventions are needed to address the negative effects of quarantine and pandemics in general. Screening tests for mental health in the school and job environments could highlight the need for shaping interventions, such as counseling, group empowerment, and family support in order to mitigate the negative impact of the COVID-19 pandemic on eating behaviors and mental health in general.

Enhancing quality of life and medication adherence for people living with HIV: the impact of an information system.

BACKGROUND: The widespread availability of antiretroviral therapy has led to improvements in life expectancy and thus an increase in the number of people living with HIV/AIDS (PLWHA) worldwide. However, a similar increase in the number of newly-diagnosed patients in Cyprus suggests the need for solutions designed to improve monitoring, planning, and patient communication. In this study, we aimed to determine whether the use of an information system to manage PLWHA might contribute to improved quality of life and critical adherence to prescribed drug regimens and ongoing medical care. METHODS: A randomized controlled trial study was conducted in Cyprus based on information that we collected using the highly valid and reliable Greek translation of the World Health Organization (WHO) Quality of Life (QOL) HIV-BREF questionnaire to assess sociodemographic variables and patient compliance. We distributed 200 questionnaires before implementing a Health Medical Care (HMC) information system at our clinic. Six months after implementing this system, 68 of the completed questionnaires were selected, including two groups of 34 participants who had been assigned at random to the intervention or the control group. Participants included PLWHA aged ≥ 18 years who had been receiving antiretroviral therapy for more than 12 months between July 15, 2020, and July 15, 2022. RESULTS: The changes in baseline to six-month scores reported for the intervention group were significantly higher than in the control group in all six subscales assessed with the WHOQOL-HIV-BREF questionnaire, as well as in the assessment of compliance. Furthermore, compliance with treatment was associated with higher scores in the questionnaire subscales, including physical health, psychological health, degree of autonomy, social relationships, life circumstances, and spirituality/religious/personal beliefs. We also identified specific demographic factors and behaviors that were associated with better compliance with scheduled medical care and the prescribed drug regimen. Specifically, men exhibited better compliance than women and younger PLWHA exhibited better compliance than the elderly as did individuals who reported a higher level of educational attainment. Additionally, individuals who did not use addictive substances, consumed less alcohol, and were managed using the monitoring information system all exhibited better compliance compared to those in the control group. CONCLUSION: The results of this study suggest that management of PLWHA via the use of an information system can contribute to improved QOL and drug compliance.

This study was conducted to find ways to improve the lives of people living with HIV/AIDS (PLWHA) in Cyprus. With more PLWHA receiving treatment and care, it's crucial to ensure they have a good quality of life and follow their treatment plans. The main question we wanted to answer was whether using a special computer system to manage PLWHA could make their lives better and help them stick to their treatment. We found that using this computer system indeed made a positive difference. People who used it reported better physical and mental health, more independence, better relationships, and overall improved life circumstances. The study showed that managing PLWHA with a computer system can lead to better quality of life and treatment adherence. Some groups, like men, younger individuals, and those with more education, did even better. Also, people who didn't use addictive substances or consume much alcohol had better results. In summary, using technology in healthcare can greatly benefit PLWHA in Cyprus. This study highlights the importance of innovative solutions in healthcare to enhance the well-being of people living with HIV/AIDS and ensure they receive the best possible care.

Survival Analysis of Elderly Patients With Laryngeal Cancer After Total Laryngectomy: A Retrospective Cohort Study.

