Resilience and Social Support Improve Mental Health and Quality of Life in Patients with Post-COVID-19 Syndrome.

Physical and mental health problems among post-COVID-19 patients are common, even a year after infection. As there is no prior study available, we investigated the impacts of resilience and social support on anxiety, depression, and quality of life among patients with post-COVID-19 syndrome. We conducted a cross-sectional study with a convenience sample. The measures included the demographic and clinical characteristics of patients, the Brief Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Patient Health Questionnaire-4 (PHQ-4), and the EuroQol-5D-3L. The mean age of patients was 44.8 years. The total PHQ-4 score suggested that 32.8% of patients with post-COVID-19 syndrome experienced severe psychological distress, 32.8% experienced moderate distress, 23% experienced mild distress, and 11.5% had no distress. Moreover, 60.7% of patients had anxiety scores of ≥3 and 69.7% had depression scores of ≥3, indicating possible major anxiety or depression disorder. The mean EQ-5D-3L index value was 0.36, and the mean EQ-5D-3L VAS was 54.1. Multivariable analysis identified that resilience and social support reduced anxiety and depression among patients. Also, we found a significant positive relationship between resilience and social support, and quality of life. Our findings suggest that resilience and social support can be protective by reducing anxiety and depression and improving quality of life among patients with post-COVID-19 syndrome. Policymakers should develop and implement healthcare management programs to provide psychological support to these patients.

Nurses quietly quit their job more often than other healthcare workers: An alarming issue for healthcare services.

AIM: To assess the level of quiet quitting among healthcare workers (HCWs) and identify possible differences between nurses, physicians, and other HCWs. We investigated the impact of sociodemographic variables, job burnout, and job satisfaction on quiet quitting levels. BACKGROUND: The quiet-quitting phenomenon is not new but has been frequently discussed during the COVID-19 pandemic. Interestingly, the level of quiet quitting among HCWs has not been measured yet. METHODS: We conducted a cross-sectional study with a convenience sample. We measured sociodemographic variables, job burnout, job satisfaction, and quiet quitting. We adhered to STROBE guidelines for cross-sectional studies. FINDINGS: Among our sample, 67.4% of nurses were quiet quitters, while the prevalence of quiet quitting for physicians and other HCWs was 53.8% and 40.3%, respectively. Multivariable linear regression analysis identified that the levels of quiet quitting were higher among nurses than physicians and other HCWs. Moreover, greater job burnout contributed more to quiet quitting, while less satisfaction implied more quiet quitting. HCWs who work in shifts and those working in the private sector experienced higher levels of quiet quitting. DISCUSSION: More than half of our HCWs were described as quit quitters. Levels of quiet quitting were higher among nurses. Job burnout and job dissatisfaction were associated with higher levels of quiet quitting. IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY: Measurement of quiet quitting and identification of risk factors are essential to prevent or reduce quiet quitting levels among HCWs. Our study provides information on this field helping managers and organizations to identify quiet quitters within HCWs. Policymakers and managers should develop and implement interventions both at an organizational level and at an individual level.

Prevalence and risk factors of adverse effects after the first COVID-19 booster dose: evidence from Greece.

Background: In general, COVID-19 vaccines are safe and effective, but minor adverse effects are common. However, adverse effects have not been measured in several countries including Greece. Objective: To estimate the prevalence of adverse effects after the first COVID-19 booster dose, and to identify possible risk factors. Material and methods: We conducted a cross-sectional study with a convenience sample in Greece during November 2022. We measured several adverse effects after the booster dose, such as fatigue, headaches, fever, chills, nausea, etc. We considered gender, age, chronic disease, self-assessment of health status, COVID-19 diagnóstico, and self-assessment of COVID-19 course as possible predictors of adverse effects. Results: In our sample, 96% developed at least one adverse effect. Half of the participants (50.2%) developed one to five adverse effects, 35.9% developed six to ten adverse effects, and 9.5% developed 11 to 16 adverse effects. Mean number of adverse effects was 5.5. The most frequent adverse effects were pain at the injection site (84.3%), fatigue (70.8%), muscle pain (61%), swelling at the injection site (55.2%), headache (49.8%), fever (42.9%), and chills (41%). Females developed more adverse effects than males (p < 0.001). The prevalence of adverse effects of COVID-19 vaccines was statistically significant and positively associated with the severity of COVID-19 among COVID-recovered individuals (p < 0.05). Moreover, younger age was associated with increased adverse effects (p < 0.001). Conclusions: Almost all participants in our study developed minor adverse effects after the booster dose. Female gender, COVID-19 patients with worse clinical course, and younger individuals experienced more often adverse effects.

