Community-Based Virtual Reality Interventions in Older Adults with Dementia and/or Cognitive Impairment: A Systematic Review.

INTRODUCTION: Virtual reality devices have been widely used for the rehabilitation among older people with cognitive impairments. They enable the user to navigate in three-dimensional environments, which are constructed by a computer. Recent studies have been focused on the cognitive benefits of virtual reality for people with cognitive deficits. The current study aimed to investigate the overall impact of community-based virtual reality interventions in older adults with dementia and/or cognitive impairment. METHODS: A systematic review of the literature was conducted according to the PRISMA guidelines. Google Scholar, PubMed, Science Direct and Scopus databases were searched for the years 2010-2022. RESULTS: Of the 245 articles 20 met the inclusion criteria. The results of the current systematic review indicated that virtual reality improved older adults' cognitive and motor skills and increased their positive emotions while minimizing less positive ones. However, there is insufficient data of its impact on their overall quality of life. CONCLUSION: There is a need to implement and evaluate interventions that examine its impact not only on cognitive functioning, but also on other aspects of older people with cognitive deficits.

Patterns of flavored e-cigarette use among adult vapers in the USA: an online cross-sectional survey of 69,233 participants.

BACKGROUND: Flavored e-cigarettes remain a controversial topic with regulators planning or already implementing restrictions worldwide. In this study, we examined patterns of flavor use in e-cigarettes among a convenience sample of US adult vapers. METHODS: Participants aged ≥ 18 years who reported ever using an e-cigarette were included in the study (N = 69,233) and responded to an online questionnaire. Their smoking status was recorded as well as patterns of flavor use at e-cigarette use initiation, at the time of the survey and at the time of smoking cessation (for participants who used to smoke and were using e-cigarettes at the time of quitting). RESULTS: The most popular flavors at e-cigarette use initiation were fruit (82.8%), followed by dessert/pastry/bakery (68.6%) and candy/chocolate/sweet (52.2%). Slightly higher prevalence of using fruit and dessert/pastry/bakery flavors was observed in those who never smoked compared to those who were currently and formerly smoking. Tobacco flavors were used by 20.8% of the participants and was by far the least prevalent among participants who never smoked. Similar patterns were observed with participants' choices at the time of the survey, but tobacco flavor use was substantially reduced (7.7%). Only 2.1% reported tobacco as the single most often used flavor. The most prevalent flavor at the time of quitting smoking was again fruit (83.3%), followed by dessert/pastry/bakery (68.0%) and candy/chocolate/sweet (44.5%). These flavors were considered the most helpful for quitting smoking. Tobacco flavor use at the time of smoking cessation was reported by 15.0%, while 9.3% considered it helpful for quitting smoking. CONCLUSION: Non-tobacco flavors were popular among the US adult vapers who participated in the study, and were popular choices at the time of quitting smoking for those who formerly smoked. Tobacco flavor use prevalence was low and was further reduced over time. Regulators should consider the flavor choice of adult consumers, especially those who quit smoking, when preparing legislation on flavored e-cigarettes.

Association between electronic cigarette use and smoking cessation in the European Union in 2017: analysis of a representative sample of 13 057 Europeans from 28 countries.

OBJECTIVES: To examine the association between electronic cigarette (e-cigarette) use and smoking cessation in the European Union (EU) in 2017 according to e-cigarette use frequency and smoking cessation duration. DESIGN: Cross-sectional survey of EU citizens, representative of the population (Special Eurobarometer 458). Weighted proportions (95% CI) and adjusted prevalence ratios (aPRs) were calculated. SETTING: EU. PARTICIPANTS: 13 057 EU citizens aged ≥15 years (6904 current and 6153 former smokers). RESULTS: Current daily e-cigarette use was reported by 2.4% (1.8%-3.1%) of current and 3.3% (2.5%-4.2%) of former smokers (p=0.002), while former daily use was reported by 5.6% (4.7%-6.8%) and 1.9% (1.3%-2.7%), respectively (p<0.001). More than half of all former smokers had quit for >10 years. Current daily e-cigarette use was rare among former smokers of >10 years (0.2%, 0.1%-0.6%) and was more prevalent in former smokers of ≤2 and 3-5 years (12.9%, 9.1%-17.9% and 9.0%, 5.8%-13.7%, respectively). Compared with never use, current daily e-cigarette use was associated with being a former smoker of ≤2 (aPR 4.96, 95% CI 3.57 to 6.90) and 3-5 years (aPR 3.20, 95% CI 2.10 to 4.87). Former daily e-cigarette use was associated with being a former smoker of ≤2 years (aPR 1.96, 95% CI 1.21 to 3.12). Current daily e-cigarette use was negatively associated with being a former smoker of 5-10 and >10 years. CONCLUSIONS: Current daily e-cigarette use in the EU in 2017 was rare among former smokers of >10 years and was positively associated with recent (≤5 years) smoking cessation. Former daily e-cigarette use was also positively associated with recent (≤2 years) smoking cessation.