Objective This study investigates the overall survival (OS) of elderly patients who underwent total laryngectomy for laryngeal cancer (LC) and examines the impact of tumor-node-metastasis (TNM) staging on survival rates. Methods A retrospective cohort study utilized data from the Otorhinolaryngology Clinic at the University Hospital of Patras, including 75 elderly patients (>65 years) who underwent total laryngectomy for LC between 2000 and 2015. Survival analysis was performed using the Kaplan-Meier estimator, with comparisons made using the Log-rank test. Statistical significance was defined as the p-value being less than or equal to 0.05. Results Over the 16-year period, new LC cases were predominantly male (97.3%) with a mean age of 73.88 years (range: 65-89 years). Most patients were smokers (96%) and alcohol users (54.7%). Histologically, 18.7% of tumors were classified as poorly differentiated, 65.3% as moderately differentiated and 16% as well differentiated. Post-surgical TNM staging indicated 10.7% stage II, 37.3% stage III and 52% stage IV, primarily located in the glottis (62.7%) and followed by supraglottis (34.7%). All patients underwent total laryngectomy, with 69.3% and 37.3% receiving neck dissection and adjuvant therapy (chemotherapy or radiotherapy), respectively. During follow-up, 39 patients died, with 74.3% due to disease-related causes. Five-year OS rates were 44.6%, with variations by stage (stage II: 62.5%, stage III: 55.8%, stage IV: 32.4%; p=0.039) and age (65-75 years: 51.7%, >75 years: 34.7%; p=0.039). Conclusions TNM staging of the laryngeal cancer significantly influences the overall survival of elderly patients undergoing total laryngectomy for LC. Early diagnosis of the disease is crucial for patient survival.

Clinical Outcome in Persons with Severe Mental Disorders Attending a Mental Health Day Center during the COVID-19 Pandemic.

BACKGROUND: Studies assessing the psychological impact of the COVID-19 pandemic on populations highlight the emergence of mental health difficulties, especially if a mental health disorder is already present. Patients with severe mental illnesses (SMIs) may be even more vulnerable to the psychosocial effects of the pandemic. However, little is known regarding the possible impact of the pandemic on SMI patients supported by community-based mental health day centers. METHODS: A two-year prospective study comprising 29 individuals with SMI was conducted by the Skitali Mental Health Day Center in Ioannina, Northwest Greece. The described group of examined patients consisted mainly of psychotic patients (65.5%). Patients were assessed using the Health of Nations Outcome Scale and the Global Assessment of Functioning scale, and scores prior to and after the onset of the pandemic were compared. RESULTS: The results indicated that participants did not present any significant decline in their overall clinical status during the COVID-19 pandemic and the national lockdown measures. CONCLUSIONS: This finding is relevant because previous research has shown that the pandemic may negatively impact adherence to treatment and service attendance and that the symptomatology of patients with SMIs may further deteriorate. It is suggested that the operation of mental health day centers during collective stressful events should be preserved, but further research is needed to evaluate their role in maintaining continuity of care during such events.

Spread of multidrug-resistant Pseudomonas aeruginosa clones in a university hospital.

An outbreak of multidrug-resistant Pseudomonas aeruginosa (MDRPA) infections in a university hospital is described. Phenotypic and genotypic analysis of 240 isolates revealed that 152 patients, mainly in the intensive care unit (ICU), were colonized or infected with MDRPA, the majority with O11. All metallo-ß-lactamase (MBL)-positive isolates carried the bla(VIM-2) or bla(VIM-1) gene. One or more type III secretion system toxin genes were detected in most isolates. Five dominant pulsed-field gel electrophoresis (PFGE) types were characterized, associated with ST235, ST111, ST253, ST309, and ST639.

Prevalence, Risk Factors, and Economical Cost of Work-Related Injuries Among Olive Workers in the Achaia Region, Greece.

Background Olive gathering involves tree climbing, carrying heavy loads, navigating rough terrain, and using sharp tools. However, little is known about occupational injuries among olive workers. The aim of this study is to evaluate the prevalence and risk factors of occupational injuries among olive workers in a rural Greek area and to assess the financial burden on the health system and insurance funds. Methods A questionnaire was administered to 166 olive workers in the Aigialeia municipality in the Achaia region, Greece. The questionnaire contained detailed information on demographic characteristics, medical history, working environment, protective measures, gathering tools, and type and site of injuries. Moreover, data were recorded about the duration of hospitalization, medical examinations and treatment received, sick leaves, complications, and rate of re-injury. Direct economic costs were calculated for hospitalized and non-hospitalized patients. The associations between olive workers' characteristics, risk factors, and occupational injury within the last year were examined using log-binomial regression models. Results In total, 85 injuries were recorded in 50 workers. The prevalence of one or more injuries in the last year was 30.1%. Factors associated with a higher rate of injury were male gender, age > 50 years, working experience > 24 years, history of arterial hypertension and diabetes mellitus, climbing habits, and non-use of protective gloves. The average cost of agricultural injuries was more than 1400 € per injury. The cost seems to be associated with the severity of the injury, as injuries requiring hospitalization were associated with increased costs, higher cost of medication, as well as more days of sick leave. Losses due to sick leave cause the greatest financial costs. Conclusions Farm-related injuries are quite usual among olive workers in Greece. Injury risk is influenced by gender, age, working experience, medical history, climbing habits, and use of protective gloves. Days off work have the greatest financial cost. These findings can be useful as a starting point to train olive workers to reduce the incidence of farm-related injuries in Greece. Knowledge of risk factors for farm-related injuries and diseases could help the development of proper interventions to minimize the problem.