Antecedentes: En general, las vacunas COVID-19 son seguras y eficaces, pero son frecuentes los efectos adversos leves. Sin embargo, los efectos adversos no se han medido en varios países, entre ellos Grecia. Objetivo: Estimar la prevalencia de efectos adversos tras la primera dosis de refuerzo de COVID-19 e identificar posibles factores de riesgo. Métodos: Realizamos un estudio transversal con una muestra de conveniencia en Grecia durante noviembre de 2022. Se midieron varios efectos adversos tras la dosis de refuerzo, fatiga, dolores de cabeza, fiebre, escalofríos, náuseas, etc. Consideramos el sexo, la edad, la enfermedad crónica, la autoevaluación del estado de salud, el diagnóstico de COVID-19 y la autoevaluación del curso de COVID-19 como posibles predictores de los efectos adversos. Resultados: En nuestra muestra, el 96% desarrolló al menos un efecto adverso. La mitad de los participantes (50,2%) desarrollaron de uno a cinco efectos adversos, el 35,9% desarrollaron de seis a diez efectos adversos, y el 9,5% desarrollaron de 11 a 16 efectos adversos. La media de efectos adversos fue de 5,5. Los efectos adversos más frecuentes fueron dolor en el punto de inyección (84,3%), fatiga (70,8%), dolor muscular (61%), hinchazón en el punto de inyección (55,2%), cefalea (49,8%), fiebre (42,9%) y escalofríos (41%). Las mujeres presentaron más efectos adversos que los hombres (p < 0,001). La prevalencia de los efectos adversos de las vacunas COVID-19 fue estadísticamente significativa y se asoció positivamente con la gravedad de COVID-19 entre los individuos recuperados de COVID (p < 0,05). Además, la menor edad se asoció con mayores efectos adversos (p < 0,001). Conclusiones: Casi todos los participantes en nuestro estudio desarrollaron efectos adversos menores tras la dosis de refuerzo. El sexo femenino, los pacientes de COVID-19 con peor evolución clínica y los individuos más jóvenes experimentaron efectos adversos con mayor frecuencia.

Estimation of the optimal time needed for weaning of Intensive Care Unit tracheostomized patients on mechanical ventilation. A prospective observational study.

BACKGROUND AND AIM: Determining the time that is required for weaning, as well as the factors that influence it can be used for the appropriate planning of patient's medical and nursing care. The aim of this study is to estimate the optimal time an Intensive Care Unit (ICU) patient with tracheostomy needs to wean from mechanical ventilation. METHODS: This prospective observational study was conducted on 162 patients from two general hospitals in Athens, Greece.  A specially designed recording form was created to conduct the study. The Statistical Package for the Social Sciences (SPSS) v.25 for Windows was used to record and analyze the data. The level of statistical significance was set at α=5%. RESULTS: Results were found after comparing and associating the demographic and clinical characteristics and medical history of patients with the duration of weaning, the length of post-tracheostomy ICU stay and the time from intubation to tracheostomy. CONCLUSIONS: According to the results of our study, there are various factors that affect success and duration of weaning. More specifically, there seems to be an association between duration of weaning and age, number of closure attempts, success of closure, time from intubation to tracheostomy, length of the patient's post-tracheostomy ICU stay and diagnosis upon admission. The shorter the duration of weaning, the greater the benefits for the patients themselves, such us avoiding respiratory damage, reduction of mortality and morbidity and preventing of length of patient's ICU stay.

The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review.

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of "Institute for Healthcare Improvement Ventilator Bundle", i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the "IHI Ventilator Bundle" combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle's compliance should be the gold standard combination.

Seasonal Influenza Vaccine Intention among Nurses Who Have Been Fully Vaccinated against COVID-19: Evidence from Greece.

