Publications by authors named "Theodora Psaltopoulou"

153 Publications

Adolescent Perspectives About Online Hate Speech: Qualitative Analysis in the SELMA Project.

Acta Med Acad 2021 Aug;50(2):264-276

MSc Program "Strategies of Developmental and Adolescent Health", 2nd Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.

Objective: This paper aims to study the views, perceptions and representations of online hate speech among adolescents in the Greek cohort of the SELMA Project.

Methods: Qualitative research was conducted in focus groups of 36 Greek adolescents and the data were processed through thematic analysis method.

Results: The majority was unfamiliar with the term "hate speech" and confused it with cyberbullying. The target characteristics of hate, ethnicity, race, gender, religion, physical weakness, disability, sexual orientation, and appearance emerged. Regarding people involved in hate speech, perpetrators in both hate speech and bullying were described to share common characteristics. The emphasis was placed on the victims' resilience, as well as their socialization, as protective behaviors. Participants stressed the value of the right to freedom of speech, although there was no agreement on its limits. Additionally, it was highlighted that awareness of what is right and wrong is mostly taught by parents, while the role of education was also important. An important finding was that the majority of teenagers were optimistic, supporting the belief that it is possible to find a realistic solution.

Conclusion: The findings support the need for prevention strategies in the school environment, so that adolescents will be able to recognize and potentially combat hate speech in the online and offline worlds.
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http://dx.doi.org/10.5644/ama2006-124.342DOI Listing
August 2021

Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis.

Neurology 2021 Nov 12. Epub 2021 Nov 12.

Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Objective: To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).

Methods: A study was eligible if it enrolled AIS patients older than 18 years, with an LVO treated with either successful or unsuccessful EVT, and provided either individual or mean 24-hour systolic BP values after the end of the EVT procedure. Individual patient data from all studies were analyzed using a generalized linear mixed-effects model.

Results: A total of 5874 patients (mean age: 69±14 years, 50% women, median NIHSS on admission: 16) from 7 published studies were included. Increasing mean systolic BP levels per 10 mm Hg during the first 24 hours after the end of the EVT were associated with a lower odds of functional improvement (unadjusted common OR=0.82, 95%CI:0.80-0.85; adjusted common OR=0.88, 95%CI:0.84-0.93) and modified Ranking Scale score≤2 (unadjusted OR=0.82, 95%CI:0.79-0.85; adjusted OR=0.87, 95%CI:0.82-0.93), and a higher odds of all-cause mortality (unadjusted OR=1.18, 95%CI:1.13-1.24; adjusted OR=1.15, 95%CI:1.06-1.23) at 3 months. Higher 24-hour mean systolic BP levels were also associated with an increased likelihood of early neurological deterioration (unadjusted OR=1.14, 95%CI:1.07-1.21; adjusted OR=1.14, 95%CI:1.03-1.24) and a higher odds of symptomatic intracranial hemorrhage (unadjusted OR=1.20, 95%CI:1.09-1.29; adjusted OR=1.20, 95%CI:1.03-1.38) after EVT.

Conclusion: Increased mean systolic BP levels in the first 24 hours after EVT are independently associated with a higher odds of symptomatic intracranial hemorrhage, early neurological deterioration, three-month mortality, and worse three-month functional outcomes.
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http://dx.doi.org/10.1212/WNL.0000000000013049DOI Listing
November 2021

Consumption of Fruits, Vegetables and Bladder Cancer Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.

Nutr Cancer 2021 Nov 2:1-14. Epub 2021 Nov 2.

Department of Clinical Therapeutics, "Alexandra" Hospital, Medical School, National University of Athens, Athens, Greece.

We examined the association between fruit/vegetable consumption and bladder cancer (BC) risk in a systematic review and meta-analysis of prospective cohort studies stratifying results by gender, smoking status and geographical region. Eligible studies were sought in MEDLINE and EMBASE up to April 20, 2020. Random-effects (DerSimonian-Laird) models were implemented for the calculation of pooled relative risks (RRs) and 95% confidence intervals (CI). Fifteen eligible studies were identified (1,993,881 subjects, 11,097 BC cases). Vegetable consumption (pooled RR = 0.95, 95% CI: 0.87-1.04,  = 10) as well as combined fruit/vegetable consumption was not associated with BC risk. Regarding fruit intake, the overall protective trend did not reach significance (pooled RR = 0.91, 95%CI: 0.81-1.02,  = 11); we found however a significant association in East Asians. A trend toward a protective association with citrus fruit consumption was also noted (pooled RR = 0.83, 95%CI: 0.69-1.01,  = 6), once again with a significant effect in East Asians. Moreover, no association was found regarding the subgroups of leafy vegetables, dark green vegetables, and berries. Single studies pointed to a reduced BC risk in never smoking males consuming cruciferous vegetables and East Asians consuming yellow vegetables. In conclusion, our study reveals possible protective effects; larger studies are needed to investigate the emerging trends.
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http://dx.doi.org/10.1080/01635581.2021.1985146DOI Listing
November 2021

Association Of -308G/A, -238G/A TNF-α Polymorphisms with Multiple Myeloma Risk and Survival: A Systematic Review and Meta-Analysis.

Clin Lymphoma Myeloma Leuk 2021 Aug 31. Epub 2021 Aug 31.

Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Electronic address:

Introduction: Tumor necrosis factor alpha (TNF-α) is a cytokine with a key role in proinflammation and multiple diseases, including cancer. The gene encoding TNF-α is located within a highly polymorphic region on chromosome 6p21.3; two polymorphisms -308G/A (rs1800629) and -238G/A (rs361525) have been associated with occurrence of human diseases. There is a debate in recent meta-analyses that reached discrepant conclusions regarding the potential role of TNF-α polymorphisms in multiple myeloma (MM) risk. The aim of this systematic review and meta-analysis is to investigate the association between the aforementioned two polymorphisms with the risk and survival of MM.

