The Sociodemographic Factors Related to Disability of Applicants of Welfare Benefits in Greece: A Cross-Sectional Survey Based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0.

INTRODUCTION: The aim of the present study was to report on the prevalence of disability and its association with sociodemographic factors among welfare benefit applicants in Greece. The study also compared the disability scores between different health conditions using the WHODAS 2.0 (12-item version), a biopsychosocial-model-based measure. METHODS: The Greek WHODAS 2.0, 12-item version, was administered by interview. A three-member medical committee assessed the medical records of the applicants and assigned a disability percentage based on the biomedical measure of disability percentage determination (Barema scale). RESULTS: The majority of the participants were female (56.65%). Certain health conditions were presented more frequently among welfare benefit applicants (mental health disorders and neoplasms). The domains with the highest rate of difficulty were the "participation" and "life activities" domains. Significant differences were found between WHODAS 2.0 and Barema scores for all eight different health condition categories. The factorial ANOVA (8x2) showed a significant interaction effect between health condition category and gender with respect to the WHODAS 2.0 score (F = 19.033, p <.001, η2 = 0.13). The WHODAS 2.0 score was negatively correlated to gender, years of studies, and marital status and positively correlated to age, working status, and the Barema score. The results revealed that male participants with a partner who were younger, had more studies, were actively working, and had a lower Barema score would have lower WHODAS scores. CONCLUSION: Sociodemographic characteristics of welfare benefit applicants are associated with disability levels based on WHODAS 2.0. Certain health conditions, like mental health or neuromusculoskeletal conditions, are associated with higher disability scores. There are differences between the biopsychosocial and the biomedical approaches to disability assessment. The implementation of WHODAS 2.0 may contribute to a better understanding of the lived experience of patients and is a feasible and efficient tool. Combining biomedical and biopsychosocial approaches may enhance the procedures of disability assessment and help in the development of policies that support people with disabilities.

Correction: Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324-336.

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Psychometric Properties of the 12-Item World Health Organization Disability Assessment Schedule (WHODAS 2.0), Greek Version: A Cross-Sectional Study on Applicants of Welfare Benefits.

INTRODUCTION: The International Classification of Functioning, Disability, and Health (ICF) provides a framework for the biopsychosocial model of disability and was developed by the World Health Organization (WHO). The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is an ICF-based tool that measures health and disability at the population level or in clinical practice. The aim of the study was to examine the psychometric properties of the Greek version of the WHODAS 2.0 (12-item) administered to 10,163 adults who had applied for welfare benefits in three regions of Greece. METHODS: The WHODAS 2.0, administered by interview was the primary outcome variable. Principal axis factoring (PAF) and confirmatory factor analysis (CFA) assessed the data fit to the model (construct validity). The correlation between Barema disability percentage (assessed by a three-member medical committee) and WHODAS 2.0 score and the correlation between WHODAS 2.0 score and the number of comorbidities were also examined (concurrent validity). Cronbach's alpha was used to assess the internal consistency of the questionnaire. Floor and ceiling effects were also examined. RESULTS: Internal consistency was acceptable (Cronbach's alpha=0.918). A significant association was found between Barema disability percentage and the WHODAS 2.0 score. Factor analysis showed a clear two-factor solution (PAF and CFA), while no floor or ceiling effects were evident. CONCLUSION: The Greek version of the 12-item WHODAS 2.0 was found to be reliable and valid in a wide sample of applicants for welfare benefits.

Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis.

Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible airflow limitation. Patient participation in Pulmonary Rehabilitation (PR) programs has a beneficial effect on disease management, improving patients' functional capacity and quality of life. As an alternative to traditional programs or as a complementary activity, the inclusion of virtual reality (VR) games is proposed. The aim of this research study was to investigate the effectiveness of incorporating VR in the pulmonary rehabilitation program of patients with COPD. A systematic literature search was performed for randomized controlled trials (RCTs) in the electronic databases Google Scholar, PubMed, and Pedro from January 2014 to March 2022. The search involved screening for studies examining the effectiveness of enhancing PR with VR. The PEDro (Physiotherapy Evidence Database) scale was chosen as the tool to assess the quality of studies. A meta-analysis was performed where possible. Six studies were included in this systematic review. The PEDro scale showed five studies of good methodological quality and one of fair quality. The variables examined were: aerobic capacity for exercise, lung function, anxiety and depression, with non-significant improvement for the MRC Dyspnea scale, marginally non-significant improvement regarding 6MWT (p = 0.05) and significant improvement for FEV1 (p < 0.05). There was variability noted in the VR applications and the proposed rehabilitation that the experimental groups followed. The application of VR is recommended for COPD patients, in combination with conventional PR. VR was found to be effective in increasing therapeutic effect and should be considered as a mean of increasing accessibility to PR. Therefore, further research, as well as additional RCTs regarding the effectiveness of VR in patients with COPD, seems necessary.

