Correlation of Cancer Caregiver's Burden, Stress, and Their Quality of Life.

OBJECTIVE: The purpose of this study is to examine the stress levels felt by family caregivers. The main objectives of this study are (a) the cross-examination of family caregiver's burden, (b) caregiver's stress levels and its impact on burden feeling, also (c) the effect of caregiving on caregiver's quality of life. METHODS: A quantitative method was developed, with the use and collection of anonymous questionnaires. Participants consisted of 121 family caregivers of patients under Home Parenteral Nutrition (HPN), along with the oversight of the company "Ygeias Erga and co." Tools that have been used for the needs of this study are a questionnaire with basic demographics: The Zarit Burden Interview (ZBI), Quality of life questionnaire (CarGQoL), and KINGSTON CAREGIVER STRESS SCALE (KCSS): Data were analyzed with SPSS 22. RESULTS: 65.3% of the participants were women with an average age of 50.7 years. 39.7% were patients' spouses and 26.4% were high school graduates. 31.7% of the participants suffered from a chronic disease, with 22.3% taking daily medication. 67.8% lived in the same house as the patient, 30.6% were taking care of the patient for 6-12 months, and 39.7% had no help from another person. 43.8% of patients were under HPN for 1-3 months. A negative correlation was found between all dimensions of the Zarit Burden Interview (ZBI) and Kingston Caregiver Stress Scale and cancer caregiver CarGQoL scale scoring. Participants, who had help from another person permanently, had a better quality of life from others with no help whatsoever. Higher stress levels were found to be correlated with worse quality of life. CONCLUSIONS: Burden increase was found to be related to stress increase. Younger participants and patients' female spouses had higher levels of stress. The present research also found that stress related to financial issues had an important role. Family caregiver support is found to be a matter of great importance, and healthcare professionals have to pay attention to their needs.

COVID-19 Pandemic and Health and Social Inequalities Worldwide: Impact and Response Measures in Greece.

OBJECTIVES: The pandemic has exacerbated pre-existing health and socioeconomic inequalities around the globe. In order to mitigate the effects of extreme isolation and containment measures, governments have taken steps to protect the health, the economy, employment, and socially vulnerable groups. The health crisis should be treated as a pretext in order to ensure universal access to health and socioeconomics.The aim of this review was the presentation of the way the pandemic contributed to the worldwide deterioration of health inequities affecting in parallel the social protection in the health, economic and educational sector along with other factors, the effects and the measures taken, in order to face the consequences of a pandemic on the social protection in Greece in comparison with other countries of Europe. METHODS: A cross-sectional bibliographic study was undertaken using keywords and phrases such as "COVID-19," "Health inequities," "Social protection," and "Social identifiers." The search was done through the search engines google scholar, PubMed, Health link, and Elsevier using either the Greek or English language. The total number of evaluated read-used articles was 30. Inclusion criteria were free full-text meta-analyses, reviews, and systematic reviews. RESULTS: The socially disadvantaged groups in the United States were found to have a lower life expectancy and higher morbidity rates than privileged social groups, as economic, health, and sociocultural precariousness are major causes of death. Patients with underlying diseases are vulnerable groups and increase the risk of coronavirus infection and quite often lead to loss of life due to complications of the disease. Greece is ranked in the 4th worst position with 61.10% in employment in all European Union (EU) countries. There is a significant increase in deaths with a percentage change from 2018 to date of 17.50%. It also holds the 3rd worst position among EU countries in the field of unemployment, while women hold the 2nd worst with a rate of 13.50%. Overworked and overindebted households due to extreme measures due to the pandemic (reduction of working time, quarantine) led to unemployment, loss of income, poverty, widening social inequalities, and deteriorating care for people with disabilities. Children due to the closure of schools and the loss of school meals are led to food insecurity. The pandemic also left many children orphaned after the death of their parents by COVID-19, with psychosocial problems exacerbated by school closures. CONCLUSIONS: The pandemic has exacerbated long-standing health and socioeconomic inequalities, stressing to governments the need to adopt political strategies that will help address them. Measures have been taken in Greece for labor protection, and unemployment benefits, such as the two-month extension of the subsidy period for the unemployed and the long-term unemployed. Minimum insurance days have also been reduced so that citizens employed in tourism, catering, and other seasonal occupations can receive unemployment benefits.

