Konstantinos Tsoumakas

Cancer in childhood: Children's and parents’ aspects for quality of life

INTRODUCTION The aim of the present study is to (a) describe the level of agreement between reports of health-related quality of life (HRQL) obtained from parents and young patients both on- and off-treatment and (b) explore the factors that may affect the level of agreement in the quality of life (QoL) between young patients and parental proxies. PATIENTS AND METHODS The study group consisted of 149 young patients (77 children and 72 adolescents) with cancer followed up by an oncology in-patient clinic of a Greek childrens hospital with one of their parents (n=298). After parental consent was obtained, data were collected using the Pediatric Quality of Life Inventory (PedsQL) and a sociodemographic data form. RESULTS The data collection showed that the best agreement was for the physical (ICC=0.82) and the school domains (ICC=0.68), whereas the worst was for the emotional (ICC=0.48) and the social domains (ICC=0.52). In the off-treatment group, the mothers age was a significant predictor of the child-proxy difference on the physical sub-scale (F=9.804, P=0.003). There was a negative relationship between the mothers age and patient proxy difference on the physical sub-scale. In the on-treatment group, the educational level of the father was found to be a significant predictor for the physical (F=4.30, P=0.041), school (F=5.51, P=0.022) and total sub-scales (F=10.41, P=0.002). Parents with basic education tended to have worse agreement with their childrens reports on the physical and school sub-scales, while parents with higher education had worse agreement with their childrens reports on the total sub-scale. CONCLUSIONS Our findings suggest that the children and adolescents with cancer reported better QoL than their parents. The predictors found to be significant need to be examined extensively by further studies.

Spontaneous preterm birth in women with chronic hepatitis B virus infection

To determine whether chronic hepatitis B virus (HBV) infection, as evidenced by serum levels of HBsAg and HBV DNA, is a risk factor for spontaneous preterm birth (SPB).

Immunization coverage and predictive factors for complete and age-appropriate vaccination among preschoolers in Athens, Greece: a cross- sectional study

BackgroundIn Greece, several new childhood vaccines were introduced recently but were reimbursed gradually and at different time points. The aim of this study was to assess immunization coverage and identify factors influencing complete and age-appropriate vaccination among children attending public nurseries in the municipal district of Athens.MethodsA cross-sectional study, using stratified sampling was performed. Immunization history was obtained from vaccination booklets. Demographic and socioeconomic data were obtained from school registries and telephone interviews. Vaccination rates were estimated by sample weighted proportions while associations between complete and age-appropriate immunization and potential determinants by logistic regression analysis.ResultsA total of 731 children (mean age: 46, median: 48, range: 10–65 months) were included. Overall immunization coverage with traditional vaccines (DTP, polio, Hib, HBV, 1st dose MMR) was satisfactory, exceeding 90%, but the administration of booster doses was delayed (range: 33.7- 97.4%, at 60 months of age). Complete vaccination rates were lower for new vaccines (Men C, PCV7, varicella, hepatitis A), ranging between 61-92%. In addition, a significant delay in timely administration of Men C, PCV7, as well as HBV was noted (22.9%, 16.0% and 27.7% at 12 months of age, respectively). Child’s age was strongly associated with incomplete vaccination with all vaccines (p< 0.001), while as immigrant status was a predictor of incomplete (p=0.034) and delayed vaccination (p<0.001) with traditional vaccines. Increasing household size and higher maternal education were negatively associated with the receipt of all and newly licensed vaccines, respectively (p=0.035).ConclusionsOur findings highlight the need to monitor uptake of new vaccines and improve age- appropriate administration of booster doses as well as early vaccination against hepatitis B. Immigrant status, increased household size and high maternal education may warrant targeted intervention.

Association between knowledge and attitudes of school nurses towards epilepsy and the risk of accidents in Greek schools.

School nurses have the ability to enhance the knowledge and tolerance of an entire community and to form more positive and sensitized attitudes to future adults. The aim of this study was to investigate the relationship between the knowledge and attitudes of nurses and the frequency of accidents caused by epilepsy in Greek schools. Our sample consisted of 306 school nurses from all over the country. It was observed that the knowledge of school nurses on epilepsy was quite high, although there were specific aspects that raise concerns on their preparedness to respond to seizure-related emergencies, while their attitudes, although positive, still need improvement. Accidents caused by epilepsy were reported by half of the nurses, and prevention was considered of major importance. Therefore, organized continuous education programs and clear guidelines by the responsible authorities would help school nurses provide better services to students with epilepsy.

