Parental health literacy and nutrition literacy affect child feeding practices: A cross-sectional study.

BACKGROUND: Health literacy (HL) and nutrition literacy (NL) are important issues to consider, in the provision of health care to children and the establishment of healthy eating behaviors. AIM: The study investigates the possible role of HL and NL levels of Greek parents, in parental Feeding Practices (PFP). METHODS: This is a cross-sectional study which was conducted in the urban area of the Attica region, Greece. The sample consisted of 402 parents (68.4% mothers). Parents completed the Greek version of Comprehensive Parental Feeding Questionnaire, the European Health Literacy Questionnaire 47 and the Greek version of the Nutrition Literacy Scale. Sociodemographic and anthropometric characteristics were also assessed. The non-parametric tests Mann-Whitney and Kruskal Wallis, the chi-square test and linear regression models were applied. RESULTS: The median for HL and NL were 33.69 and 24.00, respectively. Mothers applied the "child control" practice more frequently than fathers (p = 0.015). Linear regression analysis revealed that HL was associated positively with "healthy eating guidance" and "monitoring" (p = 0.009 and p < 0.0001, respectively) and negatively with "emotion regulation/food as reward" and "child control" (p = 0.037 and p = 0.015, respectively). NL was associated positively only with "healthy eating guidance" (p = 0.009), positively but marginally with "monitoring" (p = 0.051) and negatively with "emotion regulation/food as reward" (p = 0.020). CONCLUSIONS: Higher parental levels of HL and NL are significantly positively associated with better parental feeding practices in Greece.

Validation of the Greek Version of Hedonic, Eudaimonic, and Extrinsic Motives for Activities (HEEMA) Instrument.

Hedonia and eudaimonia are motivating forces through which individuals pursue well-being. The latter is a multidimensional concept, while hedonia and eudaimonia, both of which are realized through the reward system of the brain, are known to influence each other. Researchers have shown that specific extrinsic values (e.g., material wealth, power over other people, etc.) are associated with a sense of "good life" and may influence both hedonia and eudaimonia. The HEEMA (Hedonic, Eudaimonic, and Extrinsic Motives for Activities) scale was developed to evaluate all three ways of seeking well-being, hedonia, eudaimonia, and extrinsic values, in both a healthy and unhealthy fashion. The purpose of this study was to assess the psychometric properties of the HEEMA scale in a sample of 225 Greek individuals. Participants filled the HEEMA, SWLS, MLQ, Self-Esteem questionnaire, DASS-21, MHC-SF, and Big Five Inventory, anonymously. Reliability and validity indices of the scales were satisfactory (Cronbach's α were 0.734, 0.811, and 0.843 for the hedonic, eudaimonic, and extrinsic motives subscales, respectively). Indicatively, the study showed a positive correlation between aspects of well-being and positive emotions, satisfaction with life, sense of meaning and purpose, as well as with specific personality traits, while negative correlations were found between eudaimonic orientation and depression.

Validation of the Greek Version of Social Media Disorder Scale.

Social media platforms have gained ground in the day-to-day life of the vast majority of people globally. Growing evidence suggests that social media overuse can take a pathological form, and users can exhibit behaviors similar to those appearing in several types of addiction. The aim of this study was to validate the Greek version of the Social Media Disorder Scale (SMDS) among young adults. An online survey was conducted among Greek adults, aged 18-29 years old. A total of 251 respondents voluntarily participated. Internal consistency, criterion, and construct validity were examined. Results suggest that the Greek version of SMDS shows good psychometric properties. Internal consistency was above the acceptable margin, with a satisfying Cronbach's α coefficient. Correlations with other addiction-related constructs were found to be moderate. Construct validity of the scale was evaluated with exploratory factor analysis. Exploratory factor analysis resulted in a single factor model, which explained almost half of the total variance. The Greek version of SMDS is a psychometrically sound and valid instrument, which researchers and practitioners can use to assess social media addiction in young adults.

The Kentucky Inventory of Mindfulness Skills in Greek Undergraduate and Postgraduate Students.