Investigation of Factors That Affect the Quality of Life After a Stroke.

Stroke, as a disease, describes a group of disorders characterized by the presence of central nervous system symptoms either as a result of ischemia (ischemic stroke) or bleeding (hemorrhagic stroke). The appearance of a stroke results in a permanent physical or cognitive disability. The stroke incidence is the third cause of death after heart disease and cancer, and is the main cause of long-term disability.The effects of a stroke on a patient's daily life, and hence on his quality of life, are intense and long-lasting. These include memory problems, speech difficulty, depression, reduced vision loss, and decreased walking ability. This limitation of the patient's motor activity has a direct negative impact on the quality of his life.To investigate the degree of this impact, a research was carried out at a hospital of Central Greece. The total sample consisted of 90 patients and the responses showed that post-stroke symptoms are significant. Consequences and treatment control of the disease on the life of the sample were the questions with the highest score showing the significant effect that a stroke has on life the patients.More specifically, the sample showed through responses that the disease affects their lives to a great extent. The pre-stroke scores on the domains of the sample are clearly higher than post-stroke. The highest difference was found in the use of the upper extremities in self-care and family roles while the lowest was found in the domain of thinking. The most affected domains were as follows: thinking, vision, and language. Alternatively, the least affected domain was family roles.

Milder impact of the COVID-19 pandemic on the practice of orthopaedic surgery in Greece and Cyprus than other European countries.

PURPOSE: The aim of this study was to highlight the impact of the COVID-19 pandemic on the practice of orthopaedics in Greece and Cyprus. METHODS: The survey used the online questionnaire from AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie; Society for Arthroscopy and Joint Surgery) to facilitate the comparison between different European countries. The questionnaire was distributed online to members of the HAOST (Hellenic Association of Orthopaedic Surgery and Trauma), the ΟΤΑΜΑΤ (Orthopaedic and Trauma Association of Macedonia and Thrace) and the CAOST (Cypriot Association of Orthopaedic Surgery and Trauma). The questionnaire consisted of 29 questions, which included demographic data, questions on the impact of the pandemic on the practice of orthopaedic surgery and questions on the impact on the personal and family life of orthopaedic surgeons. RESULTS: The questionnaire was sent to 1350 orthopaedic surgeons in Greece and Cyprus, 303 of whom responded (response rate 22.44%). 11.2% of the participants reported cancellation of overall orthopaedic procedures. According to 35.6-49.8% of the participants, arthroscopic procedures were continued. As regards elective primary arthroplasties, 35.3% of the participants reported that these continued to be performed at their hospitals. Post-operative follow-ups as well as physiotherapy were affected by the pandemic, and changes were also observed in the habits of orthopaedic surgeons in their personal and family lives. CONCLUSION: The orthopaedic service in Greece and Cyprus decreased during the first wave of the COVID-19 pandemic. Arthroscopic procedures and total joint replacements decreased significantly, but not to the same extent as in other countries. Health systems were not fully prepared for the first wave of the pandemic and the various countries took social measures at different times and to different extents. Thus, studying the impact of the pandemic on the practice of orthopaedic surgery in different countries can help health systems to better prepare for future pandemics; public health can then be shielded and hospitals can continue to provide high-quality orthopaedic care. LEVEL OF EVIDENCE: Level V.

GREEK MILITARY NURSING OFFICERS' COMPASSION COMPETENCE AND COMPASSION LEVEL AT WORK AND THEIR PROFESSIONAL QUALITY OF LIFE.

