Maria Rekleiti

Prevalence of obesity in children aged 6-12 years in Greece: nutritional behaviour and physical activity

Introduction During the last two decades, obesity has proved to be one of the most important problems of public health, and it is considerably more frequent in developed countries, not only in adults, but in children, too. The aim of the current study is to evaluate the prevalence of overweight and obesity in children. Material and methods Two thousand three hundred and seventy-four pupils in primary education were considered for the study (1206 boys and 1168 girls). Results In the population-based study, the proportion of overweight children was 23.9%, of obese children 7.3%, and of those with central obesity 35.5%. The boys were obese in a higher percentage than the girls (9.2% vs. 5.3%, p < 0.05). The obesity rates were gradually reduced as the children were growing older. The nutritional habits which were identified to have a positive association with obesity were the following: skipping breakfast, not consuming fruits and vegetables, and consuming bread and soft drinks. Childrens healthy nutrition in school was related to lower rates of generalised and central obesity, while the hours spent watching TV were positively associated with all types of obesity. Conclusions Results from the study suggest that a high proportion of children are overweight or obese. Therefore, it is important to adhere to a healthy lifestyle which emphasizes healthy food choices and habits, regular physical activity, and limiting screen time.

Assessing a sun protection program aimed at Greek elementary school students for malign melanoma prevention.

INTRODUCTION Numerous countries have launched campaigns regarding sun protection in the last decades. AIM The aim of the present study was to assess an intervention program aimed at higher knowledge and healthier attitudes regarding sun protection. MATERIALS AND METHODS The sample consisted of 4,133 students aged 8-12 years from a single Greek province. RESULTS In most items, knowledge levels after the intervention were found to be higher than those before (2.8±0.9 vs 3.3±0.9), while knowledge about sun protection factors seems to have had the highest improvement (27.1% vs 56.6%). However, student attitudes did not appear to improve, with the exception of applying sunscreen with a higher SPF (29.7% vs 54.8%). Girls seemed to have healthier attitudes compared to boys, but gender played no role with regard to knowledge levels. Also, place of residence did not play any role regarding knowledge levels, although those living in semi-urban areas seemed to have more unhealthy attitudes. Logistic regression by correlating knowledge and attitudes established that higher knowledge levels are usually accompanied by healthier attitudes, albeit marginally. CONCLUSIONS The intervention had a positive contribution to the student knowledge level regarding sun protection and also led to small improvements regarding some attitudes. Continuous similar interventions could lead to better results and the adoption of healthier attitudes.

Sun-Protection Habits of Primary Students in a Coastal Area of Greece

Aim. The aim of the present study was to record habits and attitudes of primary school students in Greece regarding sun-protection measures. Materials and Methods. 2,163 students with an average age of 9.9 (±1.1) years, studying in 14 schools of a Greek region, constituted our sample. The SPSS 17.0 software was used for the statistical analysis and significance level was set to P ≤ 0.05. Results. Our sample had an equal gender distribution. 16% of the students belonged to the high-risk group, 70.2% of the participants lived 0–5 km away from the sea (urban area), 84.2% of the students were Greek, and 15.8% had non-Greek nationality. Half of the participants said they wear a hat when under the sun and 72% of them said they use sunscreen. 33.1% of the students said they had a sunburn last summer. Greek students as well as those who lived near the sea had better behaviour patterns regarding sun protection. Finally, children who did not use a sunscreen systematically had suffered sunburns more often than the rest. Conclusions. Health education programmes are necessary for students and parents/teachers alike, in order to raise awareness about everyday sun protection.

Investigation of Anxiety and Depression in Patients with Chronic Diseases

The health of an individual depends on both his/her physical and psychological condition. In recent years it has been observed that chronic patients have frequently an affected psycho-emotional state. The purpose of this study is to investigate anxiety and depression in patients with chronic diseases and the correlation of the results with daily physical activity levels and individual health levels, as well comorbidity. This study included patients with chronic diseases that were treated in a local general hospital or were visiting often outpatient clinics of the same hospital due to their condition. The sample in this particular study included 204 patients; 118 of them were women and 86 men. From the total sample that participated in our research, 118 (57.8%) were females and the majority of the participants were secondary/basic education graduates (67%), married (71%), living in urban areas (53%). Hypertension was the most frequent chronic disease in our sample, followed by hypercholesterolemia and diabetes mellitus. Comparing the occurrence of depression and anxiety symptoms in both questionnaires in relation to the expected frequency in the general population, significant levels of depression and anxiety symptoms were recorded. Taking into consideration the findings of this research, anxiety and depression symptoms can have profound effects regarding the control of chronic diseases, the patients’ quality of life and their general health.