Smoking prevalence among hospitalized COVID-19 patients and its association with disease severity and mortality: an expanded re-analysis of a recent publication.

BACKGROUND: There is a lot of debate about the effects of smoking on COVID-19. A recent fixed-effects meta-analysis found smoking to be associated with disease severity among hospitalized patients, but other studies report an unusually low prevalence of smoking among hospitalized patients. The purpose of this study was to expand the analysis by calculating the prevalence odds ratio (POR) of smoking among hospitalized COVID-19 patients, while the association between smoking and disease severity and mortality was examined by random-effects meta-analyses considering the highly heterogeneous study populations. METHODS: The same studies as examined in the previous meta-analysis were analyzed (N = 22, 20 studies from China and 2 from USA). The POR relative to the expected smoking prevalence was calculated using gender and age-adjusted population smoking rates. Random-effects meta-analyses were used for all other associations. RESULTS: A total of 7162 patients were included, with 482 being smokers. The POR was 0.24 (95%CI 0.19-0.30). Unlike the original study, the association between smoking and disease severity was not statistically significant using random-effects meta-analysis (OR 1.40, 95%CI 0.98-1.98). In agreement with the original study, no statistically significant association was found between smoking and mortality (OR 1.86, 95%CI 0.88-3.94). CONCLUSION: An unusually low prevalence of smoking, approximately 1/4th the expected prevalence, was observed among hospitalized COVID-19 patients. Any association between smoking and COVID-19 severity cannot be generalized but should refer to the seemingly low proportion of smokers who develop severe COVID-19 that requires hospitalization. Smokers should be advised to quit due to long-term health risks, but pharmaceutical nicotine or other nicotinic cholinergic agonists should be explored as potential therapeutic options, based on a recently presented hypothesis.

The influence of delayed cord clamping and cord milking on inflammatory cytokines in umbilical vein and neonatal circulation.

INTRODUCTION: The purpose of the present study was to compare the levels of tumor necrosis factor α (TNF-α), and interleukins (IL) 1, 6, 8 and 10 in the umbilical cord and neonatal circulation among neonates with early and late cord clamping. MATERIAL AND METHODS: A consecutive series of 76 cases of uncomplicated pregnancy and an uneventful parturition was evaluated. In 40 cases, delayed cord clamping was used and in the remaining 36, early cord clamping was practiced. Blood samples were collected from the umbilical vein immediately after cord clamping and at 24 h from the median cubital or basilic vein of the neonate. RESULTS: Significant differences were noted in the hematocrit and hemoglobin levels at 24 h that favored delayed clamping. None of the evaluated markers of inflammation differ between the two groups. Spearman's rho revealed a significant correlation between umbilical cord TNF-α and TNF-α neonatal values at 24 h (r = 0.551, p = 0.022) in the early clamped group. Significant correlations were also noted between umbilical cord TNF-α and TNF-α neonatal values at 24 h (r = 0.728, p = 0.001), umbilical cord IL-10 and neonatal IL-10 at 24 h (r = 0.487, p = 0.047) and umbilical cord IL-1b and neonatal IL-1b at 24 h (r = 0.516, p = 0.034). CONCLUSIONS: Delayed cord clamping or cord milking does not alter the levels of inflammatory cytokines in cord blood and neonatal serum. Future studies should evaluate the impact of delayed cord clamping in selected high-risk pregnancies.

Evaluation of food photographs assessing the dietary intake of children up to 10 years old.