Seasonal influenza continues to be a significant public health issue causing hundreds of thousands of deaths annually. Nurses are a priority risk group for influenza vaccination and a high vaccine uptake rate among them is crucial to protect public health. Thus, the aim of our study was to estimate the levels of influenza vaccine acceptance, as well as its determinants, among nurses for the 2022/2023 season. We conducted a cross-sectional study with a convenience sample in Greece. We collected data via an online survey in September 2022. Most of the nurses in the study possessed a MSc/PhD diploma (56.2%) and had previously been infected by SARS-CoV-2 (70.3%). Among nurses, 57.3% were willing to accept the influenza vaccine, 19% were hesitant, and 23.7% were unwilling. Older age, higher levels of perceived support from significant others, and higher COVID-19-related physical exhaustion were positively related to influenza vaccination intention. In contrast, more side effects because of COVID-19 vaccination and higher levels of exhaustion due to measures taken against COVID-19 were negatively associated with vaccination intention. Since the influenza vaccination acceptance rate among nurses was moderate, policymakers should develop and implement measures tailored specifically to nurses in the context of the COVID-19 pandemic to decrease vaccine hesitancy.

Cost and reimbursement analysis of end-of-life cancer inpatients. The case of the Greek public healthcare sector.

BACKGROUND: While hospital-based Palliative Care services are usually covered through the main funding healthcare framework, traditional reimbursement methods have been criticized for their appropriateness. The present study investigates for the first time the case of treating end-of-life cancer patients in a Greek public hospital in terms of cost and reimbursement. METHODS: This retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs. RESULTS: The average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient's and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups' (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described. CONCLUSION: Although the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations. POLICY SUMMARY: There is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions' reluctance to admit them with a serious impact on access and equity of end-of-life cancer care.

Predictors of second COVID-19 booster dose or new COVID-19 vaccine hesitancy among nurses: A cross-sectional study.

AIMS AND OBJECTIVES: To assess the levels of second COVID-19 booster dose/new COVID-19 vaccine hesitancy among nurses and explore the potential predictors of vaccine hesitancy. BACKGROUND: COVID-19 full vaccination seems to be highly effective against highly contagious variants of SARS-CoV-2. Healthcare workers are at high-risk group since they have experienced high levels of COVID-19-associated morbidity and mortality. DESIGN: An on-line cross-sectional study was carried out in Greece in May 2022, using a self-administered questionnaire. METHODS: The study population included nurses in healthcare services who were fully vaccinated against COVID-19 at the time of study. We considered socio-demographic characteristics, COVID-19-related variables, and attitudes toward COVID-19 vaccination and pandemic as potential predictors of vaccine hesitancy. We applied the STROBE checklist in our study. RESULTS: Among 795 nurses, 30.9% were hesitant toward a second booster dose or a new COVID-19 vaccine. Independent predictors of hesitancy included lower educational level, absence of a chronic condition, good/very good self-perceived physical health, lack of flu vaccination during 2021, front-line nurses that provided healthcare to COVID-19 patients, nurses that had not been diagnosed with COVID-19 and nurses that had at least one relative/friend that has died from COVID-19. Moreover, increased compliance with hygiene measures, increased fear of a second booster dose/new COVID-19 vaccine and decreased trust in COVID-19 vaccination were associated with increased hesitancy. CONCLUSIONS: Our study shows that a significant percentage of nurses are hesitant toward a second booster dose/new COVID-19 vaccine. This initial hesitancy could be a barrier to efforts to control the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: Nurses' role during the COVID-19 pandemic is essential since they are the front-line healthcare workers empowering the public with their passion and empathy. There is a need to communicate COVID-19 vaccine science in a way that is accessible to nurses in order to decrease COVID-19 vaccine hesitancy. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Post-COVID-19 Syndrome and Related Dysautonomia: Reduced Quality of Life, Increased Anxiety and Manifestation of Depressive Symptoms: Evidence from Greece.