Materials And Methods: Eligible articles were identified through an extensive search in PubMed database (end of search: June 18, 2020). The pooled effect estimates were calculated following the random-effects models by Der Simonian and Laird. Separate analyses were conducted by ethnicity. Between-study heterogeneity was quantified, and the deviation of genotype frequencies in controls from the Hardy-Weinberg equilibrium was evaluated.

Results: Eighteen studies (2934 cases, 4291 controls) have been included in the quantitative synthesis examining risk and 5 studies for survival (557 cases). No association was found between -308G/A and -238G/A TNF-α polymorphisms and MM susceptibility in all genetic models for both Caucasian and East Asian populations. There was no association between -308G/A and -238G/A TNF-α polymorphisms and survival (overall or progression-free) of MM.

Conclusion: This systematic review and meta-analysis did not reveal a significant effect of -308G/A and -238G/A TNF-α polymorphisms upon risk or survival of MM.
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http://dx.doi.org/10.1016/j.clml.2021.08.010DOI Listing
August 2021

Obesity, metabolic syndrome, and cancer: pathophysiological and therapeutic associations.

Endocrine 2021 12 8;74(3):478-497. Epub 2021 Oct 8.

Hematology and Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Overweight, obesity, and metabolic syndrome (MetS) have become epidemic conditions affecting 39%, 13%, and 20% of the population respectively. The aim of this article is to review the literature on the association of obesity and MetS with the risk of cancer. We also explore the effect of lifestyle modifications, such as diet, physical activity, and antidiabetic medications, on cancer incidence. Increased body mass index (BMI) has been associated with a multitude of site-specific cancers, reaching relative risk (RR) 1.54 [95% confidence interval (CI) 1.47-1.61] per 5 unit increase for endometrial cancer, as well as with overall cancer risk (RR 1.03, 95% CI 1.02-1.05). Central adiposity measured by waist circumference or waist-to-hip ratio has been suggested as a stronger predictor than BMI for several cancers, such as colorectal cancer. Metabolic Syndrome has been consistently and positively associated with the risk of very common cancers like colorectal (RR 1.34, 95% CI 1.24-1.44), endometrial (RR 1.62, 95% CI 1.26-2.07) and postmenopausal breast cancer (RR 2.01, 95% CI 1.55-2.60). Hyperglycemia and subsequently T2DM have been also shown to increase the risk of cancer. Nevertheless, these risk factors are modifiable and therefore implementing lifestyle modifications could prevent an important number of cancer cases. Adherence to cancer prevention guidelines, including maintaining a healthy weight, having regular physical exercise (RR 0.58-0.90 for different cite specific cancers) and following a healthy dietary pattern (RR 0.74-0.94 for different cite specific cancers) have a protective effect on the risk of cancer. The strength of this review is the presentation of the best evidence, as the data derive mainly from meta-analyses. Public health policies should focus on the modification of risk factors and future research is needed to reveal the pathophysiological links between these risk factors and cancer to develop more efficient prevention and treatment strategies.
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http://dx.doi.org/10.1007/s12020-021-02884-xDOI Listing
December 2021

Occupational Exposure and Multiple Myeloma Risk: An Updated Review of Meta-Analyses.

J Clin Med 2021 Sep 16;10(18). Epub 2021 Sep 16.

Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece.

The precise etiology of multiple myeloma remains elusive, but both genetic and environmental factors have been suggested to contribute to disease risk. Several occupational categories and toxic agents have been implicated as potentially causative, yet findings from the literature are inconsistent. The aim of this review was to summarize and critically comment on the accumulated epidemiological evidence, across published meta-analyses, about the association between occupational exposure and risk of multiple myeloma. Overall, results from eleven meta-epidemiological studies underscore a significantly increased risk for firefighters, hairdressers, and employees exposed to engine exhaust, whereas farming and methylene chloride exposure have been non-significantly correlated with the disease. Further epidemiological studies are of utmost importance whilst emphasis should be placed on occupational hazard surveillance, as such studies will obtain a more accurate picture of disease occurrence in working populations, and will enable both the implementation of preventive actions and the evaluation of their effectiveness.
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http://dx.doi.org/10.3390/jcm10184179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469366PMC
September 2021

Play Behaviors in Children during the COVID-19 Pandemic: A Review of the Literature.

Children (Basel) 2021 Aug 17;8(8). Epub 2021 Aug 17.

2nd Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.

Play is a key factor for children's healthy psychological, emotional, social, and cognitive development. During the COVID-19 pandemic, it has been postulated that children's play was affected, not only regarding the time children spent playing but also in terms of the qualitative characteristics of play. The aim of this review was to investigate how children's play has changed during the COVID-19 pandemic. A review was conducted in the PubMed, Google Scholar, EMBASE, SCOPUS, ERIC, PsycInfo, and JSTOR databases up to 6 December 2020. Furthermore, references of eligible studies as well as of relevant articles were searched using a snowballing technique. The search retrieved 17 eligible studies, conducted in Europe and North America. In general, outdoor play was reduced during the pandemic; on the other hand, there was an increase in indoor play and in videogames-screen time. COVID-19 was present in children's pretend play. Children's play was a key contributor to children's mood and wellbeing. Furthermore, teachers were especially concerned about how children's play was affected during the lockdown measures. There is evidence that children's play habits were affected during the COVID-19 pandemic; further research is required, especially cross-culturally oriented.
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http://dx.doi.org/10.3390/children8080706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393419PMC
August 2021

Psychometric Properties of the Greek Version of the Medical Office on Patient Safety Culture in Primary Care Settings.

Medicines (Basel) 2021 Jul 26;8(8). Epub 2021 Jul 26.

Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece.

Background: Safety culture is considered one of the most crucial premises for further development of patient care in healthcare. During the eight-year economic crisis (2010-2018), Greece made significant reforms in the way the primary health care system operates, aiming at the more efficient operation of the system without degrading issues of safety and quality of the provided health services. In this context, this study aims to validate a specialized tool-the Medical Office Survey on Patient Safety Culture (MOSPSC)-developed by the Agency for Healthcare Research and Quality (AHRQ) to evaluate primary care settings in terms of safety culture and quality.

