Chara Tzavara

A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting.

BackgroundPercutaneous metal stenting is an accepted palliative treatment for malignant biliary obstruction. Nevertheless, factors predicting survival are not known.MethodsSeventy-six patients with inoperable malignant biliary obstruction were treated with percutaneous placement of metallic stents. Twenty patients had non-hilar lesions. Fifty-six patients had hilar lesions classified as Bismuth type I (n = 15 patients), type II (n = 26), type III (n = 12), or type IV (n = 3 patients). Technical and clinical success rates, complications, and long-term outcome were recorded. Clinical success rates, patency, and survival rates were compared in patients treated with complete (n = 41) versus partial (n = 35) liver parenchyma drainage. Survival was calculated and analyzed for potential predictors such as the tumor type, the extent of the disease, the level of obstruction, and the post-intervention bilirubin levels.ResultsStenting was technically successful in all patients (unilateral drainage in 70 patients, bilateral drainage in 6 patients) with an overall significant reduction of the post-intervention bilirubin levels (p < 0.001), resulting in a clinical success rate of 97.3%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial liver drainage. Minor and major complications occurred in 8% and 15% of patients, respectively. Mean overall primary stent patency was 120 days, while the restenosis rate was 12%. Mean overall secondary stent patency was 242.2 days. Patency rates were similar in patients with complete versus partial liver drainage. Mean overall survival was 142.3 days. Survival was similar in the complete and partial drainage groups. The post-intervention serum bilirubin level was an independent predictor of survival (p < 0.001). A cut-off point in post-stenting bilirubin levels of 4 mg/dl dichotomized patients with good versus poor prognosis. Patient age and Bismuth IV lesions were also independent predictors of survival.ConclusionsPercutaneous metallic biliary stenting provides good palliation of malignant jaundice. Partial liver drainage achieved results as good as those after complete liver drainage. A serum bilirubin level of less than 4 mg/dl after stenting is the most important independent predictor of survival, while increasing age and Bismuth IV lesions represent dismal prognostic factors.

Online Social Networking in Adolescence: Patterns of Use in Six European Countries and Links With Psychosocial Functioning

PURPOSE Online communication tools, such as social networking sites (SNS), have been comprehensively embraced by adolescents and have become a dominant daily social practice. Recognizing SNS as a key context of adolescent development, this study aimed to investigate associations between heavier SNS use, and adolescent competencies and internalizing problems. METHODS Data was collected in six European countries: Greece, Spain, Poland, the Netherlands, Romania, and Iceland. Participants were 10,930 adolescents aged 14-17 years (F/M: 5,719/5,211; mean age 15.8 ± .7 years); 62.3% were aged 14-15.9 years and 37.7% were aged 16-17.9 years. Participants reported on their use of online communication tools, and their general competencies and internalizing problems (Youth Self Report). RESULTS SNS are both ubiquitous--used by 70% of adolescents--and engaging, given that 40% of users spend 2 or more hours daily on SNS (labeled heavier SNS use). Heavier SNS use was associated with more internalizing problems, and the relation was consistently more pronounced among younger adolescents. Moreover, heavier SNS use was associated with lower academic performance and lower activities scores, especially for younger adolescents. In contrast, among older adolescents heavier SNS use was positively associated with offline social competence. CONCLUSIONS Although heavier SNS use is associated with higher social competence for older adolescents, it is also associated with increased internalizing problems and diminished competencies in academics and activities, especially for younger adolescents. Age, capturing developmental differences in social and regulatory skills, appears to moderate the effects of heavier SNS use on adolescent functioning.

Insomnia and its correlates in a representative sample of the Greek population

BackgroundInsomnia is a major public health concern affecting about 10% of the general population in its chronic form. Furthermore, epidemiological surveys demonstrate that poor sleep and sleep dissatisfaction are even more frequent problems (10-48%) in the community. This is the first report on the prevalence of insomnia in Greece, a southeastern European country which differs in several socio-cultural and climatic aspects from the rest of European Community members. Data obtained from a national household survey (n = 1005) were used to assess the relationship between insomnia symptoms and a variety of sociodemographic variables, life habits, and health-related factors.MethodsA self-administered questionnaire with questions pertaining to general health and related issues was given to the participants. The Short Form-36 (Mental Health subscale), the Athens Insomnia Scale (AIS) as a measure of insomnia-related symptoms, and the International Physical Activity Questionnaire (IPAQ) were also used for the assessment.ResultsThe prevalence of insomnia in the total sample was 25.3% (n = 254); insomnia was more frequent in women than men (30.7% vs. 19.5%) and increased with age. Multiple regression analysis revealed a significant association of insomnia with low socio-economical status and educational level, physical inactivity, existence of a chronic physical or mental disease and increased number of hospitalizations in the previous year.ConclusionsThe present study confirms most findings reported from other developed countries around the world regarding the high prevalence of insomnia problems in the general population and their association with several sociodemographic and health-related predisposing factors. These results further indicate the need for more active interventions on the part of physicians who should suspect and specifically ask about such symptoms.

