Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital.

Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020-February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki "AHEPA" in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019-February 2020 and during the first year of the pandemic (n = 223), March 2020-February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient's outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.

Comparison of the Sensor-Augmented Pump System with the Advanced Hybrid Closed-Loop Delivery System: Quality of Life, Diabetes Distress, and Glycaemic Outcomes in a Real-Life Context.

BACKGROUND: Type 1 diabetes mellitus (T1D) is a chronic disease that requires exogenous insulin administration and intensive management to prevent any complications. Recent innovations in T1D management technologies include the Advanced Hybrid Closed-Loop delivery system (AHCL). The pioneer AHCL system provides automated basal and automated bolus corrections when needed. OBJECTIVE: This study aimed to compare the Advanced Hybrid Closed-Loop (AHCL) system and the Sensor-Augmented Pump (SAP) with Predictive Low Glucose Management (PLGM) system, in relation to glycaemic outcomes, general and diabetes-related Quality of Life (QoL), and diabetes distress. METHODS: General and diabetes-related QoL were assessed with the Diabetes Quality of Life Brief Clinical Inventory (DQOL-BCI) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF), respectively. Diabetes distress was assessed with the Diabetes Distress Scale for Type 1 diabetes (T1-DDS). RESULTS: Eighty-nine T1D adults participated in the study, mostly females (65.2%), with a mean age of 39.8 (± 11.5 years). They had on average 23 years of diabetes (± 10.7) and they were on continuous subcutaneous insulin infusion therapy. Significant differences favoring the AHCL over the SAP + PLGM system were demonstrated by lower mean glucose levels, less time above range, lower scores on DQOL-BCI, T1-DDS, and higher scores on WHOQOL-BREF. Finally, the linear regression models revealed the association of time in range in most of the above aspects. CONCLUSION: This study highlighted the advantages of the AHCL system over the SAP + PLGM system in the real-world setting in relation to general and diabetes-related QoL, diabetes distress, and glycaemic outcomes.

Dimensionality and psychometric properties of the Greek version of the Diabetes Impact and Device Satisfaction (DIDS) scale.

Type 1 diabetes mellitus (T1D) is a chronic condition with rising prevalence. The only treatment for individuals with T1D to prevent diabetes-related complications is exogenous insulin administration. Diabetes-related technology has significantly contributed to the management of T1D by reducing the burden of living with diabetes and providing greater flexibility in insulin management during daily activities. This study presents the psychometric properties of the Greek translation of the Diabetes Impact and Device Satisfaction (DIDS) Scale, which assesses satisfaction with the use of an insulin delivery device and the impact of diabetes management on individuals with T1D. A sample of 101 adults with T1D, mostly females (71.3%), with a mean age of 38.4 years (± 11.7), completed the translated Greek version of DIDS (DIDS-Gr). Exploratory factor analysis revealed three factors: 'Device Satisfaction', 'Diabetes Management Impact', and (new factor) 'Device Usability'. The internal consistency indices (Cronbach's alpha) for the subscales were 0.86, 0.71, and 0.60, respectively. Furthermore, convergent validity was demonstrated with moderate to high positive correlations between the DIDS-Grand the Diabetes Quality of Life Brief Clinical Inventory (DQoL-BCI) and its subscales, while divergent validity was also confirmed with weaker correlations with the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Additionally, test-retest reliability and differential validity were present in our study. Therefore, DIDS-Gr is a valid and reliable measure for assessing the impact of diabetes on individuals with T1D and the satisfaction with the use of an insulin delivery device in Greece.

[Depressive symptoms and insulin pump therapy in people with type 1 diabetes mellitus: A systematic review].