OBJECTIVE: Young children lack basic skills related to recognizing the types of foods they consume and dietary surveys often rely on parents' response. The present study aimed to evaluate how well parents of children aged from 3 months to 10 years perceive images of portions of foods commonly consumed by young children. DESIGN: Pre-weighed, actual food portions (n 2314) were shown to the study participants who were asked to indicate the picture that corresponded to the food in view. Mean differences between picture numbers selected and shown were estimated and compared using unpaired t tests or Tukey-Cramer pairwise comparisons. SETTING: Real-time testing of parents' perception of food images presenting portion sizes consumed by children up to 10 years old. SUBJECTS: A convenience sample of 138 parents/caregivers of young children (69 % females). RESULTS: Individuals selected the correct or adjacent image in about 97 % of the assessments. Images presenting amorphous solids (i.e. pies and pastries with a filling), liquid or semi-liquid dishes (i.e. soups, porridges, fruit and vegetable purées) were more prone to bias. There was no indication that personal characteristics (gender, age, educational background, age, number of offspring) were associated with differences in the way parents/caregivers perceived the food pictures. CONCLUSIONS: Food pictures may not be appropriate to quantify the intake of liquid, semi-liquid or amorphous solid foods in surveys addressing young children and studies evaluating their performance as food portion anchors should ensure the inclusion of several and various amorphous foods in the assessment.

Electronic cigarette use in Greece: an analysis of a representative population sample in Attica prefecture.

BACKGROUND: The purpose was to assess prevalence and correlates of electronic cigarette (e-cigarette) use in Greece in 2017. METHODS: A cross-sectional survey of a representative sample of 4058 adults living in Attica prefecture (35% of the Greek adult population) was performed in May 2017 through telephone interviews. Prevalence and frequency of e-cigarette use were assessed according to the smoking status, and logistic regression analysis was performed to identify correlates of use. RESULTS: Current smoking was reported by 32.6% of participants. Ever e-cigarette use was reported by 54.1% (51.4-56.8%) of current smokers, 24.1% (21.7-26.5%) of former smokers and 6.5% (5.3-7.7%) of never smokers. Past experimentation was the most prevalent pattern of e-cigarette use among ever users (P < 0.001). Almost 80% of ever and 90% of current e-cigarette users were using nicotine. Extrapolated to the whole Attica population (3.1 million), there were 1 million current smokers, 848,000 ever e-cigarette users and 155,000 current e-cigarette users. The majority of current e-cigarette users (62.2%) were former smokers. Only 0.2% of never smokers were current e-cigarette users. One out of 20 participants considered e-cigarettes a lot less harmful than smoking. Being current or former smoker were the strongest correlates current e-cigarette use (OR 30.82, 95%CI 10. 21-69.33 and OR 69.33, 95%CI 23.12-207.90 respectively). CONCLUSIONS: E-cigarette use in Greece is largely confined to current or former smokers, while current use and nicotine use by never smokers is extremely rare. The majority of current e-cigarette users were former smokers. Most participants overestimate the harmfulness of e-cigarettes relative to smoking.

Sense of Coherence in Religious Christian Orthodox Women in Greece.

Investigation of correlation between the way of life of women-secular and devoted (belonging to a Christian Orthodox fraternity)-and their stress management skills. Sample population consisted of 200 women, 100 belonging to an Orthodox Christian fraternity and 100 secular women, 18 years of age and older from the wider Thessaloniki area (North Greece). Antonovsky's Scale Sense of Coherence (SOC) was used for stress management skills evaluation. The mean SOC score was 138 (95 % CI 133.9-142.1) for secular and 149.9 (95 % CI 144.9-154.9) for devoted women. The presence of a strong sense of coherence for those women belonging to the fraternity (p = 0.004) and older age (p = 0.019) correlate with higher SOC scores. Religiousness appears to enhance stress management skills in women although additional evidence needs in support of the findings of this research.

Sense of Coherence (SOC) in Christian Orthodox Monks and Nuns in Greece.

