Household adult smoking behaviors and prevalence of asthma in Greek schoolchildren: five surveys during 1998-2018.

OBJECTIVE: Environmental tobacco smoke exposure is a well-recognized risk factor for asthma development and poor asthma control in children. However, the relationship between changes in parental smoking habits over time and the prevalence of childhood asthma remains largely unknown. Our objective was to investigate the trends of parental smoking behaviors in relation to childhood wheeze/asthma rates over a 20-year period. SUBJECTS AND METHODS: A standardized questionnaire on household overall smoking and household indoor tobacco smoking (HITS) habits was distributed to 8-9-years-old school children in the context of five cross-sectional surveys conducted in 1998 (n=3,076), 2003 (n=2,725), 2008 (n=2,688), 2013 (n=2,554) and 2018 (n=2,648). RESULTS: The parental overall smoking and HITS rates have substantially decreased during the study period (p-for-trend<0.001). However, while HITS declined among the fathers of asthmatic and non-asthmatic children as well as among the mothers of non-asthmatic ones (p-for-trend<0.001), it remained unchanged in the case of the mothers of asthmatic participants (p-for-trend 0.283). The mothers of asthmatic children consistently reported more HITS than those of non-asthmatic participants, while prevalence changes of current wheeze/asthma over the surveillance period were in complete agreement with changes in maternal HITS (cross-correlation coefficient 0.918 at zero-year lag) but not with paternal smoking behaviors. CONCLUSIONS: Overall and indoor smoking rates of school children's adult family members declined substantially during the 1998-2018 period in Greece. However, no such trend was noted among mothers of asthmatic children, while temporal changes in maternal indoor smoking rates occurred in parallel with those of childhood asthma prevalence.

Impact of COVID-19 vaccination on parental and childhood stress levels in Greece.

OBJECTIVE: The impact of COVID-19 vaccination on parental and childhood stress levels has not been thoroughly investigated. Our aim was to explore the above relationship and identify factors that may influence the dissemination of stress within the family during the pandemic. SUBJECTS AND METHODS: A cross-sectional e-survey was conducted among a nationwide sample of parents in May 2021 in Greece. Parental stress was assessed using the Perceived Stress Scale (PSS) and the Revised Impact of Event Scale (IES-R) tools. Childhood mental well-being was evaluated with the Children's Revised Impact of Event 13 (CRIES 13) scale. RESULTS: 1,703 unique questionnaires were analyzed; 19.5% of responders were completely vaccinated, 23.7% were partially vaccinated, 38.3% were awaiting vaccination, and 18.5% were classified as vaccine-hesitant (15.2% would delay, and 3.3% refused the vaccination). Stress levels were significantly lower in completely or partially vaccinated parents than in vaccine-hesitant ones (p<0.001 for PSS/IES-R). Vaccination status emerged as a strong and independent predictor of PSS and IES-R. A significant decrease in PSS and IES-R scores was observed in 991 participants between March 2020 and May 2021 (p<0.001 for PSS/IES-R). Vaccine uptake was associated with lower PSS and IES-R scores, irrespective of the phase of the pandemic or other sociodemographic factors. The CRIES 13 score of the participant's children (n=2,969) was 19.4 ±14.9 and positively correlated with the PSS and IES-R scores. Children whose parents were vaccinated had lower stress levels than those of vaccine-hesitant parents (p<0.001). CONCLUSIONS: Parental vaccination against COVID-19 is a significant stress and anxiety predictor for both parents and their offspring. Parental and childhood stress levels were correlated, while the effect of vaccination was independent of the pandemic phase. The campaigns to promote vaccine uptake against COVID-19 should also highlight its potential benefit on the psychological well-being of the family.

Child abuse experience, training, knowledge, and attitude of healthcare professionals in sixty hospitals in Greece.

OBJECTIVE: This study aims to record the overall perception of healthcare professionals on child abuse and identify potential affecting factors in a nationwide scale in Greece as well as to provide information that might be useful for future educational actions. MATERIALS AND METHODS: A total of 1,185 healthcare professionals in 60 hospitals with pediatric departments across Greece participated in this cross-sectional study. Participants included pediatricians, pediatric surgeons, residents, nurses, psychiatrists, psychologists, and social workers. Sections under investigation involved experience and training in child abuse, knowledge of formal and judicial issues, clinical knowledge, and self-assessment. RESULTS: Although more than half of the participants had confronted child abuse (n=712, 60.08%), only 273 (38.34% of them) submitted reports. One third of participants reported that they had received some training (n=440, 37.13%), mainly of postgraduate nature and based on personal initiative. Of those who reported child abuse, 175 (64.10%) had been trained. Each professional category was aware of topics regarding its own interest, without adequate knowledge of other disciplines. One third of psychiatrists, psychologists, and social workers felt confident in discussing with children and parents. Relevant scores were lower in the other categories. The lower scores were recorded among nurses and residents. The training deficit and reluctance to engage with judicial issues were the main causes of avoidance to deal with child abuse. CONCLUSIONS: Focused and organized training in child abuse is crucial to create reliable professionals in the field. The internet is a considerably helpful tool. Professionalism must characterize knowledge and practice in child abuse at the same level as in other medical topics. Motivation to engage should be early inspired and developed during the graduate years.