Factors Affecting Mental Patients’ Behaviors and Attitudes Regarding Smoking

Background: Patients with mental health problems are in high risk to develop addiction, since smoking incidence is three times higher than that of the general population. The aim of the study was to investigate the factors affecting mental health patients’ smoking habits. Methods: The sample of study were 356 patients out of 403 initially approached, with 142 hospitalized in hospital facilities and 214 in community settings. The «Smoking in psychiatric hospitals” and General Health Questionnaire (GHQ-28) questionnaires were used. A principal component analysis was performed using the correlation coefficients of the various variables and an orthogonal varimax rotation, in order to interpret the seven factors emerging. Among the variables the most important factors appeared to be the type of healthcare facility, legal status, depression and age. Results: The type of healthcare facility was correlated to demographic characteristics, clinical features, psychopathology and functionality, but also to the attitudes and behaviors related to smoking. More specifically, the in-hospital patients were heavier smokers, about 90% of the patients said they would consider quitting smoking. The various variables had only a small effect on the intention to quit smoking. The comparison of the coefficients of determination of each variable, showed that age had the strongest effect (R2=0.152), while the GHQ D subscale (severe depression) had the least significant effect (R2=0.023). From all (7) factors, it appears that hospitalization was positively correlated with factor 5 and negatively with the factors 2, 3 and 6, legal status (commitment order) negatively with factors 1 and 4, while depression (or consuming antidepressants) positively factor 4 and negatively to factors 1 and 3. Finally, age was the only variable that is associated with the agent 7. Conclusions: Patients are permissive to staff’s smoking in the healthcare facility and may resist attempts to restrict it. It is important that these conclusions are taken into account in any systematic attempt to limit smoking within mental health settings.

Appropriate utilization of restricted antibiotics in a general hospital of a perfecture area in Greece.

INTRODUCTION Over-consumption of antibiotics has led to increased bacterial resistance and higher prevalence of hospital -acquired infections, resulting in rising treatment costs and prolonged length of hospital stay. The purpose of the study was to correlate the use of restricted antibiotics with recommended diagnosis and cost. MATERIALS AND METHODS All restricted antibiotics that were administered in a 240-bed general hospital in a semi-urban area within a year were recorded. The reason for administering each such antibiotic during the first three months of the study was also recorded. PASW 18 (SPSS Inc.) was used for the statistical analysis; a variable was considered statistically significant when statistical significance was p= 0.05. RESULTS 1118 patients were registered, of which 35,05% were employees, insured with IKA, 33,05% were farmers and covered by OGA and 31,9% were insured in other Social Insurance Funds or uninsured. The most commonly administered antibiotic combination was that of piperacillin/tazobactam, which was mainly used in the Internal Medicine Dept. of the Hospital. The most commonly used restricted antibiotic, administered after an antibiogram, was the combination of piperacillin/tazobactam (n= 13), mainly prescribed for respiratory infection. One third of the recorded restricted antibiotics were administered before an antibiogram had been taken for fever of unknown origin (n= 128). CONCLUSION Rational use of restricted antibiotics is an important component of public health policies aiming at reducing hospital-acquired infections. Hospitalization costs rise when restricted antibiotics are used, and the possibility for the development of resistant bacteria increases.

The effects of a first-aid education program for middle school students in a Greek urban area.

