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1.
JMIR Aging ; 3(1): e15480, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32427105

RESUMO

BACKGROUND: During the last decade, more research has focused on web-based interventions delivered to support caregivers of people with dementia. However, little information is available in relation to internet use among caregivers in general, especially those caring for people with dementia. OBJECTIVE: The aim of this study was to evaluate the dementia-related internet use and factors that may be associated with its use among caregivers of people with dementia in Greece. METHODS: Secondary data from the Greek Dementia Survey of the Athens Association of Alzheimer's Disease and Related Disorders were collected from April to June 2017. A total of 580 caregivers of people with dementia participated in the study. RESULTS: The majority of the caregivers reported that they had used the internet in the previous 3 months (84.1%, 488/580). Nearly half of the caregivers (47.5%, 276/580) reported that they had received dementia services online. Bivariate analysis showed that a dementia-specific search of information was associated with age, education, kinship, and years of care. Age (odds ratio [OR] 2.362, 95% CI 1.05-5.33) and education (OR 2.228, 95% CI 1.01-4.94) were confirmed as predictors, with younger caregivers and those with higher educational attainment being more likely to search for dementia-specific information. Use of the internet to search for dementia information was only related to hours of care. The internet use by caregivers within the previous 3 months was associated with variables such as age, education, occupation, kinship, years of care, and self-reported impact on physical and social health. CONCLUSIONS: Caregivers of people with dementia in Greece, as in the other southern European countries, are essential agents of the national health system. The existing short- and long-term respite care services are limited or nonexistent. Currently, caregivers receive mostly support and education from memory clinics and municipality consultation centers, which are mainly based in central cities in Greece. Despite the dementia awareness movement in Greece, there is still space to integrate the role of technology in the support and education of caregivers. Development of training programs for enhancing electronic health literacy skills as well as web-based services provision could support Greek caregivers in their everyday caring tasks.

2.
Health Qual Life Outcomes ; 18(1): 105, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321519

RESUMO

BACKGROUND: The QOL-PCD questionnaire is a recently developed Health Related Quality of Life (HRQoL) instrument for Primary Ciliary Dyskinesia. The aim of this study was to translate the adult QOL-PCD questionnaire into Greek language and to conduct psychometric validation to assess its performance. METHODS: Forward translations to Greek and backward translation to English were performed, followed by cognitive interviews in 12 adult PCD patients. The finalized translated version was administered to a consecutive sample of 31 adult, Greek speaking PCD patients in Cyprus for psychometric validation, which included assessment of internal consistency, test-retest reliability, construct and convergent validity. Internal consistency was assessed by Cronbach's alpha test in terms of the overall and sub-scales. Test-retest reliability was assessed by repeat administration of the questionnaire within 2 weeks and calculation of the intra-class correlation (ICC). Construct validity was assessed by comparing different groups of patients based on a-priori hypotheses and convergent validity was evaluated by examining associations between the QOL-PCD and SF-36 questionnaires. RESULTS: Moderate to good internal consistency was observed (Cronbach's α: 0.46-0.88 across sub-scales) and test-retest reliability assessment demonstrated good repeatability for most scales (ICC: 0.67-0.91 across subscales). Patients of female gender, older age and lower lung function exhibited lower QOL-PCD scores in general, while high correlations for most QOL-PCD scales with corresponding SF-36 scales were observed, in particular for physical functioning (r = 0.78, p < 0.05). CONCLUSION: The adult version of QoL-PCD questionnaire has been translated according to international guidelines resulting to a cross-culturally validated Greek version which exhibited moderate to good metric properties in terms of internal consistency, stability, known-group and convergent validity.

3.
Sci Total Environ ; 714: 136693, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31978777

RESUMO

The characteristics of desert dust storms (DDS) have been shown to change in response to climate change and land use. There is limited information on the frequency and intensity of DDS over the last decade at a regional scale in the Eastern Mediterranean. An algorithm based on daily ground measurements (PM10, particulate matter ≤10 µm), satellite products (dust aerosol optical depth) and meteorological parameters, was used to identify dust intrusions for three Eastern Mediterranean locations (Crete-Greece, Cyprus, and Israel) between 2006 and 2017. Days with 24-hr average PM10 concentration above ~30 µg/m3 were found to be a significant indicator of DDS for the background sites of Cyprus and Crete. Higher thresholds were found for Israel depending on the season (fall and spring: PM10 > 70 µg/m3, winter and summer: PM10 > 90 µg/m3). We observed a high variability in the frequency and intensity of DDS during the last decade, characterized by a steady trend with sporadic peaks. The years with the highest DDS frequency were not necessarily the years with the most intense episodes. Specifically, the highest dust frequency was observed in 2010 at all three locations, but the highest annual median dust-PM10 level was observed in 2012 in Crete (55.8 µg/m3) and Israel (137.4 µg/m3), and in 2010 in Cyprus (45.3 µg/m3). Crete and Cyprus experienced the same most intense event in 2006, with 24 h-PM10 average of 705.7 µg/m3 and 1254.6 µg/m3, respectively, which originated from Sahara desert. The highest 24 h-PM10 average concentration for Israel was observed in 2010 (3210.9 µg/m3) during a three-day Saharan dust episode. However, a sub-analysis for Cyprus (years 2000-2017) suggests a change in DDS seasonality pattern, intensity, and desert of origin. For more robust conclusions on DDS trends in relation to climate change, future work needs to study data over several decades from different locations.