OBJECTIVE: Aim: Of this study was to investigate the level of Military Nursing Officers'(MNOS) compassion competence and their personal level of compassion at work and their correlation with the professional quality of life. PATIENTS AND METHODS: Materials and methods This is a cross-sectional study carried out from December 2019 to May 2020 using the method of convenience sampling. The study involved 235 MNOs serving in Greek Military Hospitals. A single questionnaire containing Compassion at Work index, Compassion competence scale and ProQOL 5 was used for data collection. A total of 400 questionnaires were distributed with a response rate of 58.75%. Data analysis was performed using the statistical package SPSS 22.0. RESULTS: Results: The research showed that there was a significant positive correlation of the Compassion Satisfaction score with the com¬passion at work and compassion competence scales. So, the more compassion participants had, the more satisfaction they received from the care they put into their work. Conversely, the more compassion participants had, the less burnout they felt. Regarding secondary traumatic stress, it was found that the higher the participants' score on the dimensions of compassion in the dimension "Being non-judgmental", "Being tolerant to personal distress" and "Being empathic", the lower the secondary traumatic stress they felt. The position at hospital, the score on the compassion dimension in the dimension "Experiencing the suffering of others" were found to be independently related to the Compassion Satisfaction score. Specifically, Head Nurses had a 3.86 points lower score compared to Nurse managers. Higher values in the "Experiencing the suffering of others" dimension were related to a higher Compassion Satisfaction score. Nursing Officers who scored higher in compassion dimensions such as "Being non-judgmental", "Being tolerant to personal distress" and "Being empathic", they felt lower secondary traumatic stress. CONCLUSION: Conclusions: It is really important for Military nursing Officers to be compassionate in order to get more satisfaction from caring about their work and feel less burnout.

Translation and validation of the Greek version of the Jefferson Scale of Attitudes toward Physician and Nurse Collaboration (JSAPNC).

The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSATPNC) is an established tool to assess attitudes toward physician-nurse collaboration. The aim of this study was to translate and culturally adapt the JSATPNC for use in Greece and test its psychometric properties. The final study sample included 621 physicians and nurses working in two general hospitals of Northern Greece during 2017. The study sample was randomly split into two halves; separate exploratory and confirmatory factor analyses were conducted. A regression analysis including sociodemographic variables was performed to predict the JSATPNC total score. The Cronbach's alpha was .74. A four-scale model (a) interprofessional collaboration, (b) involvement in decision-making, (c) expertise, (d) physician's dominance was extracted from the exploratory factor analysis. The confirmatory factor analysis indicated an acceptable model fit (RMSEA = .069, SRMR = .083, TLI = .875, CFI = .903). There was adequate evidence for both convergent and discriminant validity, apart from the "physician's dominance" scale; the exclusion of items 9 and 12 from this scale resulted in an alternative model with the improved model fit (RMSEA = .062, SRMR = .078, TLI = .902, CFI = .916). The test-retest intraclass correlation coefficients were all above .7. Age and profession of the respondents emerged as important predictors of the total scale score. The Greek version of the JSATPNC shows promise as a reliable and valid instrument for evaluating collaboration between physicians and nurses.

Diabetic patient assessment of chronic illness care using PACIC.

BACKGROUND: The Patient Assessment of Chronic Illness Care plus is used in order to assess whether provided care is congruent with the Chronic Care Model, according to patients. The purpose of this study was to correlate PACIC+ and the revised 5As "ask, advise, agree, assist and arrange" scoring of a sample of DM patients, with their QoL, depressive symptomatology, demographic and disease characteristics, self-management behaviours of healthy eating and physical activity. METHODS: This is a cross-sectional study where data were collected between January and April 2018 by using three questionnaires (PACIC+, SF-36, CES-D) from a sample of 90 DM patients treated at a Public General Hospital of Central Greece. Anonymous self-completed questionnaires were used to collect the data. Data was processed in the Statistical Package for the Social Sciences (SPSS). RESULTS: The mean age of the participants with DM was 52.8 years (SD = 21.2 years), with cardiovascular disease and arterial hypertension scoring as the most frequently reporting chronic comorbidities. The healthcare received by DM patients has been correlated with their QoL. More specifically SF - 36 and PACIC+ scale scores showed a positive and low correlation in several subscales. The total score of PACIC+ scale as well as the Patient activation score were increased in higher scores of vitality (p = 0.034 & p = 0.028 respectively), hence both scores correlate significantly with latter. In addition, Delivery System / Practice Design score was increased in higher scores of mental health (p = 0.01) and MCS (p = 0.03). CONCLUSIONS: The shift from hospital care focusing on the disease to a more patient-oriented approach puts forward a dynamic holistic approach to chronic diseases and the reduction of their impact. Finding evidence-based and effective strategies to promote health, prevent and manage chronic diseases such as diabetes mellitus is deemed to be crucial and necessary. PACIC+, which is a tool of a patient-level assessment of CCM implementation, can be used by countries which intend to apply changes in the way their health systems provide chronic care and specifically wish to improve the quality of chronic disease care and the QoL of their patients.