This paper aims to investigate the stress management skills of Christian Orthodox monks and nuns, as measured by Antonovsky's scale sense of coherence (SOC). A case-control study was designed to test the hypotheses whether monks and nuns have higher SOC than secular people. The study population consisted of 193 individuals, 96 monks and nuns (study group) and 97 secular men and women (control group). SOC score was higher in monks and nuns as compared to the secular population (p = 0.002), men as compared to women (p = 0.012) and persons of older age (p = 0.004) as compared to younger individuals.

Awareness and Current Use of Electronic Cigarettes in Indonesia, Malaysia, Qatar, and Greece: Findings From 2011-2013 Global Adult Tobacco Surveys.

INTRODUCTION: Increases in electronic cigarette (e-cigarette) awareness and current use have been documented in high income countries but less is known about middle and low income countries. METHODS: Nationally representative household survey data from the first four Global Adult Tobacco Surveys to assess e-cigarettes were analyzed, including Indonesia (2011), Malaysia (2011), Qatar (2013), and Greece (2013). Correlates of e-cigarette awareness and current use were calculated. Sample sizes for Greece and Qatar allowed for further analysis of e-cigarette users. RESULTS: Awareness of e-cigarettes was 10.9% in Indonesia, 21.0% in Malaysia, 49.0% in Qatar, and 88.5% in Greece. In all four countries, awareness was higher among male, younger, more educated, and wealthier respondents. Current e-cigarette use among those aware of e-cigarettes was 3.9% in Malaysia, 2.5% in Indonesia, 2.2% in Greece and 1.8% in Qatar. Across these four countries, an estimated 818 500 people are currently using e-cigarettes. Among current e-cigarette users, 64.4% in Greece and 84.1% in Qatar also smoked cigarettes, and, 10.6% in Greece and 6.0% in Qatar were never-smokers. CONCLUSIONS: E-cigarette awareness and use was evident in all four countries. Ongoing surveillance and monitoring of awareness and use of e-cigarettes in these and other countries could help inform tobacco control policies and public health interventions. Future surveillance should monitor use of e-cigarettes among current smokers and uptake among never-smokers and relapsing former smokers.

Evaluation of a digital food photography atlas used as portion size measurement aid in dietary surveys in Greece.

OBJECTIVE: To evaluate how well respondents perceive digital images of food portions commonly consumed in Greece. DESIGN: The picture series was defined on the basis of usual dietary intakes assessed in earlier large-scale studies in Greece. The evaluation included 2218 pre-weighed actual portions shown to participants, who were subsequently asked to link each portion to a food picture. Mean differences between picture numbers selected and portions actually shown were compared using the Wilcoxon paired signed-rank test. The effect of personal characteristics on participants' selections was evaluated through unpaired t tests (sex and school years) or through Tukey-Kramer pairwise comparisons (age and food groups). SETTING: Testing of participants' perception of digital food images used in the Greek national nutrition survey. SUBJECTS: Individuals (n 103, 61 % females) aged 12 years and over, selected on the basis of the target population of the Greek nutrition survey using convenience sampling. RESULTS: Individuals selected the correct or adjacent image in about 90 % of the assessments and tended to overestimate small and underestimate large quantities. Photographs of Greek traditional pies and meat-based pastry dishes led participants to perceive the amounts in the photos larger than they actually were. Adolescents were more prone to underestimating food quantities through the pictures. CONCLUSIONS: The digital food atlas appears generally suitable to be used for the estimation of average food intakes in large-scale dietary surveys in Greece. However, individuals who consistently consume only small or only large food portions may have biased perceptions in relation to others.

[Knowledge, competence and educational needs of mental health staff on palliative care for the elderly with dementia].

Dementia is a clinical syndrome for which the benefits of palliative care have been recognized. The aim of this study was to investigate the knowledge and educational needs of mental health physicians and nurses and also their perceptions of their competence regarding palliative care for the elderly with dementia. A total of 96 mental health professionals (doctors, nurses) working in a public psychiatric hospital and its allied community mental health settings participated in the study. The Palliative Care Quiz for Nursing (PCQN) was used to detect their knowledge on palliative care as well as a questionnaire to collect participants' demographics, their perceptions about their competence in palliative care provision and their educational needs on the basic domains of palliative care for the elderly with dementia. Results revealed participants' significant lack of knowledge (PCQN =7.79/20) and low perception of competence regarding palliative care for elderly persons with dementia. Participants who were psychiatrists, who had work experience between 16-20 years and provided care to more than ten patients with terminal dementia per year, showed higher PCQN scores at a statistically significant level (p=0.001). The majority (93.6%) of participants considered training in palliative care for dementia patients as necessary, particularly in providing information to family/carers, relieving the psychosocial burden of family/carers, managing the terminal stage of dementia, providing information to dementia patients and planning their advanced care. The findings of this study could inform the design of training programs on palliative care for the elderly with dementia in Greece.

