Children with autism in the Greek educational system: ongoing challenges during the COVID-19 pandemic

The inclusion of children with autism spectrum disorder (ASD) in typical educational settings has only recently gained momentum in Greece, responding to the recommendations of the international conventions. Reform of special education legislation spotlights the inclusion of children with autism in mainstream schools. The principal goal is to accept the diversity and heterogeneity of all students. This paper presents the educational policy for children with ASD in Greece and comments on teachers’ perceptions of inclusion. School closures due to the COVID-19 pandemic had an adverse impact on children's lives and created a new environment with different demands for educational inclusion

Sleep insufficiency and incident diabetes mellitus among indigenous and minority populations in Greece

Objective: To investigate the potential association between sleep pathology and diabetes mellitus (DM) using self-reported questionnaires. Material and Methods: 957 adults aged between 19 and 86 years old were enrolled in this cross-sectional study. Multistage stratified cluster sampling was used and subjects were classified into three groups [short (8h) sleep duration]. Individuals were classified as diabetics if they responded positively to the questions: “Have you ever been told that you are diabetic or have high blood sugar by a health professional?” or “Are you on antidiabetic medication?”. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined. Results: DM prevalence was higher among expatriated and Muslim Greeks (23.1% and 18.7%, respectively) compared to indigenous Greek Christians (4.4%). DM prevalence was significantly associated with short sleep duration (aOR=2.82, p<0.001), excessive daytime sleepiness (aOR=2.09, p=0.019) and poor sleep quality (aOR=2.56, p<0.001), while its relation with insomnia (aOR=1.63, p=0.065) and risk for obstructive sleep apnea (aOR=1.53, p=0.080) were of marginal statistical significance. Conclusion: This study indicates an association between sleep quantity, quality and DM and supports early pharmacological and cognitive behavioral interventions on sleep disturbances in order to reduce the burden of DM with increased focus on minority population needs

Explainable AI-based identification of contributing factors to the mood state change in children and adolescents with pre-existing psychiatric disorders in the context of COVID-19-related lockdowns in Greece

The COVID-19 pandemic and its accompanying restrictions have significantly impacted people’s lives globally. There is an increasing interest in examining the influence of this unprecedented situation on our mental well-being, with less attention towards the impact of the elongation of COVID-19-related measures on youth with a pre-existing psychiatric/developmental disorder. The majority of studies focus on individuals, such as students, adults, and youths, among others, with little attention being given to the elongation of COVID-19-related measures and their impact on a special group of individuals, such as children and adolescents with diagnosed developmental and psychiatric disorders. In addition, most of these studies adopt statistical methodologies to identify pair-wise relationships among factors, an approach that limits the ability to understand and interpret the impact of various factors. In response, this study aims to adopt an explainable machine learning approach to identify factors that explain the deterioration or amelioration of mood state in a youth clinical sample. The purpose of this study is to identify and interpret the impact of the greatest contributing features of mood state changes on the prediction output via an explainable machine learning pipeline. Among all the machine learning classifiers, the Random Forest model achieved the highest effectiveness, with 76% best AUC-ROC Score and 13 features. The explainability analysis showed that stress or positive changes derived from the imposing restrictions and COVID-19 pandemic are the top two factors that could affect mood state

Association between sleep insufficiency and dyslipidemia: a cross-sectional study among Greek adults in the primary care setting

Objective: To investigate the potential association between sleep insufficiency and dyslipidemia (DL) in the primary care setting using self-reported questionnaires. Material and Methods: 957 adults aged between 19 and 86 years old from the rural area of Thrace, Greece were enrolled in this cross-sectional study. Multistage stratifed cluster sampling was used and the subjects were classifed into three groups according to sleep duration [short (8h) sleep duration]. DL was defined by a positive response to the question “Have you ever been told by a doctor or health professional that your blood cholesterol or triglyceride levels were high?”, or if they were currently taking antilipidemic agents. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined. Results: DL prevalence was significantly associated with short sleep duration (aOR=2.18, p<0.001) and insomnia (aOR=1.43, p=0.050), while its relation with poor sleep quality (aOR=1.31, p=0.094) and risk for obstructive sleep apnea (aOR=1.32, p=0.097) were of marginal statistical significance. Concerning insomnia subtypes, DL was significantly associated with difficulties maintaining sleep (aOR=2.99, p<0.001) and early morning awakenings (aOR=1.38, p=0.050), but not difficulties initiating sleep (aOR=1.18, p=0.328). Conclusion: This study reveals an association between sleep pathology and DL. Thus, early pharmacological and cognitive or behavioral interventions that improve sleep are deemed necessary in order to decrease DL burden