Reliability and validity of the Greek translation of the patient assessment of chronic illness care + (PACIC-PLUS GR) survey.

BACKGROUND: This study aimed to investigate the Patient Assessment of Chronic Illness Care+ (PACIC+) which is a tool to assess care for Chronic Conditions combining PACIC items with an overall 5As score derived from the '5As' model (ask, advise, agree, assist, and arrange), and is congruent with the Chronic Care Model. In addition, the study at hand aimed to translate the PACIC+ tool into Greek and test its psychometric properties to the Greek patients. METHODS: Questionnaires were collected from 268 chronic patients. Internal consistency and reliability were determined by the calculation of Cronbach's alpha coefficient. A confirmatory factor analysis (CFA) was conducted in order to test the construct validity of the questionnaire. Validity was further examined by investigating the correlation of PACIC+ with SF-36 and its association with sex and age. RESULTS: Internal consistency reliability was accepted with a Cronbach's alpha above 0.70 for all PACIC+ dimensions. CFA showed that the 10-dimensional model fitted the data well (RMSEA = 0.059, CFI = 0.91 and GFI = 0.83). Most of the correlations coefficients between PACIC+ and SF-36 dimensions were significant. A significant and negative correlation was found between PACIC+ summary score, Patients' activation and Goal Setting/ Tailoring with age. CONCLUSIONS: The Greek translation of the PACIC+ questionnaire has good psychometric properties and has proven to be a credible and valid tool to be used by Greek researchers in order to measure patients' perceived care during treatment. It demonstrated high reliability and internal consistency, extending the applicability of this instrument to Greek speaking chronic patients.

How breast cancer treatments affect the quality of life of women with non-metastatic breast cancer one year after surgical treatment: a cross-sectional study in Greece.

BACKGROUND: The continuously increasing survivorship of female breast cancer makes the monitoring and improvement of patients' quality of life ever so important. While globally there is a growing body of research on health-related quality of life 1 year after surgical treatment for non-metastatic breast cancer, up-to-date information regarding Greek patients is scarce. OBJECTIVE: To measure the level of QoL of non-metastatic BC survivors in Greece 1 year after surgery. METHODS: A sample of 200 female breast cancer survivors aged 18 to 75, who followed up as outpatients in five public hospitals were included in this cross-sectional study. All recruited patients agreed to participate in the study (100% response rate). Quality of life data were collected through the EORTC QLQ-C30 as well as BR23 questionnaires. RESULTS: Cronbach's alpha for all scales of the two questionnaires was from 0.551 to 0.936 indicating very good reliability. According to the Multiple Linear Regression, older patients showed a lower future perspective (p = .031), with those living in rural areas, which was associated with more financial difficulties (p = .001). Women with tertiary education and those who had been hospitalized in a university hospital recorded better on global health status (p = .003 and .000 respectively). Patients who underwent chemotherapy reported better scores in the emotional function sub-scale (p = .025). Women with reconstruction and at least one complication appeared to have significantly better scores in future perspective and social function (p = .005, .002 respectively). CONCLUSIONS: Breast cancer survivors were found to have an overall good quality of life, functioning/symptoms scores and were satisfied with the provided care.

A longitudinal study of multiple lifestyle health risk behaviours among nursing students and non-nursing peers.

AIM: The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students. BACKGROUND: Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves. DESIGN: Longitudinal comparative study. MEASUREMENTS: We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self-administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed. RESULTS: There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake. CONCLUSION: Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health-promoting role. We need strategies to safeguard the professional nursing practice.

Greek students' attitudes, perception and knowledge regarding generic medicines in times of economic crisis: a cross-sectional study.