Perceptions and attitudes of people with severe mental disorders towards smoking in Greece.

Despite its significant decline in the general population, smoking remains endemic and highly prevalent among people with mental disorders. The impact of smoking-attributable morbidity on life expectancy is significant since, in comparison to the general population, people with severe mental disorders have a 15-20-year reduction in life expectancy. A cross-sectional study was conducted among 1015 people with mental disorders through personal interviews. The questionnaire was designed to examine these patients' knowledge, perceptions, and attitudes towards smoking. Individuals were recruited from the mental health residential community services, the outpatient department, and the inpatient facilities of the Psychiatric Hospital of Attica. Statistical analysis was performed using SPSS 26.0. In the sample analyzed, the current-smoking prevalence stood at 68.4% (n=643), while 12.3% reported being former smokers. A staggering 86.3% smoked their first cigarette within 30 minutes of waking up, indicating a high level of dependence. Most of the former smokers (83.6%) reported that their main reason for quitting smoking was to improve their health, and the overwhelming majority (97.4%) had done so using no smoking cessation aid. Although slightly over half of the participants (53.7%) believed that health professionals adequately inform smokers about the harmful health effects of tobacco products, the information provided by health professionals on smoking cessation programs and tobacco harm reduction alternatives was considered sufficient by a mere 11.2%. Multiple logistic regression analysis demonstrated that outpatients tended to have a greater likelihood of being current smokers as compared to inpatients (OR=1.45), while users of mental health residential community services showed a significantly lower likelihood of being current smokers in comparison to inpatients (OR=0.49). Additionally, it was found that women had a lower likelihood of being current smokers compared to men (OR=0.51), while divorced/ widowed participants had a greater likelihood of being current smokers compared to single ones (OR=1.93). Finally, multiple regression analysis indicated that participants with psychotic disorders displayed a 2.39 times greater likelihood of being current smokers compared to those with mood disorders (OR=2.39). Understanding the knowledge, beliefs, and attitudes of people with mental disorders towards tobacco is an essential first step to confronting this neglected epidemic.

Tracing Time Trends of Births in Greece.

Introduction The aim of this study was to comprehensively investigate and present time trends in births in Greece over the last seven decades. Methods Data on live births were derived from the Hellenic Statistical Authority, covering a 72-year period from 1950 to 2021. Trends in the number of births were assessed using joinpoint regression analysis. The annual percentage change (APC) and the average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI) and level of statistical significance p<0.05. Results The overall trend during 1950-2021 was clearly downward (AAPC = -0.9, 95% CI: -1.2 to -0.7). Over the first three decades, births fluctuated to a record high of 162,839 in 1967, with an overall slight downward trend (1950-1981: APC = -0.2, 95% CI: -0.4 to -0.1, p<0.001). During the 1980 decade, the trend was sharply downward (1981-1988: APC = -4.7, 95% CI: -6.2 to -3.2, p<0.001), followed by a stabilization in the 1990s (1988-2001: APC = -0.1, 95% CI: -0.7 to 0.4, p=0.586). The first decade of the 21st century was the only period during the last seven decades with an increasing trend in births in the Greek population (2001-2008: APC = 1.9, 95% CI: 0.3 to 3.5, p = 0.021), but it was followed by plummeting trends during the recent years (2008-2021: APC = -2.7, 95% CI: -3.2 to -2.3, p<0.001), leading to the historic low of 83,756 births in 2019. Conclusion The time trend analysis of births in Greece indicated a dramatic plummet in natality in Greece, predominantly attributed to the large decline in births in the 1980s, which could not be reversed in the 1990s and 2000s. The recent decrease in births was associated with the financial recession and has put the Greek population in a disastrous low-fertility spiral.

The impact of COVID-19 lockdown on children's and adolescents' mental health in Greece.