4.
J Vasc Access ; 21(1): 86-91, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31328625

RESUMO

PURPOSE: In an effort to reduce catheter-related bloodstream infection's incidence rates in an intensive care unit, several evidence-based procedures recommended by the Centers for Disease Control and Prevention for centrally inserted central catheters were implemented. A failure to fully comply with the recommendation for prompt removal of the centrally inserted central catheters was attributed, mainly to the difficulties and inadequacies raised from establishing peripheral venous access. METHODS: The ultrasound-guided peripheral venous cannulation method as a supplementary intervention to the Centers for Disease Control and Prevention's recommendations was incorporated and examined during the subsequent year. RESULTS: A significant reduction on catheter-related bloodstream infection incidence rates out of the expected range was found. Centrally inserted central catheters utilization ratios were reduced by 10.7% (p < 0.05; 58%-47%) and the catheter-related bloodstream infection incidence rate was reduced by 11.7 per thousand device-days (15.9-4.16/1000 centrally inserted central catheters days (2015-2016 group, respectively)). CONCLUSION: The reduction of catheter-related bloodstream infection was higher than that described in the published literature. This probably shows that the combination of the five evidence-based procedures recommended by the Centers for Disease Control and Prevention together with that of ultrasound-guided peripheral venous cannulation method can increase the compliance with the Category IA recommendation for removal or avoidance of unnecessary placement of centrally inserted central catheters and decrease the catheter-related bloodstream infections in a more effective way, by affecting the patients' centrally inserted central catheter exposure.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Remoção de Dispositivo , Ultrassonografia de Intervenção , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/normas , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/normas , Chipre/epidemiologia , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/normas , Desenho de Equipamento , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Ultrassonografia de Intervenção/normas , Estados Unidos
5.
J Med Internet Res ; 21(11): e12504, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31778120

RESUMO

BACKGROUND: As the population ages, many more people will be in need of long-term care. According to a recent report by Alzheimer's Disease International and the Karolinska Institute, 84% of people with dementia are cared for at home and 16% in nursing homes. Several Web-based interventions have been developed to assist the work of carers at home. Measuring the levels of electronic health (eHealth) literacy is of top priority to facilitate inclusion of this population and develop training programs to enhance eHealth literacy skills. OBJECTIVE: This study aimed to adapt the eHealth Literacy Scale (eHeals) for carers of people with dementia, who speak Greek as their native language and live in Greece and Cyprus, and to test the reliability and validity of the scale for carers. METHODS: The content validity of the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) was assessed with an expert panel (N=10). A descriptive study with face-to-face interviews among 101 primary carers of people with dementia was conducted. In addition to the eHeals-Carer to assess their perceived eHealth literacy, participants responded to a brief questionnaire regarding characteristics of internet use and provided sociodemographic data. The internal consistency of the tool and the construct validity via an exploratory factor analysis (EFA) were explored. RESULTS: The Mean Item-Level Content Validity Index (CVI) and Scale-Level CVI Average was 0.93. The participants were mostly women (75.2%, 76/101), aged less than 60 years (67.3%, 68/101) with secondary education. The internal consistency was estimated at a Cronbach alpha of .83. Two factors were extracted from the EFA: information seeking questions 1 to 5 (factor 1) and evaluation questions 6 to 8 (factor 2). CONCLUSIONS: eHeals-Carer is the first perceived eHealth literacy tool adapted for carers of people with dementia. The use of Web-based services available for carers could help them and improve the health care system in the long term. In Greece and Cyprus, there is a lack of services, and improving the digital skills of carers could provide them with the means to support themselves at home and improve care provision. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.8080.

