Salivary inflammatory markers in tension type headache and migraine: the SalHead cohort study.

OBJECTIVE: To investigate the possible association between salivary CRP, IL-1ß, and IL-6 levels, depression/anxiety and migraine, and tension type headache (TTH) in saliva of these patients. METHOD: A longitudinal prospective study was conducted on 30 migraineurs, 30 TTH patients, and 30 age-matched healthy controls. Anxiety and depression were measured by using the Hamilton Anxiety Rating Scale (HAM-A), and the Beck Depression Inventory (BDI). Salivary IL-6, IL-1ß, and CRP were collected in distinct time points as A: headache-free period, B: during headache, C: 1 day after headache attack, and measured by using ELISA kits. RESULTS: No significant differences were found in time variation of CRP, IL-1ß, and IL-6 levels between migraine and TTH (p > 0.05). IL1-ß had the highest discriminative value (area under the curve = 0.924, p value < 0.001), and then CRP (area under the curve = 0.763, p value < 0.001) and IL-6 (area under the curve = 0.537, p value = 0.58). CRP and IL-6 were negatively correlated with HAM-A and BDI scores. CONCLUSION: IL1-ß had the highest discriminative value between headache patients and controls compared with CRP and IL-6. CRP and IL-6 were correlated with lower symptom scores of anxiety and depression prior or immediately after the headache period in patients groups.

Testamentary Capacity Assessment: Legal, Medical, and Neuropsychological Issues.

INTRODUCTION: The increase in the aging population and the number of patients with dementia led to the research in older adults' capacity assessment over the last 3 decades. Many cases of contested wills occur due to lack of testamentary capacity (TC), especially in cases of dementia. AIM: Purpose of the present study was to overview the legal, medical, and neuropsychological aspects of TC as well as the instruments used for TC assessment. FINDINGS: The testator/testatrix with intact TC has realistic perception of his or her property value, lack of psychopathology affecting contact with reality, and intact intention of how and to whom he or she will dispose his or her assets. It is frequent for the health practitioners to serve as "gold standards assessors" by examining an individual's ability to make a valid will and giving evidence to the court to support or not a will contest. The TC assessment is a complex process of clinical and legal practice requiring usually a variety of methods, that is, interviews, evaluation of clinical records, and administration of neuropsychological instruments. CONCLUSION: The evaluation of TC is a multidimensional process that integrates both the legal and medical field, requiring a collaborative approach to its definition and assessment.

Preliminary evidence for gender effects of levetiracetam monotherapy duration on bone health of patients with epilepsy.

Enzyme-inducing antiepileptic drugs AEDs have adverse effects on bone mineral density (BMD), whereas studies on levetiracetam (LEV), a nonenzyme-inducing agent, have showed conflicting results. The aim of this study was to further elucidate the role of LEV in bone health. A sample of forty-six patients with epilepsy (mean age: 35.7 years, range: 20.2-64.2 years, 39.1% males) on LEV monotherapy for at least one year (range: 1.5-14.5 years, median 5.5 years) underwent femoral neck (FN) and lumbar spine (LS) BMD measurements. The T- and Z-scores were calculated. Results showed that 15.2% of the patients were identified with osteopenia and none with osteoporosis. Pearson's correlations revealed a negative but not significant association of LEV duration with bone-related measurements (range of rhos: from -0.004 to -0.23), except for LS T-scores. In terms of FN BMD measurements, Z-scores, and T-scores, longer LEV therapy duration had adverse but not significant effects on bone health after adjusting for age and gender. With regard to LS BMD measurements, Z-scores, and T-scores, men taking LEV for at least 5.5 years had better, although not significant, bone health compared with men with shorter LEV exposure, after adjusting for age. The opposite was found in women, although differences did not reach significance. These preliminary results are indicative of a differential effect of LEV therapy duration in men and women, which could presumably account for the incongruity of the already published studies. Also, LS assessments were more sensitive to these gender differences. Future larger studies should validate these results.

