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Vima AsklipiouRostrum of Asclepius Vol 20, No. 2 (2021): April - June 2021 Current Issue

Hot Topic

The effect of COVID-19 on socio-economic health determinants and the inequal social impact | 101-114

Athanasios Makrakis

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The COVID-19 virus spread rapidly to the international community as an infectious contagious disease and was classified by the WHO as a pandemic on the 13th of March 2020. Its prevalence in conditions of social interaction and overcrowding has constituted a gate of transmission especially to the lower socioeconomic classes and has adversely developed chronic diseases due to comorbidity increasing the morbidity and mortality rates of the population.

The treatment of COVID-19 was carried out mainly with a similar repressive practice of the Middle Ages. The measure of quarantine (lock down) which translates into restriction and isolation of the individual has been restored. Of course, the application of social distancing negatively affected the well-being and revealed strong phenomena of psychological approach (e.g. depression, anxiety) caused by the disruption of social relations as well as the escalation of domestic violence with unclear future consequences for the institution and individuals.

The world community has received information exaggerations of extreme cases of the disease from the media, creating a conflicting intra-individual field, between essential health care and oversensitive phobic tendency of possible infection and symptoms.

Success in tackling the threat of the effects of COVID-19 should focus on reasoned information from reputable bodies and organizations of known prestige while improving and restraining socioeconomic factors from individual policies that contribute to the mitigation of social inequalities.

Keywords: COVID-19, social and digital inequalities, socio-economic determinants of health, pandemic

Special Article

DNA damage and smoking: a biological approach | 115-121

Iοannis Delimaris

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In the human cell, genetic material is found in the nucleus (nuclear DNA) and in mitochondria (mitochondrial DNA). Although DNA is generally regarded as a stable chemical molecule, the role of external environmental factors (eg smoking) in causing DNA damage has not been fully elucidated. Νumerous researches have been done concerning the effects of smoking on various organs of the body (susceptibility to cerebral myocardium, peripheral angiopathy, chronic obstructive pulmonary disease, lung cancer etc.).The aim of the present brief review study is to examine the potential relationship between DNA damage and smoking. The study material included articles on the topic found in international databases, such as Google Scholar and PubMed, using the appropriate keywords: DNA damage, smoking, tobacco, oxidative stress, and a combination of these. As criteria for including  the studies were used: a) studies of any date b) publication language: English or Greek. Criteria for excluding studies were: (a) studies in languages ​​other than English (b) free announcements at meetings, written submissions to the publisher, and theses. It seems that smokers are more likely to have increased levels of DNA damage. However, additional well-designed research is needed to further clarify the relationship.

Keywords: DNA damage, Smoking, tobacco, oxidative stress

Original Papers

Workplace affect and emotional regulation in interdisciplinary teams of the Differential Diagnosis Centers and Support for Special Educational Needs (KEDDY). The mediator role of Emotional Intelligence | 122-140

George Tsouvelas , Γεώργιος Κουλιεράκης

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Introduction: The study of workplace affect constitutes a new paradigm of research, which is mainly determined by the theory of Emotional Intelligence (EI) and the theory of emotion regulation. Emotional management at workplace is crucial especially in environments where interdisciplinary collaboration and teamwork is needed, such as the Diagnostic and Support Centers for Diagnosis for Special Education (KEDDY).

Aim:  The present study investigates the relationship between strategies of emotion regulation, EI and workplace affect.

Material and Method: A quantitative cross-sectional study was conducted among 197 employees (153, 77,7% were women), with a mean age of 39,5 years, derived from 34 KEDDY of the country. Data was collected using printed anonymous questionnaires, namely scales of workplace affect, EI and emotion regulation, which were voluntarily completed by the participants. Correlation checks (Pearson’s r) were performed, the t criterion was used to compare independent samples, while two structural equation models were used.

Results: Positive workplace affect was positively correlated with the cognitive reappraisal strategy and EI. Negative workplace affect was positively correlated with emotional suppression and negatively with EI. According to structural equation models, EI fully mediated the relationship between cognitive reappraisal and positive workplace affect. Socio-demographic factors did not correlate with dimensions of workplace affect (positive and negative).

Conclusions: Cognitive reassessment constitutes an adaptive workplace emotion regulation strategy. This study highlights the usefulness of developing emotional skills programs in the workplace, aiming to improve work satisfaction and empower employees to manage workplace conflicts and difficulties.