Use of Long-Acting Injectable Antipsychotics in a Clinical Sample of Community-Dwelling Patients with Schizophrenia-Spectrum Disorders in Rural Greece.

Data on the use of long-acting injectable antipsychotics (LAIs) in rural community mental healthcare settings are scarce. This study aimed to investigate the prescription patterns of LAIs in a clinical sample of patients with schizophrenia-spectrum disorders in rural Greece. All patients with schizophrenia-spectrum disorders who regularly attend the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T) in northwestern Greece were included in the study. The sample consists of 87 patients (59 males and 28 females) with a mean age of 54.4 years and a mean illness duration of 28 years. Most patients (72.4%) received antipsychotic monotherapy, and nearly 30% received an LAI formulation, mostly a second-generation LAI (20 of 26 patients, 76.9%). The treatment regimen comprised benzodiazepines in one-third of the patients and antidepressants in one-quarter. There was no statistically significant association between treatment regimen and the clinical and demographic variables studied, except for biological sex (female). The percentage of patients treated with LAIs in this study was almost three times higher than the rate previously reported in Greece and is higher than the rates reported in other countries. Patients with schizophrenia-spectrum disorders in rural Greece may have adequate access to innovative treatment with second-generation LAIs. Further research is needed to demonstrate the cost-effectiveness of LAI treatment in rural communities and to elucidate the factors associated with such treatment.

Epidemiological Study of Autism Spectrum Disorders in Greece for 2021: Nationwide Prevalence in 2-17-Year-Old Children and Regional Disparities.

This study estimated the crude prevalence of autism spectrum disorders (ASD) in Greece in 2021. A retrospective study was conducted for 2021 using data provided for research purposes for the first time by the Greek National Health Service Organization for Healthcare Services Provision (EOPYY) related to the ICD-10 diagnosis codes F84.0-F84.9 (ASD). Treatments were categorized by gender, age, and location. Statistical analysis was performed using the open-source software R. In total, 15,706 children aged 2-17 years were registered with ASD: 12,380 boys and 3326 girls. In total, 6,117,910 therapies were prescribed: 4,844,173 for boys and 1,273,737 for girls. Boys are estimated to be diagnosed 3.5 times more often than girls. On average, approximately 390 treatments are prescribed per person per year for both sexes. The annual prevalence is estimated at 0.94%, ranging from 0.42% to 1.44% depending on geographic region. Our findings provide evidence-based data for the planning of policies regarding health, education, and employment for people with ASD. The number of children and treatments makes ASD a public health concern to support children and their families and ensure equal participation in all aspects of society.

Who is coercively admitted to psychiatric wards? Epidemiological analysis of inpatient records of involuntary psychiatric admissions to a University General Hospital in Greece for the years 2008-2017.

BACKGROUND: Involuntary psychiatric admissions are a widely used practice despite ethical concerns about coercion. There are particular concerns that vulnerable groups, such as single, unemployed or racial minorities, may be more subjected to such practices. AIM: We aimed to investigate the social patterns of involuntary psychiatric admissions from 2008 to 2017 at University General Hospital in Ioannina, Greece. METHOD: We retrospectively assessed inpatient records from 2008 to 2017 of patients admitted to the Department of Psychiatry of the Ioannina University General Hospital, Northwestern Greece. Alternative patients of alternative years were selected for inclusion; this yielded 332 patients involuntarily admitted, corresponding to 28.5% of total involuntary psychiatric admissions. RESULTS: Over the 10-year period, the overall numbers of annual involuntary psychiatric admissions remained relatively stable, as did the length of hospital stay (mean = 23.8 days). The most common disorder upon admission was schizophrenia spectrum disorders, accounting for approximately two-thirds of all admissions, followed by mood disorders (about 20%). There was evidence that people who lacked social support or experienced financial hardship were more greatly represented among those admitted: 70.2% of admitted patients were single and 64.8% were unemployed. Most patients had been admitted to the psychiatric ward in the past (64.2%). CONCLUSION: Our study indicates potentially worrisome evidence that patients who are in vulnerable positions are at elevated likelihood of being involuntarily admitted to psychiatric wards. Future research is needed to evaluate the socio-demographic patterning of involuntary admissions in other European countries.

