Globalny kryzys finansowy, konsekwencje zdrowotne i wskazania dla pracowników ochrony zdrowia: przegląd literatury

Aim. Identifying the effects of the global financial crisis on health, public health system(s) and healthcare workers is the main purpose of this paper.Material and methods. A review of the literature was undertaken. The following keywords were adopted: economic crisis, financial crisis, health implications, public health, unemployment, labour substitution, mental health, healthcare (nursing), and education as a Mesh word or text words in the title and in the abstract, via MedLine/ Cinahl and Scopus database. A ten-year timeframe (2001-2011) was set in order to include the most recent studies. Articles reporting the relationship between financial crisis, health problems, mortality, use of public health care service(s), and implications on healthcare workers roles were included and analysed. A content analysis methodology of the articles retrieved was then performed.Results. The economic downturn that has unfolded in recent years is expected to produce adverse social and health effects. Extended research data reveal that people’s health status is definitely affected by the economic crisis and consequently the healthcare sector will have to be reformed to meet the new challenges more efficiently. Economics depressions have a direct impact on overall health, on public spending directed to the healthcare system, on the quality of the services provided and on restructuring of the roles and functions of healthcare personnel.Conclusions. Preliminary lessons learnt from the current global financial crisis suggest undertaking several strategies at the: a) social and public health level, b) healthcare system level; c) healthcare workers education level and, d) at the nursing professional level. (PNN 2012;1(4):164–169)Cel. Ukazanie wpływu światowego kryzysu finansowego na zdrowie, systemy zdrowotne oraz pracowników ochrony zdrowia.Materiał i metody. Dokonano przeglądu literatury w bazach MedLine/Cinahl i Scopus, na podstawie następujących słów kluczowych i terminów Me SH pojawiających się w tytule lub streszczeniu: kryzys ekonomiczny, kryzys finansowy, konsekwencje zdrowotne, zdrowie publiczne, bezrobocie, zdrowie psychiczne, pielęgniarstwo, ochrona zdrowia i wykształcenie. W celu uzyskania najbardziej aktualnych informacji zawężono okres, z którego pochodzi literatura, do 10 lat (2001–2011). Analizie poddano artykuły dotyczące związków między kryzysem finansowym a problemami zdrowotnymi, śmiertelnością, dostępem do usług medycznych i konsekwencjami dla ról pełnionych przez pracowników ochrony zdrowia.Wyniki. Bez wątpienia kryzys ekonomiczny, który pogłębia się od kilku lat, ma negatywny wpływ na zdrowie publiczne, co wynika z licznych badań. W konsekwencji, sektor zdrowia publicznego będzie wymagał reform, aby sprostać nowym wyzwaniom. Problemy ekonomiczne mają bezpośredni wpływ na ogólne zdrowie, na wydatki publiczne przeznaczone na ochronę zdrowia, na jakość opieki oraz na konieczność ponownego zdefiniowania ról pracowników ochrony zdrowia.Wnioski. Wczesne wnioski płynące z obserwacji wpływu kryzysu na zdrowie wskazują na konieczność zastosowania pewnych strategii na następujących poziomach: a) społecznym i zdrowia publicznego; b) systemu ochrony zdrowia; c) edukacji pracowników ochrony zdrowia oraz d) na poziomie pielęgniarstwa. (PNN 2012;1(4):164-169

A sex-specific evaluation of predicted lean and fat mass composition and cardiovascular disease onset and progression: A combined analysis of the ATTICA and GREECS prospective epidemiological studies