The Kentucky Inventory of Mindfulness Skills (KIMS) is a widely used multidimensional tool for assessing the tendency of the individual to be mindful in everyday life. The aim of the present study was to standardize a Greek version of KIMS and to explore its psychometric properties in the Greek population. A sample of 213 Greek undergraduate and postgraduate students from various educational institutions completed the questionnaires. The Mindful Attention and Awareness Scale (MAAS), Toronto Alexithymia Scale (TAS-20), and Perceived Stress Scale (PSS-14) were used to evaluate the criterion validity of KIMS. The Principal component analysis (PCA) resulted in a four-component solution, similar to the structure of the English version of the inventory: "Observing," "Describing," "Acting with awareness," and "Accepting without judgment." All components combined accounted for 45.79% of variance. The subscales had adequate internal consistency, and their scores were correlated with MAAS, TAS, and PSS scores, indicating satisfying criterion validity. Associations between the "Observing" subscale and demographic characteristics were also revealed. This version of KIMS can be safely utilized for assessing mindfulness skills and the efficacy of mindfulness-based interventions in Greek populations.

Adherence to the Mediterranean diet and weight status in children: the role of parental feeding practices.

The study examines Parental Feeding Practices (PFP) in relation to adherence to the Mediterranean Diet (MD) and children's weight status. It's a cross-sectional study of 402 parents (68.4% mothers), with children aged 2-12 years. Parents completed the Comprehensive Parental Feeding Questionnaire and the Mediterranean Diet Quality Index for children and adolescents (KIDMED), evaluating children's adherence to the MD. Logistic regression showed that in children aged 2-<6 years, "emotion regulation/food as reward" and "pressure" decrease MD adherence (OR = 0.186, p < 0.0001 and OR = 0.496, p = 0.004), and "monitoring" decrease excess body weight (OR = 0.284, p = 0.009). In older children (6-12 years), "healthy eating guidance" and "monitoring" increase MD adherence (OR = 3.262, p = 0.001 and OR = 3.147, p < 0.0001), "child control" decreases MD adherence (OR = 0.587, p = 0.049), "pressure" decrease excess body weight (OR = 0.495, p < 0.0001) and "restriction" increase excess body weight (OR = 1.784, p = 0.015). "Healthy eating guidance" and "monitoring" seem to be the best PFP employed, in terms of children's MD adherence and weight status.

Low health literacy and perceived stress in adults: is there a link?

OBJECTIVES: Mental stress, low health literacy (HL) and nutrition literacy (NL) are associated with serious negative health outcomes. The aim of this study was to investigate HL and NL levels, in relation to levels of perceived stress, in adults. METHODS: This cross-sectional study was conducted in the urban area of the Attica region, Greece. The sample consisted of 1,281 individuals, aged ≥ 18 years. The European Health Literacy Questionnaire 47, the Greek version of the Nutrition Literacy Scale and the Perceived Stress Scale 14 were used. Socio-demographic characteristics were also assessed. Nonparametric Mann-Whitney U and Kruskal-Wallis tests, Pearson chi-square and multiple linear regression models were used. RESULTS: The sample's perceived stress mean value (SD) was 26.47 (7.27) with women scoring statistically significantly higher than men. The mean HL and NL scores were 32.28 (8.28) and 22.11 (5.67), respectively. Linear regression analysis has shown that perceived stress was significantly negatively associated with HL (p < 0.001) but not with NL levels (p = 0.675) after adjusting for a series of confounding variables. CONCLUSIONS: Low health literacy seems to be very significantly associated with high levels of perceived stress. The reasons behind this association require further investigation.

Socioeconomic inequalities in relation to health and nutrition literacy in Greece.