Methods: Factor analysis determined the correlation of the factor structure in Greek data with the original questionnaire. The relation of the factor analysis with the Cronbach's coefficient alpha was also determined, including the construct validity.

Results: Eight composites with 34 items were extracted by exploratory factor analysis, with acceptable Cronbach's alpha coefficients and good construct validity. Consequently, the composites jointly explained 62% of the variance in the responses. Five items were removed from the original version of the questionnaire. As a result, three out of the eight composites were a mixture of items from different compounds of the original tool. The composition of the five factors was similar to that in the original questionnaire.

Conclusions: The MOSPSC tool in Greek primary healthcare settings can be used to assess patient safety culture in facilities across the country. From the study, the patient safety culture in Greece was positive, although few composites showed a negative correlation and needed improvement.
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http://dx.doi.org/10.3390/medicines8080042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401961PMC
July 2021

Sonothrombolysis in Patients With Acute Ischemic Stroke With Large Vessel Occlusion: An Individual Patient Data Meta-Analysis.

Stroke 2021 Dec 25;52(12):3786-3795. Epub 2021 Aug 25.

Department of Neurology, University of Tennessee Health Sciences Center, Memphis (G.T., A.W.A., A.V.A.).

Background And Purpose: Evidence about the utility of ultrasound-enhanced thrombolysis (sonothrombolysis) in patients with acute ischemic stroke (AIS) is conflicting. We aimed to evaluate the safety and efficacy of sonothrombolysis in patients with AIS with large vessel occlusion, by analyzing individual patient data of available randomized-controlled clinical trials.

Methods: We included all available randomized-controlled clinical trials comparing sonothrombolysis with or without addition of microspheres (treatment group) to intravenous thrombolysis alone (control group) in patients with AIS with large vessel occlusion. The primary outcome measure was the rate of complete recanalization at 1 to 36 hours following intravenous thrombolysis initiation. We present crude odds ratios (ORs) and ORs adjusted for the predefined variables of age, sex, baseline stroke severity, systolic blood pressure, and onset-to-treatment time.

Results: We included 7 randomized controlled clinical trials that enrolled 1102 patients with AIS. A total of 138 and 134 confirmed large vessel occlusion patients were randomized to treatment and control groups respectively. Patients randomized to sonothrombolysis had increased odds of complete recanalization compared with patients receiving intravenous thrombolysis alone (40.3% versus 22.4%; OR, 2.17 [95% CI, 1.03-4.54]; adjusted OR, 2.33 [95% CI, 1.02-5.34]). The likelihood of symptomatic intracranial hemorrhage was not significantly different between the 2 groups (7.3% versus 3.7%; OR, 2.03 [95% CI, 0.68-6.11]; adjusted OR, 2.55 [95% CI, 0.76-8.52]). No differences in the likelihood of asymptomatic intracranial hemorrhage, 3-month favorable functional and 3-month functional independence were documented.

Conclusions: Sonothrombolysis was associated with a nearly 2-fold increase in the odds of complete recanalization compared with intravenous thrombolysis alone in patients with AIS with large vessel occlusions. Further study of the safety and efficacy of sonothrombolysis is warranted.
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http://dx.doi.org/10.1161/STROKEAHA.120.030960DOI Listing
December 2021

Early and late endocrine complications of COVID-19.

Endocr Connect 2021 Sep 20;10(9):R229-R239. Epub 2021 Sep 20.

Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Endocrine system plays a vital role in controlling human homeostasis. Understanding the possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19-infected patients as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express angiotensin-converting enzyme 2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with low triiodothyronine, low thyroid stimulating hormone, or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited, and therefore, long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.
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http://dx.doi.org/10.1530/EC-21-0184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8494407PMC
September 2021

Domestic Violence During the COVID-19 Pandemic: A Systematic Review.

Trauma Violence Abuse 2021 Aug 17:15248380211038690. Epub 2021 Aug 17.

Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, Greece.

Background: COVID-19 outbreak and the followed confinement measures have raised concerns to specialists worldwide regarding the imminent increase in domestic violence cases. The present systematic review aims to identify the international trends in domestic violence during the COVID-19 epidemic and to examine the possible differences among all population groups and different geographic areas worldwide.

Method: The following databases were accessed: DOAJ, ERIC, Google Scholar, ProQuest, Pubmed, PsycNet, and SCOPUS, up to July 22, 2020.

Results: A total of 32 studies were considered eligible. Data from North America, Europe, Asia-Pacific Area, Africa, and worldwide researches were retrieved. COVID-19 has caused an increase in domestic violence cases, especially during the first week of the COVID-19 lockdown in each country. In children, however, although the specialists' estimations suggested an increase in child maltreatment and abuse cases, the rate of police and social services' reports has declined during the COVID-19 pandemic. School closures that isolated students at home seemed to have contributed to this decrease.

Conclusions: Domestic violence has been a considerable issue imposed by the COVID-19 epidemic to a worldwide context. The home confinement led to constant contact between perpetrators and victims, resulting in increased violence and decreased reports. In order to minimize such issues, prevention measures and supporting programs are necessary.
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http://dx.doi.org/10.1177/15248380211038690DOI Listing
August 2021

Exposure to pesticides and childhood leukemia risk: A systematic review and meta-analysis.

Environ Pollut 2021 Sep 18;285:117376. Epub 2021 May 18.

Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110, Greece; Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA; Institute of Biosciences, University Research Center of Loannina, University of Ioannina, Ioannina, Greece. Electronic address:

Despite the abundance of epidemiological evidence concerning the association between pesticide exposure and adverse health outcomes including acute childhood leukemia (AL), evidence remains inconclusive, and is inherently limited by heterogeneous exposure assessment and multiple statistical testing. We performed a literature search of peer-reviewed studies, published until January 2021, without language restrictions. Summary odds ratios (OR) and 95% confidence intervals (CI) were derived from stratified random-effects meta-analyses by type of exposure and outcome, exposed populations and window of exposure to address the large heterogeneity of existing literature. Heterogeneity and small-study effects were also assessed. We identified 55 eligible studies (n = 48 case-control and n = 7 cohorts) from over 30 countries assessing >200 different exposures of pesticides (n = 160,924 participants). The summary OR for maternal environmental exposure to pesticides (broad term) during pregnancy and AL was 1.88 (95%CI: 1.15-3.08), reaching 2.51 for acute lymphoblastic leukemia (ALL; 95%CI: 1.39-4.55). Analysis by pesticide subtype yielded an increased risk for maternal herbicide (OR: 1.41, 95%CI: 1.00-1.99) and insecticide (OR: 1.60, 95%CI: 1.11-2.29) exposure during pregnancy and AL without heterogeneity (p = 0.12-0.34). Meta-analyses of infant leukemia were only feasible for maternal exposure to pesticides during pregnancy. Higher magnitude risks were observed for maternal pesticide exposure and infant ALL (OR: 2.18, 95%CI: 1.44-3.29), and the highest for infant acute myeloid leukemia (OR: 3.42, 95%CI: 1.98-5.91). Overall, the associations were stronger for maternal exposure during pregnancy compared to childhood exposure. For occupational or mixed exposures, parental, and specifically paternal, pesticide exposure was significantly associated with increased risk of AL (OR: 1.75, 95%CI: 1.08-2.85; OR: 1.20, 95%CI: 1.07-1.35). The epidemiological evidence, supported by mechanistic studies, suggests that pesticide exposure, mainly during pregnancy, increases the risk of childhood leukemia, particularly among infants. Sufficiently powered studies using repeated biomarker analyses are needed to confirm whether there is public health merit in reducing prenatal pesticide exposure.
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http://dx.doi.org/10.1016/j.envpol.2021.117376DOI Listing
September 2021

Sexual Activity in Adolescents and Young Adults through COVID-19 Pandemic.

Children (Basel) 2021 Jul 5;8(7). Epub 2021 Jul 5.

2nd Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.

During the COVID-19 pandemic, it has been postulated that the sexual life of adolescent and young adults has been impacted in various aspects, potentially affecting their well-being. Our aim is to investigate the potential changes in the sexual activity and relationships of adolescents and young adults during the COVID-19 pandemic. In general, a decrease in sexual desire was reported during the COVID-19 pandemic, in both genders. Fewer sexual intercourses and bonding behaviors between partners were associated with loneliness and depressive symptoms. On the contrary, an increase in sexual desire was expressed in a few people, with masturbation to be the most preferable means of satisfaction. The present paper highlights the multifaceted impact of COVID-19 upon the sexual life of adolescents and young adults during the ongoing pandemic. The changes observed in their sexual activity and relationships, could provide the basis of future preventive and educational programs.
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http://dx.doi.org/10.3390/children8070577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306416PMC
July 2021

Patient Safety Culture Assessment in Primary Care Settings in Greece.

Healthcare (Basel) 2021 Jul 13;9(7). Epub 2021 Jul 13.

Department of Hegiene, School of Medicine, University of Athens, 115 27 Athens, Greece.

Introduction: A positive safety culture is considered a pillar of safety in health organizations and the first crucial step for quality health services. In this context, the aim of this study was to set a reference evaluation for the patient safety culture in the primary health sector in Greece, based on health professionals' perceptions.

Methods: We used a cross-sectional survey with a 62% response rate ( = 459), conducted in primary care settings in Greece (February to May 2020). We utilized the "Medical Office Survey on Patient Safety Culture" survey tool from the Agency for Healthcare Research and Quality (AHRQ). The study participants were health professionals who interacted with patients from 12 primary care settings in Greece.

Results: The most highly ranked domains were: "Teamwork" (82%), "Patient Care Tracking/Follow-up" (80% of positive scores), and "Organizational Learning" (80%); meanwhile, the lowest-ranked ones were: "Leadership Support for Patient Safety" (62%) and "Work Pressure and Pace" (46%). The other domains, such as "Overall Perceptions of Patient Safety and Quality" (77%), "Staff Training" (70%), "Communication about Error" (70%), "Office Processes and Standardization" (67%), and "Communication Openness" (64%), ranked somewhere in between.

Conclusions: A positive safety culture was identified in primary care settings in Greece, although weak areas concerning the safety culture should be addressed in order to improve patient safety.
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http://dx.doi.org/10.3390/healthcare9070880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304977PMC
July 2021

Association of obesity and other anthropometric characteristics with bladder cancer risk: a systematic review and meta-analysis of longitudinal cohort studies.

J BUON 2021 May-Jun;26(3):1040-1055

2nd Department of Urology, Sismanoglio Hospital , Medical School, National and Kapodistrian University of Athens, Sismanogliou 37 street, Athens, Greece.

Purpose: The purpose of this systematic review and meta-analysis was to evaluate the potential associations between anthropometric characteristics and bladder cancer risk, synthesizing longitudinal cohort studies.

Methods: Literature search across MEDLINE, EMBASE, Scopus, Google Scholar and Cochrane Central was performed up to December 31, 2019 and data abstraction was performed independently by two authors. Random-effects (DerSimonian-Laird) models were used to estimate pooled relative risks (RR) and 95% confidence intervals (95%CI); subgroup analyses were performed in geographical region, mean age, publication year, length of follow-up, sample size, method of body mass index (BMI) estimation and adjustment for smoking.

Results: 27 studies were included (88 593 bladder cancer cases in a total cohort of 49 647 098 subjects). Increased bladder cancer risk was noted in overweight men (pooled RR=1.12, 95%CI: 1.04-1.21) but not in overweight women. Both obese men (pooled RR=1.14, 95%CI: 1.06-1.22) and women (pooled RR=1.19, 95%CI: 1.02-1.38) showed increased risk. Interestingly, height increase per 5 cm did not seem to affect risk of bladder cancer in men (pooled RR=1.03, 95%CI: 0.99- 1.06) and women (pooled RR=1.02, 95%CI: 0.97-1.06). Larger waist circumference was associated with bladder cancer risk in men (pooled RR=1.18, 95%CI: 1.09-1.26) but not women.