Importance of maternal and cord blood viremia in pregnant women with chronic hepatitis B virus infection

BACKGROUND/AIM The spontaneous preterm birth (SPB) rates in a group of HBeAg-negative chronic HBV infected pregnant women without several known risk factors for preterm delivery as well as the mother to infant HBV transmission rates was evaluated. Moreover the role of maternal data during perinatal period as well as the role of HBsAg and/or HBV-DNA presence in cord blood in respect to preterm labour and vertical transmission of the infection was examined. METHODS 138 consecutive chronic HBV infected pregnant women were haematologically, serologically and virologically evaluated during the perinatal period. 102 women were finally evaluated and fifteen of them (14.7%) exhibited SPB. Overall, 44 infants who had completed the proposed vaccination schedule were evaluated at month 12 of their life. RESULTS A significant association between SPB and HBV-DNA presence in cord blood was observed (p=0.007). HBV-DNA positivity in cord blood was significantly associated with maternal HBV-DNA levels (p=0.002). The relative risk of HBV-DNA presence in cord blood was 6.43 times higher among women with serum HBV-DNA ≥ 10.000 copies/ml and lymphocyte count<1500 compared to those with all the other combinations of both parameters (p=0.001). All infants evaluated at month 12 were HBsAg-negative and exhibited undetectable HBV-DNA levels. CONCLUSION The presence of HBV-DNA in cord blood is significantly associated with SPB in chronic HBV infected pregnant women. Maternal or cord blood viremia does not pose an additional risk factor for vertical transmission of HBV infection, in passive-active immunoprotected infants from HBeAg-negative chronic HBV infected mothers.

Presence of HBV-DNA in cord blood is associated with spontaneous preterm birth in pregnant women with HBeAg-negative chronic hepatitis B virus infection.

Spontaneous preterm birth is the leading cause of perinatal morbidity and mortality. In this study the spontaneous preterm birth rates in a group of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV)-infected pregnant women without known risk factors for preterm delivery as well as the role of maternal laboratory data and hepatitis B surface antigen/HBV deoxyribonucleic acid (HBV-DNA) in cord blood in respect to preterm labour were evaluated. 138 consecutive HBeAg-negative chronic HBV-infected pregnant women were evaluated during the perinatal period. Serum HBV-DNA was determined by using the Cobas Amplicor HBV Test in both maternal and cord blood samples. 102 women were finally evaluated (36 were excluded) and 15 of them (14.7%) had spontaneous preterm birth. A significant association between spontaneous preterm birth and HBV-DNA in cord blood was observed (p = 0.007). HBV-DNA positivity in cord blood was significantly associated with maternal HBV-DNA levels (p = 0.002). The relative risk of HBV-DNA in cord blood was 6.43 times higher among women with serum HBV-DNA ≧10,000 copies/ml and lymphocyte count <1,500 compared to those with all the other combinations of both parameters (p = 0.001). In conclusion, the presence of HBV-DNA in cord blood is significantly associated with spontaneous preterm birth in chronic HBV-infected pregnant women. Women with HBV-DNA ≧10,000 copies/ml and lymphocyte count <1,500 during the perinatal period have a higher probability of HBV-DNA in their cord blood.

Oxygenation equilibration time after alteration of inspired oxygen in critically ill patients

To determine the time required for arterial oxygen partial pressure (Pao(2)) equilibration after a change in fractional inspired oxygen (Fio(2)) in intensive care unit (ICU) patients, a prospective study in a 7-bed university ICU was performed. Forty adult patients were examined using sequential arterial blood gas measurements after a .3 alteration in Fio(2). The Pao(2) value measured at 30 minutes after a step change in Fio(2) in both periods was accepted as representative of the equilibrium value for Pao(2). The mean equilibration time was 8.26+/-5.6 minutes and 4.5+/-2.65 minutes for increases and decreases in Pao(2), respectively (P=.003). The constant k values were .44 +/- .31 minutes and .72 +/- .7 minutes for increases and decreases in Pao(2), respectively. There was no significant difference between the increase and the decrease of 90% oxygenation times in the 2 groups (P=.150 and P=.446, respectively). The study confirms that a period of less than 10 minutes is adequate for 90% of the equilibration of Pao(2) to occur after an Fio(2) change in ICU patients.