6.
Respir Res ; 20(1): 212, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533829

RESUMO

BACKGROUND: Lung resection is a controversial and understudied therapeutic modality in Primary Ciliary Dyskinesia (PCD). We assessed the prevalence of lung resection in PCD across countries and compared disease course in lobectomised and non-lobectomised patients. METHODS: In the international iPCD cohort, we identified lobectomised and non-lobectomised age and sex-matched PCD patients and compared their characteristics, lung function and BMI cross-sectionally and longitudinally. RESULTS: Among 2896 patients in the iPCD cohort, 163 from 20 centers (15 countries) underwent lung resection (5.6%). Among adult patients, prevalence of lung resection was 8.9%, demonstrating wide variation among countries. Compared to the rest of the iPCD cohort, lobectomised patients were more often females, older at diagnosis, and more often had situs solitus. In about half of the cases (45.6%) lung resection was performed before presentation to specialized PCD centers for diagnostic work-up. Compared to controls (n = 197), lobectomised patients had lower FVC z-scores (- 2.41 vs - 1.35, p = 0.0001) and FEV1 z-scores (- 2.79 vs - 1.99, p = 0.003) at their first post-lung resection assessment. After surgery, lung function continued to decline at a faster rate in lobectomised patients compared to controls (FVC z-score slope: - 0.037/year Vs - 0.009/year, p = 0.047 and FEV1 z-score slope: - 0.052/year Vs - 0.033/year, p = 0.235), although difference did not reach statistical significance for FEV1. Within cases, females and patients with multiple lobe resections had lower lung function. CONCLUSIONS: Prevalence of lung resection in PCD varies widely between countries, is often performed before PCD diagnosis and overall is more frequent in patients with delayed diagnosis. After lung resection, compared to controls most lobectomised patients have poorer and continuing decline of lung function despite lung resection. Further studies benefiting from prospective data collection are needed to confirm these findings.


Assuntos
Transtornos da Motilidade Ciliar/cirurgia , Pulmão/cirurgia , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Estudos Longitudinais , Masculino , Prevalência , Estudos Prospectivos , Testes de Função Respiratória , Resultado do Tratamento , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-31443199

RESUMO

Geographical investigations are a core function of public health monitoring, providing the foundation for resource allocation and policies for reducing health inequalities. The aim of this study was to develop geodemographic area classification based on several area-level indicators and to explore the extent of geographical inequalities in mortality. A series of 19 area-level socioeconomic indicators were used from the 2011 national population census. After normalization and standardization of the geographically smoothed indicators, the k-means cluster algorithm was implemented to classify communities into groups based on similar characteristics. The association between geodemographic area classification and the spatial distribution of mortality was estimated in Poisson log-linear spatial models. The k-means algorithm resulted in four distinct clusters of areas. The most characteristic distinction was between the ageing, socially isolated, and resource-scarce rural communities versus metropolitan areas with younger population, higher educational attainment, and professional occupations. By comparison to metropolitan areas, premature mortality appeared to be 44% (95% Credible Intervals [CrI] of Rate Ratio (RR): 1.06-1.91) higher in traditional rural areas and 36% (95% CrI of RR: 1.13-1.62) higher in young semi-rural areas. These findings warrant future epidemiological studies investigating various causes of the urban-rural differences in premature mortality and implementation policies to reduce the mortality gap between urban and rural areas.


Assuntos
Geografia/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mortalidade Prematura , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Chipre , Feminino , Indicadores Básicos de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Orphanet J Rare Dis ; 14(1): 142, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196140

RESUMO

BACKGROUND: Primary Ciliary Dyskinesia (PCD) diagnosis relies on a combination of tests which may include (a) nasal Nitric Oxide (nNO), (b) High Speed Video Microscopy (HSVM) and (c) Transmission Electron Microscopy (TEM). There is variability in the availability of these tests and lack of universal agreement whether diagnostic tests should be performed in sequence or in parallel. We assessed three combinations of tests for PCD diagnosis and estimated net sensitivity and specificity as well as cost-effectiveness (CE) and incremental cost-effectiveness (ICE) ratios. METHODS AND RESULTS: A hypothetical initial population of 1000 referrals (expected 320 PCD patients) was followed through a probabilistic decision analysis model which was created to assess the CE of three diagnostic algorithms (a) nNO + TEM in sequence, (b) nNO + HSVM in sequence and (c) nNO/HSVM in parallel followed, in cases with conflicting results, by confirmatory TEM (nNO/HSVM+TEM). Number of PCD patients identified, CE and ICE ratios were calculated using Monte Carlo simulations. Out of 320 expected PCD patients, 313 were identified by nNO/HSVM+TEM, 274 with nNO + HSVM and 198 with nNO + TEM. The nNO/HSVM+TEM had the highest mean annual cost (€209 K) followed by nNO + TEM (€150 K) and nNO + HSVM (€136 K). The nNO + HSVM algorithm dominated the nNO + TEM algorithm (less costly and more effective). The ICE ratio for nNO/HSVM+TEM was €2.1 K per additional PCD patient identified. CONCLUSIONS: The diagnostic algorithm (nNO/HSVM+TEM) with parallel testing outperforms algorithms with tests in sequence. These findings, can inform the dialogue on the development of evidence-based guidelines for PCD diagnostic testing. Future research in understudied aspects of the disease, such as PCD-related quality of life and PCD-associated costs, is needed to help the better implementation of these guidelines across various healthcare systems.