Healthcare workers' hand hygiene knowledge and compliance evaluation, in a Greek university hospital.

OBJECTIVE: Healthcare associated infections affect both patients and employees, in terms of morbidity, mortality, and financial costs. Routine hand hygiene is the most important factor against this pestilence. Hand hygiene knowledge and compliance of healthcare workers are considered poor worldwide. Herein, we aimed to measure knowledge and compliance with hand hygiene of the healthcare workers at a university hospital. MATERIALS AND METHODS: The "WHO hand hygiene knowledge questionnaire for healthcare workers" was translated in the Greek language, and was validated linguistically, culturally, and psychometrically. Reliability, content, construct, and convergent validity were measured. A survey on hand hygiene knowledge, and compliance, based on this questionnaire, was conducted on 439 employees. RESULTS: The translated questionnaire presented good reliability, with Guttman's Lambda-6 evaluation (0.7). Content Validity Ratio was 84.6%. Confirmatory and exploratory factor analysis showed moderate construct validity. Convergent validity showed low correlation between the questionnaire items. Regarding the answers received, it was found that only 55.3% of the respondents received formal training on hand hygiene during the last three years prior to the study. Furthermore, 74.0% of them used alcohol-based solutions routinely. Only 54.3% of the participants presented an acceptable level of hand hygiene knowledge. CONCLUSIONS: The translation and validation of the WHO questionnaire resulted in an acceptable, reliable, and valid instrument. The survey showed that hand hygiene is rather a matter of habit, than of knowledge, and that there is great need of more organized training.

Prediction of complicated appendicitis risk in children.

OBJECTIVE: We aimed to predict the risk of complicated appendicitis in children, constructing a risk-based prediction tool with the optimal combination of sensitivity and specificity outcomes. PATIENTS AND METHODS: This is a prospective study on a random sample of children with acute appendicitis who underwent appendectomy. Clinical examination, history, routine laboratory tests, Alvarado and pediatric appendicitis scores, operative and histopathological findings were taken into consideration. The predictive ability of the outcome variables was assessed by the Receiver Operating Characteristics (ROC) analysis. The overall predictive ability and determination of the best cut-off value (the higher sum of sensitivity plus specificity) were calculated. A Classification and Regression Tree (CRT) was used to create a multi-level classification algorithm. The model was set to predict the outcome of complicated appendicitis, considering as potential predictors the demographic characteristics, the clinical findings, and the outcome parameters. RESULTS: The various combinations of clinical and laboratory parameters did not improve their overall diagnostic ability. However, the CRT analysis resulted in a short classification algorithm based on the Pediatric appendicitis score, neutrophils percentage and the CRP. This model yielded a significantly better predictive ability than all the other combinations of the outcome parameters. The application of the model would predict complicated appendicitis with 90% sensitivity and 78.6% specificity. CONCLUSIONS: The constructed predictive model may be a useful tool for daily practical use by the clinician, especially in areas where modern diagnostic imaging facilities are absent or not always available. Clinical evaluation and close follow-up remain the more accurate preoperative method to decide the performance and timing of appendectomy.

The association between obesity and the risk for development of eating disorders - A large-scale epidemiological study.

OBJECTIVE: Eating disorders and obesity are serious, multifactorial diseases with increasing prevalence worldwide, often manifesting during childhood and adolescence. The aim of this study was to investigate the risk for developing eating disorders in children and adolescents of Primary and Secondary Education, with normal or excessive body weight. MATERIALS AND METHODS: A representative sample (N=3504) of students from schools of Western Greece, 50.2% boys, aged 10-16 years old, participated in the present cross-sectional epidemiological study. The students' dietary habits were assessed through multiple-choice questions and the risk for the development of eating disorders was evaluated using the Eating Attitudes Scale (EAT-13) validated questionnaire. Anthropometric measurements were obtained and the BMI, BMI% and BMI z-score were calculated. RESULTS: Nearly 20% of the participants, particularly those with overweight or obesity, were at increased risk for developing eating disorders (25% of normal weight-, 28.2% of overweight- and 33% of participants with obesity). Boys were more likely to develop eating disorders than girls, but not statistically significantly. A positive correlation of: (1) the overall EAT-13 score, (2) food pre-occupation score and (3) dieting score, with BMI z-score and obesity was found, as opposed to a negative correlation of Important Others score with BMI z-score and obesity. CONCLUSIONS: Increased awareness regarding the risk for developing eating disorders or disordered eating in children and adolescents with overweight and obesity is recommended to avoid underdiagnosis of this condition. Prompt identification of children at risk contributes to the implementation of targeted and effective prevention and treatment interventions.