The testamentary capacity in acute stroke. A cross-sectional study.

Succession law, which governs the creation and validity of wills, is closely tied to testamentary capacity (TC), the cognitive competence required for a valid will. This study explores TC in acute stroke patients and its connections to demographic and clinical characteristics. The research included first-time stroke patients admitted within 24 hours of symptom onset, meeting specific criteria. Data were collected, and assessment tools like the Addenbrooke's Cognitive Examination III (ACE-III) and Testamentary Capacity Assessment Tool (TCAT) were used. The study found that TCAT scores were not significantly affected by age or gender but positively correlated with education, the Barthel Index and ACE-III scores. They were negatively associated with National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores. Specific cognitive domains, particularly memory and attention, were independent determinants of TCAT scores. This research introduces TCAT as a valuable tool for evaluating testamentary capacity in stroke patients and highlights the multifaceted nature of TC, emphasizing the need for a nuanced approach. As the population ages and complex medical conditions become more prevalent, understanding the interplay between cognitive functioning and testamentary capacity becomes increasingly crucial for both legal and medical professionals.

APOE Allele Frequency in Southern Greece: Exploring the Role of Geographical Gradient in the Greek Population.

BACKGROUND: the apolipoprotein e4 allele (APOE4) constitutes an established genetic risk factor for Alzheimer's Disease Dementia (ADD). We aimed to explore the frequency of the APOE isoforms in the Greek population of Southern Greece. METHODS: peripheral blood from 175 Greek AD patients, 113 with mild cognitive impairment (MCI), and 75 healthy individuals. DNA isolation was performed with a High Pure PCR Template Kit (Roche), followed by amplification with a real-time qPCR kit (TIB MolBiol) in Roche's Light Cycler PCR platform. RESULTS: APOE4 allele frequency was 20.57% in the ADD group, 17.69% in the MCI group, and 6.67% in the control group. APOE3/3 homozygosity was the most common genotype, while the frequency of APOE4/4 homozygosity was higher in the AD group (8.60%). APOE4 carrier status was associated with higher odds for ADD and MCI (OR: 4.49, 95% CI: [1.90-10.61] and OR: 3.82, 95% CI: [1.59-9.17], respectively). CONCLUSION: this study examines the APOE isoforms and is the first to report a higher APOE frequency in MCI compared with healthy controls in southern Greece. Importantly, we report the occurrence of the APOE4 allele, related to ADD, as amongst the lowest globally reported, even within the nation, thus enhancing the theory of ethnicity and latitude contribution.

Relationship of quality of life, psychopathologic symptoms and ways of coping in Greek nursing staff. / Relación entre calidad de vida, síntomas psicopatológicos y formas de afrontamiento en las enfermeras griegas.

OBJECTIVE: Our aim was to investigate the relationship of quality of life, psychopathological symptoms and ways of coping of nursing staff in two General Hospitals in Greece. METHOD: This was a cross-sectional study of 302 nurses in two General Hospitals in Greece between October and November of 2015. Data collection was performed using three questionnaires: the World Health Organisation Quality Of Life BREF; the Falk Self-Reporting Questionnaire for the detection of possible psychiatric comorbidity, and the Ways of Coping Scale for Stressful Situations. RESULTS: From a sample of 302 nurses, the poorer the mental and physical health of the nursing staff, the more their quality of life was impaired in all dimensions (physical, psychological, social and environmental) (P<.001, P=.047, P=.001). Also, while the scores in coping strategies "positive approach-positive reappraisal", "positive approach-problem solving" and "positive approach (overall)" rose, the score in the General Scale dropped; in other words, the employees' general health improved. CONCLUSION: Coping strategies such as positive approach, improved the nurses' general health. In contrast, their mental health deteriorated when they adopted the wishful thinking/daydream and/or the escape/avoidance strategies. Finally, as their general health worsened, their quality of life was impaired in all dimensions, whereas poor mental health of nurses was associated with lower quality of life in the physical and psychological dimensions.