Conclusion: Bladder cancer risk seems to be related with obesity overall and central obesity in men. In contrast to other cancer types, height does not seem to affect risk, but more studies are needed to extract safe conclusions.
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July 2021

A Mediterranean diet microsimulation modeling in relation to cardiovascular disease burden: the ATTICA and GREECS epidemiological studies.

Eur J Clin Nutr 2021 Jul 6. Epub 2021 Jul 6.

Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.

Background/objectives: To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet.

Subjects/methods: An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths.

Results: Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect).

Conclusions: This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part.
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http://dx.doi.org/10.1038/s41430-021-00967-6DOI Listing
July 2021

Effects of Nutrition, and Physical Activity Habits and Perceptions on Body Mass Index (BMI) in Children Aged 12-15 Years: A Cross-Sectional Study Comparing Boys and Girls.

Children (Basel) 2021 Apr 3;8(4). Epub 2021 Apr 3.

Department of Endocrinology, Children's Hospital P. & A. Kyriakou, Thivon & Levadeiasstr, Ampelokipoi T.K., 11527 Athens, Greece.

: The aim of the present study was to examine the effects of socioeconomic status, nutrition and physical activity lifestyle habits and perceptions on Body Mass Index (BMI) in children aged 12-15 years in Greece. Furthermore, to compare the difference between the two sexes. This is a cross-sectional study conducted on a representative secondary school cohort that included 5144 subjects, aged 12 to 15 years. Students and their parents filled in validated questionnaires evaluating socioeconomic status, nutrition and physical activity. International Obesity Task Force cut offs were used to classify the children. Factor analysis of mixed data and partial proportional ordered logistic models were used to analyze ΒMΙ distributions. All analyses were stratified by gender. Boys were 2.9 (95%CI: 2.592-3.328) times more likely to be overweight/obese than girls. Partial proportional ordinal models indicate significant associations between nutritional and physical habits and perceptions variables but also significant gender differences in socio-demographic, nutritional risk factors as well as physical activity habits and perceptions. A clear understanding of the factors that contribute to the sex differences in nutrition and physical activity habits and perceptions may guide intervention efforts.
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http://dx.doi.org/10.3390/children8040277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066370PMC
April 2021

The relationship of the built and food environments with the metabolic syndrome in the Athens metropolitan area: a sex-stratified spatial analysis in the context of the ATTICA epidemiological study.

Hormones (Athens) 2021 Dec 16;20(4):723-734. Epub 2021 Apr 16.

Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave., 17671, Athens, Kallithea, Greece.

Purpose: The built and food environments are widely acknowledged to play an important role in defining human health by influencing, among others, behaviors such as nutrition habits and physical activities. The aim of this study was to identify the spatial variability of the sex-specific prevalence of the metabolic syndrome (MetS) and its environmental determinants in the Athens metropolitan area.

Methods: Data on the prevalence of the MetS were provided by the ATTICA epidemiological study for 2749 participants, with complete data for geographical identification (1375 women [44 years old {SD = 14 years}] and 1374 men [45 years old {SD = 13 years}]), while socioeconomic, demographic, and environmental characteristics were provided by official national and international databases.

Results: Approximately 20% of the people residing in the study area were diagnosed with MetS, with its prevalence being almost two times higher in men compared to women. Areas more extensively covered by green urban spaces and sports facilities were shown to have a lower prevalence of MetS, while greater density and availability of supermarkets and street markets were inversely related to MetS prevalence in both sexes. In addition, the present analysis revealed that the beneficial role of the built environment's characteristics on MetS prevalence was significantly stronger in the male population, while the preventive effect of the food environment's characteristics was almost 1.5 times stronger in the female population CONCLUSION: Although individualized prevention and treatment approaches are necessary to decrease the burden of MetS, environmental modifications that promote healthy behaviors represent an essential health approach.
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http://dx.doi.org/10.1007/s42000-021-00293-3DOI Listing
December 2021

Cyberbullying and Obesity in Adolescents: Prevalence and Associations in Seven European Countries of the EU NET ADB Survey.

Children (Basel) 2021 Mar 18;8(3). Epub 2021 Mar 18.

MSc Program "Strategies of Developmental and Adolescent Health", 2nd Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.

Background: overweight and obese individuals may often face aggressive messages or comments on the internet. This study attempts to evaluate the association between cyberbullying victimization and overweight/obesity in adolescents participating in the European Network for Addictive Behavior (EU NET ADB) survey.

Methods: a school-based cross-sectional study of adolescents aged 14-17.9 years was conducted ( = 8785) within the EU NET ADB survey, including data from seven European countries (Germany, Greece, Iceland, the Netherlands, Romania, Poland, Spain). Complex samples and univariate and multivariate logistic regression analyses were performed.

Results: overall, overweight adolescents were more likely to have been cyberbullied compared to their normal weight peers (adjusted OR (Odds ratio) = 1.20, CI (confidence intervals): 1.01-1.42); this association was pronounced in Germany (adjusted OR = 1.58, CI: 1.11-2.25). In Iceland, obese adolescents reported cyberbullying victimization more frequently compared to their normal weight peers (adjusted OR = 2.87, 95% CI: 1.00-8.19). No significant associations with cyberbullying victimization were identified either for obese or overweight adolescents in Greece, Spain, Romania, Poland, and the Netherlands.

Conclusions: this study reveals an overall association between cyberbullying victimization and overweight on the basis of a sizable, representative sample of adolescent population from seven European countries. Country-specific differences might reflect differential behavioral perceptions, but also normalization aspects.
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http://dx.doi.org/10.3390/children8030235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003084PMC
March 2021

Tracing Ocular Conditions in 15,921 Interwar Refugees, Veria, Greece (1926-1940).