Type 1 Diabetes mellitus (T1DM) is a chronic, multifactorial metabolic disease that requires constant medical care. T1DM is the result of an irreversible destruction of pancreatic ß-cells, inevitably leading individuals to chronic exogenous insulin dependence. The prevalence of depression among T1DM is common and affects both the progression and management of the disease. The aim of this study is to present the depressive symptoms in people with T1DM who apply and those who do not apply the insulin pump therapy method and to highlight differences in terms of gender and age. The literature review was conducted using the databases PubMed, Science-Direct and Scopus. The inclusion criteria were the following: the studies had to be conducted in T1DM patients, study depressive symptomatology, the number of participants in the studies to be more than 70 people and to be in English. Initially, 464 articles were retrieved and 11 articles met the requirements for inclusion in the systematic review. The results of the systematic review, excluding paediatric patients with T1DM, showed that patients who apply the insulin pump therapy method were more likely to have higher prevalence and intensity of depressive symptoms, compared to users of multiple daily injections. Respectively, increased depressive symptoms in women with T1DM were presented, regardless of the method of treatment. Factors that mediate this difference in depressive symptoms are the sense of freedom and flexibility in lifestyle, fewer dietary restrictions, the sense of constant "bonding" and social stigma. Finally, mental health professionals should frequently evaluate the depressive symptoms of the T1DM patients, as it has a direct impact on the development and management of the disease.

Diabetes Mellitus Type 1 During COVID-19: Psychological Symptoms and Eating Attitudes.

BACKGROUND: Diabetes Mellitus Type 1 is a chronic metabolic disorder, the treatment of which extremely burdens the patient. The lockdown, as a measure to prevent the spreading of the 2019 coronavirus disease, was a major challenge for the general public. People with chronic diseases, such as T1D patients, have complex emotional and psychological needs and are at increased risk for both depressive symptoms and anxiety. OBJECTIVE: The aim of this study was to evaluate the impact of body mass index of T1D patients on the psychological symptoms and eating habits, as well as the prognostic factors of the psychological symptoms during the lockdown period. METHODS: Diabetes mellitus patients were invited to complete this survey from the outpatient Diabetes clinic of the General Hospital of Chania and the "AHEPA" General University Hospital of Thessaloniki in Greece. Psychological symptoms were assessed using the DASS-42 questionnaire, and eating habits were assessed using the EAT-26 questionnaire. RESULTS: Overall, 112 T1D patients were analyzed (response rate: 28.8%). Obese T1D patients appear to be at greater risk of developing psychological symptoms, such as depression, anxiety, and stress. Furthermore, disordered eating behaviors and bulimia and food preoccupation subscale are associated with psychological symptoms. CONCLUSION: The findings suggest that obese T1D patients are at greater risk of developing psychological symptoms. Moreover, when an eating disorder is triggered, negative psychological symptoms such as depression and anxiety are reduced. The results of this study may guide targeted interventions among T1D patients.

Dimensionality and psychometric properties of the Parent Diabetes Distress Scale -Greek (PDDS-Gr).

Type 1 diabetes (T1D) is a chronic disease characterised by insulin deficiency due to autoimmune destruction of beta-pancreatic cells. T1D, formerly known as juvenile diabetes, is the most common form of diabetes in children and adolescents. On diagnosis, parents of children with TID experience considerable stress, because they need to care for a child in a challenging and life-threatening situation that requires adherence to an intensive medical regimen, constant monitoring of, and coping with their child's condition. T1D is a complex condition that affects both children and their parents in many aspects of their daily lives. This study presents the psychometric properties of the Greek translation of the Parent Diabetes Distress Scale (PDDS), which assesses diabetes distress in parents of children with T1D. A sample of 95 parents, mainly mothers (88.4%), with a mean age of their children 12.2 years (± 3.6) and a diabetes duration of 4.7 years (± 3.4), completed the Greek translation of the PDDS. Exploratory factor analysis (EFA) revealed a five-factor model: 'Parent/child relationship distress', 'Personal distress', 'Child diabetes management distress', 'Future distress', and 'Healthcare team distress'. Confirmation Factor Analysis (CFA) confirmed the construct validity of the scale. The internal consistency indices (Cronbach alpha) for the subscales ranged from 0.69 to 0.89, while the unidimensional structure had an alpha of 0.90. Furthermore, convergent validity was shown with moderate positive correlations between the PDDS-Gr and the subscales of the DASS-21 (depression, anxiety, and stress), the child's age (in years), and the HbA1c value. Finally, parents of children with inadequate glycemic control (HbA1c ≥ 7%) presented higher scores on both the unidimensional structure and the subscales 'Parent/child relationship distress' and 'Healthcare team distress' of the PDDS-Gr. The PDDS-Gr is a valid and reliable tool for assessing diabetes distress in parents of children with T1D and can be used in both clinical and research settings.