The aim of the study was to investigate the impact of the COVID-19 lockdown on children's and adolescents' mental health in Greece during the lockdown of spring 2020. A cross-sectional survey of 1232 Greek parents was conducted in spring 2020. 35.1% of parents reported that their children's psychological health was significantly affected. Parental unemployment, limited opportunity for tele-work and deteriorating psychological health, increased family conflicts and children's pre-existing physical health conditions were all significantly associated with mental health impact. Children and adolescents may experience adverse mental health effects due to the COVID-19 pandemic.

Vaccination Coverage during Childhood and Adolescence among Undergraduate Health Science Students in Greece.

High rates of vaccination coverage in childhood represent one of the most important cost-effective tools of primary prevention and have substantially reduced the incidence of and mortality from vaccine-preventable diseases globally. Vaccination coverage of young people has not been well estimated in Greece. Anonymous self-completed questionnaires and the participants' Child Health Booklet were used to estimate complete vaccination coverage of mandatory vaccinations against vaccine-preventable diseases of undergraduate students at the University of West Attica during the academic year 2020−2021. Student's t-tests were used to estimate mean values. Overall, 79% (95% CI: 78−81%) of study participants were fully vaccinated. This coverage was lower in males especially for vaccines that should be done during childhood (p = 0.045). High vaccination percentage (>90%) was observed for the meningococcus group A, C, W135, Y, measles-mumps-rubella, hepatitis B and meningitis C vaccine. Nevertheless, suboptimal coverage was assessed for the booster dose of tetanus, diphtheria, pertussis, for the human papillomavirus vaccine among girls, for the tuberculosis, for the meningococcus group B, for the pneumococcal, and for the seasonal influenza vaccines. In conclusion, the promotion of routine vaccination programs for young adults needs to be strengthened. An identification system for under-vaccinated students, an efficient reminder system and university campus vaccine program practices should be established, particularly among males.

Implementation of the e-Bug Project in Greece.

The e-Bug pack and web site educational material has been translated and adapted to the Greek language and educational background, and implemented throughout Greece as a supplementary educational resource in elementary and junior high schools. Elementary and junior high school teachers in Greece have actively participated in the development of the e-Bug educational resource and supported the implementation of all e-Bug activities. Dissemination to all key national stakeholders has been undertaken, and endorsement has been obtained from educational and medical associations, societies and institutions. Independent evaluation has been carried out, as part of dissertation thesis projects, for postgraduate studies. The e-Bug educational resource provides all the essentials for the dissemination of good health behaviours in hygiene, monitoring the spread of infection and the prudent use of antibiotics, to the youth of this country. Its contribution is expected to be evident in the next adult generation.

Diet and expression of estrogen alpha and progesterone receptors in malignant mammary tissue.

Estrogen receptor (ER) and/or progesterone receptor (PR) expression has been associated with more favorable breast cancer prognosis. Results on the differential association of diet with ER and/or PR positive and negative tumors have been inconclusive. In a large case-control study conducted in Athens, Greece, we investigated whether diet is associated with the expression of ER-alpha or PR in mammary tumors of 421 women with histologically confirmed breast cancer. Diet was assessed through an extensive food frequency questionnaire and results were analyzed using multiple logistic regression. After controlling for non-nutritional variables and mutually adjusting for energy-generating nutrients and ethanol, carbohydrate intake was inversely associated with ER-alpha (P = 0.04) and PR (P = 0.10) expression. The odds ratios (OR) per one standard deviation increment were 0.69 with 95% confidence interval (95% CI) 0.48-0.98 for ER-alpha and 0.72 (95% CI 0.49-1.07) for PR expression. No consistent or statistically significant associations were noted for any of the other energy-generating nutrients or food groups examined. Although in these data no strong relations of qualitative aspects of diet with hormone receptor expression in breast cancer tumors were evident, the inverse association of carbohydrate intake with ER-alpha, and perhaps PR, expression merits further study in future investigations.

Changes from 2017 to 2018 in e-cigarette use and in ever marijuana use with e-cigarettes among US adolescents: analysis of the National Youth Tobacco Survey.