Background: Post-COVID-19 syndrome affects a significant number of SARS-CoV-2 infected individuals, even in asymptomatic cases causing several neurological and neuropsychiatric symptoms and signs. Materials and Methods: An online cross-sectional study with a convenience sample was conducted in Greece from November 2022 to January 2023. We measured the demographic and clinical characteristics of patients with post-COVID-19 dysautonomia in terms of the quality of life with the EQ-5D-3L, and anxiety and depressive symptoms by employing Patient Health Questionnaire-4. Results: The study population included 122 patients with post-COVID-19 syndrome. One out of four patients (27.8%) manifested post-COVID-19 dysautonomia, while the mean duration of COVID-19 symptoms was 11.6 months. Anxiety and depressive symptoms were worse after the post-COVID-19 syndrome (p<0.001 in both cases). A statistically significant reduction in quality of life was observed among patients after the post-COVID-19 syndrome (p<0.001 for both EQ-5D-3L index value and EQ-5D-3L VAS). Post-COVID-19 dysautonomia increased depression symptoms after developing the post-COVID-19 syndrome (p=0.02). We found a negative relationship between the duration of COVID-19 symptoms and the quality of life (p<0.001). Moreover, our results showed that depressive symptoms were more common among females after the post-COVID-19 syndrome (p=0.01). Also, the quality of life was lower among females than males (p=0.004 for EQ-5D-3L index value, and p=0.007 for EQ-5D-3L VAS). Conclusions: Our results suggest that post-COVID-19 syndrome causes a tremendous impact on the patients' quality of life and mental health. In addition, we found that the groups most psychologically affected were patients with post-COVID-19 dysautonomia, females, and patients with a longer duration of symptoms. Policy makers should assign priority rights to vulnerable groups in future psychiatric planning. Policy measures should focus on the mental health of post-COVID-19 patients who seem to be particularly vulnerable.

COVID-19 Vaccine Uptake among Healthcare Workers: A Systematic Review and Meta-Analysis.

The vaccine-induced immunity of healthcare workers (HCWs) is crucial to controlling the COVID-19 pandemic. Therefore, we conducted a systematic review and meta-analysis to assess the COVID-19 vaccine uptake among HCWs worldwide and to identify predictors of vaccination. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL, and medRxiv up to 25 August 2022. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We found 25 studies including 491,624 vaccinated HCWs, while the full sample included 555,561 HCWs. The overall proportion of vaccinated HCWs was 77.3%. Vaccine uptake for studies that were conducted in North America (85.6%) was higher than the proportion for studies that were conducted in Asia (79.5%), Europe (72.8%), and Africa (65.6%). The overall prevalence of COVID-19 vaccine uptake was 83.6% and 77.4% for physicians and nurses, respectively. Older age, white race, physicians' profession, seasonal influenza vaccine, direct COVID-19 patient care, and confidence in COVID-19 vaccine safety and effectiveness were positive predictors of vaccine uptake, while history of SARS-CoV-2 infection was a negative predictor. Deep understanding of the factors that influence HCWs' decisions to receive a COVID-19 vaccine is critical to implementing tailored communication strategies for HCWs who are at risk for not getting vaccinated.

Predictors of Willingness of the General Public to Receive a Second COVID-19 Booster Dose or a New COVID-19 Vaccine: A Cross-Sectional Study in Greece.

Given the concerns of waning immunity from the primary COVID-19 vaccines and the first booster dose, we conducted an online cross-sectional study in May 2022 to investigate willingness to receive a second COVID-19 booster dose or a new COVID-19 vaccine and its associated factors. Overall, 62% of the participants were willing to be vaccinated, 25.8% were unsure, and 12.3% were unwilling to be vaccinated. The main reasons against accepting a second COVID-19 booster dose/new COVID-19 vaccine were concerns about the side effects and the effectiveness and the opinion that further vaccination is unnecessary. Males, younger individuals, participants without a previous COVID-19 diagnosis, and those with good/very good self-perceived physical health were significantly more frequently willing to receive a second COVID-19 booster dose or a new COVID-19 vaccine. Additionally, increased fear of the COVID-19, increased trust in COVID-19 vaccinations, and decreased fear of a second booster dose or a new COVID-19 vaccine was associated with increased willingness. Our results show some hesitancy and unwillingness toward further COVID-19 vaccination and indicate that the fear of COVID-19 and trust in COVID-19 vaccination affects public opinion.