Dimensionality and psychometric properties of the Greek version of the Τype 1 Diabetes Stigma Assessment Scale (DSAS-1-Gr).

Type 1 Diabetes Mellitus (T1D) is one of the most common chronic diseases affecting children and adolescents. The daily management of T1D requires continuous insulin therapy, as well as the inevitable adjustment of daily activities according to glycaemic control, both of which may result in experiencing T1D related stigma. A significant proportion of people with T1D have been shown to experience social discrimination and stigma, which can lead to emotional distress and act as a barrier to help-seeking behavior. This study presents the psychometric properties of the Greek translation of the Diabetes Stigma Assessment Scale-1 (DSAS-1), which assesses self-perceived stigma in people with T1D. A sample of 105 adults with T1D, mostly females (70.5%), with a mean age of 34.3 years (±11.1), and mean disease duration of 19.4 years (±10.5), completed the translated in Greek DSAS-1 (DSAS-1-Gr). Exploratory and confirmatory factor analyses were used to investigate the construct validity of the scale. In line with the original version, the results of the present study supported the three-factor model of the scale 'identity concerns', 'different treatment', 'blame and judgment'. The internal consistency indices (Cronbach alpha) of the three subscales were above α=.80 and .88 for the whole scale. Moderate correlations were found between the DSAS-1-Gr and the Diabetes Distress scale for type 1 Diabetes (T1-DDS), the Rosenberg self-esteem scale, and the DASS-21 subscales (depression, anxiety, and stress), which is indicative of convergent validity. DSAS-1-Gr correlated negatively with the diabetes duration (in years), which was indicative of discriminant validity. Finally, females presented higher total DSAS-1-Gr score than males. DSAS-1-Gr is a valid and reliable tool to be used in clinical practice to assess stigma in Greek people with T1D.

Exhaustion and burnout in the healthcare system in Greece: A cross-sectional study among internists during the COVID-19 lockdown.

The COVID-19 pandemic has rapidly changed everyday life around the world. The situation created by the COVID-19 pandemic has been shown to be associated with severe mental health problems in frontline medical and nursing staff. The aim of this study was to investigate exhaustion, disengagement, secondary traumatic stress, compassion satisfaction, burnout, as well as depression, anxiety and stress among internists in Greece, during the second lockdown period. Internists were approached through the Internal Medicine Society of Greece and a total of 117 participated in the study (response rate: 15.3%). The participants responded through a Google form on the Depression, Anxiety and Stress Scale - 21, the Oldenburg Burnout Inventory (OLBI) and the Professional Quality of Life Scale version 5 (ProQOL-5). Exhaustion was found in the majority of the participants (88%), 65.8% met the criteria for at least moderate levels of compassion satisfaction and 71.8% presented moderate levels of burnout. Furthermore, about half of the participants met the criteria for moderate to extremely severe levels of depression, anxiety and stress. Finally, regression analyses showed that depression was associated with both the OLBI and ProQOL-5 scales. The majority of the internists, during the lockdown period in Greece, were evaluated as "exhausted", with high rates of negative psychological symptoms. The present study, despite the limitations, highlights the impact of the COVID-19 pandemic on internists, which triggered a shift in attention onto the treatment, and especially the prevention, of stressful situations for health professionals.

The diabetes quality of life brief clinical inventory in combination with the management strategies in type 1 diabetes mellitus with or without the use of insulin pump.