Objectives: To evaluate the association of predicted lean and fat mass on 10-year first and recurrent CVD incidence separately for men and women. Methods: Two prospective studies, ATTICA (2002-2012, n = 3042 subjects free-of-CVD, n = 1514 men (46 ± 13 years) and n = 1528 women (45 ± 14 years)) and GREECS (2004-2014, n = 2172 subjects with acute coronary syndrome (ACS), n = 1649 men (65 ± 13 years) and n = 523 women (62 ± 11 years)) were used. Lean mass index (LMI) and fat mass index (FMI) were created through total body lean and fat mass (indirectly calculated through population formulas based on body weight, height and waist circumference) divided by height squared. Follow-up was performed in n = 2020 of ATTICA (n = 317 first CVD events) and in n = 2172 patients of GREECS (n = 811 recurrent CVD events). Results: In ATTICA study, CVD rate from 1st to 3rd FMI tertile was 9.4%, 16.1% and 19.9% while in GREECS 36.2%, 37.0%, 38.3%. The LMI-related rates were 17.1%, 15.0% and 11.9% vs. 38.8%, 35.8% and 36.7%. Multiadjusted analysis revealed U-shape trend between LMI and CVD recurrence with 2nd LMI tertile having the best prognosis; this observation was more evident in women. In apparently healthy subjects, LMI-cardioprotective association was revealed only in 3rd tertile (HR = 0.91 95%CI (0.74, 0.95)); this was more evident in men. The FMI aggravating association (3rd tertile) was retained significant only in healthy women and ACS men. Conclusion: This work expands previous findings regarding body composition and cardiac health, implying that the association of lean and fat mass on long-term CVD incidence varies according to sex and prevention stage

Dietary patterns, weight perception and obesity status, among 10–12-year-old children; an epidemiological study in Greece

Adherence to certain dietary patterns influences obesity status in both children and adults. Weight perception influences dietary habits. The aim of this study was to examine children’s dietary habits and obesity status, in relation to weight perception. One thousand seven hundred Greek students enrolled in this study during 2014–2016. Children’s characteristics were assessed through validated questionnaires, and weight status was classified according to the criteria of the International Obesity Task Force. Dietary patterns were assessed through exploratory factor analysis. Overall, 52.2% of children characterized themselves as normal weight, 34.5% as low weight, and 13.3% as overweight/obese; 52.5% of children were in accordance with their actual weight status, with girls being more likely to overestimate their weight. Children followed three dietary patterns, i.e., starchy and protein foods, unhealthy/high-fat foods, and healthy foods. Children who followed the healthy dietary pattern and had accurate weight perception (in accordance with their actual weight), had lower odds of being overweight/obese (p < 0.001). Accurate weight perception in conjunction with healthy dietary habits may play a determinant role in the prevention of obesity. From a public health perspective, early identification of children’s weight misperception along with healthy dietary habit promotion shape a crucial role in childhood obesity confrontation

Mental Health and Wellbeing at Schools: Health Promotion in Primary Schools with the Use of Digital Methods

Mental health disorders among primary school children remain a crucial issue. Early health promotion interventions can positively affect and prevent the onset of mental disorders. Promising digital mental health methods have been implemented for adolescents and youths with scarce evidence among younger ages. Therefore, the aim of the current systematic review was to identify health promotion interventions on mental health and wellbeing, with the use of digital methods, delivered in primary school settings. Six digital interventions have been identified, three of which were targeting teachers and the others students. Regardless of the limited number of studies, the effectiveness of the web-based interventions upon teachers' knowledge and attitudes and the positive impact on children's behavioral improvements has been documented. The lack of adequate evidence highlights the need for further research in the field. The current review provides information for professionals working in primary schools useful for the design and implementation of effective mental health and wellbeing interventions

Epidemiology of acute coronary syndrome: socio-economic and behavioral characteristics of secondary prevention among patients with acute coronary syndrome: the 10 year (2003-2013) follow-up of the GREECS study