Laboratory Surveillance of Acinetobacter spp. Bloodstream Infections in a Tertiary University Hospital during a 9-Year Period.

Multidrug-resistant Acinetobacter baumannii infections have become a threat for public health worldwide. The aim of the present study was to follow-up resistance patterns of Acinetobacter spp. bloodstream isolates in a Tertiary University Hospital over the last nine years, from 2014 to 2022. Susceptibility patterns were followed for the following antimicrobial agents: amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, imipenem, meropenem, tigecycline, trimethoprim/sulfamethoxazole, and colistin. Minimal inhibitory concentration (MIC) values to ampicillin/sulbactam, cefepime, ceftazidime, minocycline, piperacillin/tazobactam were evaluated from 2020 to 2023. During the study period, 853 Acinetobacter spp. bloodstream infections (BSIs) were recorded, accounting for 5.36% of all BSIs. A. baumannii was isolated in 795 cases (93.2%), during the study period. Most BSIs were recorded in adult intensive care units (ICU) (46.2%) and medical wards (42%). Among A. baumannii isolates, 4.5% were multidrug-resistant, 84.7% were extensively drug-resistant, and 8.5% were pandrug-resistant. Resistance to carbapenems was over 95%. Resistance to tigecycline increased significantly during the last years of the study (2020-2022); A. baumannii isolates with MIC ≤ 2 µg/mL accounted for 28.5% of all isolates. Resistance to colistin exhibited an increasing pattern up to 42.2% in 2022. Increasing resistance rates and the evolution of pandrug-resistant isolates call for the urgent application of preventive and response actions.

Post-Traumatic Stress as a Psychological Effect of Mild Head Injuries in Children.

BACKGROUND: Head trauma is one of the most common pediatric emergencies. While the psychological effects of severe head injuries are well studied, the psychological consequences of mild head injuries often go overlooked. Head injuries with a Glasgow Coma Scale score of 13-15, with symptoms such as headache, vomiting, brief loss of consciousness, transient amnesia, and absence of focal neurological signs, are defined as mild. The aim of this study is to evaluate the stress of children with mild head injuries and their parents' relevant perception during the early post-traumatic period. METHODS: This is a prospective cross-sectional study on a cohort of children with mild head injuries and their parents. Two questionnaires were implemented, the Child Trauma Screening Questionnaire (CTSQ) which was compiled by the children, and the Children's Revised Impact of Event Scale (CRIES-13), compiled by their parents. Both questionnaires are widely used and reliable. The first presents an excellent predictive ability in children with a risk of post-traumatic stress disorder, while the second is a weighted self-completed detecting instrument for the measurement of post-traumatic stress in children and adolescents, with a detailed evaluation of their reactions to the traumatic incident. The participants responded one week and one month after the traumatic event. RESULTS: A total of 175 children aged 6-14 years and 174 parents participated in the study. Stress was diagnosed in 33.7% of children after one week, and in 9.9% after one month. Parental responses suggesting stress presence in their children were 19.0% and 3.9%, respectively. These outcomes showed that mild head injuries are not so innocent. They are often underestimated by their parents and may generate a psychological burden to the children during the early post-traumatic period. CONCLUSIONS: Mild head injuries may affect the emotional welfare of children. Healthcare providers should understand the importance of the psychological effect of this overlooked type of injury. They should be trained in the psychological effect of trauma and be aware of this probability, promptly notify the parents accordingly, and provide psychological assistance beyond medical treatment. Follow-up and support are needed to avoid the possibility of future post-traumatic stress disorder. More extensive research is needed as the outcomes of this study regarded a limited population in numbers, age, and survey period. Furthermore, many children with mild head injuries do not ever visit the emergency department and stay at home unrecorded. Community-based research on the topic should therefore be considered.