Today, many health-related hazards are known to be of multifactorial etiology, and prevention has been proved to be necessary even in early age before unhealthy habits become established [1]. Children have the ability to learn and mimic others’ behavior, which allows them to build knowledge, attitudes and behavioral patterns. Some of the factors that mold a childs perceptions on health are family, school and also the so-called ‘parallel’ school, i.e. social life, experiences and interaction with ones environment [2]. The most effective way of promoting health in schools is through the development of health education programs. Such programs may also promote learning procedures and connect schools to current social reality. These programs aim at modifying students’ behavior by enhancing personal responsibility, self-confidence, as well as the students’ ability to adopt positive lifestyle choices. A basic rule for the implementation of health education programs is that schools should be actively involved in and supportive of such programs, that these programs are acceptable to students and teachers, and that any opportunity for further cooperation with parents or the community should be fully maximized. The aim of the present pilot study was to determine levels of first aid knowledge among middle school students, before and after the educational intervention, and also to develop an education program aiming at attitude modification and knowledge advancement. This study was part of an environmental education program named ‘Natural Disasters’, which is organized every year by the Ministry of Education. The educational procedure was based on a team-centered system, through which the teams were actively involved, following Kolbs model of experiential learning [3]. The teaching plan was aimed at developing knowledge, attitudes and abilities that enable responsible choices concerning first aid. During the courses, several examples of activities were given, and potential first aid scenarios were discussed. Students were asked to participate in many activities in order to gain experiential learning. Experiential learning has proven to be more efficient than the classical learning of subjects and abilities, as students through practice and personal experience gradually learn the material [4, 5]. Our pilot study involved 87 middle school students in an urban area in Greece, who filled in a questionnaire before and after having experiential learning courses about basic first aid. SPSS 16.0 was used for statistical analysis. There was a statistically significant difference between before and after the educational intervention concerning the following questions: position for resuscitation (27.6% vs. 80.5%), nose bleeding (29.9% vs. 87.4%), choking (56.3% vs. 88.5%), unconsciousness (60.9% vs. 82.8%), recovery position (75.9% vs. 87.4%), trauma (77% vs. 89.7%) and self-protection when giving first aid (78.2% vs. 94.3%). There was no significant statistical difference between questions concerning burns (92% vs. 94.3%) and electric shocks (81.6% vs. 89.7%). There was an important but not big enough statistical difference about the ‘clearing the airway’ question (29.9% vs. 52.9%) (Figure 1). Figure 1 Most noticeable differences before and after educational intervention concerning some first aid situations This pilot study showed that middle school students lack basic knowledge of first aid. First aid education is not integrated in the school curriculum, and it is usually up to the individual teacher whether or not to teach first aid. The most common way students learn something about first aid is via non-profit and non-governmental organizations, various associations and private initiative. Students showed great interest in our program, participating actively, asking questions and clarifying many vague impressions they had from the occasional first aid bits and pieces. The results of similar studies carried out in Europe and the U.S.A. emphasize the importance of developing basic knowledge in the field of first aid not only for students but for the general population as well, and also the value of proper learning based on international science-based guidelines [6, 7]. In spite of the fact that the program has boosted students’ knowledge, the need for further use of the experiential teaching method is obvious. Teenagers should know how to deal with possible health risks and be able to provide basic help to anyone who needs it [7, 8]. International experience has shown that full implementation of health education programs has had some valuable effects, such as: better quality of life for students and families; the social role of schools becomes enhanced; health-related problems are highlighted and explained; students learn how to protect themselves against health risks; in the long run, hospital treatment costs will be reduced; and, finally, local communities get to use available resources and rouse people to get involved. Furthermore, it has been established that the effectiveness of health education programs depends on the teachers’ cooperation and also on the contribution of other international organizations (e.g. WHO, EU) [9, 10]. Besides the significant advantages for the students’ health and attitudes, teaching first aid in middle schools will allow students to master the scientific way of thinking and making decisions, and to form new-found attitudes favoring humanistic values; teaching first aid will also make them able to offer help, and build mental and social skills necessary for every modern civilized person. Health and Environmental Education programs have been shown to be highly effective and therefore the use and implementation of such programs should be expanded accordingly.

Tetanus vaccination coverage among nurses in Greece

To the Editor: Hepatitis B virus is mainly transmitted parenterally and represents amajor risk factor forhealth careworkers because of their frequent exposure to patient biologic materials (blood and body fluid). Epidemiologic studies have shown that the incidence of infection following a needlestick contaminated with hepatitis B virus ranges from 6% to 30%. Therefore, workers performing tasks involving exposure to blood or blood-contaminated body fluids should be vaccinated. With this study, we wanted to estimate the coverage levels of hepatitis B vaccination among Greek nurses against hepatitis B. A self-reported questionnaire was used, based on the original questionnaire used in the survey of McEwen and Farren (after permission of the authors). In our study, 63.2% of the participant Greek nurses reported that they were fully vaccinated. The majority of immunized nurses (66%) was female (P5 .008), and 72.6% of fully vaccinated nurses worked in intensive care units; 84.3% of those who were fully vaccinated had their antibody titer measured to assess the efficacy of the vaccine. Of these, 10.5% reported their titer was negative. Reported reasons for declining vaccination included concerns about adverse effects, beliefs that are not in increased risk for infection and prior hepatitis B infection. The main reasons for receiving vaccination were self-protection and family protection. Compared with other studies, we found lower vaccination rates among nurses. The higher vaccination levels in these studies probably rely in development and application of continuing immunization programs for health care workers. In conclusion, our study showed that a substantial number of Greek nurses (40%) are not vaccinated for hepatitis B, despite being in great risk for infection because of frequent exposure to blood or other potentially infectious biologic materials. Although efforts have been made to tackle this issue during the last years, there is still a need for more efficient vaccination strategies. This would contribute further into reducing the number of unprotected health care workers and