Depressive Symptoms and Anger Expression Among Survivors After Stroke.

INTRODUCTION: Stroke is a frequent cause of death and one of the most common causes of disability and depression in the countries of the Western world. Depression is associated with limited functionality, reduced self-care, and increased mortality in patients with stroke. Anger often occurs in these patients and may disrupt the course of their recovery. AIM: The investigation of the presence of depressive symptomatology, the expression of anger, and the degree of functioning/independence of patients after stroke. METHOD: One hundred and ten patients after stroke completed the Center for Epidemiological Studies-Depression (CES-D) scale, the State-Trait Anger Expression Inventory, and the Barthel Index. RESULTS: Patients who lived alone had a higher depressive symptomatology score than patients who did not live alone (p = 0.009). An increase in the total depressive symptomatology score was related to an increase in the anger expression score (p = 0.011), increase in anger-in score (p < 0.001), increase in anger-out score (p < 0.001), and decrease in anger control score (p = 0.001). Females had lower anger-in scores compared to men (p = 0.029). Individuals with a history of previous stroke had higher anger-out scores compared to people without a history of previous stroke (p = 0.025). An increase in the patient's functional/independence score was associated with an increase in anger control score (p = 0.015). CONCLUSIONS: Early detection and management of depression and anger will facilitate patient's compliance to the rehabilitation program in order to achieve optimal therapeutic results and ensure a better quality of life.

Is manual therapy of the diaphragm effective for people with obstructive lung diseases? A systematic review.

BACKGROUND: Diaphragm dysfunction is common among people with obstructive lung disease (OLD). The effectiveness of manual therapy (MT) techniques specifically targeting this region remains unclear. The scope of this systematic review is to investigate the effectiveness of MT on the zone of apposition (ΖΟΑ) of the diaphragm in lung function, diaphragm excursion (DE), chest expansion, exercise capacity (EC), maximal inspiratory pressure (PImax) and dyspnea in people suffering from OLD. METHODS: Key databases were systematically searched. Two independent reviewers screened the papers for inclusion. Methodological quality and the quality of evidence were assessed using the PEDro scale and the GRADE approach, respectively. RESULTS: Two studies were included. One showed that diaphragmatic stretching and the manual diaphragm release technique (MDRT) improved DE and CE (p<0.001, p<0.05, respectively). The other showed that MDRT improved DE and EC (p<0.05, p<0.05, respectively). CONCLUSION: This systematic review provides preliminary evidence on the effectiveness of MT on the ZOA of the diaphragm in people with COPD. Further research is needed in order for definitive conclusions to be drawn. REGISTRATION NUMBER IN PROSPERO: CRD42022308595.

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.

Reply to Salimi, M. Comment on "Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324-336".

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The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Reeducation Exercises, in Patients with Non-Specific Chronic Neck Pain: Protocol for Development of Outcome Measures and a Randomized Controlled Trial.