Testamentary Capacity Assessment Tool (TCAT): A Brief Instrument for Patients with Dementia.

BACKGROUND: In current practice, it is common for the medical practitioner to assess a person's testamentary capacity (TC) and give evidence to the Courts about a potential will contest. TC is an advanced cognitive activity that is both situation- and task-specific. OBJECTIVE: The aim of the present study was the development of a brief, specialized instrument for TC assessment in patients with dementia. METHOD: We developed a short tool consisting of four subtests, assessing the person's core functions which are required for TC: memory (orientation, autobiographical memory and realistic perception of beneficiaries), absence of serious psychopathology, knowledge of financial parameters (value of assets, everyday life products, bills), and intention (vignettes, theory of mind). For its validation, we examined 64 outpatients from the Cognitive Disorders/Dementia Unit, 2nd Department of Behavioral Neurology, University of Athens. The decision of the expert served as the gold standard for the evaluation of TC. RESULTS: Of the 64 participants, 39 were judged by the expert as capable of TC and the remaining 25 as incapable. For the total scale (maximum score of 48), the best combination of sensitivity (82.6%) and specificity (100%) was obtained for a cut-off score of 32/33. Cronbach's alpha showed high levels of internal reliability for the scale (α= 0.86) and the point-biserial correlation coefficients showed high levels of criterion-related validity (rbp = 0.797, p < 0.001). CONCLUSION: The new instrument appears to be a reliable screening tool for the evaluation of TC in dementia, which can be used by both the expert and the non-expert. Further research is needed to confirm these promising findings.

Reliability and Validation of the Greek Version of the Boston Carpal Tunnel Questionnaire.

BACKGROUND: The Boston Carpal Tunnel Questionnaire (BCTQ) is an easy, brief, self-administered questionnaire developed by Levine et al for the assessment of severity of symptoms and functional status of patients with carpal tunnel syndrome. The aim of our study was to develop and validate the Greek version of BCTQ. METHODS: We conducted a cross-sectional study of 90 patients with idiopathic carpal tunnel syndrome. The original English version of BCTQ was adapted into Greek using forward and backward translation. Reliability was assessed by internal consistency (Cronbach α and item-total correlation) and reproducibility. Validity was examined by correlating the Boston Questionnaire scores to Canterbury severity scale for electrodiagnostic severity grading. RESULTS: The Greek version showed high reliability (Cronbach α 0.89 for Symptom Severity Scale and 0.93 for Functional Status Scale) and construct validity (Pearson correlation coefficient 0.53 for Symptom Severity Scale and 0.68 for Functional Status Scale). Test-retest were 0.75 for Symptom Severity Scale and 0.79 for Functional Status Scale ( P < .05). Receiver operating characteristic curve analysis showed that the optimal cutoff of Symptom Severity Scale for the discrimination of subjects with low electrodiagnostic severity grading than subjects with high electrodiagnostic severity grading was 1.95 with sensitivity equal to 75.5% and specificity equal to 68.3%. CONCLUSIONS: The Greek version of the BCTQ is a valid, reliable screening tool for assessment in daily practice of symptoms and functional status in patients with carpal tunnel syndrome.

Capecitabine Induced Multifocal Leukoencephalopathy: Do We Have Always to Switch off the Chemotherapy?

Capecitabine is a well tolerated and safe 5-fluorouracil agent for adjuvant, neoadjuvant chemotherapy or metastatic cases. Neurological side effects require discontinuation of chemotherapy. We report this unique case of a 50-year-old female, who presented an isolated episode of dysarthria and ataxia under bevacizumab, capecitabine, and oxaliplatin treatment due to reversible multifocal leukoencephalopathy that did not recur after readministration of chemotherapy.

Job stress and burnout in the care staff of Leros PIKPA Asylum 25 years after the first Deinstitutionalisation and Rehabilitation Greek Project.