Cyberbullying victimization prevalence and associations with internalizing and externalizing problems among adolescents in six European countries

More than one in five of European adolescents reported cyberbullying victimization.The prevalence rate of cyber victimization was higher among girls than boys.The prevalence rate was highest in Romania while the lowest was in Spain.Externalizing, internalizing and academic problems were associated with cyber victimization. Cyberbullying victimization is an important adolescent health issue. The cross-national study aimed to investigate the prevalence of cyber victimization and associated internalizing, externalizing and academic problems among adolescents in six European countries. A cross-sectional school-based study of 14-17year-old adolescents (N=10,930; F/M: 5719/5211; mean age 15.8?0.7years) was conducted in Spain, Poland, the Netherlands, Romania, Iceland and Greece. In total, 21.4% of adolescents reported cyber victimization in the past 12months. Reports were more frequent among girls than boys (23.9% vs. 18.5%), and among the older adolescents compared to the younger ones (24.2% vs. 19.7%). The prevalence was highest in Romania and Greece (37.3% and 26.8%) and lowest in Spain and Iceland (13.3% and 13.5%). Multiple logistic regression analysis indicated that cyber victimization was more frequent among adolescents using the internet and social networking sites for two or more hours daily. Multiple linear regression analysis showed that externalizing, internalizing and academic problems were associated with cyber victimization. Overall, cyber victimization was found to be a problem of substantial extent, concerning more than one in five of the studied European adolescents. Action against cyber victimization is crucial while policy planning should be aimed at the prevention of the phenomenon.

Mediterranean Diet and Metabolic Syndrome in an Urban Population The Athens Study

BACKGROUND Previous studies demonstrated the beneficial impact of the Mediterranean diet (MedDiet) on metabolic syndrome (MetS). The aim of this study was to retrospectively investigate the association between MedDiet and MetS in a representative sample of the Athenian population in the early 1980s, when MetS had not been established as an entity yet. METHODS In a cross-sectional epidemiologic survey of cardiovascular disease (CVD), 2,074 randomly selected adults were examined: 900 men and 1,174 women (age, 46.9 ± 14.9 years). MetS was defined according to criteria of the National Cholesterol Education Program-Adult Treatment Panel III. A validated questionnaire concerning nutrition habits was administered, and MedDiet was assessed according to guidelines of the Division of Nutrition/Epidemiology, Athens University Medical School. RESULTS Overall, 1,023 participants (49.3%) followed MedDiet (47.3% men, 52.0% women, P = .033) with similar rates across age groups (P = .337). MetS was diagnosed in 24.0% of those following MedDiet, compared with 27.9% of those not following it (P = .041). Participants with CVD or diabetes mellitus were less likely to follow MedDiet (43% vs 50%, P = .009). Multivariate analysis revealed that MedDiet is associated with a 20% reduction in MetS (odds ratio = 0.80, 95% confidence interval = 0.65-0.98), after adjustment for age, gender, smoking, light physical activity, serum levels of low-density lipoprotein cholesterol and γ-glutamyl transferase, diabetes mellitus, CVD, family history of hypertension, and/or hyperlipidemia. CONCLUSIONS Results indicate that adherence to MedDiet may attenuate the prevalence of MetS and, consequently, the increasing burden of diabetes mellitus and CVD, especially in urban populations.

Additive effect of depressed mood and vasomotor symptoms on postmenopausal insomnia.

Objective:The aim of this study was to investigate the role of vasomotor and mood symptoms on insomnia in postmenopausal women. Methods:One hundred sixty-three postmenopausal women, not receiving hormone therapy, attending a menopause clinic at the University of Athens, Greece, were included in this cross-sectional study. Climacteric symptoms were assessed by Greenes scale, whereas psychological morbidity was measured by Zung Self-Assessment Depression Scale, Symptom Checklist-90-R, and Athens Insomnia Scale. Results:Vasomotor symptoms were significantly associated with insomnia (P = 0.001). When depressive symptomatology was added to the logistic regression analysis, the predictive ability of the model was significantly improved as defined by the increase in the log likelihood (P < 0.001) and the increase in the area under the receiver operating characteristic curve. Conclusions:Insomnia in postmenopausal women attending a menopause clinic is related both to the effects of vasomotor symptoms and depressive symptomatology. Mood symptoms seem to affect sleep independently of vasomotor symptoms, suggesting that depression should be carefully assessed and treated in postmenopausal women with insomnia.

