Comparative analysis of sexual harassment between male and female nurses: A cross-sectional study in Greece.

AIMS: The aims of this work are to compare the frequency of sexual harassment among male and female nurses in Greece and capture the reasons for not reporting sexual harassment. BACKGROUND: The #MeToo and #TimesUp movements have emphasized the ubiquity of sexual harassment in health care. Yet, limited studies have explored sexual harassment among male and female nurses and the reasons for not reporting it. METHODS: An online cross-sectional survey was conducted using the Sexual Experiences Questionnaire (SEQ) to collect data from 1.264 female nurses and 507 male nurses. RESULTS: Sixty-seven per cent of female nurses have experienced sexual harassment at least once in their working lives, whereas male nurses' exact figure was 41%. The most common type of sexual harassment for both groups was gender harassment, followed by unwanted sexual attention and sexual coercion. Female nurses experienced more severe adverse consequences, whereas male nurses experienced moderate negative consequences. CONCLUSIONS: Policymakers and hospital managers should create mechanisms to allow victims to report their experiences and establish an independent committee to assess victims' complaints. IMPLICATIONS FOR NURSING MANAGEMENT: Managers are called to change how hospitals deal with sexual harassment cases, modernize their management style, and support sexual harassment victims to break their silence without fear of negative consequences.

Economic evaluation in psychiatric pharmacogenomics: a systematic review.

Nowadays, many relevant drug-gene associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health care. To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of PGx testing for the prescription of antidepressants and antipsychotics. From a total of 1159 studies initially identified by literature database querying, and after manual assessment and curation of all of them, a mere 18 studies met our inclusion criteria. Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) genome-guided interventions were cost-effective and 7 (38.9%) were less costly compared to standard treatment based on cost analysis. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 drug-gene associations and for combinatorial PGx panels, but evidence is limited for many other drug-gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs, as well as the underreporting of study design elements, which can influence though the economic evaluation. Overall, the findings of this article demonstrate that although there is growing evidence on the cost-effectiveness of genome-guided interventions in psychiatric diseases, there is still a need for performing additional research on economic evaluations of PGx implementation with an emphasis on psychiatric disorders.

Are male nurses sexually harassed? A cross-sectional study in the Greek Health System.

BACKGROUND: The #MeToo and #Times Up movements have put a global spotlight on the phenomenon of sexual harassment in healthcare. Yet, most studies have explored sexual harassment among female professionals. This study departs from current research practices and investigates the frequency of sexual harassment in male nurses working in the Greek NHS and the reasons for not reporting their experiences. METHODS: A cross-sectional study was conducted using the Sexual Experiences Questionnaire (SEQ) to collect data from 507 male nurses working in Greece's various settings during October and February 2021. The electronic survey was sent to male nurses (n=3,091 registered with the Hellenic Association of Nurses. Survey items were consent form, demographics, three-dimensions of sexual harassment, silencing and negative consequences. Questions were measured using five-point Likert scales, binary scale and multiple-choice questions. ANOVA and T-tests were used to investigate whether specific groups more frequently dealt with sexual harassment. Multiple regression analyses were conducted to investigate the association between independent variables (sexually harassing behaviours) and the dependent variable (participants' negative physical, mental, and job-related outcomes). RESULTS: 40% of male nurses have experienced sexual harassment at least once in their working lives, and the most common form of sexual harassment faced was gender harassment, followed by unwanted sexual attention. Male doctors and male nurses were the most common perpetrators. Private and younger male nurses with up to 5 years of experience experienced more frequent sexual harassment. 30% did not report sexual harassment due to the fear that no one would believe them, and because of beliefs, no action would be taken against the wrongdoer. Multiple regression analyses showed that unwanted sexual attention and sexual coercion were associated with physical and job-related outcomes. Cronbach Alpha was 0.91. CONCLUSION: A high proportion of male nurses have experienced sexual harassment during their careers. Being younger with limited working experience and working in the private sector were positively associated with sexual harassment. Policymakers and health managers should focus on sexual harassment prevention strategies and report-enabling policies.

Gastrointestinal bleeding in athletes.