Vaccination coverage among school children in Western Greece from 2016 to 2019.

Vaccine hesitancy has increased, which has an effect on vaccine uptake. The aim of our study was to investigate childhood vaccination coverage in Western Greece and identify factors affecting it. We also aimed to assess trends in childhood vaccination coverage nationwide. A cross-sectional study was conducted (2016-2019) in all the primary schools in Patras, the third largest city in the country. Data collection was undertaken using child vaccination booklets and questionnaires on socio-demographics. Multiple regression analyses were performed to evaluate relevant associations. We also performed a systematic review of published data on childhood vaccination coverage in Greece during the last two decades. Data for 1657 children was collected and 371 questionnaires were returned. High vaccination coverage (>90%) was observed for the majority of the vaccines. For the pneumococcal conjugate vaccine (PCV), coverage with four doses, as recommended at the time of study, was suboptimal (39.2%). For human papillomavirus vaccines and the meningococcal serogroup B vaccine, full vaccination coverage was 2.6% and 6.5%, respectively. No association with socio-demographics was found for vaccines with high coverage. For PCV the number of doses given was related to Greek nationality (ß = 0.185, p < .001) and parental employment status (ß = -0.115, p = .043). Compared to previous studies (16 eligible), there was a trend toward higher coverage. Public health interventions should focus on increasing vaccine uptake of specific vaccines among populations with particular characteristics. A national network recording vaccine coverage is urgently required in the country to monitor vaccine uptake and assess trends over time.

Anxiety and depression among parents of children with mild head injuries.

OBJECTIVE: Parents who escort their children in hospital may present emotional disorders. Personnel pressure and reduced time availability often prevent their detection, reducing the efficacy of parental support. We aimed to identify the prevalence and assess the severity of anxiety and depression among parents of children with mild head injuries who were admitted for a 24-hour observation period in a pediatric hospital, and to detect possible determinants for the severe forms of the two emotional disorders. PATIENTS AND METHODS: A cohort of 163 parents participated in our survey for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Associations of the two disorders with factors of possible prognostic significance, such as gender, age, family status, residence, education, employment, and income were studied. Multinomial logistic regression analysis, with anxiety and depression of the parents as dependent variables, was performed. RESULTS: More than half of parents presented clinical scores for both disorders. Female gender, distant residence, high school level education, unstable employment, and low income were determinants for severe anxiety. Depression in fathers was five times more likely to be severe than subclinical compared to mothers. CONCLUSIONS: Psychological support and guidance of parents who escort their children with mild head injuries are mandatory. When accredited trauma support is not available, it is the hospital personnel who must identify and support these parents.

Small-airway dysfunction precedes the development of asthma in children with allergic rhinitis

BACKGROUND: Epidemiological evidence suggests the existence of a direct link between allergic rhinitis (AR) and asthma. Several studies also support the presence of small-airway dysfunction (SAD) in non-asthmatic children with AR. However, it remains unknown whether SAD can predict the progression of AR to asthma. Our objective was to explore the existence of SAD in non-asthmatic children with AR and to assessed its ability to predict the development of asthma. METHODS: Seventy-three 6-year-old children with intermittent moderate-severe AR but without asthma symptoms/medication within the last two years, underwent spirometry and measurement of respiratory resistance (Rrs) and reactance (Xrs) before and after bronchodilation (BD) (300mcg salbutamol). Lung function measurements were performed in the absence of nasal symptoms and repeated at AR exacerbation. SAD was defined as >30% decrease in Rrs or >50% increase in Xrs at 6 or 8Hz post-BD. Participants were followed for five years. RESULTS: Twenty-three children (31.5%) developed asthma; this group presented significant post-BD changes in Rrs and Xrs, but only at AR exacerbation. The ability of these changes to predict the development of asthma was exceptional and superior to that of the spirometric parameters. SAD (22 children, 30.1%), emerged as the single most efficient predictor of asthma, independently of other risk factors such as parental asthma, personal history of eczema and type of allergic sensitisation. CONCLUSION: SAD precedes the development of asthma in children with AR. Changes in respiratory impedance at AR exacerbation may assist in identifying those at risk to progress to asthma

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Small-airway dysfunction precedes the development of asthma in children with allergic rhinitis.