Poor health literacy (HL) is associated with poor health behaviours and outcomes. The aim of the study was to investigate the effect of socioeconomic status on HL and nutrition literacy (NL) in Greece. This is a cross-sectional study which took place in Attica, Greece. 1281 individuals, aged ≥18 years of both sexes, participated. The European Health Literacy Questionnaire and the Greek version of the Nutrition Literacy Scale were used. Linear regression analysis revealed that education was significantly positively associated with HL (p = 0.002) and medium annual income was significantly associated with higher HL (p = 0.024), in contrast to low annual income. Education (p < 0.001) was significantly positively associated with NL. Unskilled particpants had lower NL compared to skilled paricipants (p = 0.021) and participants with medium annual income had significantly higher NL (p = 0.003) in comparison to participants with low annual income. Socioeconomic inequalities seem to negatively associate with HL and NL in Greece.

Low health literacy and excess body weight: a systematic review.

OBJECTIVE: There is recent evidence that poor health literacy (HL) could be implicated in the aetiology of obesity and could be an important reason behind obese people's inability to encounter difficulties in overcoming obesity issues. The current study reviews the recent scientific evidence investigating the possible link between poor HL levels and excess body weight in adults and children. METHODS: The authors performed a thorough systematic computer-assisted literature search from 1 January 2005 up to 31 May 2017. Only English original studies in healthy people, investigating the relationship between HL and excess body weight, were included. RESULTS: Twenty-two studies in total were included in this literature review, 17 studies were conducted in adults and 5 in children. In 17 out of 22 studies reviewed, low HL was significantly associated with increased body mass index, overweight and obesity. In case of children and adolescents, the above association seems to be more consistent compared to adults. CONCLUSION: There is good evidence that low levels of HL are associated with excess body weight, particularly in children. Initiatives to improve health literacy levels could be a useful tool in the management of the obesity epidemic.

Functional Gastrointestinal Symptoms in Children with Autism and ADHD: Profiles of Hair and Salivary Cortisol, Serum Leptin Concentrations and Externalizing/Internalizing Problems.

BACKGROUND: Functional Gastrointestinal Disorders (FGIDs) present a higher prevalence in individuals with Neurodevelopmental Disorders (NDDs). The Stress System and the Gut-Brain axis (GBA) may mediate these relations. We aimed to assess the prevalence and profile of FGIDs in a clinical sample of children with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) compared to typically developing children (TD) as well as to investigate possible relations between stress-related biomarkers and internalizing/externalizing problems in children with NDDS. METHODS: In total, 120 children, aged between 4 and 12 years old, formed three groups (N = 40, each): ADHD, ASD and TD. Salivary cortisol, hair cortisol and serum leptin were measured. RESULTS: The ASD group had more FGID problems than the TD group (p = 0.001). The ADHD and ASD groups had higher total internalizing/externalizing problems than the TD group (p < 0.0001, p < 0.0001, p = 0.005, respectively). Children with FGIDs showed more total, internalizing and externalizing problems compared to children without FGIDs (p < 0.0001, p < 0.0001, p = 0.041, respectively). The ADHD group showed lower AUCg values (p < 0.0001), while the hair cortisol was higher for the TD group (p < 0.0001). CONCLUSION: In conclusion, children with NDDs had more FGID symptoms and present higher internalizing and externalizing problems. Children with ADHD and FGIDs had more internalizing problems compared to those without FGIDs. No differences in stress-related biomarkers were shown to differentiate children with NDDs with and without FGIDs. Future prospective studies including a greater number of children may elucidate the biological pathways linking these comorbidities.

An educational intervention to improve health and nutrition literacy in hypertensive patients in Greece.