BACKGROUND: The penetration of generic medicines in the pharmaceutical market is influenced, among others, by the consumer's attitude upon them. The attitude of students in health management and recent alumni is particularly important, as they constitute tomorrow's policymakers. The aim of our study was to assess their attitude, perception and knowledge towards generic medicines. METHODS: A cross-sectional study was undertaken, involving students in Health Management and recent alumni. The ATtitude TOwards GENerics (ATTOGEN) validated questionnaire was used, which consists of 18 items, yielding 6 scales (trust, state audit, knowledge, drug quality, drug substitution and fiscal impact), with all item responses expressed on a 5-point Likert scale and higher scores denoting greater disagreement. Correlation coefficients were computed and independent sample tests were performed using non-parametrical statistical methods. RESULTS: A total of 1402 students were interviewed, with a female predominance (62.88%). The mean (SD) scores for the six scales of the ATTOGEN questionnaire were: Trust: 2.877 (0.940), State audit: 3.251 (0.967), Knowledge: 1.537 (0.688), Drug quality: 2.708 (0.971), Drug substitution: 3.828 (1.127) and Fiscal impact: 2.299 (0.860). Trust over generics was statistically significantly associated with all ATTOGEN scales (all p < 0.001). In addition, the increased level of knowledge about generics was associated with recognition of the generic medicines' quality equivalence (p < 0.001) and positive fiscal impact (p = 0.018). Pharmacists declared having a superior knowledge of generic medicines, being more satisfied with the information they receive about them and strongly believing in drug substitution (p < 0.001). Comparatively to other professionals, pharmacists also indicated substantial differences between branded and generic medicines more often (p < 0.001). They also argued to a greater extent that generic medicines were invented and promoted to resolve the financial crisis of social security institutions at the expense of citizens (p < 0.001). CONCLUSIONS: This study demonstrated a mixed attitude of students regarding generic medicines. Trust and knowledge emerged as key factors shaping the students' attitude towards generics. Among students, pharmacists exhibited a distinct response pattern. This study underlines the importance of addressing and correcting health management students' misbeliefs about generics' quality and utility.

Investigation of the association between quality of life and depressive symptoms during postpartum period: a correlational study.

BACKGROUND: The onset of a major depressive episode is experienced by a large number of women in the weeks or months following delivery. Postpartum depression may deem those women experiencing it incapable of taking care for themselves, their family and their infants, while at the same time it could negatively affect their quality of life. The present study assessed the quality of life of a sample of mothers in Greece, in order to investigate the association between postpartum depression and quality of life (QoL). METHODS: 145 women in a Private-General Obstetrics and Pediatric Clinic in Greece completed the Edinburgh Postnatal Depression scale (EPDS) and SF-36 questionnaire on the third and fourth day after delivery (caesarean or normal childbirth). The data were analyzed using SPSS version 17.0. Linear and logistic regression analysis was performed in order to find the independent factors related to the quality of life and postpartum depression symptoms. RESULTS: 9.9% of the participants experienced postpartum depression symptoms. Significant associations were found between the place of residence and symptoms of postpartum depression, and more specifically, women outside of Attica indicated higher levels of postpartum depression symptoms (p = 0.008) than women living in Attica. The level of education was also found to be significantly associated with postpartum depression symptoms, since women with Primary and Secondary education experienced higher levels of postpartum depression symptoms (p = 0.005) than those with a tertiary education. Concerning quality of life, women with postpartum depression symptoms scored 24.27 lower in «Role-Physical¼, 15.60 lower in «Bodily pain¼, 11.45 lower in «General Health¼, 14.18 lower in dimension of «Vitality¼, 38.25 lower in Role - Emotional and 16.82 lower in dimension of mental health, compared to those without depression symptoms. CONCLUSION: Postpartum depression symptoms are associated with the quality of life of women after pregnancy, and therefore constitute a powerful predictor of the quality of life. Health care professionals should provide individualized care for the prevention and treatment of Postpartum Depression symptoms in order to help women improve their quality of life.

Burnout among nurses working in social welfare centers for the disabled.