BACKGROUND: Epidemiological evidence suggests the existence of a direct link between allergic rhinitis (AR) and asthma. Several studies also support the presence of small-airway dysfunction (SAD) in non-asthmatic children with AR. However, it remains unknown whether SAD can predict the progression of AR to asthma. Our objective was to explore the existence of SAD in non-asthmatic children with AR and to assessed its ability to predict the development of asthma. METHODS: Seventy-three 6-year-old children with intermittent moderate-severe AR but without asthma symptoms/medication within the last two years, underwent spirometry and measurement of respiratory resistance (Rrs) and reactance (Xrs) before and after bronchodilation (BD) (300mcg salbutamol). Lung function measurements were performed in the absence of nasal symptoms and repeated at AR exacerbation. SAD was defined as >30% decrease in Rrs or >50% increase in Xrs at 6 or 8Hz post-BD. Participants were followed for five years. RESULTS: Twenty-three children (31.5%) developed asthma; this group presented significant post-BD changes in Rrs and Xrs, but only at AR exacerbation. The ability of these changes to predict the development of asthma was exceptional and superior to that of the spirometric parameters. SAD (22 children, 30.1%), emerged as the single most efficient predictor of asthma, independently of other risk factors such as parental asthma, personal history of eczema and type of allergic sensitisation. CONCLUSION: SAD precedes the development of asthma in children with AR. Changes in respiratory impedance at AR exacerbation may assist in identifying those at risk to progress to asthma.

Clinical and microbiological profile of persistent coagulase-negative staphylococcal bacteraemia in neonates.

An atypical pattern of coagulase-negative staphylococcal (CoNS) sepsis, characterized by persistence despite aggressive antibiotic therapy, has been described in neonates cared for in neonatal intensive-care units. Our aim was to analyse the clinical, microbiological and molecular determinants of this persistent CoNS bacteraemia. Neonates with late-onset CoNS bacteraemia were studied for a 2-year period. Demographic, clinical, laboratory, microbiological and molecular data were compared between neonates with persistent (≥3 consecutive positive blood cultures) and non-persistent CoNS bacteraemia. Twenty-nine infants with persistent and 43 with non-persistent bacteraemia were identified, with no significant differences regarding demographic and clinical characteristics between the two groups. Of a total of 170 CoNS isolates, 80 showed biofilm production (54 persistent and 26 non-persistent; p 0.013), whereas 127 were positive for the icaA and icaD genes (74 persistent and 53 non-persistent; p 0.598). Sixty ica-positive isolates did not produce slime, whereas 13 ica-negative isolates showed biofilm production. Endotracheal intubation and the presence of central vascular catheters were significant risk factors for persistent bacteraemia, but, in a logistic regression model, only biofilm production was significantly related to the persistent form of the disease (p 0.005). In this study, persistent CoNS sepsis in neonates requiring intensive care was not related to most of the known clinical risk factors, and it was associated with severe thrombocytopenia. Isolates associated with persistent bacteraemia were more likely to produce biofilm, independently of the presence of the ica operon.

Reactive thrombocytosis in febrile young infants with serious bacterial infection.

OBJECTIVE: to estimate the incidence of reactive thrombocytosis among febrile young infants and to asses the utility of platelet count as a potential predictor of serious bacterial infection (SBI). DESIGN: retrospective study between January 2005 and December 2008. SETTING: tertiary care pediatric unit. PARTICIPANTS: all infants 29 to 89 days of age, admitted with rectal temperature > 38oC without a focus of infection. MAIN OUTCOME MEASURES: the results of the sepsis evaluation on admission were recorded. SBI included all cases of occult bacteremia, urinary tract infection, bacterial meningitis, pneumonia, bacterial gastroenteritis and infections of the soft tissues and bones. RESULTS: of the 408 infants studied, 103 (25.2%) had SBI. Platelet count was significantly higher in infants with SBI compared to those without (median 513000 /mm3 [interquartile range 455,000-598,000/mm3] vs median 398000/mm3; [interquartile range 313,000-463,000/mm3]; P<0.001). Thrombocytosis had only moderate ability in predicting SBI (area under the curve: 0.74, 95 % CI 0.70-0.79). The combination of platelet count >450,000/mm3, WBC >15,000/mm3, Creactive protein >2 mg/dL, and pyuria >10 WBC/hpf would lead to misclassification of 4 infants with SBI (3.9% of SBIs; negative likelihood ratio 0.08). CONCLUSION: reactive thrombocytosis was a frequent finding in young infants with SBI. Thrombocytosis >450,000 cells/mm3, in combination with leucocytosis, elevated CRP and pyuria, may help in early recognition of febrile young infants at risk for SBI.