Aims and method To identify correlates between burnout and job stress of care staff at Leros PIKPA Asylum. Forty-nine asylum employees were assessed by Maslach's Burnout Inventory, a sociodemographic questionnaire, the Perceived Stress Scale and the Job Content Questionnaire. Results Emotional exhaustion is related negatively to social support (P = 0.010, r = -0.362). Lack of job achievements is related positively to overall job responsibility (P = 0.040) and negatively to lack of job satisfaction (r = -0.430). Depersonalisation was negatively associated with support from superiors (P = 0.036). Employees with high levels of perceived stress reported higher levels of fatigue (P = 0.050). Positive associations of perceived stress with depression (P = 0.011) and sleep problems (P<0.001) were also detected. Positive correlation was found between monthly salary and lack of sense of personal achievement (P = 0.020). Clinical implications It is necessary to address these issues through staff education and stress management.

Relación entre calidad de vida, síntomas psicopatológicos y formas de afrontamiento en las enfermeras griegas / Relationship of quality of life, psychopathologic symptoms and ways of coping in Greek nursing staff

Objetivo: Nuestro objetivo es investigar la relación entre calidad de vida, síntomas psicopatológicos y formas de afrontamiento en el personal de enfermería en dos hospitales generales en Grecia. Método: Estudio transversal con 302 profesionales de enfermería de dos hospitales generales en Grecia realizado entre octubre y noviembre de 2015. La recopilación de los datos se realizó mediante tres cuestionarios: el cuestionario calidad de vida, versión breve (BREF) de la Organización Mundial de la Salud; el cuestionario de autoevaluación de Falk para la detección de posibles comorbilidades psiquiátricas, y la escala de formas de afrontamiento de situaciones estresantes. Resultados: De una muestra de 302 enfermeras, cuanto peor era la salud mental y física del personal de enfermería, más se deterioró su calidad de vida en todos los aspectos (físico, psicológico, social y ambiental) (p < 0,001; p = 0,047; p = 0,001). Además, mientras las puntuaciones en las estrategias de afrontamiento «enfoque positivo-reevaluación positiva», «enfoque positivo-solución de problemas» y «enfoque positivo (en general)» van aumentando, la puntuación en la escala general es cada vez menor; en concreto, la salud general de los empleados va mejorando. Conclusión: Las estrategias de afrontamiento, como el enfoque positivo, mejoraron la salud general de los profesionales de enfermería. Por el contrario, su salud mental se deterioró cuando adoptaron las estrategias ilusiones/ensueño y/o escape/evitación. Finalmente, como la salud general va empeorando, su calidad de vida se ve afectada en todas las dimensiones, mientras que la mala salud mental de las enfermeras se asoció con una menor calidad de vida con respecto a las dimensiones física y psicológica

Objective: Our aim was to investigate the relationship of quality of life, psychopathological symptoms and ways of coping of nursing staff in two General Hospitals in Greece. Method: This was a cross-sectional study of 302 nurses in two General Hospitals in Greece between October and November of 2015. Data collection was performed using three questionnaires: the World Health Organisation Quality Of Life BREF; the Falk Self-Reporting Questionnaire for the detection of possible psychiatric comorbidity, and the Ways of Coping Scale for Stressful Situations. Results: From a sample of 302 nurses, the poorer the mental and physical health of the nursing staff, the more their quality of life was impaired in all dimensions (physical, psychological, social and environmental) (P < .001, P = .047, P = .001). Also, while the scores in coping strategies "positive approach-positive reappraisal", "positive approach-problem solving" and "positive approach (overall)" rose, the score in the General Scale dropped; in other words, the employees' general health improved. Conclusion: Coping strategies such as positive approach, improved the nurses' general health. In contrast, their mental health deteriorated when they adopted the wishful thinking/daydream and/or the escape/avoidance strategies. Finally, as their general health worsened, their quality of life was impaired in all dimensions, whereas poor mental health of nurses was associated with lower quality of life in the physical and psychological dimensions