9.
BMC Health Serv Res ; 19(1): 322, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117994

RESUMO

BACKGROUND: Regular asthma reviews are recommended by international guidelines to improve the quality of life of asthma patients. To facilitate these reviews in primary care practice, there is a need for structured asthma review tools. AIM: The aim of this study was to assess the metric properties of the Greek-translated version of the Active Life with Asthma (ALMA) review. METHODS: A convenience sample of 156 asthmatic patients from three public hospitals participated in this methodological study with a descriptive cross-sectional correlation design. Participants responded to the 19-item ALMA questionnaire and provided socio-demographic and clinical information. The construct validity of the tool was explored in exploratory factor analysis and the internal consistency of scale and sub-scales was estimated using Cronbach's α. Convergence validity was assessed using the Asthma Control Questionnaire (ACQ), a commonly used asthma control measure, and concurrent criterion validity was assessed using the MiniAQoL, an asthma-specific quality of life questionnaire. Known-group validity was assessed based on observed differences in terms of frequency of hospitalizations or emergency visits in the past year. RESULTS: Amongst 156 participants, 95 (60.9%) were women and the median age was 50-65 years old. Exploratory factor analysis (KMO = 0.83 and Bartlett test < 0.001) with principal component extraction and orthogonal rotation revealed a clear structure of three factors with little cross-loading: physical, environmental and mental domains, as in the original study. Cronbach's alpha coefficient for internal consistency for the whole scale was 0.85, while for the sub-scales, these were: environmental a = 0.69, mental a = 0.76 and physical a = 0.85. Test-retest reliability based on the correlation between scores of 20 participants responding twice two weeks apart was r = 0.92. There was stong correlation in the expected direction between ALMA and ACQ (r = - 0.70) as well as miniAQoL (r = 0.71). Finally, there were statistically significant higher ALMA scores in participants who reported emergency visits and hospital admissions in the past year. CONCLUSION: In general, the ALMA showed good metric properties. It appears to be a reliable and valid tool which can be used as a measure for asthma control and self-management in clinical practice as well as future descriptive or intervention research studies.


Assuntos
Asma/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Asma/etnologia , Asma/prevenção & controle , Estudos Transversais , Análise Fatorial , Feminino , Grécia/etnologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Exame Físico/métodos , Atenção Primária à Saúde , Psicometria , Reprodutibilidade dos Testes , Autogestão/métodos , Inquéritos e Questionários , Tradução , Adulto Jovem
10.
BMC Public Health ; 19(1): 627, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118020

RESUMO

BACKGROUND: Area-level measures of socioeconomic deprivation are important for understanding and describing health inequalities. The aim of this study was the development and validation of a small-area index of socioeconomic deprivation for Cypriot communities and the investigation of its association with the spatial distribution of all-cause premature adult mortality. METHODS: Six area-level socioeconomic indicators were used from the 2011 national population census (low educational attainment, unemployment, not owner occupied household, single-person household, divorced or widowed and single-parent households). After normalization and standardization of the geographically smoothed indicators, Principal Component Analysis (PCA) was used to construct indicator weights. The association between deprivation indices and the spatial distribution of all-cause premature adult mortality was estimated in Poisson log-linear spatial models. RESULTS: PCA resulted in two principal components explaining the 65.7% of the total variance. The first principal component included four indicators (low educational attainment, single-person households, divorced or widowed and single-parent households, the latter however with a negative loading) and it thought more likely to capture rural-related aspects of deprivation. The second principal component included the other two indicators (unemployment and not owner occupied households) and it is more likely to capture urban-related aspects of material deprivation. Restricting the analysis in the metropolitan areas of the island resulted in a different set of indicators for the urban-specific deprivation index. All developed indices were linearly associated with all-cause premature adult mortality. The all-cause premature adult mortality increased by 17% per 1 standard deviation (SD) increase in rural-related socioeconomic deprivation (95% CrI: 8-27%) and 8% per 1 SD increase in urban-related aspects of material deprivation (95% CrI: 3-15%) in the nationwide analysis and 9% per 1 SD increase in urban-specific socioeconomic deprivation (95% CrI: 4-15%) across metropolitan areas. CONCLUSIONS: The results of this study demonstrate that a set of small-area indices of socioeconomic deprivation across Cypriot communities have good construct and predictive validity. However, the study indicates that different aspects of socioeconomic deprivation may be important in rural and urban areas in Cyprus. The developed socioeconomic deprivation indices could offer a valid new tool for Cypriot public health research and policy in terms of identifying areas in greatest need, guiding resource allocation and developing area-targeted public health programmes and policies.