Psychological and psychopathological characteristics of children and adolescents with epilepsy in Thrace, Greece

The appearance of a chronic disease during childhood can have a great impact on the child’s development. The child follows a specific procedure of comprehension and adjustment, which appears to be influenced by a variety of factors and also by the specific disease characteristics, resulting in some cases in psychopathological symptoms. It is estimated that epilepsy concerns approximately 5/1000 children. What makes epilepsy a matter of special interest in comparison to other chronic conditions is that it is a heterogeneous CNS disorder that consists of clinical syndromes, characterized by different types of seizures, different underlying etiologies, frequency and severity, different treatment strategies and longitudinal outcomes. Moreover the age of onset for the great majority of the cases is usually in childhood and adolescence. The purpose of this study was a. to assess school attendance and participation in school activities of children and adolescents with epilepsy, b. to investigate if school is informed by the parents and if schoolmates are informed by the children themselves, c. the detection of concomitant psychopathology, d. the evaluation of stigma, overprotection, and the selfesteemated quality of life of the children and their parents and e. to determine which factors (demographic data, disease characteristics, cultural variables etc) could be correlated with all these aspects of school and family life an finally f. to compare and contrast the specific characteristics of the Christian and Muslim children with epilepsy, in the region of Thrace. This was a prospective study conducted at the University Hospital of Alexandroupolis, Greece, from November 2006 to February 2008. Children with epilepsy, aged 1-18, were recruited on a consecutive basis through the child and adolescent psychiatry, pediatric and neurology-epilepsy outpatient clinics which had been invited to participate in the study. Demographic data, information concerning epilepsy such as age of onset, duration, seizure type, seizure frequency, type of therapy, seizure severity, information concerning the school such as lost school days, participation in specific school activities, school and schoolmates’ informing were recorded. In order to assess the severity of epilepsy the ‘‘Illness Severity Index’’ (ISI) was used. Children and their parents were evaluated clinically by a semi-structured questionnaire in order to detect symptoms of psychopathology and to evaluate family’s aspects such as overprotection, stigma and self-esteemed quality of life. Statistical analysis of the data was performed using the Statistical Package for the Social Sciences (SPSS), version 13.0 (SPSS, Inc., Chicago, IL, USA). Data concerning abstenteism, participation in school activities, school and schoolmates’ informing, concomitant psychopathology, overprotection, stigma and self-esteemated quality of life were characterized as dependent variables and were correlated with the characteristics of the participants. Chi-square test was used to evaluate any potential association between the dependent variables. Multivariate stepwise logistic regression models were constructed to explore the independent effect of children’s and disease characteristics on the dependent variables. In order to compare characteristics between the different cultural groups (Christians-Muslims) Student’s t-test and Mann-Whitney test were also used. In our study the whole number of the participants had missed at least one school day due to epilepsy. The great number of lost school days has been found to be related with shorter duration of the disease, greater disease severity, lower educational level, insufficient knowledge of epilepsy, greater seizure worry and overprotection. Non-participation in specific activities was found to be related with age over 12, generalized seizures, greater seizure worry, overprotection and stigma Schools have been informed of the disease in the majority of our patients (75, 8%). Greater disease duration, lower seizure worry and better knowledge of the disease were correlated with better school informing. ...............................................