Until now, non-specific chronic neck pain has mainly been considered as a musculoskeletal system dysfunction, with associated psychological involvement due to its prolonged or recurrent nature. However, patients with non-specific chronic neck pain frequently additionally exhibit respiratory dysfunction. Emerging evidence suggests that addressing the respiratory dysfunction in these patients will provide additional therapeutic benefits in musculoskeletal and respiratory-related outcomes for several reasons (biomechanical, biochemical, and psychological). Motor control dysfunction of the muscles surrounding the spine (diaphragm included) negatively affects the mechanics and biochemistry of breathing (pH-homeostasis). An impaired and ineffective breathing pattern has been recognized as the primary source of many unexplained symptoms (anxiety, depression, confusion, chest pain, hypocapnia, and breathlessness) in patients with non-specific chronic neck pain. The proposed protocol's purpose is dual: to assess the relative effectiveness of manual therapy in the cervical spine and the diaphragm, in combination with breathing reeducation exercises, along with cervical spine manual therapy or usual physical therapy care on the underlying dysfunctions in patients with non-specific chronic neck pain via a randomized controlled clinical trial, and to validate part of the outcome measures. Several musculoskeletal and respiratory dysfunction outcomes will be employed to delimit the initial extent and level of dysfunction and its resolution with the treatments under study.

The Effectiveness of Spinal, Diaphragmatic, and Specific Stabilization Exercise Manual Therapy and Respiratory-Related Interventions in Patients with Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis.

Patients with nonspecific chronic neck pain (NSCNP) exhibit respiratory dysfunction. This systematic review aimed to analyze randomized controlled trials (RCTs) investigating the effect of spinal and/or diaphragmatic and/or specific stabilization exercise manual therapy and/or respiratory exercises on musculoskeletal and respiratory diagnostic outcomes in patients with NSCNP. A systematic search and selection of RCTs was performed in three scientific databases (Pubmed, Scopus, and Physiotherapy Evidence Database (PEDro)) and one search engine (Google Scholar) from inception to April 2022. Relevant studies published in the English language were extracted, evaluated, and independently rated for methodological quality (PEDro scale). The quality of the evidence was assessed with the GRADE approach. Out of 1089 studies collected in total, 1073 were excluded (i.e., did not meet the inclusion criteria or were duplicates). Sixteen RCTs were finally included, rated on 5.62/10 (PEDro score) on average for methodological quality. Overall, there was sparse evidence that spinal and/or diaphragmatic manual therapy and/or trunk stabilization exercises and/or respiratory exercises significantly improved pain, disability, and respiratory outcomes in patients with NSCNP immediately post-treatment. However, the clinical heterogeneity between studies was significant, and the level of certainty of the evidence was low to very low. More, high-quality RCTs are required, contributing to the holistic diagnostic monitoring and management of patients with NSCNP.

Active Joint Position Sense in Children With Unilateral Cerebral Palsy.

Objective The aim of the study was to examine the differences in joint position sense at the elbow joint between 15 children with unilateral cerebral palsy (CP) and 15 typically developing (TD) controls without neurological or other health deficits. Methodology Joint position sense, a major proprioceptive component, was evaluated actively using a Kin Com 125 AP isokinetic dynamometer (Chattanooga Group, Chattanooga, TN). Results A significant interaction was found (p<0.05) between disability and side, with respect to the active reproduction movement scores. Post-hoc independent t-tests, with Bonferroni adjustments, revealed significant differences for the dominant (t=-3.63, p=0.001) and non-dominant sides respectively (t=-6.19, p=0.000). Repeated measures t-test revealed wider errors with the non-dominant (affected side) in the active reproduction test, compared to the dominant (nonaffected) side for the CP group of children (t=-4.73, p=0.000). A positive correlation was evident between the level of spasticity and joint position sense (Rho=0.71, p=0.003). Conclusions Based on our findings, joint position sense is impaired at the elbow joint in children with spastic hemiplegia. The proprioceptive deficit is present at both the affected and unaffected sides and is related to the level of spasticity.

Avascular necrosis of the femoral head: Evaluation of hyperbaric oxygen therapy and quality of life.

Introduction: The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy - HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. Methods: This was a prospective observational non-controlled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients' QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN (MHOT), and VAS, in three different phases: before HBO2; after the completion of the first phase (20 HBO2 sessions, up to two months); and after the completion of the second phase (20 HBO2 sessions, up to two months after the first phase). A reassessment was made on the completion of each phase. Ratings were also made after the completion of each phase, over the first five months of follow-up. Results: All 73 patients (67.1% males, 32.9% females, mean age: 40.34, SD ±± 9.99) participated in the study. Steinberg scale, mean EQ (F (1, 57) = 25.18, η2 = .306 and F (1, 43) = 43.402, η2 = .502); mHHS (F (1, 61) = 67.13, η2 = .524) and F (1, 43) = 31.84, η2 = .425); MHOT (F (1, 61) = 11.68, η2 = .161) and F (1, 43) = 98.01, η2 = .695); and VAS (F (1, 53) = 24.11, η2 = .313) and F (1, 39) = 45.61, η2 = .539), improved between the first and second measurements and between the second and third measurement accordingly (p < .01). Conclusion: HBO2 treatment does not induce alteration of quality of life and is well tolerated and accepted by patients.