First COVID-19 Booster Dose in the General Population: A Systematic Review and Meta-Analysis of Willingness and Its Predictors.

The emergence of breakthrough infections and new highly contagious variants of SARS-CoV-2 threaten the immunization in individuals who had completed the primary COVID-19 vaccination. This systematic review and meta-analysis investigated, for the first time, acceptance of the first COVID-19 booster dose and its associated factors among fully vaccinated individuals. We followed the PRISMA guidelines. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL and medrxiv from inception to 21 May 2022. We found 14 studies including 104,047 fully vaccinated individuals. The prevalence of individuals who intend to accept a booster was 79.0%, while the prevalence of unsure individuals was 12.6%, and the prevalence of individuals that intend to refuse a booster was 14.3%. The main predictors of willingness were older age, flu vaccination in the previous season, and confidence in COVID-19 vaccination. The most important reasons for decline were adverse reactions and discomfort experienced after previous COVID-19 vaccine doses and concerns for serious adverse reactions to COVID-19 booster doses. Considering the burden of COVID-19, a high acceptance rate of booster doses could be critical in controlling the pandemic. Our findings are innovative and could help policymakers to design and implement specific COVID-19 vaccination programs in order to decrease booster vaccine hesitancy.

Early versus Late Tracheostomy Promotes Weaning in Intensive Care Unit Patients: a retrospective observational study.

BACKGROUND AND AIM: The time interval between the patients' intubation and the performance of a tracheostomy has been considered as critical for the disease prognosis and outcome. The aim of the present study was to compare and contrast the outcomes of early vs late tracheostomy with regard to ICU patients' weaning from respiratory support. METHODS: This retrospective observational study, involved patients who were hospitalized in two general and one Covid-19 ICUs of two tertiary hospitals in Athens and were subjected to tracheostomy. Data were collected from the patients' medical records in order to estimate the duration of patient weaning and the number of days from the patients' intubation until the time of tracheostomy. In the present study the term earlytracheostomy denotes tracheostomy performed within 14 days from patient intubation and late tracheostomydefines the tracheostomy carried out after 14 days. For Covid-19 patients, guidelines suggested that tracheostomies should be performed 21 days following intubation, due to the high risk of virus transmission. RESULTS: One hundred and thirty-one patients who underwent tracheostomy participated in the study. Most tracheostomies were performed using the percutaneous technique. The group of patients tracheostomized within 14 days after their admission in ICU weaned faster from respiratory support compared to ones who were tracheostomized after 14 days. CONCLUSIONS: The most common distinction between early and late tracheostomy is 14 days, with early tracheostomy being more beneficial in terms of patients' outcomes, and specifically ICU patients' weaning.

Social Support Mediates the Relationship between COVID-19-Related Burnout and Booster Vaccination Willingness among Fully Vaccinated Nurses.

COVID-19 booster doses for high-risk groups such as nurses are necessary to reduce the impacts of the pandemic and promote public health. We examined the relationship between COVID-19-related burnout and booster vaccination willingness among nurses, and we assessed whether social support can buffer this relationship. We conducted a cross-sectional study with 963 fully vaccinated nurses working in healthcare settings in Greece. We used the multidimensional scale of perceived social support to measure social support and the COVID-19 burnout scale to measure COVID-19-related burnout. We measured vaccination willingness with a scale from 0 (extremely unlikely to take a booster dose) to 10 (extremely likely). Among nurses, 37.1% reported being very likely to be vaccinated, 34.4% reported being uncertain about their likelihood of vaccination, and 28.6% reported being very unlikely to be vaccinated with a booster dose. We found that COVID-19-related burnout reduced vaccination willingness, while social support functioned as a partial mediator of this relationship. In conclusion, nurses who experienced burnout were less likely to accept a booster dose. Furthermore, increasing nurses' social support reduced the negative effects of burnout, resulting in improved booster vaccination willingness. Immunization awareness programs should be implemented in order to address nurses' concerns and support booster doses.

COVID-19-Related Burnout and Intention of Fully Vaccinated Individuals to Get a Booster Dose: The Mediating Role of Resilience.