Acta Med Acad 2020 Dec;49(3):292-296

Department of History of Medicine and Medical Deontology, Medical School, University of Crete, Greece.

Objective: This historical epidemiological study aims to investigate ocular conditions in Greek refugees during the Interwar period (1926-1940) in the region of Imathia, Greece.

Materials And Methods: The archival material encompasses 15,921 patients who were admitted to the Refugee Hospital of Veria, Imathia, Greece. Descriptive statistics were estimated.

Results: Twenty-two cases of ocular conditions were identified. Ten patients had anterior segment conditions, such as keratitis, blepharoconjunctivitis, conjunctivitis, epithelioma, leukoma and an operated cataract. Another patient was diagnosed with ocular trachoma. Four patients presented sympathetic ophthalmia; two additional patients suffered from ophthalmia due to syphilis. One patient was diagnosed with ocular malaria. Four cases of ocular traumas were recorded, among which an ocular burn due to gunpowder, a motorcycle accident leading to a retro-ocular hematoma, and a kick in the eye resulting in ocular trauma were notable.

Conclusion: The disease spectrum in Greek refugees reflects the adverse conditions during the Interwar era.
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http://dx.doi.org/10.5644/ama2006-124.319DOI Listing
December 2020

Neuroimaging Findings in Adolescents and Young Adults with Anorexia Nervosa: A Systematic Review.

Children (Basel) 2021 Feb 12;8(2). Epub 2021 Feb 12.

MSc "Strategies of Developmental and Adolescent Health", 2nd Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.

Background: Anorexia nervosa (AN) is a serious, multifactorial mental disorder affecting predominantly young females. This systematic review examines neuroimaging findings in adolescents and young adults up to 24 years old, in order to explore alterations associated with disease pathophysiology.

Methods: Eligible studies on structural and functional brain neuroimaging were sought systematically in PubMed, CENTRAL and EMBASE databases up to 5 October 2020.

Results: Thirty-three studies were included, investigating a total of 587 patients with a current diagnosis of AN and 663 healthy controls (HC). Global and regional grey matter (GM) volume reduction as well as white matter (WM) microstructure alterations were detected. The mainly affected regions were the prefrontal, parietal and temporal cortex, hippocampus, amygdala, insula, thalamus and cerebellum as well as various WM tracts such as corona radiata and superior longitudinal fasciculus (SLF). Regarding functional imaging, alterations were pointed out in large-scale brain networks, such as default mode network (DMN), executive control network (ECN) and salience network (SN). Most findings appear to reverse after weight restoration. Specific limitations of neuroimaging studies in still developing individuals are also discussed.

Conclusions: Structural and functional alterations are present in the early course of the disease, most of them being partially or totally reversible. Nonetheless, neuroimaging findings have been open to many biological interpretations. Thus, more studies are needed to clarify their clinical significance.
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http://dx.doi.org/10.3390/children8020137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918703PMC
February 2021

Continuing Cancer Therapy through the Pandemic While Protecting Our Patients: Results of the Implementation of Preventive Strategies in a Referral Oncology Unit.

Cancers (Basel) 2021 Feb 12;13(4). Epub 2021 Feb 12.

Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece.

Cancer patients infected with SARS-CoV-2 have worse outcomes, including higher morbidity and mortality than the general population. Protecting this vulnerable group of patients from COVID-19 is of the utmost importance for the continuous operation of an oncology unit. Preventive strategies have been proposed by various societies, and centers around the world have implemented these or modified measures; however, the efficacy of these measures has not been evaluated. In our center, a referral oncology/hematology unit in Athens, Greece, we implemented strict protective measures from the outset of the pandemic in the country and we have prospectively recorded the epidemiological characteristics of COVID-19. Among 11,618 patient visits performed in our unit, 26 patients (case-to-visit ratio of 0.22%) were found positive for SARS-CoV-2, including 4 (1%) among 392 patients that were screened before starting primary systemic treatment. Among patients tested positive for SARS-CoV-2, 22 were symptomatic at the time of diagnosis; subsequently, 12 required hospitalization and 5 died due to COVID-19. Detailed contact tracing indicated that there was no in-unit transmission of the infection. Thus, strict implementation of multilevel protective strategies along with a modestly intense screening program allowed us to continue cancer care in our unit through the pandemic.
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http://dx.doi.org/10.3390/cancers13040763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918613PMC
February 2021

Obesity in Children and Adolescents during COVID-19 Pandemic.

Children (Basel) 2021 Feb 12;8(2). Epub 2021 Feb 12.

2nd Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.

Background: The COVID-19 pandemic has led to special circumstances and changes to everyday life due to the worldwide measures that were imposed such as lockdowns. This review aims to evaluate obesity in children, adolescents and young adults during the COVID-19 pandemic.

Methods: A literature search was conducted to evaluate pertinent studies up to 10 November 2020.

Results: A total of 15 articles were eligible; 9 identified 17,028,111 children, adolescents and young adults from 5-25 years old, 5 pertained to studies with an age admixture ( = 20,521) and one study included parents with children 5-18 years old ( = 584). During the COVID-19 era, children, adolescents and young adults gained weight. Changes in dietary behaviors, increased food intake and unhealthy food choices including potatoes, meat and sugary drinks were noted during the ongoing COVID-19 pandemic. Food insecurity associated with financial reasons represents another concern. Moreover, as the restrictions imposed reduced movements out of the house, physical activity was limited, representing another risk factor for weight gain.

Conclusions: COVID-19 restrictions disrupted the everyday routine of children, adolescents and young adults and elicited changes in their eating behaviors and physical activity. To protect them, health care providers should highlight the risk of obesity and provide prevention strategies, ensuring also parental participation. Worldwide policies, guidelines and precautionary measures should ideally be established.
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http://dx.doi.org/10.3390/children8020135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918914PMC
February 2021

Overweight/Obesity and Monoclonal Gammopathy of Undetermined Significance.