Introduction: The increased coronary heart disease (CHD) morbidity rate, worldwide, as well as the progressive aging of the population, is considered as the greatest public health burden, in both developed and developing countries. Additionally, CHD is responsible for almost 20% of deaths in Europe annually, while a significant number of them is attributed to modifiable risk factors related to lifestyle habits. However, the long term impact of socio-economic and behavioral determinants has been scarcely evaluated and examined, in the context of secondary disease prevention, posing an innovative research project. Thus, the aim of the present work was to investigate the association between behavioral/socio-economic characteristics and the 10-year (2004-2014) Acute Coronary Syndrome (ACS) prognosis, among cardiac patients.Methodology: From October 2003 to September 2004, almost all consecutive patients (n = 2,172) diagnosed with ACS (i.e. acute myocardial infarction (AMI) or unstable angina (UA)) that were hospitalized in the cardiology clinics or the emergency units of 6 major General Hospitals in Greece were enrolled in the study. During 2013-14, the 10-year follow-up was performed in 1,918 participants (88% participation rate). Information regarding the clinical, socio-demographic, psychological and behavioral characteristics was obtained, through personal interview, by a standard questionnaire. The development of fatal or non-fatal ACS events was recorded through medical records or hospital registries. Logistic regression models were applied to evaluate the impact of educational, financial, psychological, physical, smoking and clinical patients’ status on the 10-year ACS prognosis had lower risk of any ACS recurrent event (fatal-non fatal), within the decade. Results: The overall fatal/non-fatal 10-year ACS incidence was n=811 (37.3%); of them 78.8% were men and 21.2% were women, (p=0.016)). Of the n=811 ACS events, 383 (47.3%) were fatal, and, thus, the overall 10-year fatal incidence was 17.7% (74,5% men and 25,5% women) (p=0,016). The median follow-up time was 8,08 years for men and 7,78 years for women, 8.4 years (p=0,07). After taking into account various potential confounders, it was observed that ACS patients in high educational level had better 10-year prognosis. Additionally, the protective role of good/very good financial status has been revealed, statistically significant results (HR=0.76, 95%CI 0.60, 0.95, p=0.01). A significant interaction was observed between depressive symptoms, marital status and the10-year ACS incidence. Specifically, among non-married, single or divorced patients, 1-point increase in the CES-D score was associated with 2% higher risk of having recurrent ACS events (HR=1.02, 95%CI 1.00, 1.04) and 4% higher risk of having fatal ACS event (HR=1.04, 95%CI 1.02, 1.06), during the decade.Regarding smoking habits, it was observed that for every 30 pack-years of smoking the associated ACS risk increased by 6% (95%CI 1.03,1.30) and for fatal ACS event by 8% (95%CI 1.03,1.63). Patients who reported exposure to secondhand smoke had 33% higher risk for any ACS event (fatal, non-fatal) (95%CI 1.12, 1.60) and 27% higher risk for fatal ACS event (95%CI 1.01, 1.60). Moreover, a significant inverse association was revealed between physical activity (moderate/HEPA vs. inactive/low) and the 10-year ACS incidence (OR=0.74 95% CI 0.53, 1.03). Evaluating the clinical factors, diabetes mellitus was highlighted as the sole aggravating clinical factor in ACS recurrent events, in relation to the other two factors (hypertension and hypercholesterolaemia). Regarding dietary habits, the cardioprotective role of exclusive olive oil consumption vs. a combination of added fats was observed, even among obese patients. Furthermore, patients with even 1 portion of sweet /week consumption experienced 23% higher risk of a recurrent ACS event, as compared with the ones who reported never/rare consumption (95% CI 0.99, 1.53), while patients who consumed 1-2 cups of coffee/day had 35% higher risk of recurrent fatal or non-fatal ACS episodes when compared with those who reported never/rare consumption, during the follow-up period (95%CI 1.01, 1.79).Conclusions: ACS is regarded as the most preventable, multifactorial chronic disease due to modifiable risk behaviors. The present work highlighted the significant role of socio-demographic, behavioral and clinical characteristics in the long-term cardiovascular prognosis, among ACS patients. Taking into account the demographic changes and the adverse aspects of modern lifestyle habits, it is crucial for public health strategies to be embedded within the secondary health care provision, with emphasis given on the effective management of environmental risk factors and development of primary health care services.Key words: Acute Coronary Syndrome; secondary prevention; risk factors; health promotion; primary health care services; public health.Εισαγωγή: Η στεφανιαία νόσος παρουσιάζει αυξημένη νοσηρότητα σε παγκόσμια κλίμακα και με δεδομένη την προοδευτική γήρανση του πληθυσμού, αποτελεί σημαντικό νοσολογικό φορτίο, τόσο στις αναπτυγμένες όσο και στις αναπτυσσόμενες χώρες, με τεράστιο οικονομικό κόστος. Επιπλέον, ευθύνεται για το 20% των θανάτων στην Ευρώπη, ετησίως και ένας σημαντικός αριθμός αυτών αποδίδεται σε τροποποιήσιμους παράγοντες που σχετίζονται με τον τρόπο ζωής. Ωστόσο, η μακροπρόθεσμη επίδραση των κοινωνικο-οικονομικών και συμπεριφοριστικών προσδιοριστών έχει ελάχιστα αξιολογηθεί και αναλυθεί, στο πλαίσιο της δευτερογενούς πρόληψης της νόσου, αποτελώντας καινοτόμο ερευνητικό πεδίο. Σκοπός της παρούσας διατριβής ήταν η καταγραφή της 10ετούς επίπτωσης (2003-2013) δεύτερης εκδήλωσης Οξέος Στεφανιαίου Συνδρόμου (ΟΣΣ) μέσω της αποτίμησης των προαναφερθέντων προσδιοριστών όπως, κάπνισμα, διατροφή, σωματική δραστηριότητα, κατάθλιψη, κοινωνικο-οικονομικό επίπεδο.Μεθοδολογία: Aπό τον Οκτώβριο 2003 μέχρι το Σεπτέμβριο 2004 συλλέχθηκε δείγμα από καρδιολογικές κλινικές 6 γενικών νοσοκομείων της Ελλάδας και εντάχθηκαν σχεδόν όλοι οι διαδοχικοί ασθενείς (ν=2,172) με διαγνωσμένο Οξύ Στεφανιαίο Σύνδρομο. Κατά τα έτη 2013-2014 πραγματοποιήθηκε ο 10ετής επανέλεγχος, όπου συμμετείχαν 1,918 ασθενείς (88% ποσοστό συμμετοχής). Πληροφορίες, αναφορικά με τα κλινικά, κοινωνικο-δημογραφικά, ψυχολογικά και τρόπου ζωής χαρακτηριστικά ελήφθησαν μέσω προσωπικής συνέντευξης. Κατά τη στατιστική ανάλυση χρησιμοποιήθηκαν μοντέλα λογαριθμικής παλινδρόμησης, τα οποία εκτίμησαν την επίδραση του εκπαιδευτικού και οικονομικού επιπέδου, της ψυχολογικής κατάστασης, της σωματικής δραστηριότητας, του καπνίσματος των κλινικών παραγόντων και διατροφικών συνιστωσών στον 10ετή κίνδυνο επανεμφάνισης καρδιαγγειακού επεισοδίου.