Assuntos
Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Mortalidade Prematura/tendências , Fatores Socioeconômicos , Adulto , Censos , Chipre/epidemiologia , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Reprodutibilidade dos Testes , População Rural/estatística & dados numéricos , Pais Solteiros , Análise de Pequenas Áreas , Desemprego , Viuvez
11.
BMC Womens Health ; 19(1): 67, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096963

RESUMO

BACKGROUND: International literature reveals that single mothers experience increased levels of chronic stress, which is mainly due to economic hardship and reduced levels of social support. Eventually this leads to psychological distress. While most of the studies commonly identify that mental health disorders are common among single mothers compared to their married counterparts, the magnitude of the problem might be even larger since diagnosis-specific tools may mask important levels of distress of milder intensity. This study aims to assess the level of mental distress experienced by single mothers as measured by the GHQ-28, and how it is influenced by socioeconomic factors, as well as the level of perceived social support. METHODS: Between January and March 2012, Greek speaking single mothers who reside in Cyprus were recruited by either personal conduct through Single Mothers' Association (SMA), or by using snowball sampling technic. Mental distress was assessed with the General Health Questionnaire (GHQ-28) and perceived social support with the Social Provision Scale (SPS). All scales were completed anonymously and voluntarily by 316 single mothers. Univariable and multivariable associations with socio-demographic characteristics were investigated using chi-square tests and in multivariable backward stepwise logistic regression models respectively. Odds ratio of psychological distress across decreasing levels of social support were estimated in logistic regression models. . RESULTS: As many as 44.6% of the sample appeared to experience psychological distress (GHQ-28 total score ≥ 5). Strong associations with all health assessment tools were observed with variables relating to the lowest monthly family income, the presence of economic difficulties, the higher educational level, the age group 35-44 years and pre-existing illness. Social support as perceived by the mothers displayed a strong negative independent association with psychological distress, even after adjusting confounders. CONCLUSION: This study highlights that single mothers are very likely to experience poor psychological well-being. With a steady rise in the proportion of single-parent families headed by a mother, these findings highlight a significant issue that would adversely affect many women and consequently their children and the community. It also emphasizes the necessity for interventions and strategies at community level in order to support this vulnerable population group.


Assuntos
Saúde Mental/estatística & dados numéricos , Mães/psicologia , Família de Pais Solteiros/psicologia , Estresse Psicológico/psicologia , Adulto , Criança , Estudos Transversais , Chipre , Feminino , Humanos , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Pobreza/psicologia , Apoio Social , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Adulto Jovem
12.
PLoS One ; 14(4): e0215372, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31002708

RESUMO

BACKGROUND/OBJECTIVE: Gestational diabetes mellitus (GDM) is a common pregnancy complication, with complex disease mechanisms, and several risk factors may contribute to its onset. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risk factors associated with GDM, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by convincing evidence. METHODS: We searched PubMed and ISI Web of Science from inception to December 2018 to identify meta-analyses examining associations between putative risk factors for GDM. For each meta-analysis we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. RESULTS: Thirty eligible meta-analyses were identified, providing data on 61 associations. Fifty (82%) associations had nominally statistically significant findings (P<0.05), while only 15 (25%) were significant at P<10-6 under the random-effects model. Only four risk factors presented convincing evidence:, low vs. normal BMI (cohort studies), BMI ~30-35 kg/m2 vs. normal BMI, BMI >35 kg/m2 vs. normal BMI, and hypothyroidism. CONCLUSIONS: The compilation of results from synthesis of observational studies suggests that increased BMI and hypothyroidism show the strongest consistent evidence for an association with GDM. Diet and lifestyle modifications in pregnancy should be tested in large randomized trials. Our findings suggest that women with known thyroid disease may be offered screening for GDM earlier in pregnancy.


Assuntos
Índice de Massa Corporal , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/prevenção & controle , Hipotireoidismo/complicações , Feminino , Humanos , Metanálise como Assunto , Estudos Observacionais como Assunto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
13.
Perspect Psychiatr Care ; 55(1): 48-60, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29766513

RESUMO

PURPOSE: To explore nurse's knowledge and attitudes toward the care of people with dementia. DESIGN AND METHODS: A systematic review informed by the PRISMA-P (preferred reporting items for systematic reviews and meta-analyses protocols) guidelines in four databases (CINAHL, PsyINFO, Pubmed, Cohrane, EMBASE) using keywords "attitudes," "behaviors," "dementia," "knowledge," and "nurses." Predetermined inclusion criteria were selected. The review was conducted between January 1 and December 30, 2017. FINDINGS: Sixteen quantitative studies, one qualitative, and two mixed methods studies were included. Nurses lack knowledge, communication skills, management strategies, and confidence in the provision of dementia care. Interventional studies suggested that knowledge and attitudes improved after training programs were implemented. PRACTICE IMPLICATION: This review contributes to care advancement and practice development through the reinforcement of organizational support and educational opportunities for nurses.