BACKGROUND: In the healthcare sector, we often come across the burnout syndrome. It is an occupational syndrome which causes, physical and emotional exhaustion. More information is needed on the dangers of burnout and how often it occurs in healthcare. The purpose of this study was to investigate burnout and factors associated with the syndrome among nurses working with people that are mentally challenged. METHODS: A cross-sectional survey was conducted, among 180 nurses working in public health centers for the disabled in multiple regions of Greece. A self-administered questionnaire with questions about socio-demographic and work-related characteristics was used, as well as the Maslach Burnout Inventory (MBI) for burnout assessment. Univariate and multivariate analyzes were performed. RESULTS: The burnout dimensions of emotional exhaustion (Mean = 31.36) and depersonalization (Mean = 11.27) were at high levels while personal accomplishment was at low levels (Mean = 44.02). Female nurses had a higher personal accomplishment score (Mean = 44.82, p = 0.047) than men (Mean = 42.10, p = 0.047). Marital status, daily routine and relationships with supervisors were significantly related with emotional exhaustion and personal accomplishment and professional experience with higher levels of emotional exhaustion and depersonalization. Reason for professional selection was an independent predictor for depersonalization and personal accomplishment, with those that have selected the nursing profession randomly or because of the fear of unemployment having higher scores. Moderate relationships with colleagues was an independent predictor for all burnout dimensions. CONCLUSIONS: Nurses working in services for people with intellectual disabilities in Greece show increased burnout levels. Burnout can be prevented by offering more opportunities for professional advancement and education, new ways to provide supervisor support, provide incentives for nurses to initiate or participate in innovative programs. Specific training on conflict resolution, collaboration, reinforcement and stress coping techniques must be implemented.

The impact of occupational stress on nurses' caring behaviors and their health related quality of life.

BACKGROUND: Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses' health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health. METHODS: A correlational study of nurses (N = 246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed. RESULTS: Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health. CONCLUSION: Occupational stress affects nurses' health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

Parents' attitudes, perceptions and coping strategies regarding school bullying.

OBJECTIVES: The aim of this study was to record parents' knowledge and attitudes towards bullying experienced by their children and to explore the strategies they choose to manage bullying incidents. METHODS: A cross-sectional study was conducted. The study population consisted of parents of children who have experienced bullying in a primary or secondary school classroom. The "Parents' Strategies to Cope with Bullying" questionnaire was used to collect data. Regarding parents' coping with bullying, the strategy "Support and advice to the child" scored the highest and the strategy "Social support and information" the next highest. RESULTS: Of the parents, 44.3 % had received some information/education regarding the phenomenon of bullying with the most important source of information being reading. According to the results of multivariate linear regression, mothers more often applied the strategy "social support and information" (Coefficient b=0.9, 95 % CI for b=0.7 to 1.1, p<0.001) and parents with lower educational level more often applied the strategy "avoidance" (Coefficient b=-0.5, 95 % CI for b=-0.8 to -0.2, p=0.004). CONCLUSIONS: School bullying remains a major worldwide phenomenon over time. Although parents choose to support their children, they do not receive information and training on how to manage bullying from a formal institution, making the need for such programs imperative.

Translation, cultural adaptation and pilot testing of a questionnaire measuring the factors affecting the acceptance of telemedicine by Greek cancer patients.

The emergency presented through the COVID-19 pandemic exposed the need to adopt remote, technology-driven solutions and make healthcare services more resilient. To do so, we need technological applications (i.e., telemedicine) that are designed and tailored to the end-users (i.e., chronic patients) needs and the type of healthcare service they get (i.e., cancer care). The requirements above are especially relevant to Greece, being a country with numerous sparsely populated regions (e.g., islands, regions at the borders) and a deteriorating access to healthcare for all citizens. Trying to address such diverse problems and needs, there have been multiple, different telemedicine and telecare projects in Greece in the past years. To support the future design and implementation of such endeavours, in this study we translated a questionnaire measuring the acceptance of telemedicine by patients and adapted it to the Greek context. We continued by running a small-scale pilot with 73 Greek women with breast cancer to assess the adapted instrument for its reliability and construct validity. The created questionnaire had good overall and internal reliability scores for most sub-scales. Factor analysis did not identify the same number of latent dimensions as the original theoretical model. Reverse wording items needing to be recoded were identified, and items that could be omitted in future versions of the questionnaire. Increasing the sample size for the purposes of a longitudinal study, the construct, convergent, and discriminant validity are elements to be further examined in future studies. It is envisaged that the creation of this questionnaire will support the adoption of telemedicine by Greek healthcare services into more routine areas of patient care provision.