The combination of inspiratory muscle training and high-flow nasal cannula oxygen therapy for promoting weaning outcomes in difficult-to-wean patients: protocol for a randomised controlled trial.

BACKGROUND: According to the literature, 20-30% of intubated patients are difficult to wean off mechanical ventilation and have a prolonged intensive care unit (ICU) stay with detrimental effects on muscle strength, functional ability and quality of life. Inspiratory muscle training (IMT) via a threshold device has been proposed as an effective exercise for minimising the effects of mechanical ventilation on respiratory muscles of critically ill patients with prolonged weaning. In addition, high-flow nasal cannula (HFNC) oxygen has been proved to provide efficient support for both high- and low-risk patients after extubation, thus preventing re-intubation. MATERIAL AND METHODS: A randomised controlled trial was designed to assess the efficacy of combining IMT and HFNC as therapeutic strategies for patients with high risk for weaning failure. Once patients with prognostic factors of difficult weaning are awake, ventilated with support settings and cooperative, they will be randomised to one of the two following study groups: intervention group (IMT and HFNC) and control group (IMT and Venturi mask). IMT will start as soon as possible. Each allocated oxygen delivery device will be applied immediately after extubation. IMT intervention will continue until patients' discharge from ICU. The primary outcome is the rate of weaning failure. Secondary outcomes are maximal inspiratory and expiratory strength, endurance of respiratory muscles, global muscle strength, functional ability and quality of life along with duration of ventilation (days) and ICU and hospital length of stay. CONCLUSION: The present study could significantly contribute to knowledge of how best to treat patients with difficult weaning and high risk of re-intubation.

The effect of a holistic self-management plan on asthma control.

The holistic self-management plan includes lifelong actions that enable patients to cope with their disease. The present study was designed to evaluate the effect of a holistic self-management plan on asthma control. A 12-month controlled study was conducted. Adult patients with mild-to-moderate asthma (n = 24) who attended the emergency asthma department were randomized to two groups: One group followed four educational sessions and three personal home sessions (n = 12), while a second group received a short manual with asthma information (n = 12). The main measure was the asthma control test (ACT), while secondary outcomes were self-efficacy (general self-efficacy scale, GSE), end-tidal carbon dioxide (ETCO2), respiratory rate (RR), breathing hold time (BHT), the Nijmegen Questionnaire (NQ), and spirometry (FEV1% predicted (forced expiratory volume in 1 second % predicted)) scores. The 2 × 4 ANOVA showed a significant interaction effect between intervention and time in ACT (p = 0.001), GSE (p < 0.001), ETCO2 (p < 0.001), RR (p < 0.001), BHT (p < 0.001), NQ (p = 0.05), and FEV1% predicted (p < 0.001). Predictors of asthma control were self-efficacy and ETCO2. In conclusion, this exploratory study provided support for the effectiveness of holistic self-management in asthma control. Behavioral changes, as indicated by the development of self-efficacy and the reduction of hyperventilation, contributed to the effectiveness of the intervention.

The scope of physiotherapy services provided in public ICUs in Greece: A pilot study.