Clin Lymphoma Myeloma Leuk 2021 06 15;21(6):361-367. Epub 2021 Jan 15.

Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Background: Obesity and high body mass index (BMI) are associated with increased incidence of multiple myeloma (MM). MM usually evolves from a precursor asymptomatic disease, namely monoclonal gammopathy of undetermined significance (MGUS). MGUS progresses to MM at a 1% annual rate; however, risk factors predisposing to MGUS are not completely understood. We conducted a systematic review to assess the relationship between obesity and high BMI with MGUS prevalence and progression to MM. To our knowledge, this is the first systematic review evaluating the role of obesity in MGUS.

Patients And Methods: We searched the Medline database and ClinicalTrials.gov for studies investigating BMI and obesity association with MGUS incidence and progression. The algorithm consisted of a predefined combination of the words "obesity," "obese," "body mass index," "overweight," "diet," "nutrition," "food," "dietary," "adiponectin," "monoclonal gammopathy," and "MGUS".

Results: Overall, 12 articles were retrieved, including 11 eligible articles and 1 clinical trial. More than 57,068 patients were evaluated in this systematic review. Discrepancies between the identified studies were noted. Multiple studies support the notion that obesity or high BMI are positively linked to MGUS prevalence and transition to MM. In contrast, other studies revealed no such association. Visceral adipose tissue metabolic activity and decreased adiponectin concentrations were identified as biomarkers of MGUS progression to MM.

Conclusion: Obesity and increased BMI seem to be implicated both in MGUS development and progression to MM. Further studies should be designed to confirm this hypothesis.
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http://dx.doi.org/10.1016/j.clml.2021.01.008DOI Listing
June 2021

Integrin expression in correlation to clinicopathological features and prognosis of prostate cancer: A systematic review and meta-analysis.

Urol Oncol 2021 04 6;39(4):221-232. Epub 2021 Feb 6.

Department of Clinical Therapeutics, "Alexandra" Hospital, National and Kapodistrian University of Athens, Greece.

Background: The prompt identification of patients with poor prognosis is essential in order to improve the treatment outcomes in prostate cancer (CaP); as a novel approach, several molecular markers, including integrins, have been discussed as prognostic biomarkers. Our aim was to comprehensively examine aberrant expression of integrins in correlation with clinicopathological features and prognosis in CaP by synthesizing all available evidence, in a systematic review and meta-analysis.

Methods: A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Scientific literature databases (Pubmed, Embase, and Scopus) were systematically searched until May 10, 2020. Random-effects (DerSimonian-Laird) models were used to estimate pooled odds ratios (ORs) for cross-sectional correlations with clinicopathological characteristics and relative risks for longitudinal associations with prognosis.

Results: Fourteen studies were included with a total number of 3,194 CaP cases examined (13 cross-sectional and four longitudinal cohort study arms). Correlation of low expression of α (pooled OR = 0.10, 95% confidence interval [CI]: 0.04-0.28, P < 0.001) and β (pooled OR = 0.45; 95% CI: 0.21-1.00, P = 0.049) integrin with high Gleason score was noted. A borderline trend between reduced expression of α integrin and an advanced clinical stage of CaP (pooled OR = 0.48; 95% CI: 0.22-1.03, P = 0.06) was observed. No associations with biochemical recurrence and survival were documented.

Conclusions: Evidence on the association of low expression of integrins α and β and more advanced CaP exist, whereas significant results on survival were not documented; further studies are warranted.
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http://dx.doi.org/10.1016/j.urolonc.2020.12.024DOI Listing
April 2021

Sexually Transmitted Infections in a Cohort of 15,921 Refugees (1926-1940) in the Region of Imathia, Northern Greece.

Acta Dermatovenerol Croat 2020 Dec;28(3):180-187

Spyros N. Michaleas, BA, MA, PhD candidate, Department of History of Medicine and Medical Deontology, Medical School, University of Crete, Heraklion, Greece;

This historical epidemiological study evaluates sexually transmitted infections (STIs) among Greek refugees during the Interwar period in the region of Imathia, Central Macedonia, Greece, as a part of the effort against sexually transmitted infections in Greece (1910-1940). We examined the archives of the Refugee Hospital of Veroia - the capital of the regional unit of Imathia (March 5, 1926 to October 27, 1940). This is a report of previously unpublished primary material comprising a cohort of 15,921 cases, among whom 41 patients were hospitalized on account of syphilis and 19 on account of gonococcal infection. Descriptive statistics were estimated. Primary (n=4), secondary (n=2), tertiary (n=13), congenital (n=7), and not further specified (n=15) cases of syphilis were identified, whereas a variety of differential diagnosis problems arose. Syphilis and gonococcal infection/gonorrhea seemed to affect various social groups, as evidenced by the variety of professions involved. Refugee patients originated from various areas such as Caucasus, Thrace, Constantinople, Bithynia, and Pontus. Lack of information and poor healthcare led to spreading of STIs in Greece. Law 3032/1922 was crucial for the Greek effort against sexually transmitted infections.
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December 2020

Vegetarian Diets and Eating Disorders in Adolescents and Young Adults: A Systematic Review.

Children (Basel) 2020 Dec 28;8(1). Epub 2020 Dec 28.

MSc Program "Strategies of Developmental and Adolescent Health", 2nd Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.

Background: Eating disorders are more common among adolescents and young adults. An increase in the rates of these disorders has been reported during the last years. Meanwhile, vegetarianism is becoming more popular in these age groups. The purpose of the present paper is to evaluate the association between eating disorders and vegetarian diets in adolescents and young adults.

Methods: Systematic review of related articles published in PubMed, PsycInfo and Google Scholar up to 30 May 2019.

Results: A total of 20 studies (14,391 subjects) were deemed eligible for this systematic review. The majority of the studies reported significant correlations between vegetarianism and eating disorders. However, due to the cross-sectional design, a causal link between eating disorders and vegetarian status cannot be established.