Assuntos
Competência Clínica , Demência/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros , Humanos
14.
BMC Public Health ; 18(1): 1061, 2018 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-30139337

RESUMO

BACKGROUND: Social capital can been described as an individual or a collective attribute, with structural and cognitive components, and a bonding, bridging and linking typology. While extensively studied in the community, studies in occupational settings are sparse by comparison. Furthermore, there is no uniformity in its measurement. This study investigated the construct validity of a Workplace Social Capital questionnaire (WSC), originally developed in the Finnish Public Sector occupational cohort, in a different socio-cultural setting (Cyprus), language (Greek) and occupational group (Registered Nurses). It also explored its criterion concurrent validity according to observed association with self-rated health and psychological distress. METHODS: Participants were 10% of all registered nurses (N = 362) who responded to the 8-item WSC scale during a nationwide educational programme. A unidimensional model was compared with the postulated two-factor (structural vs cognitive) and three-factor model (bonding, bridging, linking) in Confirmatory Factor Analyses. The association with self-rated health (0-100 Visual Analogue Scale) and mental distress (GHQ-12 ≥ 4) was assessed in linear and logistic regression models. RESULTS: A bonding (Cronbach's a = 0.76), bridging (a = 0.78) and linking (a = 0.89) structure explained 77.6% of the variance and was a better fit as indicated by goodness of fit indices. Elevated odds of mental distress and poorer self-rated health were observed among participants with the lowest levels of perceived workplace social capital. In adjusted models, associations appeared stronger with bonding social capital (adjOR of mental distress = 2.71 95% CI = 1.08, 6.79) while those with the highest scores rated their health higher by 8.0 points on average (95% CI = 2.1, 13.8). Low linking social capital was also associated with poorer health but no consistent associations were observed with bridging. CONCLUSION: While associations appeared stronger with bonding and linking, this may reflect a weakness of the measure to fully capture bridging social capital. Even though, this aspect might need strengthening, the WSC showed good metric properties in a different setting, language and occupational group. Cross-national and cognitive validation studies are needed.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Capital Social , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Local de Trabalho/psicologia , Adulto , Estudos Transversais , Chipre/epidemiologia , Autoavaliação Diagnóstica , Feminino , Grécia/epidemiologia , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Apego ao Objeto , Reprodutibilidade dos Testes
15.
Public Health Nutr ; 21(5): 967-980, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29173197

RESUMO

OBJECTIVE: To assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive breast-feeding (EBF) in Cyprus up to the sixth month. DESIGN: Cross-sectional and longitudinal descriptive study. BF and EBF were estimated based on mothers' self-reported BF status in line with Step 7 of the WHO/UNICEF Baby-Friendly Hospital Initiative questionnaire and based on 24 h recall. SETTING: Maternity wards in all public hospitals and twenty-nine (of thirty-five) private maternity clinics nationwide. SUBJECTS: Consecutive sample of 586 mothers recruited within 48 h from birth, followed up by telephone interview at the first, fourth and sixth month. RESULTS: Although 84·3 % of mothers initiated BF before discharge, prevalence of BF at the sixth month was 32·4 %, with the highest reduction observed between the first and fourth months. Prevalence of EBF at 48 h was 18·8 % and fell gradually to 5·0 % at the sixth month. Mothers with higher educational attainment or higher family income were more likely to breast-feed until the sixth month. In terms of EBF, an association was observed only with education, which persisted until the sixth month. Other than social gradient, mode of delivery was the strongest determinant of BF initiation, exclusivity and continuation. Mothers who gave birth vaginally were three to four times more likely to initiate BF (OR=3·1; 95 % CI 1·7, 5·4) and EBF (OR=4·3; 95 % CI 2·7, 6·8). CONCLUSIONS: The low prevalence of BF and EBF in Cyprus, together with the fact that caesarean section rates are currently among the highest in Europe, suggest the need for further research to understand this multidimensional phenomenon and for interdisciplinary policy action to protect, promote and support BF.