Η εμφάνιση ενός χρόνιου νοσήματος στην παιδική ηλικία μπορεί να επηρεάζει καθοριστικά την αναπτυξιακή πορεία του ατόμου. Το παιδί ακο- λουθεί μία ιδιαίτερη διαδικασία κατανόησης και προσαρμογής, η οποία φαί- νεται να εξαρτάται από πολλούς παράγοντες αλλά και από τα ιδιαίτερα χαρα- κτηριστικά της νόσου, με αποτέλεσμα σε κάποιες περιπτώσεις την εμφάνιση ψυχοπαθολογίας. Η επιληψία υπολογίζεται ότι αφορά περίπου 5/1000 παιδιά. Ιδιαιτερό- τητες σε σχέση με άλλες χρόνιες νοσολογικές καταστάσεις αποτελούν το ότι εμφανίζει πολλούς τύπους με διαφορετική υποκείμενη αιτιολογία, διαφορετική συχνότητα και βαρύτητα, διαφορετικές θεραπευτικές στρατηγικές, διαφορετική εξέλιξη, το ότι στην πλειονότητα των περιστατικών ξεκινά στην παιδική και εφηβική ηλικία και το ότι αφορά εξ’ορισμού το κεντρικό νευρικό σύστημα (ΚΝΣ). Σκοπός της μελέτης ήταν α) η αξιολόγηση της παρακολούθησης στο σχολείο παιδιών και εφήβων με επιληψία, η αξιολόγηση της συμμετοχής τους σε δραστηριότητες και η αξιολόγηση του βαθμού ενημέρωσης του σχολείου και των συνομηλίκων, β) η ανίχνευση και καταγραφή συνοδού ψυχο- παθολογίας, γ) η αξιολόγηση των δυναμικών της οικογένειας με την κατα- γραφή στοιχείων σχετικά με την υπερπροστατευτικότητα, το στίγμα και την ποιότητα ζωής, δ) η ανίχνευση των παραγόντων (δημογραφικά στοιχεία - χαρακτηριστικά της νόσου- πολιτισμικά στοιχεία ) που μπορεί να σχετίζονται με τα προηγούμενα και ε) η σύγκριση των επιμέρους χαρακτηριστικών των παιδιών με επιληψία, τα οποία ανήκουν σε διαφορετικές πολιτισμικές κοινότητες (Χριστιανική –Μουσουλμανική ) στην περιοχή της Θράκης. Στη μελέτη συμπεριελήφθησαν παιδιά και έφηβοι με επιληψία ηλικίας 1-18 ετών, που εξετάσθηκαν στα εξωτερικά ιατρεία της Παιδιατρικής και της Παιδοψυχιατρικής Κλινικής και στο Ειδικό Ιατρείο Επιληψίας της Νευρο- λογικής Κλινικής του @ημοκριτείου Πανεπιστημίου Θράκης στο Πανεπιστη- μιακό Νοσοκομείο Αλεξανδρούπολης. Καταγράφηκαν τα δημογραφικά στοιχεία, τα χαρακτηριστικά της νόσου (ηλικία έναρξης, τύπος κρίσεων, συχνότητα, τύπος φαρμακευτικής αγωγής), οι απουσίες από το σχολείο, η συμμετοχή σε αθλοπαιδιές, η ενημέρωση του σχολείου και η ενημέρωση των συνομηλίκων. Υπολογίσθηκε ο @είκτης Βαρύτητας Νόσου για κάθε περιστατικό με βάση τα στοιχεία που καταγράφηκαν για τα χαρακτηριστικά της νόσου. Τα παιδιά – έφηβοι, καθώς και οι γονείς- κηδεμόνες τους, υποβλήθηκαν σε ημιδομημένη συνέντευξη με στόχο την ανίχνευση ψυχοπαθολογίας, την αξιολόγηση των δυναμικών στην οικογένεια και την υποκειμενική τους αξιολόγηση για την ποιότητα της ζωής τους. Η στατιστική ανάλυση των δεδομένων έγινε με τη χρήση του στατιστικού πακέτου "Statistical Package for the Social Sciences" (SPSSChicago, IL, USA). Τα στοιχεία σχετικά με την συμμετοχή στο σχολείο, την ενημέρωση, την ψυχοπαθολογία, την υπερπροστατευτικότητα, το στίγμα και την αυτοεκτίμηση της ποιότητας ζωής χαρακτηρίσθηκαν ως εξαρτημένες μεταβλητές και συσχετίσθηκαν με τα υπόλοιπα χαρακτηριστικά των συμμετεχόντων. Για το σκοπό αυτό χρησιμοποιήθηκε ο έλεγχος χ2. Στη συνέχεια χρησιμοποιήθηκε υπόδειγμα πολυπαραγοντικής λογιστικής παλινδρόμησης για την μελέτη εκείνων των μεταβλητών που σχετίζονται ανεξάρτητα με τις εξαρτημένες μεταβλητές. Για τη σύγκριση των χαρακτηριστι- κών μεταξύ των ομάδων Χριστιανών –Μουσουλμάνων χρησιμοποιήθηκαν το Student’s t-test, το Mann-Whitney test και ο έλεγχος χ2. Η ταξινόμηση των μεταβλητών που διαφέρουν μεταξύ των δύο ομάδων έγινε με τη χρήση της διακρίνουσας ανάλυσης. @ιαπιστώθηκε ότι το σύνολο των παιδιών είχαν χάσει τουλάχιστο μία ημέρα σχολείου εξαιτίας της επιληψίας. Οι πολλές απουσίες σχετίζονταν σημαντικά με μικρότερη διάρκεια και μεγαλύτερη βαρύτητα της νόσου, με χειρότερη γνώση για τη νόσο, με χαμηλότερο μορφωτικό επίπεδο, με μεγαλύτερο φόβο των γονέων για τη νόσο και με υπερπροστατευτικό περιβάλλον. Η μη συμμετοχή σε αθλοπαιδιές και δραστηριότητες σχετίσθηκε με ηλικία μεγαλύτερη των 12 ετών, γενικευμένες κρίσεις, φόβο των γονέων για τη νόσο, υπερπροστατευτικό περιβάλλον και αυξημένη υποκειμενική αίσθηση του στίγματος. .....................................