Sleep Architecture and Epileptic Characteristics of Drug Naïve Patients in Childhood Absence Epilepsy Spectrum. A Prospective Study

PURPOSE Childhood absence epilepsy (CAE) is an epileptic syndrome presenting between 2nd-10th years. The spells are elicited with hyperventilation (HV) while sleep seems to exacerbate the electrical activity. Our aim is to describe sleep architecture and its relationship with epileptic discharges (EDs) in patients with CAE, before treatment and one year later. METHODS Twenty-eight, drug-naive children were recruited (21 girls), mean age 90.1 ± 32.6 months. Routine-EEG and overnight EEG-polygraphy were conducted upon diagnosis and one year later. Patients were separated in two groups of similar mean age, according to their clinical response at the second recording: group A: children with absolute control of absences and group B: children with partial control. Sleep parameters, EDs and arousals were measured. The effect of medication on sleep parameters was examined, according to 2 groups: valproic-treated and non valproic-treated. RESULTS Group A showed significant improvement in total sleep time, REM-sleep latency, REM-sleep, arousals-number/hour and arousals-duration/hour between the two recordings. Comparing the two groups for each recording separately, group A initially demonstrated greater epileptic activity and worse sleep parameters, whereas in the second recording exhibited total elimination of the EDs and significantly less arousals. Group B demonstrated persisting EDs and slight deterioration in some sleep parameters during the second recording, despite the lower epileptic load initially. No significant difference was identified between valproic and non-valproic treated patients, regarding the effect on sleep parameters. CONCLUSION Absolute control of absences and normalization of the electroencephalogram are accompanied by more continuous, stable and efficacious sleep in children with CAE.

Reliability and validity of the Clinical Cultural Competency Questionnaire-Greek version (CCCQ-G) -

Introduction: Cultural competency is a term that is widely used regarding health care providers around the world. As a consequence, a plethora of new instruments have been introduced in order to describe, evaluate and measure the new term of cultural competence. Objective: This study aimed to determine the validity and reliability of the Clinical Cultural Competency Questionnaire-Greek version (CCCQ-G) among Healthcare Professionals. Methods: Two hundred and twenty (220) health professionals, from three (3) general pediatric hospitals in Greece completed the questionnaire. Internal consistency was determined and convergent validity was further examined with the intercorrelations of subscales. The structure of the questionnaire was investigated using factor analysis. Results: Analysis resulted in a six-factor solution, explaining 55 % of the variance. All subscales resulting from the factor analysis had alphas that ranged from 0.71 to 0.91. Correlations among the scales were all statistically significant. Higher scores in most subscales were observed for health care professionals who had attended transcultural health courses. Conclusions: The Greek version of CCCQ was found to possess good reliability and validity, therefore, the instrument could be used in future research studying cultural competence of health care professionals.

Current vaccination coverage against hepatitis B among pregnant women in Greece: far away from the ideal target

pelvic inflammatory disease, leading to the formation of abscesses. Sexual transmission has also been proved possible [3]. In 1996, a novel name, Haemophilus quentini [4] was proposed in place of ‘‘H. influenzae cryptic genospecies’’—a term used to describe strains with specific virulence towards the genital area due to distinctive endothelial adhesion profiles. H. influenzae cryptic genospecies is traditionally found as biotype IV [3], but has also been reported as biotype II [5] or I [6]. Both the API-NH and Vitek-NHI systems identified our isolate as biotype II, while their accuracies in biotyping have also been individually established [7]. Our isolate therefore probably belonged to the H. influenzae cryptic genospecies, according to similar reports [5]. However, the only way to identify the cryptic genospecies or H. quentini is by molecular analysis, which was unfortunately not feasible in our hospitals. The very rare manifestation of non-typeable H. influenzae in genital tract infections must not preclude its consideration in the differential diagnosis of tubo-ovarian abscesses, preterm birth [7] and/or life threatening bacteremias [6]. Molecular methods should prove in the future, the relative frequency of H. quentini and resulting biotypes in clinical samples from the affected female adnexa.