BACKGROUND: Suboptimal control of blood pressure (BP) is a public health challenge in Greece. This educational intervention attempts to improve health literacy (HL) and nutrition literacy (NL) in primary healthcare (PHC) patients with hypertension (HTN). MATERIALS AND METHODS: This was a proof-of-concept (PoC) educational intervention. Twenty-four patients with HTN and low or medium levels of HL agreed to participate in this 6-week educational intervention. The program was delivered by a general practitioner (GP) in group A and by a qualified nurse in group B. Group C was the control group. The levels of HL of NL, adherence to the Mediterranean diet, and perceived stress were assessed using the European Health Literacy Survey Questionnaire 16 (HLS_EU_Q16) and part B (reading a medication label) of the High Blood Pressure-Health Literacy Scale (HBP-HLS), the Nutrition Literacy Scale-Greek (NLS-Gr), the Mediterranean Diet Adherence Screener (MEDAS), and the Perceived Stress Scale (PSS-14), respectively, together with certain socioeconomic, dietary, and lifestyle characteristics. The Kruskal-Wallis and Wilcoxon nonparametric, the Chi-square, and the McNemar-Bowker tests were used. The analysis was done with the STATA software, version 14 (MP & Associates, Sparta, Greece). RESULTS: No statistically significant differences were found in the total score of HL and NL before and after the intervention; however, the results indicate a slight improvement in HL and NL levels in the two intervention groups, together with small improvements in knowledge and behaviors related to HTN and dietary salt. A trend of improvement in the MEDAS levels in the GP's group and the HBP-HLS levels in the nurse's group was also reported. CONCLUSION: A slight improvement in HL and NL levels in the two intervention groups has been reported, and the changes, however, were not statistically significant.

Differences in segmental hair cortisol concentration analysis among children and adolescents with overweight and obesity, their parents, and normal weight peers.

PURPOSE: Dysregulation of the stress system via incidental long exposure to glucocorticoids (GCs) can lead to weight gain. In addition, family and maternal stress can also have an impact on children's weight. Hair is used in several studies to evaluate cortisol (GC) levels in children and adolescents with excess weight as a retrospective stress biomarker, depending on the hair length the cortisol measurement depicting different time periods. We aimed to investigate whether there is a difference among segmental hair cortisol concentration (HCC) analysis between children and adolescents with overweight and obesity, their mothers, and normal weight peers. METHODS: This study recruited 25 children aged 6-14 years with a body mass index (BMI) ≥ 85th centile and their mothers, as well as 20 children of the same age with a BMI < 85th centile. Hair cortisol concentration was measured using electrochemiluminescence immunoassay. RESULTS: Segmental HCC analysis exhibited gradually decreasing values in all participants as segments of hair were more distantly located from the scalp. A positive correlation was found between BMI z-score and HCC of the first segment of hair in children and adolescents with elevated BMI (b = 1.84, p = 0.033), as well as with maternal HCC / of an only child (b = 15.77, p = 0.01). There were no associations between mother-child dyads and children and adolescents of different BMI groups, even though minors with excess weight exhibited higher HCC levels in all segments of hair in comparison to their normal weight counterparts. CONCLUSIONS: Hair cortisol of all participants exhibited a gradually declining concentration. More studies with larger samples and more sensitive methods of analysis are warranted in order to draw firmer conclusions.

Validation of the Greek Version of Social Appearance Anxiety Scale in Adolescents and Young Adults.

Many people are worried about their social appearance. The fear of negative evaluation and judgment regarding one's look in social circumstances is referred to as social appearance anxiety. Social appearance anxiety belongs to social anxiety. The aim of the present study was to validate the Social Appearance Anxiety Scale (SAAS) in the Greek language and to examine its psychometric properties. An online survey was conducted in a Greek population sample of adolescents and young adults aged 18 to 35 years. The survey instruments included the Social Appearance Anxiety Scale, the Social Physique Anxiety Scale (SPAS), 2 subscales of Multidimensional Body-Self Relations Questionnaire Appearance Scale (MBSRQ), the Appearance Schemas Inventory-Revised Scale (ASI-R) and the Depression Anxiety Stress Scale (DASS). A total of 429 respondents participated in this research. The statistical analysis showed that the Greek version of the SAAS has good psychometric properties. The internal consistency of questions within the SAAS was 0.942. Positive correlations were found between SAAS and SPAS, the overweight preoccupation subscale of MBSRQ, the ASI-R and the DASS, while negative correlations were observed between SAAS and the appearance evaluation subscale of MBSRQ and age. The results of this study suggest that the Greek version of SAAS can be used as a reliable and valid instrument in the Greek population.

Strong Correlations between Social Appearance Anxiety, Use of Social Media, and Feelings of Loneliness in Adolescents and Young Adults.