Αποτελέσματα: Η 10ετής επίπτωση νέου ΟΣΣ επεισοδίου (θανατηφόρου ή μη) ήταν ν=811 (37,3%) (78,8% στους άνδρες και 21,2% στις γυναίκες (p=0,016); η 10ετής επίπτωση ΟΣΣ θνητότητας ήταν 17,7% (74,5% στους άνδρες και 25,5% στις γυναίκες) (p=0,016). Ο διάμεσος χρόνος επιβίωσης ήταν 8,08 έτη για τους άνδρες και 7,78 έτη για τις γυναίκες (p=0,07). Μετά από έλεγχο για συγχυτικούς παράγοντες, παρατηρήθηκε ότι οι ασθενείς υψηλής εκπαίδευσης είχαν καλύτερη 10ετή πρόγνωση. Επίσης, αναδείχθηκε ο προστατευτικός ρόλος της καλής/πολύ καλής οικονομικής κατάστασης, σε στατιστικά σημαντικό βαθμό (HR=0.76, 95%CI 0.60, 0.95, p=0.01). Μελετώντας το ρόλο της κατάθλιψης και της οικογενειακής κατάστασης στην επίπτωση των ΟΣΣ, παρατηρήθηκε σημαντική αλληλεπίδραση μεταξύ τους. Συγκεκριμένα, στους «μη έγγαμους» ασθενείς (πχ. άγαμοι, διαζευγμένοι, χήροι) 1-μονάδα αύξηση της κλίμακας CES-D συσχετίστηκε με 2% μεγαλύτερο κίνδυνο για επαναλαμβανόμενα ΟΣΣ επεισόδια (HR=1.02, 95%CI 1.00, 1.04) και με 4% υψηλότερο κίνδυνο για θανατηφόρο ΟΣΣ επεισόδιο, κατά τη 10ετία (HR=1.04, 95%CI 1.02, 1.06). Αναφορικά με το κάπνισμα παρατηρήθηκε ότι για κάθε 30 πακέτα-έτη καπνίσματος ο κίνδυνος για επαναλαμβανόμενο ΟΣΣ αυξανόταν κατά 6% (95%CI 1.03,1.30) και για θανατηφόρο ΟΣΣ κατά 8% (95%CI 1.03,1.63). Οι ασθενείς που ανέφεραν έκθεση σε παθητικό κάπνισμα είχαν 33% υψηλότερο κίνδυνο για θανατηφόρο ή μη θανατηφόρο συμβάν ACS (95%CI 1.12, 1.60) και 27% μεγαλύτερο κίνδυνο για θανατηφόρο συμβάν ΟΣΣ (95%CI 1.01, 1.60). Επιπρόσθετα, σημαντικά αρνητική συσχέτιση παρατηρήθηκε μεταξύ της σωματικής δραστηριότητας («μέτρια»/«ενεργή» έναντι «αδρανής»/«χαμηλή») και της 10-ετούς πρόγνωσης του ΟΣΣ (OR=0.74 95% CI 0.53, 1.03). Από τα κλινικά χαρακτηριστικά, ο σακχαρώδης διαβήτης φάνηκε να αποτελεί τον σημαντικότερο επιβαρυντικό παράγοντα στην επανεμφάνιση συμβαμάτων ΟΣΣ, συγκριτικά με τους άλλους δύο κλινικούς παράγοντες (αρτηριακή υπέρταση και υπερχοληστερολαιμία). Μελετώντας επιμέρους διατροφικές συνήθειες, αναδείχθηκε ο προστατευτικός ρόλος της αποκλειστικής κατανάλωσης ελαιολάδου έναντι του συνδυασμού με άλλα λίπη και έλαια. Επιπρόσθετα, θετική συσχέτιση παρατηρήθηκε ανάμεσα στην κατανάλωση έστω και μίας μερίδας γλυκών/εβδομάδα και στην εμφάνιση ενός νέου ΟΣΣ επεισοδίου (OR=1.23, 95% CI 0.99, 1.53), όπως επίσης και στην κατανάλωση καφέ φάνηκε ότι οι ασθενείς που κατανάλωναν 1-2 φλιτζάνια καφέ/ημέρα είχαν 35% μεγαλύτερο κίνδυνο εμφάνισης επαναλαμβανόμενων επεισοδίων ΟΣΣ (θανατηφόρων ή μη), σε σύγκριση με τους ασθενείς που ανέφεραν ποτέ/σπάνια κατανάλωση (95%CI 1.01, 1.79).Συμπεράσματα: Το ΟΣΣ θεωρείται η πιο προβλέψιμη πολυπαραγοντική χρόνια νόσος καθώς οι σημαντικότεροι παράγοντες κινδύνου είναι τροποποιήσιμοι. Η παρούσα διατριβή ανέδειξε κοινωνικο-δημογραφικά, τρόπου ζωής (συμπεριφοριστικά) και κλινικά χαρακτηριστικά των στεφανιαίων ασθενών, τα οποία αποτελούν τον ακρογωνιαίο λίθο της μακροπρόθεσμης δευτερογενούς πρόγνωσης της νόσου. Με γνώμονα τον σύγχρονο τρόπο ζωής αλλά και την ολοένα επιταχυνόμενη αλλαγή του δημογραφικού χάρτη, κρίνεται αναγκαία η λήψη μέτρων δημόσιας υγείας στο πλαίσιο της δευτεροβάθμιας φροντίδας υγείας, με έμφαση στην αποτελεσματική διαχείριση των περιβαλλοντικών παραγόντων κινδύνου και διαμόρφωση κατάλληλων δομών πρωτοβάθμιας φροντίδας υγείας. Λέξεις Κλειδιά: Οξύ Στεφανιαίο Σύνδρομο; δευτερογενής πρόληψη; παράγοντες κινδύνου; προαγωγή υγείας; δομές πρωτοβάθμιας φροντίδας υγείας; δημόσια υγεία