Validation of the Greek Version of Euthanasia Attitude Scale (EAS) in Greek Medical Doctors.

This study aimed to examine the reliability and validity of the Euthanasia Attitude Scale (EAS) in Greek medical doctors. A cross-sectional study design was conducted, including 120 physicians at clinical setting in 2019 (men 64.5%). A self-report questionnaire, including socio-demographic data and the Euthanasia Attitude Scale, which assesses attitudes towards euthanasia, were used for data collection. The mean (standard deviation) of the EAS were 74.62 (14.33). The Cronbach's alpha was 0.944 and the confirmatory factor analysis to investigate the validity of the EAS scale, after modification effects, revealed an acceptable adjustment for the questionnaire. The GFI index was above 0.8 and close to 0.9, and the CFI index was above 0.9, which is the acceptable limit. The RMSEA index was acceptable below 0.08. The total Gr-EAS correlated with all five factors (Pearson r = 0.400−0.973, p < 0.001). According to the findings of this study, the Euthanasia Attitude Scale is a reliable and valid measure for assessing the attitudes toward euthanasia in Greek physicians. This Greek adaptation will be valuable in future studies examining the attitude of physicians towards euthanasia.

Physicians' attitudes towards euthanasia and correlation with their spirituality.

"Suffering" patients' wishes concerning hastening their own death by means of euthanasia, raised by personal, psychological, social and other motives, are becoming increasingly common. This raises controversies and marks challenges within both the scientific community and the public. The aim of this study is to investigate physicians' attitudes towards euthanasia and its correlation with their spirituality. The final sample consisted of 93 physicians (64.5% men), whose attitudes on euthanasia who were evaluated using Euthanasia Attitude Scale (EAS) and Daily Spiritual Experience Scale (DSES). Physicians' attitudes correlate with their specialty (p=0.037), years of service (p=0.037), as well as the number of end stage patients they cared for and died within the last 12 months (p=0.016). Oncologists and other physicians with similar specialty, those with longer clinical experience and those who treat more end-stage patients to strongly oppose to the above practices. Spirituality, estimated with Daily Spiritual Experience Scale -DSES, is correlated with a negative attitude toward euthanasia (p<0.001). Finally, a considerable gap in physicians' training regarding the management of end stage patients has been highlighted. Physicians are opposed to euthanasia and they require the acquisition of competencies in end-of-life care in order to fulfill their profession's current and future demands in the domain of palliative care.

The effect of an information brochure on patients undergoing cardiac catheterization on their anxiety, knowledge and fear: A randomized controlled study.

Introduction: Patients who undergo coronary angiography experience a rather stressful situation. They need information about this invasive procedure which most of the times find either from the internet, their referring physicians, acquaintances or friends with past experience of an invasive procedure. Aim: The aim of the study was on the one hand to test the potential beneficial effects of an information brochure on undergoing a cardiac catheterization for the first time and on the other hand to highlight the importance of informing patients before coronary angiography and its beneficial effects on both reducing their fear and anxiety. Methods: Patients were randomly assigned to an experimental group receiving the brochure at least 1 day before the cardiac catheterization (N = 44), or to a control group not receiving the brochure (N = 44). The SFQ, ISQ and STAI tools were distributed to both groups. Results: All experimental subjects in the intervention group read the brochure. The intervention group had significantly lower scores on both short-term and overall fear compared to the control group. However, the fear of the long-term consequences of cardiac catheterization was similar in both groups. Women had higher fear of the short-term consequences of catheterization than men. The control group experienced a mean satisfaction score of 10.9 points (SD= 2.5 points) while the intervention group had a score of 11.1 points respectively (SD= 2.3 points). In addition, 95, 5% of the control group and 88, 6% of the intervention group patients considered that the provision of information could have been improved. In terms of stress, patients with co-morbidities scored 7.39 points higher, meaning they experienced more symptoms of permanent anxiety, compared to patients who did not have an underlying disease. In addition, the more the patients were satisfied with the information provided, the fewer the symptoms of transient anxiety they experienced. Conclusions: Providing information in the form of a brochure regarding cardiac catheterization before the procedure, is of great importance and constitutes an efficient intervention.