Because an annual COVID-19 booster vaccine appears to be required to control the pandemic, identifying the factors that influence individuals' decision to receive a booster dose is critical. Thus, our goal was to quantify the influence of COVID-19-related burnout on vaccination intention and to investigate the role of resilience in mediating the link between burnout and intention. We conducted a cross-sectional study with a convenience sample during October 2022. We used the COVID-19 burnout scale and the Brief Resilience Scale. The study sample included 1256 people who had received their primary COVID-19 vaccination. Among the participants, 34.1% reported being very likely to be vaccinated with a booster dose. COVID-19-related burnout was found to be inversely connected with vaccination intention. Moreover, our results suggested that resilience not only had a positive direct effect on vaccination intention but also mediated the relationship between burnout and vaccination intention. Although our study had limitations, such as a convenience sample and information bias, we demonstrate the critical role of resilience in reducing the impact of COVID-19-related burnout on the vaccination intention. Policymakers should develop and implement initiatives to address the issues of COVID-19-related burnout and enhance booster adoption by strengthening psychosocial resources such as resilience.

Attitudes toward COVID-19 Pandemic among Fully Vaccinated Individuals: Evidence from Greece Two Years after the Pandemic.

Background: Considering the major effects of COVID-19 pandemic on health, social, economic, and political dimensions of all countries, positive attitudes toward COVID-19 pandemic are essential to control the pandemic. In our study, we investigated attitudes toward COVID-19 pandemic among fully COVID-19 vaccinated individuals two years after the pandemic and we identified predictors of attitudes. Materials and Methods: We conducted an on-line cross-sectional study with 815 fully COVID-19 vaccinated individuals in Greece during May 2022. A self-administered and valid questionnaire was disseminated through social media platforms. We measured socio-demographic variables and COVID-19-related variables as potential predictors of attitudes toward COVID-19 pandemic. The outcome variable was attitudes toward COVID-19 pandemic (compliance with hygiene measures, trust in COVID-19 vaccination, fear of COVID-19, and information regarding the COVID-19 pandemic and vaccination). Results: We found a very high level of compliance with hygiene measures, a high level of trust and information about the COVID-19 pandemic and vaccination, and a moderate level of fear of COVID-19. Also, we identified that females, participants with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis adhered more in hygiene measures. Trust in COVID-19 vaccination was higher among females, older participants, those with a higher educational level, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis. Moreover, females, older participants, those with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, those that received a flu vaccine in previous season, and those without a previous COVID-19 diagnosis experienced more fear of COVID-19. Finally, level of information regarding COVID-19 pandemic and vaccination was higher for participants with a higher educational level, those without a chronic disease, those with a better self-perceived physical health, and those that received a flu vaccine in previous season. Conclusions: Understanding predictors of attitudes toward COVID-19 pandemic among fully vaccinated individuals is crucial for developing appropriate public health campaigns in the future. Vaccination should be accompanied by positive attitudes in order to decrease the frequency of negative outcomes of COVID-19, such as hospitalization, complications and mortality.

Factors affecting adult intensive care units costs by using the bottom-up and top-down costing methodology in OECD countries: A systematic review.

OBJECTIVES: To review the studies, which calculated the total intensive care unit costs and indicated the main cost drivers in the intensive care by using either top-down, bottom-up approach or the combination of them. RESEARCH METHODOLOGY/DESIGNS: A systematic review of papers published until October 2020 was conducted. Search was performed on PubMed, Medline, Scopus and Science Direct databases. SETTING: This review i examined costs in adult intensive care units, in countries belonging to the Organisation for Economic Co-operation and Development (OECD) (medical, surgical or general adult , paediatric and neonatal were not included). MAIN OUTCOME MEASURES: Eighteen articles were included in the review. RESULTS: Eight of the studies used the top-down costing methodology, six of them used the bottom-up approach and four of them used both of them. The mean total patient cost per day ranged from €200.75 to €4321.91 (all costs are presented in 2020 values for euro). Human resources were identified as the largest proportion of total costs. Length of stay, mechanical ventilation, continuous haemodialysis and severe illness are the main cost drivers of intensive care unit total costs. CONCLUSION: There are a variety of methods and study designs used to calculate costs of an intensive care unit stay.t It is necessary to evolve standardised costing methods in order to make comparisons and succeed in cost-effective management.