Sleep disturbance in haemodialysis patients is closely related to depression

OBJECTIVE To investigate the relationship between depression and disturbed sleep in haemodialysis patients (HP), and its relative contribution in the development of reported sleep problems. METHOD A total of 101 patients suffering from end-stage renal disease (ESRD) were assessed through the Athens Insomnia Scale (AIS) for potential sleep problems. Anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS), and their health-related quality of life and functional status were assessed through the Short Form-36 questionnaire (SF-36). Socio-demographic, anthropometric and clinical data along with a series of biochemical measures were also collected. RESULTS Multiple logistic regression analysis showed that the independent predictors associated with insomnia in ESRD patients were female sex (OR=7.58) and depression as measured by the HADS (OR=2.59). CONCLUSION Incorporating a standard assessment and eventually treatment of depressive symptoms into the care provided to haemodialysis patients might improve psychological well-being, insomnia and quality of life, and, consequently, reduce mortality risk in this population.

Treatment compliance and early termination of therapy: a comparative study.

Background: Compliance in therapy appears to be linked to the process of therapeutic alliance. A positive patient–therapist relationship usually leads to successful completion of therapy. The aim of this study was to compare evidence, collected at two time periods in a Community Mental Health Center in Athens, on factors affecting treatment compliance. The hypothesis was that by modifying the therapeutic team’s functioning, noncompliance could be reduced. Methods: Epidemiological data were collected from child and adolescent out-patient files at two time periods: time period A, 1990–1994, n = 455 (sample A) and time period B, 2000–2002, n = 476 (sample B). Variables pertaining to the patient, his family and recommended treatment were examined. Student’s t test and the Pearson χ2 test were used in order to explore the correlation of the variables with treatment completion in each sample. Logistic regression analyses were used to determine whether the effect of each variable on treatment completion differed between the two samples. Results: In sample A, most patients (58.6%) did not comply with therapy. The type of recommended treatment, the number of sessions, season of admission and the type of presented problem were found to correlate with treatment completion. Between the two time periods, certain modifications were implemented in the team’s functioning (less diagnostic sessions, focused psychotherapy techniques, less time interval between referral and first diagnostic appointment). A significant reduction in the early termination rate (45.7%) was noted in sample B. The type of recommended treatment, the number of sessions, the family’s situation, the mother’s educational level and the patient’s gender were related to treatment completion in sample B. The effect of the type of proposed treatment and the mean number of sessions of the completed treatments differed significantly between the two samples. Conclusions:Early termination rates in therapy decreased between two time periods. This decrease may be attributed to modifications in the team’s functioning, aimed at improving the therapeutic relationship. The limitation of this study is that only those factors pertaining to the service’s organization and functioning were investigated.

Sociodemographic and socioeconomic determinants of health services utilization in Greece: the Hellas Health I study.

The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34–44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors. The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.

Physical activity may promote sleep in cardiac patients suffering from insomnia

Data obtained from a national household survey in Greece (n=1005) were used to assess the relationship between physical activity and insomnia in a group of subjects suffering from several major disabling physical illnesses. A self-administered questionnaire with questions pertaining to general health and related issues was given to the participants. The Short Form-36, the Athens Insomnia Scale (AIS), and the International Physical Activity Questionnaire (IPAQ) were included in the assessment. Half (49.5%) of the participants had moderate or vigorous physical activity and 33.4% had a chronic somatic disease. The prevalence of insomnia in the total sample was 25.3% (n=254); subjects having moderate or vigorous physical activity were 56% less likely to have insomnia in univariate analysis. Multiple analysis revealed a significant interaction of physical activity with heart failure or myocardial ischemia (OR=0.054, 95% CI: 0.003-0.95), indicating that subjects having moderate or vigorous physical activity and heart failure or myocardial ischemia had lower odds for having insomnia compared to individuals with heart problems and low physical activity levels. Consequently, cardiac patients suffering from insomnia seem to benefit from physical exercise. Since sleep disorders are quite frequent in cardiac patients and may result in both physical and psychological complications which deteriorate even further their quality of life and health, our results need replication in this particularly vulnerable population.