Parental Stress Scale: Psychometric Properties in Parents of Preschool Children with Developmental Language Disorder

Parents of children with developmental disabilities experience more stress compared to those of typically developing children; therefore, measuring parental stress may help clinicians to address it. The Parental Stress Scale (PSS) is a self-rceport measure in the public domain that assesses stress related to child rearing. The present study tested the psychometric properties of the Greek version of the PSS in 204 parents (mean age: 39.4 ± 5.7, 124 mothers and 80 fathers) of kindergarten children diagnosed with Developmental Language Disorder (DLD) after a clinical assessment. Confirmatory factor analysis (CFA) was used to confirm the original four-factor structure. The results showed that the original four-factor structure (parental rewards, parental stressors, lack of control and parental satisfaction) is valid in this specific Greek population. The reliability was high (ω = 0.78) and there were weak correlations (r = −0.372, r = −0.337, r = −0.236), yet of statistical significance (p < 0.001), with similar psychological constructs (quality of life, emotional functioning and worries). Our data confirmed that the PSS is a reliable and valid tool to measure parental stress in parents of children with DLD. Greek clinicians (mental health professionals, speech-language pathologists) can evaluate parental stress and design early interventions targeting specific stress aspects, along with core language interventions for the children

A Holistic Approach to Expressing the Burden of Caregivers for Stroke Survivors: A Systematic Review

This systematic review explores the multifaceted challenges faced by caregivers of stroke survivors, addressing the global impact of strokes and the anticipated rise in survivors over the coming decades. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a thorough literature search identified 34 relevant studies published between 2018 and 2023. The review categorizes caregiver burden into four domains: physical health, social functioning, financial issues, and psychological health. Caregivers often experience a decline in physical health, marked by chronic fatigue, sleep disturbances, and pain. Emotional distress is prevalent, leading to anxiety and depression, especially in cases of high burden. Financial strains arise from medical expenses and employment changes, exacerbating the overall burden. Contextual factors, such as cultural norms and resource availability, influence the caregiver experience. The Newcastle–Ottawa scale assessed the methodological quality of studies. The conclusion emphasizes tailored interventions and support systems for caregivers, with practical recommendations for healthcare professionals, therapists, mental health professionals, financial counselors, and policymakers. This comprehensive review enhances the understanding of caregiver experiences and provides actionable insights to improve stroke care and rehabilitation The study’s novelty lies in its holistic examination of caregiver burden in stroke care, its focus on the recent literature, and its emphasis on forecasting caregiver outcomes, contributing valuable insights for proactive intervention strategies

Health-Related Quality of Life and Behavioral Difficulties in Greek Preschool Children with Developmental Language Disorder

Developmental language disorder (DLD) has a great impact on language skills as well as on a wide range of functioning areas, such as social and school functioning. In the present study, we aim to explore the Health-Related Quality of Life (HRQoL) of preschool children with DLD, compared to children with no language difficulties, using a self and proxy report method. A total of 230 parents of preschool children with DLD and 146 parents of children without language difficulties completed the Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Generic Core Module and the Strengths and Difficulties Questionnaire (SDQ). Additionally, 71 children with DLD and 55 peers without DLD completed the self-reported PedsQLTM module. The parents of kindergarten children (5–6 years old) with DLD reported that their kids experience worse social and school functioning compared to the control group. In addition, the children with DLD self-reported lower physical and social functioning. The parents of children with DLD reported that their children experience higher hyperactivity/inattention problems than the parents of the control group. Kindergarten children with DLD have a poorer HRQoL compared to their peers, as perceived by themselves and their parents. Moreover, children with DLD present with higher hyperactivity and inattention symptoms. Health professionals working with children who have DLD need to consider not only the language difficulties but also the children’s wellbeing and symptoms of hyperactivity and inattention