AIMS: The aims of this study are to evaluate any differences in the Quality of life among Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Dose Injection (MDI) insulin delivery, applying the Diabetes Quality of life Brief Clinical Inventory (DQoL-BCI) questionnaire, and assess the diabetes management strategies between the two groups. METHODS: One hundred and ten adult participants (male/female ratio 1:2.7) with type 1 diabetes were recruited in this online survey. Forty-eight of them were using CSII and the rest 62 (were using) MDI insulin delivery. A 23-item socio-demographic/diabetes management strategies questionnaire and the 15-item DQoL-BCI were administered. RESULTS: CSII users scored statistically, significantly better at the satisfaction treatment subscale (p = 0.032) of the DQoL-BCI and emerged that they were implemented more management strategies such as dietician guidance services (p = 0.002), carbohydrate education seminars (p = 0.03). Predictive factors were also detected regarding the HbA1c < 7% (53 mmol/mol) and ß-coefficients in relation to DQoL-BCI questionnaire with the subscales of a negative impact and satisfaction treatment. CONCLUSION: Diabetes self-management education plays a key role to a better compliance with the treatment. Client-centered multidisciplinary centers in T1DM education are essential so that they be applicable for all T1DM patients irrespective of the type of insulin delivery they used.

Perceptions in Type 1 Diabetes Mellitus with or Without the Use of Insulin Pump: An Online Study.

BACKGROUND: Technological developments concerning the treatment of Type 1 Diabetes Mellitus have been rapid in the latest years. Insulin infusion systems along with continuous glucose monitoring, as well as long-acting insulin analogues, are part of this progress. OBJECTIVE: The aim of this study is to present the illness perceptions in type 1 diabetes mellitus, with or without the use of an insulin pump. Sexual life and body image among therapy groups subjected to subcutaneous insulin infusion (CSII) therapy and multiple daily injections (MDI) therapy were also examined. METHODS: A modified version of the Brief Illness Perception Questionnaire was used. One hundred and nine adults with type 1 diabetes mellitus, (males / females ratio 1:2.3) completed the online survey. Thirty six of them (33%) used CSII therapy and 73 of them (67%) used MDI therapy. RESULTS: Statistically important differences among the CSII and MDI therapy groups were found in treatment control, illness comprehensibility, representations of control, representation of body image and in the perception of sex life. There was no statistically significant difference among the different types of therapy for participants' negative perception of diabetes. DISCUSSION AND CONCLUSION: Negative perceptions of MDI users in treatment control, illness comprehensibility, representations of control, body image and sex life with the insulin pump, differentiate CSII and MDI therapy groups to a significant degree. According to the research, these parameters seem to interfere with accepting CSII therapy for MDI users and discourage them.

Suicide Attempts and Their Interrelation With the Economic Crisis in Chania, Greece: A Time-Series Analysis of the Period 2008-2015.

BACKGROUND: Greece has been in the grip of a severe economic crisis since 2008. It is well known that suicide attempts and actual suicides increase during periods of recession and austerity. The main aim of this study was to examine the economic crisis in relation to recorded suicide attempts in Chania, Greece, from 2008 to 2015, also taking unemployment rates into consideration. METHODS: During the research period from January 1, 2008, to December 31, 2015, 436 suicide attempts (females: n = 305 and males: n = 131) were recorded in the archives of the General Hospital of Chania. The data collected, analyzed, and used in the present study were from the archives of the emergency outpatient unit of the hospital. The unemployment data are from the Hellenic Statistical Authority. RESULTS: The rate of suicide attempts peaked in 2012 and remained relatively high until 2015. The most common suicide attempt method was poisoning by medication, with a percentage of 74.4%. In addition, the most prominent stressors related to the suicide attempts were family problems and relationship problems between couples: 40.2%. There was a statistically significant relationship between suicide attempts and unemployment rates (adjusted RR: 1.08; 95% CI, 1.07-1.09). CONCLUSIONS: Severe economic crisis seems to increase the rates of suicide attempts. The need for more detailed investigation is essential to provide insight into this global problem.