Social appearance anxiety is a type of social anxiety that is associated with body image perception and exacerbated by the use of social media, leading to feelings of loneliness. The purpose of this cross-sectional study was to examine the relations between social appearance anxiety, use of social media, and feelings of loneliness in Greek adolescents and young adults. The sample of the research consisted of 632 participants, 439 women (69.5%) and 193 men (30.5%), aged 18-35 years. The Social Appearance Anxiety Scale (SAAS), the Social Media Disorder Scale (SMDS), and the UCLA Loneliness Scale were the instruments used. Data collection was performed online, via Google forms. Multiple regression analyses were performed and demonstrated a significant positive correlation between the Social Appearance Anxiety Scale and the UCLA Loneliness Scale scores. The feeling of loneliness was predicted by the social appearance anxiety score (p < 0.0001). On the other hand, there was a significant negative correlation between the Social Appearance Anxiety Scale and the Social Media Disorder Scale scores (p = 0.002), suggesting that social media use may exacerbate appearance anxiety and, hence, loneliness. The findings suggest that there may be a complex, vicious reverberatory cycle between appearance anxiety, use of social media, and feelings of loneliness in some young people.

Psychometric Validation of the Greek Version of the Scale "Temper Loss" of the Questionnaire "Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB)".

It has become increasingly evident that vulnerability to psychopathology is identifiable early in life. A body of evidence suggests that the recognition and prevention of a spectrum of typical/atypical behaviors in preschoolers can lead to earlier diagnosis and treatment. The Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) is a parent-completed instrument that has been developed recently to differentiate normative misbehaviors in early childhood from markers of clinical risk. The aim of the present study was to validate the "Temper Loss" Subscale in the Greek language and to assess its psychometric properties in healthy children. An on-print parent-report survey was conducted among Greek children, aged between 3 and 5.5 years. The survey included the MAP-DB and the Child Behavior Checklist (CBCL). A total of 400 respondents participated in the study. The analysis suggested that the Greek version of the MAP-DB's "Temper Loss" scale has good psychometric properties. The results of the Exploratory Factor Analysis (EFA) of the 22 items were able to explain 64.4% of the total variance. Internal consistency for the one subscale was satisfactory, with Cronbach's alpha at 0.970. This scale can be used by researchers and practitioners for the evaluation of dimensional phenotypes in early childhood.

Validation of the Instagram Addiction Scale in Greek Youth.

Instagram is one of the fastest growing social networking platforms. A body of evidence suggests that Instagram problematic use and addiction have negative effects on the psychological well-being of young people. The Instagram Addiction Scale, a self-report tool assessing Instagram problematic use and addiction, has been developed recently. The aim of the present study was to validate the Instagram Addiction Scale in the Greek language and to assess its psychometric properties. An online and on-print self-report survey was conducted among Greek youth, aged between 18 and 24 years. The survey included the Instagram Addiction Scale, the Rosenberg Self-esteem Scale, the Perceived Stress Scale, and the Big Five Inventory. A total of 967 respondents participated in the study. The analysis suggested that the Greek version of the Instagram Addiction Scale has good psychometric properties. The principal component factor analysis for construct validity generated two subscales as the original instrument: social effect and impulsion. Internal consistency for the two subscales and the scale's total score was satisfactory, with Cronbach's α at 0.76, 0.85 and 0.88, respectively. Correlation analyses revealed positive associations between the perceived stress scale and social effect, and the Instagram Addiction Scale's total score (p<0.0001 and p=0.002 respectively). This is the first study validating the Instagram Addiction Scale in Greek youth, which can be used by researchers and practitioners for the evaluation of youth problematic use of Instagram.

The effects of Pythagorean Self-Awareness Intervention on patients with major depressive disorder: A pilot randomized controlled trial.