Assuntos
Aleitamento Materno , Cuidado do Lactente , Mães , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Cesárea , Estudos Transversais , Chipre , Salas de Parto , Parto Obstétrico , Escolaridade , Feminino , Humanos , Renda , Lactente , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Estudos Longitudinais , Rememoração Mental , Gravidez , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
16.
Pulm Pharmacol Ther ; 48: 15-21, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29056509

RESUMO

OBJECTIVES: Few studies have examined the potentially therapeutic effect of increasing the production of endogenous nitric oxide (NO) in Primary Ciliary Dyskinesia (PCD) and other chronic respiratory conditions. Nasal NO is low in PCD and has been found to correlate with compromised Ciliary Beat Frequency (CBF). In this study we assessed the effect of increasing l-Arginine, as the substrate of NO synthases, on CBF in biopsies of human respiratory ciliated epithelium. METHODOLOGY: A total of 28 suspect cases with chronic respiratory manifestations referred for PCD diagnostic testing and 8 healthy controls underwent nasal brushing. Obtained epithelial cells were divided between three culture medium 199 solutions, containing different levels of l-Arginine (0.33 mM as baseline, 1 mM and 10 Mm as increased levels). CBF measurements were obtained at 37 °C and 25 °C at 1, 3 and 24 h after sample acquisition. RESULTS: Among a total of 36 recruited subjects, 8 had PCD confirmed (PCD n = 8), 20 had PCD excluded (non-PCD n = 20) and 8 were healthy controls (Healthy Controls = 8). Among PCD subjects, ciliary motility was characterized by rotational (n = 5) or dyskinetic (n = 3) beating. At 37 °C, compared to baseline, higher levels of l-Arginine resulted in up to 9% CBF increase at 1 h (p = 0.007), up to 9% CBF increase at 3 h (p < 0.001) and up to 12% CBF increase at 24 h (p = 0.002). Similar although smaller scale increases were recorded at 25 °C. The effect of l-Arginine was time dependent (interaction p = 0.002) and was similar in PCD patients, non-PCD chronic respiratory patients and healthy controls (interaction p = 0.800). CONCLUSIONS: l-Arginine increases CBF and merits to be evaluated as a potential stimulator of mucociliary clearance in chronic respiratory conditions and congenital ciliary disorders with residual motility. Larger human studies are needed to confirm these findings.


Assuntos
Arginina/farmacologia , Transtornos da Motilidade Ciliar/tratamento farmacológico , Depuração Mucociliar/efeitos dos fármacos , Óxido Nítrico/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Transtornos da Motilidade Ciliar/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nítrico Sintase/metabolismo , Mucosa Respiratória/efeitos dos fármacos , Mucosa Respiratória/metabolismo , Doenças Respiratórias/tratamento farmacológico , Doenças Respiratórias/fisiopatologia , Fatores de Tempo , Adulto Jovem
17.
Biomed Res Int ; 2017: 1908712, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29209622

RESUMO

Work-related moral distress (MD) and secondary traumatic stress syndrome (STSS) may be associated with compromised health status among health professionals, reduced productivity, and inadequate safety of care. We explored the association of MD with the severity of STSS symptoms, along with the mediating role of mental distress symptoms. Associations with emotional exhaustion and professional satisfaction were also assessed. This cross-sectional survey conducted in 206 mental health nurses (MHNs) was employed across public sector community and hospital settings in Cyprus. The analysis revealed that MD (measured by the modified Moral Distress Scale) was positively associated with both STSS (measured by the Secondary Traumatic Stress Scale) and mental distress symptoms (assessed by the General Health Questionnaire-28). The association of MD with STSS symptoms was partially mediated by mental distress symptoms. This association remained largely unchanged after adjusting for gender, age, education, rank, and intention to quit the job. Our findings provide preliminary evidence on the association between MD and STSS symptomatology in MHNs. Situations that may lead health professionals to be in moral distress seem to be mainly related to the work environment; thus interventions related to organizational empowerment of MHNs need to be developed.


Assuntos
Fadiga por Compaixão/psicologia , Serviços de Saúde Mental , Enfermeiras e Enfermeiros/psicologia , Estresse Ocupacional/psicologia , Adulto , Fadiga por Compaixão/epidemiologia , Chipre/epidemiologia , Ética em Enfermagem , Feminino , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/epidemiologia , Inquéritos e Questionários , Recursos Humanos
18.
JMIR Res Protoc ; 6(11): e221, 2017 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-29133284

RESUMO

BACKGROUND: In the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers' needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored. OBJECTIVE: The aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions. METHODS: A sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer's associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe (COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures. RESULTS: As a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal consistency of the scale as estimated using Cronbach alpha coefficient was .77, somewhat lower than other validation studies. Recruitment of pilot study participants started in May 2017. CONCLUSIONS: Carers' eHealth literacy is a new field. Whereas previous studies have focused on the role and impact of low eHealth literacy and health literacy among older adults, the eHealth literacy of carers, and in fact carers of people with dementia, has not been explored. We hypothesize an association between eHealth literacy and health literacy level with carers' perceptions about caregiving role, self-efficacy, and coping strategies. A possible moderator in these associations is the secondary carers' eHealth and health literacy level, which will also be explored. By confirming the above hypotheses, tailored eHealth literacy interventions for carers of people with dementia and their families will be developed as a direct outcome of this research.