Assessment of quality of life, job insecurity and work ability among nurses, working either under temporary or permanent terms

Objectives Aim of this study was to assess and compare health, quality of life, well-being, job satisfaction and job insecurity between nurses, in a tertiary hospital in Greece, working either under permanent or temporary contract. Material and Methods In this cross-sectional study, consecutively recruited nurses answered a structured questionnaire, the WHO-5 Well-being Index (WHO-5), the Job Insecurity Index (JII), the Work Ability Index (WAI), and the Well-Being at Work Scale (WBWS). Results Included were 323 nurses (87.6% women, age M±SD 43.68±8.10 years). Tem- porary contract employees had worse quality of life (p = 0.009) and higher job insecurity: both in cognitive dimension (p = 0.013) and emotional dimension (p < 0.001). They also scored worse in the positive affect (p < 0.001), negative affect (p = 0.002) and fulfillment of expectations in work environment (p < 0.001) domains of the WBWS. Additionally, they reported less frequently occupational accidents and injuries (p = 0.001), muscu - loskeletal disorders of the spine or neck (p = 0.007), cardiovascular (p = 0.017), and gastrointestinal (p = 0.010) disorders, while they reported more frequently mental disorders (p < 0.001). Multivariate linear regression analysis showed that temporary work predicted high cognitive (p = 0.010) and emotional (p < 0.001) insecurity, low positive emotions and mood index (p = 0.007), low achievement-fulfillment index (p = 0.047) and high index of negative emotions (p = 0.006), regardless of gender and age. Conclusions Temporary employment among nurses is associated with a lower sense of job security and well-being, and a higher prevalence of mental disorders, independently of age or gender without a significantly negative effect on their ability to work. Managers, as well as occupational physicians, should recognize the extent of nurses’ job insecurity and assess their ability to work, to provide them with the necessary support and to stimulate the sense of occupational security and work capacity, so that they can thrive in their workplace and therefore be more productive and provide high quality healthcare. Int J Occup Med Environ Health. 2024;37(1):98–10

Assessment of quality of life, job insecurity and work ability among nurses, working either under temporary or permanent terms

Objectives Aim of this study was to assess and compare health, quality of life, well-being, job satisfaction and job insecurity between nurses, in a tertiary hospital in Greece, working either under permanent or temporary contract. Material and Methods In this cross-sectional study, consecutively recruited nurses answered a structured questionnaire, the WHO-5 Well-being Index (WHO-5), the Job Insecurity Index (JII), the Work Ability Index (WAI), and the Well-Being at Work Scale (WBWS). Results Included were 323 nurses (87.6% women, age M±SD 43.68±8.10 years). Temporary contract employees had worse quality of life (p = 0.009) and higher job insecurity: both in cognitive dimension (p = 0.013) and emotional dimension (p &lt; 0.001). They also scored worse in the positive affect (p &lt; 0.001), negative affect (p = 0.002) and fulfillment of expectations in work environment (p &lt; 0.001) domains of the WBWS. Additionally, they reported less frequently occupational accidents and injuries (p = 0.001), musculoskeletal disorders of the spine or neck (p = 0.007), cardiovascular (p = 0.017), and gastrointestinal (p = 0.010) disorders, while they reported more frequently mental disorders (p &lt; 0.001). Multivariate linear regression analysis showed that temporary work predicted high cognitive (p = 0.010) and emotional (p &lt; 0.001) insecurity, low positive emotions and mood index (p = 0.007), low achievement-fulfillment index (p = 0.047) and high index of negative emotions (p = 0.006), regardless of gender and age. Conclusions Temporary employment among nurses is associated with a lower sense of job security and well-being, and a higher prevalence of mental disorders, independently of age or gender without a significantly negative effect on their ability to work. Managers, as well as occupational physicians, should recognize the extent of nurses’ job insecurity and assess their ability to work, to provide them with the necessary support and to stimulate the sense of occupational security and work capacity, so that they can thrive in their workplace and therefore be more productive and provide high quality healthcare