Gastrointestinal (GI) bleeding (GIB) in athletes has previously been reported in several studies, as an important factor of underperformance in competitive sports events. Yet it is still underreported, partly because it is usually occult and self-limited soon after the effort. It can originate in either the upper or the lower GI tract and can be proportionally related to the amount and duration of effort. Key pathophysiological factors seem to include splanchnic hypoperfusion, mechanical trauma of the GI wall, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Appropriate nutrition, hydration and regulation of exercise, along with substances such as arginine and citrulline can relieve upper and lower GI symptoms, including nausea, vomiting, cramping, diarrhea, and possibly hemorrhage. Cessation of NSAIDs, use of proton pump inhibitors and H2-receptor-antagonists, as well as "training" the gut, also seem to be effective in reducing the incidence of GIB in athletes. Maintenance of hemodynamic stability and identification of the source of bleeding are key elements in the management of this condition. Endoscopy might be necessary for both. GIB should not be immediately attributed to endurance exercise, and endoscopy should always be performed to rule out other existing pathology.

Real-world Data and Economic Evaluation of Nivolumab in Previously Treated Non-small Cell Lung Cancer Greek Patients.

BACKGROUND/AIM: Nivolumab is an FDA-approved immune checkpoint inhibitor (ICI) for patients with advanced, pre-treated non-small cell lung cancer (NSCLC). However, treatment profiles and patient outcomes often differ in routine clinical practice while the financial impact of approved therapies is largely unknown. In this study, we investigated the efficacy, tolerability, and economic impact of nivolumab in real-world settings (RWS) in Greece. PATIENTS AND METHODS: Patients diagnosed with advanced pre-treated NSCLC, receiving nivolumab were recruited from October 2015 until November 2019 across 18 different clinical centers in Greece. Endpoints included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and safety. Cost analysis was conducted using a third-party public-payer perspective (National Organization for Healthcare Services Provision; EOPYY). RESULTS: A total of 346 patients, median age 66.5 years, were included. With 43.4 months median follow-up, median PFS was 7.8 months and median OS 15.8 months. The 1-year OS rate was 56.5%, 2-year OS 38.8%, and 3-year OS 27.3%. The ORR was 29.5% and DCR 58.7%, with a median response duration of 26.8 months. Patients with objective response were more likely to experience long-term survival (HR=0.14, p<0.001). Only 8.4% of patients experienced grade 3-4 adverse events. The presence of immune-related adverse events was associated with improved OS (HR=0.77, p=0.043). Nivolumab-associated economic burden accounted for €2,214.10 per cycle for each patient, mainly attributed to drug-acquisition costs. CONCLUSION: This is the first report of real-world efficacy, safety, and economic burden of nivolumab in pre-treated patients with NSCLC in Greece. Indirectly compared to clinical trials, nivolumab was associated with improved efficacy in RWS, further supporting its use in clinical practice and providing insights on clinical prognosticators. The main cost component affecting the nivolumab economic burden was drug-acquisition costs, while toxicity-associated cost was negligible.

Sexual harassment and organisational silencing in nursing: a cross-sectional study in Greece.

OBJECTIVE: This study investigates the frequency of sexual harassment among female nurses in the Greek health system and the nurses' reluctance to report their experiences. DESIGN: Cross-sectional study. SETTING: Greece. PARTICIPANTS: 1264 female nurses of working age across different settings responded to the Sexual Experiences Questionnaire (SEQ) web-based format between October 2020 and February 2021. The period investigated by the SEQ was the participant's entire professional life. The final sample consisted of 1217 nurses with valid data on the frequency of sexually harassing behaviours (gender harassment, unwanted sexual attention, sexual coercion) and the reasons for not reporting sexual harassment. MAIN OUTCOME MEASURES: The frequency of sexual harassment was measured in a 5-point Likert Scale (1: very often, 2: often, 3: occasionally, 4: rarely, 5: never), the decision to report/not report sexual harassment was measured in a yes/no format and the impact of sexual harassment on the physical, mental and job-related performance was measured in a 5-point Likert Scale (1: very positively, 2: positively, 3: moderately, 4: negatively, 5: very negatively). RESULTS: 70% of the nurses have experienced sexual harassment at least once in their working lives, while the most frequent type is gender harassment. Male doctors are the most common perpetrators. T-tests and analysis of variance showed that private and younger nurses were more likely to experience sexual harassment while divorced nurses with 1-5 years of experience dealt with sexually coercive behaviours more frequently. 30% did not report sexual harassment because of the fear of negative consequences and beliefs that no action will be taken against the perpetrator. Multiple regression analyses showed that unwanted sexual attention and sexual coercion explain the victim's physical and job-related adverse outcomes. Cronbach's α was 0.939. CONCLUSIONS: The results show that sexual harassment rates are high in the Greek health system, while many victims do not report their experiences to the authorities. This emphasises the need to implement drastic measures on behalf of the National Health Service (NHS) policy makers towards helping victims speak up without the fear of negative consequences. Nurse managers are called to implement effective policies against sexual harassment.