Conclusions: Vegetarianism seems to be associated with eating disorders. Longitudinal studies are needed to establish temporal patterns between vegetarianism and the emergence of disordered eating.
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http://dx.doi.org/10.3390/children8010012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823335PMC
December 2020

Psychosocial health of adolescents in relation to underweight, overweight/obese status: the EU NET ADB survey.

Eur J Public Health 2021 04;31(2):379-384

MSc Program "Strategies of Developmental and Adolescent Health", 2nd Department of Pediatrics, "P.&A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Background: Both deviations from normal weight, namely, underweight and overweight/obese status, have been inversely associated with psychosocial health in adolescents. This study aimed to examine the relationship between psychosocial health and body mass index (BMI) among adolescents in five European countries, while assessing the effect of sociodemographic variables.

Methods: A cross-sectional school-based study of adolescents aged 14-17.9 years was conducted in the framework of the European Network for Adolescent Addictive Behavior survey. Self-reported questionnaires from Greece, Iceland, the Netherlands, Romania and Spain were used for the current analysis. Associations between Youth Self-Report (YSR) scales and BMI status were investigated by multiple logistic regression analysis. The effect of sociodemographic variables was also measured.

Results: Τhe sample consisted of 7005 adolescents aged 14-17.9 years. Borderline/clinical scores on some YSR scales were independently associated with overweight/obesity, specifically total problems (OR = 1.52, 95% CI: 1.18-1.96), internalizing ( OR = 1.48, 95% CI: 1.16-1.91), externalizing (OR = 1.36, 95% CI: 1.10-1.68), social (OR = 1.67, 95% CI: 1.19-2.35) and thought problems (OR = 1.62, 95% CI: 1.20-2.20). Among subscales, overweight/obesity specifically correlated with anxiety/depression (OR = 1.83, 95% CI: 1.33-2.51), withdrawal/depression (OR = 1.58, 95% CI: 1.02-2.48) and rule-breaking behavior (OR = 1.55, 95% CI: 1.15-2.08). Underweight was associated with problems on activities (OR = 1.31, 95% CI: 1.01-1.68) and withdrawal/depression (OR = 1.95, 95% CI: 1.27-3.01).

Conclusions: Lower levels of psychosocial health are associated with both deviations from normal weight. These findings suggest the need for health policies that target health habits and lifestyle, as well as positive attitudes towards the body image, with respect to the different psychosocial characteristics of each body weight status category.
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http://dx.doi.org/10.1093/eurpub/ckaa189DOI Listing
April 2021

Emerging treatment strategies for COVID-19 infection.

Clin Exp Med 2021 May 30;21(2):167-179. Epub 2020 Oct 30.

Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, 80 Vas. Sofias Avenue, 11528, Athens, Greece.

The new type of coronavirus (COVID-19), SARS-CoV-2 originated from Wuhan, China and has led to a worldwide pandemic. COVID-19 is a novel emerging infectious disease caused by SARS-CoV-2 characterized as atypical pneumonia. As of July 1, 2020, more than 10 million people worldwide had been infected with SARS-CoV-2. The typical manifestations of COVID-19 include fever, sore throat, fatigue, cough, and dyspnoea combined with recent exposure. Most of the patients with COVID-19 have mild or moderate disease, however up to 5-10% present with severe and even life-threatening disease course. The mortality rates are approximately 2%. Therefore, there is an urgent need for effective and specific antiviral treatment. Currently, supportive care measures such as ventilation oxygenation and fluid management remain the standard of care. Several clinical trials are currently trying to identify the most potent drug or combination against the disease, and it is strongly recommended to enroll patients into ongoing trials. Antivirals can be proven as safe and effective only in the context of randomized clinical trials. Currently several agents such as chloroquine, hydroxychloroquine, favipiravir, monoclonal antibodies, antisense RNA, corticosteroids, convalescent plasma and vaccines are being evaluated. The large numbers of therapeutic interventions aim to define the most efficacious regimen. The aim of this article is to describe the treatment strategies that have been used for COVID-19 patients and review all the available literature.
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http://dx.doi.org/10.1007/s10238-020-00671-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598940PMC
May 2021

Effects of Body Mass Index (BMI), demographic and socioeconomic factors on organized physical activity (OPA) participation in children aged 6-15 years: a cross-sectional study comparing primary and secondary school children in Greece.

BMC Pediatr 2020 10 22;20(1):491. Epub 2020 Oct 22.

Department of Endocrinology, Children's Hospital P. & A. Kyriakou, Thibon & Levadeias str, Ampelokipoi T.K, 11527, Athens, Greece.

Background: The aim of the present study was to examine the influence of body mass index category, as well as of demographic and socioeconomic factors on the participation in organized physical activity (OPA) of schoolchildren attending primary and secondary school in Greece. Furthermore, to compare the difference between the two levels.

Methods: This is a cross-sectional study conducted on a representative elementary and secondary school cohort, derived using stratification and probability proportional to size (PPS) methodology. The final sample included 18,264 subjects, aged 6 to 15 years. Parents of all students and students of secondary schools fulfilled validated questionnaires evaluating socioeconomic status, and participation to OPA. International Obesity Task Force (IOTF) cut offs were used to classify the children. Univariate and multivariate logistic models examined factors associated with OPA. All analyses were stratified by school level.

Results: Sport participation was not reported in 37.7 and 54.4% of primary and secondary schoolchildren respectively. Having BMI within normal range, being male, having parents participating in an organized activity and a high socio-economic status seem to encourage participation in OPA in both school levels.

Conclusions: Children with normal BMI are more likely to participate in OPA. Parents as role model as well as higher socioeconomic status of the family emerge as important influencers. Participation in OPA declines as students enter secondary school. Interventions focusing on increasing physical education and activity into school daily program should be tailored to the specific needs of different weight categories and can possibly eliminate the impact of SES inequalities.
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http://dx.doi.org/10.1186/s12887-020-02276-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583225PMC
October 2020
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