Prevalence and risk factors of excess weight in school children in West Greece.

The present study estimated the prevalence of childhood obesity and identified risk factors in 10-13 year old children. A cross-sectional study was conducted, including 200 children and their parents, in seven randomly-selected primary schools across Patras, Greece. Height, weight, and waist circumference were measured, and self-reported information was collected via face-to-face interviews. Body mass index was calculated for the children and their parents. The effect of risk factors on overweight and obesity was analyzed using regression analysis. The prevalence of overweight and obesity was 32% and 10.5%, respectively. The odds of being overweight/obese increased in children whose parents had a lower educational level and/or higher body mass index. Fewer daily meals and more time spent in front of the television and/or on the computer were significantly associated with obesity in 10-13 year old children. The prevalence of excess weight in primary school children in Patras is of concern, especially for boys. Children's nutritional habits, leisure activities, and parental characteristics influence their somatometric characteristics. These findings highlight the need for future weight loss interventions targeted at this population.

Laryngeal cancer and passive smoking: the neglected factor?

In the present paper we investigate the relationship of environmental tobacco smoke (ETS) exposure to laryngeal cancer. 209 patients who were diagnosed with laryngeal cancer from 2000 to 2009 at the University Hospital of Patras, Western Greece, were reviewed with regard to patient age, disease stage at presentation, tumor differentiation, tobacco product use, alcohol consumption, occupation, and ETS exposure in the working environment. Pearson Chi-square method was used to determine the effect of ETS exposure on cancer stage, TNM classification and tumor differentiation in the dichotomized population (exposed vs. not exposed) and in groups of low, medium and high ETS exposure. ETS exposure in the working environment was found to significantly affect overall disease stage and T stage (p < 0.01) both in the dichotomic analysis and the group analysis. Minor significance was also noted for N stage (p = 0.047) in the exposure group analysis. Our data suggest that occupational ETS exposure presents a contributing risk factor for laryngeal cancer that requires further research to determine its significance.

Communication-based suicide prevention after the first attempt. A systematic review.

Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.

Systematic Review: Are the Elderly With Diabetes Mellitus Type 2 Prone to Fragility Fractures?

Diabetes mellitus type 2 (T2DM) is an emerging public health issue with high prevalence rates among older adults while fragility fractures constitute a significant public health burden with a great impact. Osteoporosis is the most important metabolic bone disease in patients with diabetes mellitus. Based on current evidence, individuals with T2DM are more vulnerable to fragility fractures than their non-diabetic counterparts, although until now, there aren't any systematic reviews or meta-analyses concerning the impact of T2DM on the risk of fragility fractures in elderly patients. The aim of this study is to fill this gap in the current literature concerning this specific patient group. Literature in PubMed and Google Scholar was searched for relevant articles published up to January 2021. The keywords used were: elderly, diabetes mellitus type 2, and fragility fractures. Among the 180 articles retrieved, only four full-text articles were eligible and, finally, two studies (one population-based cohort study and one cross-sectional study) met the inclusion criteria for the review. Although we identified 15 records through the manual research, finally 17 records were included in the current review. The records retrieved from the manual research were 11 prospective cohort studies, two population-based studies, one prospective observational study, and one retrospective cohort study. The author's name, year of publication, country, type of study, and number of patients were reported. According to this systematic review, there is almost consensus about the increased prevalence of all kinds of fragility fractures and especially low-energy hip fractures among elderly patients with T2DM compared with their counterparts without T2DM while there is relative controversy concerning non-vertebral fractures. Vertebral fractures in the elderly with T2DM require further evaluation because the results from cohort studies are more conflicting. Finally, insulin usage can increase the possibility of fragility fractures and can even double this risk. Bone fragility should be recognized as a new complication of T2DM, especially in elderly patients, due to several additional aggravating factors such as senile osteoporosis, severe vitamin D deficiency, presence of many comorbidities, increased possibility of insulin usage, and the presence of diabetes-related complications (mainly neuropathy and retinopathy). Clinicians who treat these patients should be aware of the special diagnostic and therapeutic approaches concerning these patients.