The aim of the present study was to determine the scope of physiotherapy services provided in Greek ICUs in Athens. A cross-sectional study was conducted with two postal questionnaires administered separately, one for ICU directors and one for ICU physiotherapists. Responses were received from 19 ICU directors and 103 physiotherapists employed in all the adult public mixed medical and surgical ICUs across Athens. The response rate for the survey completion was 100% for ICU directors and 68.7% for physiotherapists. The results showed a 1:50 to 1:12 range in the ratio of physiotherapists to ICU beds. Among the 19 ICUs, 15 (78.9%) employed physiotherapists on a rotational basis, while four (21.0%) retained them exclusively. On weekdays, all surveyed ICUs were covered by physiotherapists in the morning and 10/19 (52.6%) during the afternoon. On weekends, 12/19 (63.2%) of the surveyed ICUs reported physiotherapy care during the morning and 4/19 (21.0%) during both morning and afternoon. All 103 physiotherapists conducted airway clearance techniques and progressive mobilization, 92/103 (89.3%) were involved in extubating patients, 102/103 (99.0%) in passive and active range of motion exercises, and 61/103 (59.2%) in walking. In conclusion, all Greek ICUs in Athens surveyed had physiotherapy cover. The physiotherapists working in these ICUs in Athens were involved in respiratory care and mobilization.

Hyperventilation in asthma: a validation study of the Nijmegen Questionnaire--NQ.

INTRODUCTION: The Nijmegen questionnaire (NQ) has previously been used for screening the hyperventilation syndrome (HVS) in asthmatics. However, no validity study has been reported so far. OBJECTIVE: To examine the validity and reliability of the NQ in asthma patients and identify the prevalence of HVS. METHODS: The NQ (n = 162) was examined for translation, construct, cross-sectional and discriminant validity as well as for internal consistency and test-retest reliability. RESULTS: Principal component analysis and exploratory factor analysis revealed a single factor solution with 11 items and 58.6% of explained variability. These 11 NQ items showed high internal consistency (Cronbach's alpha = 0.92) and test-retest reliability (IR = 0.98). Higher NQ scores were found in the following subgroups: women versus men (p < 0.01); participants with moderate versus mild asthma (p < 0.001) or uncontrolled versus controlled asthma (p < 0.001), and participants with breath-hold time (BHT) < 30 versus ≥ 30 s (p < 0.01) or end-tidal CO2 (ETCO2) ≤ 35 versus >35 mmHg (p < 0.001). A cut-off score of >17 discriminated the participants with regard to the presence of HVS. The NQ showed 92.73% sensitivity and 91.59% specificity. The total NQ score was found significantly correlated with ETCO2 (r = -0.68), RR (r = 0.66) and BHT (r = -0.65). The prevalence of HVS was found 34%. CONCLUSION: The NQ is a valid and reliable questionnaire for screening HVS in patients with stable mild-to-moderate asthma.

The effect of treadmill training on gross motor function and walking speed in ambulatory adolescents with cerebral palsy: a randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the effect of a treadmill program on gross motor function, walking speed, and spasticity of ambulatory adolescents with spastic cerebral palsy (diplegia and tetraplegia). DESIGN: In this randomized controlled trial, 22 adolescents (13-19 yrs old) from a special school for children with physical disabilities were randomly allocated to the experimental and control training groups. The experimental training group underwent a treadmill program without body weight support at a comfortable speed. The control group received treatment with conventional physiotherapy, which consisted of three sets of exercises with mat activities, balance, gait training, and functional gross motor activities. The program lasted 12 wks with a frequency of three times per week for both groups. Pretest and posttest measurements of self-selected walking speed, gross motor function, and spasticity were conducted. RESULTS: The analysis of covariance findings examining posttest differences between groups were significant with respect to self-selected walking speed (F = 8.545, P = 0.000) and gross motor function (F = 9.088, P = 0.007), whereas no significance was found for spasticity. CONCLUSIONS: Treadmill training may improve the walking speed and gross motor function of adolescents with spastic cerebral palsy, without adverse effects on spasticity.

The effect of physiotherapy-based breathing retraining on asthma control.