AIMS: To examine changes from 2017 to 2018 in e-cigarette use and ever marijuana use with e-cigarettes among US adolescents. DESIGN: Analysis of data from the 2017 and 2018 National Youth Tobacco Survey (NYTS), cross-sectional surveys of US middle school (grades 6-8) and high school (grades 9-12) students. SETTING: United States. PARTICIPANTS: US adolescent population from middle school, with mean age = 12.7 [standard deviation (SD) = 1.0] years, and high school, with mean age = 16.1 (SD = 1.3) years. MEASUREMENTS: Analysis of e-cigarette use and ever use of marijuana with e-cigarettes according to frequency of use and smoking status, comparing 2017 with 2018. Frequent smoking and e-cigarette use was defined as use for ≥ 20 of the past 30 days. FINDINGS: Past 30 days e-cigarette use was reported by 33.1% [95% confidence interval (CI) = 29.1-37.4%] of ever/no past 30 days smokers, 68.6% (95% CI = 64.1-72.7%) of past 30 days smokers and 7.2% (95% CI = 6.3-8.2%) of never smokers in 2018 and by 19.3% (95% CI = 16.1-23.1%), 53.0% (95% CI = 46.9-58.9%) and 3.3% (95% CI = 2.7-4.4%) in 2017, respectively (all P < 0.001). Prevalence of past 30 days e-cigarette use was higher among frequent smokers (69.8%, 95% CI = 62.3-76.5% in 2018; 53.8%, 95% CI = 44.1-63.2% in 2017, P < 0.001) and lower among never smokers. Most of the latter were infrequent users, while frequent and daily e-cigarette use was 18- and 24-fold lower compared with ever smokers, respectively. Approximately half of past 30 days and 70% of frequent e-cigarette users reported ever marijuana use with e-cigarettes in both years. Past 30 days smokers were more likely to report past 30 days e-cigarette use [odds ratio (OR) = 15.79, 95% CI = 12.58-19.83 in 2018; OR = 16.11, 95% CI = 12.44-20.86 in 2017) compared with adolescents reporting no past 30 days smoking. CONCLUSIONS: Among US adolescents, e-cigarette use increased in all smoking groups in 2018 compared with 2017. Frequent and daily e-cigarette use was far lower in never-smokers compared with ever-smokers. High prevalence of ever marijuana use with e-cigarettes was observed.

A clinical audit of pneumococcal vaccination among patients with autoimmune rheumatic diseases living in Greece: The power of awareness.

INTRODUCTION: Patients with autoimmune rheumatic diseases (ARDs) are at increased risk for pneumococcal infections and should be vaccinated against Streptococcus pneumoniae. Data on the rates of pneumococcal vaccination among patients with ARDs in Southern Europe are scarce. Here, we estimate the pneumococcal vaccination rate in patients living in Greece with ARDs, explore the patients' awareness regarding vaccination, and try to recognize factors that influence the vaccine uptake. METHODS: Between October 2015 and September 2016, a structured questionnaire was provided to all consecutive patients with ARDs attending one outpatient clinic of our department. The survey included parameters concerning patients' demographics, underlying ARD and immunosuppressive medications, other comorbidities, vaccine type, knowledge about infection risk and necessity of vaccination. Univariate and multivariate analyses were performed to study any association of these factors with the vaccination uptake. RESULTS: Overall, 395 patients with ARDs (30.13% aged >65 years and 78.99% female) participated in our survey. The most frequent ARD was rheumatoid arthritis (43.04%); 40.51% of patients were receiving biologic agents and 44.56% steroids. Pneumococcal vaccination rate was 49.37%, while 45.06% of patients have been vaccinated during the last five years and only 8.21% of them had a second pneumococcal vaccine, as per national guidelines. The decision of vaccination was significantly influenced by the patient's age (>65 years) (p < 0.001) and the complete awareness of reasons for being vaccinated (p < 0.001), but not by presence of comorbidities, the type of ARD or administration of a biologic agent. The main reason for no vaccination was that it was not suggested by the caring physician (82.50%). CONCLUSIONS: In our cohort of patients with ARDs the pneumococcal vaccination was suboptimal. Better understanding of the significance of vaccination by the patient and suggestion for vaccination by the caring physician will improve vaccination uptake and optimize the clinical benefits among patients with ARDs.