Effect of Apolipoprotein E4 on the Driving Behavior of Patients with Amnestic Mild Cognitive Impairment or Mild Alzheimer's Disease Dementia.

BACKGROUND: The driving behavior of patients with mild Alzheimer's disease dementia (ADD) and patients with mild cognitive impairment (MCI) is frequently characterized by errors. A genetic factor affecting cognition is apolipoprotein E4 (APOE4), with carriers of APOE4 showing greater episodic memory impairment than non-carriers. However, differences in the driving performance of the two groups have not been investigated. OBJECTIVE: To compare driving performance in APOE4 carriers and matched non-carriers. METHODS: Fourteen APOE4 carriers and 14 non-carriers with amnestic MCI or mild ADD underwent detailed medical and neuropsychological assessment and participated in a driving simulation experiment, involving driving in moderate and high traffic volume in a rural environment. Driving measures were speed, lateral position, headway distance and their SDs, and reaction time. APOE was genotyped through plasma samples. RESULTS: Mixed two-way ANOVAs examining traffic volume and APOE4 status showed a significant effect of traffic volume on all driving variables, but a significant effect of APOE4 on speed variability only. APOE4 carriers were less variable in their speed than non-carriers; this remained significant after a Bonferroni correction. To further examine variability in the driving performance, coefficients of variation (COV) were computed. Larger headway distance COV and smaller lateral position COV were observed in high compared to moderate traffic. APOE4 carriers had smaller speed COV compared to non-carriers. CONCLUSION: The lower speed variability of APOE4 carriers in the absence of neuropsychological test differences indicates reduced speed adaptations, possibly as a compensatory strategy. Simulated driving may be a sensitive method for detecting performance differences in the absence of cognitive differences.

An Observational Study to Assess the Molecular Epidemiology and Direct Medical Costs of Epidermal Growth Factor Receptor (EGFR) Mutations in Patients with Advanced EGFR Mutation-Positive Non-Small Cell Lung Cancer Treated with Afatinib in Real-World Clinical Settings in Greece.

PURPOSE: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the preferred first-line option for patients with advanced, EGFR-mutant non-small cell lung cancer (NSCLC). Afatinib, a second-generation irreversible EGFR-TKI, has been extensively used in Greece in this setting; however, real-world data regarding molecular epidemiology and financial implications of afatinib use are lacking. MATERIALS AND METHODS: This was an observational, non-interventional, multicenter, retrospective cohort study, based on real-world data collected from the medical charts/records of patients treated with afatinib between 15/03/2015 and 25/06/2020 and were recorded on a web-based data capture system. Cox models were used to assess the prognostic significance of clinicopathological parameters with respect to clinical outcomes of interest. Cost analysis was conducted from a public third-payer perspective, and only direct medical costs reimbursed by the payer were considered. RESULTS: A total of 59 patients were treated with afatinib for their EGFR mutation-positive advanced NSCLC; the median age was 61 years (range: 37-91). Performance status was zero in 61%, and brain metastases were present in 13.6%. Forty-four patients (74.6%) had a deletion in exon 19 only, while nine (15.3%) had a mutation in exon 21, 8 of them in L858R and one in L861Q. At a median follow-up of 41.8 months (95% CI 35.9-51.4), the median PFS was 14.3 months (95% CI 12.2-16.4), and the median OS was 29 months (95% CI 25.6-33.4). Corresponding values for patients with deletion 19 only were 14.3 months (95% CI 11.5-18.5) and 28.1 months (95% CI 21.1-32.6), respectively. The mean expenditure for the treatment of each patient equals €25,333.68; with €21,865.06 being attributed to drug acquisition costs, €3325.35 to monitoring costs and €143.27 to adverse event treatment-related costs. CONCLUSION: Long-term data in the real-world setting in Greece confirm activity, tolerability and cost-effectiveness of afatinib as first-line treatment of patients with advanced EGFR-mutant NSCLC. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT04640870.