BACKGROUND: The mechanism of the breathing retraining effect on asthma control is not adequately based on evidence. OBJECTIVE: The present study was designed to evaluate the effect of physiotherapy-based breathing retraining on asthma control and on asthma physiological indices across time. STUDY DESIGN: A 6-month controlled study was conducted. Adult patients with stable, mild to moderate asthma (n = 40), under the same specialist's care, were randomized either to be trained as one group receiving 12 individual breathing retraining sessions (n = 20), or to have usual asthma care (n = 20). The main outcome was the Asthma Control Test score, with secondary outcomes the end-tidal carbon dioxide, respiratory rate, spirometry, and the scores of Nijmegen Hyperventilation Questionnaire, Medical Research Council scale, and SF-36v2 quality-of-life questionnaire. RESULTS: The 2 × 4 ANOVA showed significant interaction between intervention and time in asthma control (F = 9.03, p < .001, η(2) = 0.19), end-tidal carbon dioxide (p < .001), respiratory rate (p < .001), symptoms of hypocapnia (p = .001), FEV1% predicted (p = .022), and breathlessness disability (p = .023). The 2 × 4 MANOVA showed significant interaction between intervention and time, with respect to the two components of the SF-36v2 (p < .001). CONCLUSION: Breathing retraining resulted in improvement not only in asthma control but in physiological indices across time as well. Further studies are needed to confirm the benefits of this training in order to help patients with stable asthma achieve the control of their disease.

Validity and reliability evidence of the Asthma Control Test--ACT in Greece.

BACKGROUND: The dimensionality of the Asthma Control Test (ACT) was examined in two counterview studies. Up to now, the ACT has not been validated for the Greek asthma patients. OBJECTIVE: The present study was designed to examine the validity and reliability of the ACT responses in Greek asthma outpatients under a specialist's care. STUDY DESIGN: Following evidence for sample-specific validity, the ACT (n = 100) was examined through construct, cross-sectional, convergent, and discriminant validity as well as internal consistency and test-retest reliability [root mean squared error of approximation (RMSEA)]. RESULTS: A one-factor solution fit the data [χ(2) (chi-square) = 3.899, df (degrees of freedom) 5, ns, RMSEA <0.001]. The ACT showed a high internal consistency (Cronbach alpha = 0.72) and a high 2 months test-retest reliability (IR = 0.85) for the total sample. Significant differences were found between the five categories of asthma control patients (not controlled at all, poorly controlled, somewhat controlled, well controlled, and completely controlled), according to the specialists' rating, for the ACT (p < .001). Significant differences were found between patients with and without asthma control (p = .001), patients of different gender (p = .05), educational status (p = .05), mean year income (p = .01), body mass index (p = .05), follow-up visits (p = .01), as well as among patients of different age (p < .001) and severity (p < .001). An ACT score of 19 or less provided optimum balance of sensitivity (98.46) and specificity (88.57) for screening 'not controlled' asthma. Cross-sectional validity testing showed moderate correlation of the ACT score with FEV1% predicted (r = 0.57, p < .001) and disability (r = -0.42, p < .001) and moderately high correlation with dyspnea (r = -0.71, p < .001). Convergent validity testing showed that the ACT score was correlated with the specialists' rating (r = 0.89, p < .001). CONCLUSION: The ACT is valid and reliable in Greek outpatients with asthma under a specialist's care.

Factors associated with BMI in Greek adults with asthma.

BACKGROUND: The association between asthma and obesity remains controversial and limited to a few studies. OBJECTIVE: The present study was designed to examine the association between body mass index (BMI) and clinical measures of asthma morbidity in Greek asthma patients. STUDY DESIGN: A cross-sectional study in 100 outpatients at the asthma department of the "Amalia Fleming" General Hospital in Athens, Greece, was conducted. Asthma diagnosis was confirmed by a specialist, according to Global Initiative for Asthma (GINA) guidelines. Participants were classified, with respect to BMI (kg/m(2)), in three groups: normal: <25.0, overweight: 25.0-29.9.0 and obese: > or = 30.0. Data were modeled through multiple logistic regression analysis for the association of overweight/obesity with the study variables: demographics, asthma severity, smoking, pulmonary function (forced expiratory volume in one second; FEV(1)), asthma control (Asthma Control Test; ACT), disability associated with dyspnea (Medical Research Council [MRC] breathlessness scale), and physical activity in leisure time. RESULTS: Overweight/obesity was detected in 56 participants (56%). Multivariate regression analysis resulted in an excess risk of overweight/obesity for older participants (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 1.10-2.64 for a 10-year increase in age). CONCLUSION: Age seems to be highly associated with overweight/obesity in Greek adults with asthma who tend to maintain a similar body weight compared to the general population.