Stress plays an important role in major depressive disorder (MDD). Thus, a variety of stress management programs have been developed for people with this diagnosis. This is a pilot randomized clinical trial which implemented a holistic stress management program, Pythagorean Self-Awareness Intervention (PSAI) in adults with MDD, aiming to evaluate the effectiveness of PSAI compared to standard care for reduction of depressive symptoms (primary aim), improving mental health and quality of life (secondary aims). A total of 69 participants were randomized to an intervention group (N = 34), who received the usual care provided for patients with major depression and attended the PSAI program, and a control group (N = 35), who received the usual care only. Measurements were taken in both groups before and after the intervention and included: 1. Self-report questionnaires for measuring depressive symptoms, healthy lifestyle, perceived stress, anxiety, positive and negative affect and sleep quality, 2 Cognitive function assessment tools, 3. Hair and salivary cortisol. The intervention group demonstrated significantly greater reductions in depressive symptoms, negative affect, perceived stress, sleep quality and significantly greater increase in visual memory and healthy lifestyle compared to the control group. In addition, the intervention group demonstrated a significant reduction in first morning salivary cortisol, indicating a reduction in diurnal stress levels, while no significant change of salivary cortisol was observed in the control group. Finally, none of the study's groups demonstrated a significant change in hair cortisol concentration. In conclusion, PSAI can be applied to adults suffering from MDD with significant benefits for their mental health and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04536714.

Salivary cortisol and alpha-amylase daily profiles and stress responses to an academic performance test and a moral cognition task in children with neurodevelopmental disorders.

There is evidence that children with neurodevelopmental disorders may exhibit atypical responses to stress and alterations in concentrations and diurnal secretion of stress hormones. We assessed diurnal profiles and stress responses of salivary cortisol and alpha-amylase (sAA) in children with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and specific learning disorder (SLD) compared to typically developing children (TD). A total of 157 children of both sexes, aged between 6 and 12 years old, took part in the study distributed into four groups: ADHD (N = 34), ASD (N = 56), SLD (N = 43) and TD (N = 24). Salivary samples were collected at three time points during a day, as well as before and 5 min after an academic performance test and a moral cognition task. ADHD children had lower evening and diurnal sAA levels, adjusted for age. Also, ASD children showed lower diurnal sAA secretion, adjusted for age. The mean percentage change for salivary cortisol and sAA after both tests did not differ between the groups. In conclusion, we demonstrated alterations in diurnal autonomic functioning in children with ADHD and ASD, while hypothalamic-pituitary-adrenal axis functioning did not differ between the clinical and the comparison groups.

Low hair cortisol concentrations in obsessive compulsive disorder: A cross-sectional study.

Recent findings have highlighted the association between changes in the activity of the HPA axis, primarily its end-hormone, cortisol and OCD. However, to date, cortisol levels of OCD patients have been assessed mainly in body fluids, such as serum, saliva or urine, frequently leading to ambiguous results because of their inherent lack of stability. The aim of this study was to investigate time-integrated levels of stress exposure in 32 OCD patients and 32 sex and age-matched healthy controls by measuring endogenous cortisol in hair segments reflecting the last 3 months preceding hair collection. Psychometric parameters, including BDI, FQ, STAI, PSS and ECQ-R, were obtained in all participants; Y-BOCS was performed in the OCD patients. The OCD patients exhibited significantly higher scores in all psychometric instruments administered and lower hair cortisol concentrations than the healthy controls (p = 0.001, r = 0.41). No significant correlations were found between the HCC and the Y-BOCS total scores. After having sorted OCD patients into subtypes, according to the nature of their symptomatology, the "washers/cleaners" category showed the lowest HCC (compared to the "checking/harming", "ordering/symmetry" and "sexual/religious obsessions" categories). The novel finding of chronic low cortisol secretion in OCD patients could be attributed to a possible down-regulation of the HPA axis, as an adaptive response to chronic stress exposure. Given that the OCD subtypes reflect the great heterogeneity in the OCD spectrum, studies with larger samples should extend the investigation of HCC in patients with distinctive symptomatology, so as to develop a basis for better neuroendocrine profiling and understanding of the pathophysiology of OCD. Further work is needed in exploring HPA axis' activity over the natural course and treatments of the disorder.