Structural equation model analysis for the evaluation of overall driving performance: A driving simulator study focusing on driver distraction.

OBJECTIVE: The present research relies on 2 main objectives. The first is to investigate whether latent model analysis through a structural equation model can be implemented on driving simulator data in order to define an unobserved driving performance variable. Subsequently, the second objective is to investigate and quantify the effect of several risk factors including distraction sources, driver characteristics, and road and traffic environment on the overall driving performance and not in independent driving performance measures. METHODS: For the scope of the present research, 95 participants from all age groups were asked to drive under different types of distraction (conversation with passenger, cell phone use) in urban and rural road environments with low and high traffic volume in a driving simulator experiment. Then, in the framework of the statistical analysis, a correlation table is presented investigating any of a broad class of statistical relationships between driving simulator measures and a structural equation model is developed in which overall driving performance is estimated as a latent variable based on several individual driving simulator measures. RESULTS: Results confirm the suitability of the structural equation model and indicate that the selection of the specific performance measures that define overall performance should be guided by a rule of representativeness between the selected variables. Moreover, results indicate that conversation with the passenger was not found to have a statistically significant effect, indicating that drivers do not change their performance while conversing with a passenger compared to undistracted driving. On the other hand, results support the hypothesis that cell phone use has a negative effect on driving performance. Furthermore, regarding driver characteristics, age, gender, and experience all have a significant effect on driving performance, indicating that driver-related characteristics play the most crucial role in overall driving performance. CONCLUSIONS: The findings of this study allow a new approach to the investigation of driving behavior in driving simulator experiments and in general. By the successful implementation of the structural equation model, driving behavior can be assessed in terms of overall performance and not through individual performance measures, which allows an important scientific step forward from piecemeal analyses to a sound combined analysis of the interrelationship between several risk factors and overall driving performance.

Impact of texting on young drivers' behavior and safety on urban and rural roads through a simulation experiment.

PROBLEM: This research aims to investigate the impact of texting on the behavior and safety of young drivers on urban and rural roads. METHOD: A driving simulator experiment was carried out in which 34 young participants drove in different driving scenarios; specifically, driving in good weather, in raining conditions, in daylight and in night were examined. Lognormal regression methods were used to investigate the influence of texting as well as various other parameters on the mean speed and mean reaction time. Binary logistic methods were used to investigate the influence of texting use as well as various other parameters in the probability of an accident. RESULTS: It appears that texting leads to statistically significant decrease of the mean speed and increase of the mean reaction time in urban and rural road environment. Simultaneously, it leads to an increased accident probability due to driver distraction and delayed reaction at the moment of the incident. It appeared that drivers using mobile phones with a touch screen present different driving behavior with respect to their speed, however, they had an even higher probability of being involved in an accident. DISCUSSION: The analysis of the distracted driving performance of drivers who are texting while driving may allow for the identification of measures for the improvement of driving performance (e.g., restrictive measures, training and licensing, information campaigns). PRACTICAL APPLICATIONS: The identification of some of the parameters that have an impact on the behavior and safety of young drivers concerning texting and the consequent results can be exploited by policy decision makers in future efforts for the improvement of road safety.

A statistical analysis of the impact of advertising signs on road safety.

This research aims to investigate the impact of advertising signs on road safety. An exhaustive review of international literature was carried out on the effect of advertising signs on driver behaviour and safety. Moreover, a before-and-after statistical analysis with control groups was applied on several road sites with different characteristics in the Athens metropolitan area, in Greece, in order to investigate the correlation between the placement or removal of advertising signs and the related occurrence of road accidents. Road accident data for the 'before' and 'after' periods on the test sites and the control sites were extracted from the database of the Hellenic Statistical Authority, and the selected 'before' and 'after' periods vary from 2.5 to 6 years. The statistical analysis shows no statistical correlation between road accidents and advertising signs in none of the nine sites examined, as the confidence intervals of the estimated safety effects are non-significant at 95% confidence level. This can be explained by the fact that, in the examined road sites, drivers are overloaded with information (traffic signs, directions signs, labels of shops, pedestrians and other vehicles, etc.) so that the additional information load from advertising signs may not further distract them.