19.
BMC Infect Dis ; 17(1): 607, 2017 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-28877671

RESUMO

BACKGROUND: Device-associated health care-associated infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit. The aim of this study was to assess the incidence of DA-HAIs, mortality and crude excess mortality at a General Hospital's Intensive Care Unit (ICU) in the Republic of Cyprus for 1 year period. METHODS: A prospective cohort, active DA-HAIs surveillance study with the use of Health Acquired Infections (HAIs) ICU Protocol (v1.01 standard edition) as provided by ECDC/NHSN for the active DA-HAIs surveillance study was conducted. The study sample included 198 ICU patients admitted during the research period and hospitalized for over 48 h. The Ventilator-Associated Pneumonia (VAP), Central Line-Associated Bloodstream Infection (CLABSI), and Catheter-Associated Urinary Tract Infection (CAUTI) rates, length of stay (LOS), mortality, and crude excess mortality were calculated. RESULTS: CLABSI was the most frequent DA-HAI with 15.9 incidence rate per 1000 Central Venus Catheter (CVC) days. The VAP rate, was 10.1 per 1000 ventilator days and the CAUTI rate was 2.7 per 1000 urinary catheter days. Device associated infections were found to be significantly associated with the length of ICU stay (p < 0.001), the CVC days (p < 0.001), ventilator days (p < 0.001), and urinary catheter days (p < 0.001). The excess mortality was 22.1% for those who acquired a DA-HAI (95% CI, 2-42.2%) compared to the patients who remained DA-HAI free. Mortality of patients with VAP infection was 2.3 times higher (RR = 2.33 95% CI, 1.07-5.05) than those patients admitted without a HAI and subsequently did not acquire a DA-HAI. The most frequently isolated pathogen was Staphylococcus epidermidis (13.9%) and Candida albicans (13.9%). CONCLUSIONS: Higher DA-HAIs rates and device utilization than the international benchmarks were found in this study, calling into question the safety of preventative practices employed in this unit.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Adulto , Idoso , Candida albicans/patogenicidade , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Chipre/epidemiologia , Feminino , Hospitais Gerais , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pneumonia Associada à Ventilação Mecânica/mortalidade , Estudos Prospectivos , Staphylococcus epidermidis/patogenicidade , Cateteres Urinários/efeitos adversos
20.
Nurs Crit Care ; 22(5): 284-292, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28295902

RESUMO

BACKGROUND: Men and women appear to exhibit different susceptibilities to sepsis and possibly divergent outcomes. However, the effect of sex and gender in critical illness outcomes is still controversial and the underlying mechanisms appear to be complex. OBJECTIVES: We aimed to systematically review and synthesize evidence on the influence of sex on outcomes in critically ill adult patients with sepsis, as reported in published studies specifically including investigation of the effect of sex among their aims. Primary outcome measures include in-hospital mortality, intensive care unit (ICU) mortality and length of stay (LOS) in the ICU. SEARCH STRATEGY: The review was based on focused literature searches (CINAHL, PUBMED, EMBASE and COCHRANE). Methodological quality was assessed through the STROBE checklist and the Cochrane Tool for Bias in Cohort Studies. Meta-analysis was performed using STATA. Published observational studies addressing outcomes of sepsis among their primary aims and having included gender comparisons among primary outcomes in critically ill adult patients were included. RESULTS: A total of eight eligible studies were included. With the exception of mortality, it was not possible to perform meta-analysis for other outcomes. Included studies reported data on 25,619 patients with sepsis (14 309 male/11 310 female). There is a paucity of well-designed studies addressing the effect of sex on mortality among patients with sepsis, and absence of studies addressing the effects of sex on multiple organ dysfunction of non-infectious origin. There was significant heterogeneity among study estimates (p = 0·001; I2 =78·1%). CONCLUSIONS: Although results of data syntheses appear to point towards a small disadvantage for survival among women, our results suggest that data on the impact of sex on sepsis outcomes remain equivocal. Implications for future research include approaches to adjustment for confounders and prospective designs. RELEVANCE TO CLINICAL PRACTICE: Clarifying sex-related differences in sepsis, if any, is crucial for informing evidence-based care.


Assuntos
Causas de Morte , Estado Terminal/terapia , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Sepse/mortalidade , Fatores Etários , Estado Terminal/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Prognóstico , Medição de Risco , Sepse/diagnóstico , Sepse/terapia , Fatores Sexuais , Resultado do Tratamento
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