Prevalence and Factors Related to Nomophobia: Arising Issues among Young Adults

Nomophobia is characterized as apprehension of being apart from smartphone, which causes the user to seek proximity with the device. The purpose of this study was to explore the prevalence and factors associated to nomophobia among young adults in Athens, the capital city of Greece. A cross-sectional study was performed on a sample of 1408 young adults aged 18–25 years. The questionnaire was anonymous, including the socio-demographic characteristics of the participants, the smartphone uses, and the nomophobia questions. Statistical analyses were done by simple univariable techniques or modeling the data through generalized linear models. Almost all participants (99.9%) exhibited any level of nomophobia, with the moderate level prevailing (57.0%). Women and non-working participants were more likely to exhibit severe nomophobia (adj PR = 1.57) and any level of nomophobia was 30% higher among the participants whose father had no academic degree (p = 0.029). In addition, 59% of those with severe nomophobia had very frequent phone checking (p < 0.001) while 45.8% with any level of nomophobia reported a negative influence on their academic performance. Attention should be paid to early prevention through the development of integrated health promotion programs

Anthropometric, Lifestyle Characteristics, Adherence to the Mediterranean Diet, and COVID-19 Have a High Impact on the Greek Adolescents’ Health-Related Quality of Life

Objective: The study aimed at analyzing the relationship between anthropometric characteristics, lifestyle, and dietary habits, as well as the burden of the pandemic on the health-related quality of life among Greek pupils. Research methods and procedures: On the whole, 2088 adolescents aged 12–18 years from Attica, Greece, were enlisted in this school-based cross-sectional study that took place in May–December 2021. Health-related quality of life was estimated through the KIDSCREEN-27 questionnaire, adherence to the Mediterranean diet—through the KIDMED test. For the empirical and econometric analyses, the Mann–Whitney U and Kruskal–Wallis means comparison tests were utilized; multiple linear regression was used accordingly. Results: The present study provides evidence to the fact that boys, younger adolescents, adolescents living with both parents and with highly educated mothers had a better health-related quality of life. Concerning their eating practices, positive predictors were consuming a better-quality breakfast, having all five meals daily, consuming lunch and dinner with parents, and higher adherence to the Mediterranean diet. Moreover, sufficient night sleep time, fewer hours spent on screen viewing, more frequent walks, and having hobbies were linked to the health-related quality of life with a positive sign. In contrast, negative predictors were higher body mass index and everyday life difficulties due to the COVID-19 pandemic crisis. Conclusions: Greek adolescents’ anthropometric characteristics, BMI, lifestyle and sedentary habits, eating habits, and adherence to the Mediterranean diet were significantly related to their perceived health-related quality of life during the pandemic

The emerging phenomenon of nomophobia in young adults: a systematic review study.

Background: Nomophobia (No MObile PHone PhoBIA) refers to the worry or fear that individuals experience when they are without their mobile phone or they are unable to use it. The term was first coined in 2008 and it is considered a modern type of phobia. The aim of the present study was to retrieve and review the most relevant literature on the prevalence of nomophobia and its relationship with psychosocial and physical health among young adults. Methods: A systematic literature review was conducted according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for original papers on the phenomenon of nomophobia in young adults using the Nomophobia Questionnaire (NMP-Q) as the main measuring instrument. The literature was focused on the 3 main topics of prevalence and level of nomophobia, nomophobia and psychosocial effects, and nomophobia and physical health in young adults. Findings: The initial literature corpus consisted of 370 articles of which 40 met the inclusion criteria and were analyzed in detail. Nomophobia was observed among 15.2%-99.7% of the participants. Research findings indicated increased psychological, emotional, social, and physical side effects due to excessive smartphone use. Conclusion: The excessive use of the smartphone is an emerging threat for social, mental, and physical health. There is an increased need for further research in this regard as it is evolving into an epidemic outbreak and concerns directly the field of public health