Risk factors for stress among police officers: A systematic literature review.

BACKGROUND: Stress is common among police personnel leading to several negative consequences. OBJECTIVE: We performed a systematic literature review to identify risk factors for stress among police officers. METHODS: We searched PubMed and Scopus electronic databases through to July 2018 and we conducted this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Newcastle-Ottawa scale was used for studies quality assessment. RESULTS: After selection, 29 cross-sectional studies met the inclusion criteria and included in the review. The average quality of studies was low since no study was rated as having low risk of bias, three studies (10.3%) as moderate risk and 26 studies (89.7%) were rated as having high risk of bias. Stress risk factors were summarized in the following categories: demographic characteristics; job characteristics; lifestyle factors; negative coping strategies and negative personality traits. CONCLUSIONS: Identification of stress risk factors is the first step to create and adopt the appropriate interventions to decrease stress among police personnel. The early identification of police officers at higher risk and the appropriate screening for mental health disorders is crucial to prevent disease and promote quality of life.

Health-Related Quality of Life and Rehabilitation Costs of Patients with Amputated Limb.

AIM: The aim of this study was the evaluation of health-related quality of life (HRQoL) and rehabilitation costs of patients with amputated limb. MATERIALS AND METHODS: This is a cross-sectional study and the study sample, which was a sample of convenience, included 100 patients with amputated limb. The tools of the survey were the Short Form Questionnaire-36 (SF-36) and the Questionnaire used for measuring rehabilitation costs in trauma patients by Stergiannis et al.Results: The sample of the study consisted of 107 patients with amputation. HRQoL significantly increased (p < 0.001) between all-time points. According to the patients' answers, there were zero costs related to rehabilitation 1 year after the amputation. The type of edge amputation had significant impact on the rate of HRQoL increase. Rehabilitation costs increased over time during the first year. The mean (SD) rehabilitation cost was 1372 (2200) € at the first 6 months and 4774 (9109) € at the second half year. HRQoL was associated with age at all-time points and with costs of purchase of special pharmaceuticals, hospitalization, other expenses, number of medical visits, and cost of phone calls. CONCLUSIONS: The economic costs due to the amputation need to be studied as they affect the extent to which an amputated patient can meet his new emerging needs. Therefore, future research should focus in the economic dimension of the amputation in relation with the HRQoL of these patients and their relatives, so that new health policies may be conducted.

Characteristics and Survival Rates in Ward Patients Requiring Evaluation by Intensivist in Greece.

INTRODUCTION: Patients at risk should be admitted to the ICU if there is room for improvement. Patients who have no room for improvement or the risk of death is either too high or too low should not be admitted to the ICU. AIM: To investigate ward patient characteristics, outcomes, and survival rates after an emergency call for evaluation by an intensivist. MATERIAL AND METHOD: This is a prospective observational study of patients hospitalized at a general hospital in Greece. A data recording form was completed by the investigators in order to collect the required data. RESULTS: 115 patients (58.3%, n = 67 men and 41.7%, n = 48 women) of mean age 67.1 ± 13.8 years (range 27-92 years) were evaluated by an intensivist and were recorded. 28.7% (n = 33) were hospitalized in a surgical clinic, 67% (n = 77) were hospitalized in internal medicine clinics (oncology), and 4.3% (n = 5) of the patients were treated in the emergency department, the radiotherapy department, or the radiology department. 73% (n = 84/115) of the patients were hospitalized in the ICU. Total survival rate was 49.6% (57/115). Of the 31 patients who did not enter the ICU (out of 115 patients), 15 survived (13% of the 115 patients or 48.4% of the 31 patients not admitted to the ICU). Five (5) of them had a cardiac arrest and either died without entering the ICU or continued their hospitalization in the ward. The survival rates of the patients not admitted to the ICU who continued hospitalization at the ward was 57.7% (15/26). Of the 84 patients admitted to the ICU, 42 survived (36.5% of the 115 patients or 50% of the 84 patients admitted to the ICU). CONCLUSIONS: The survival rates of these patients are quite low and possibly multifactorial due to the severity of the disease, the unnecessary call for an intensivist due to an irreversible condition, or the delayed call of an intensivist.