Keywords: Workplace affect, strategies emotional regulation, emotional intelligence, KEDDY, interdisciplinary work teams

Quality of life in patients with heart failure | 141-157

Thomai Platia , Georgia Fasoi , Georgios Vasilopoulos , Olga Kadda , Georgia Toylia , Martha Kelesi-Stavropoulou

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Introduction: Patients with Heart Failure (HF) present low Quality of Life (QL) indicators and increased incidence of mental disorders in relation to the general population so as to other chronic diseases.

Aim: The aim of the present study was to assess the quality of life in patients with heart failure.

Material and Methods: This is a retrospective study which studied sample consisted of 42 patients hospitalized in a cardiology department of Attica Tertiary Hospital. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) weighted questionnaire was used to collect data, and patients with heart failure were included in the study according to the latest 2016 guidelines. Data analysis was performed using the SPSS statistical program ver.17.

Results: Via telephone communication with patients or their relatives it was found that 19 out of 61 patients (31.1%) died before the time of telephone communication. Thus, the statistical analysis included patients in life (n = 42). The mean age of patients was 67.8 years (± 13.6), while 85.8% were men. Regarding quality of life (MLHFQ), no statistically significant difference was found between the two genders and the subscales studied. However, a statistically significant effect of the independent variable on a subscale for quality of life was found, ie the three categories related to obesity status differ statistically significantly in the difficulty presented by these patients during their night sleep, [F (2 , 15) = 5,623, (p <0.05)].

Conclusions: The quality of life of patients with HF appeared to be affected by their obesity status. Further studies need to be conducted to investigate the quality of life in relation to comorbidities such as obesity.

Keywords: heart failure, quality of life,   risk factors

Setting boundaries in addiction treatment | 158-172

Evdokia Misouridou , Despoina Eseridou , Paraskevi Nikolaidou , Irini Segredou

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Introduction: The boundaries of people allow them to preserve their integrity, take responsibility for themselves and have control over their life by protecting them from being violated by others.

Aim: This study attempts to describe the efforts of addiction therapists to support family members who have problems with alcohol / psychoactive substance use in enforcing boundaries.

Methodology: Focus group interviews with addiction therapists were conducted and 42 vignettes of collaboration with families were collected. The Atlas-t program was used for the coding.

Results: Boundaries setting is a frequent intervention with affected family members, which is related to both the motivation and the process of differentiation of the family member who faces problems related to substance use. A necessary condition is the decrease of emotional intensity and the de-escalation of the use-conflict cycle within the family system. Behaviors that lead to unnecessary conflict or alienation are avoided, while behaviors that strengthen family relationships are reinforced.

Conclusions: Containment of affected family members’ negative feelings ensures that boundaries encourage change, avoiding the control and the blaming of the person experiencing addiction problems. Limit setting is especially difficult when there is a history of abuse, alcoholism and other problems associated with a heavy burden of guilt for the past.

Keywords: addiction, affected family members,  family, boundaries, limit setting

Systematic Review

Methods of external hemorrhage control at pre-hospital level: Systematic review | 173-189

Georgios Angelopoulos , Georgios Vasilopoulos , Niki Pavlatou , Georgia Toylia

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Introduction:  Effective and timely control of bleeding is the most important step in the management of seriously injured patients. In recent years, new techniques, devices and drugs have been developed to effectively control pre-hospital bleeding.

Aim: To review the recent international literature on the effectiveness of pre-hospital external hemorrhage control methods in the outcome of patients.

Material and Method: International bibliography was searched for studies published from 01/01/2010 to 31/08/2019 in the PUBMED database. The review included primary studies written in English that focused on the application of methods, techniques and substances to control external bleeding at pre-hospital level.

Results: Α total of 14 review articles were included in the research and selection process.  A small percentage of patients have complications from using tourniquet. The hemostatic dressings, the iTClamp® and the tranexamic acid (TXA) have been found to be effective in controlling bleeding. The iTClamp® can be applied very quickly, in less than a minute. At the same time, the TXA was associated with better patient outcomes and fewer units of transfused blood.
Conclusion: The tourniquet, the haemostatic dressings, the iTClamp® and the TXA help to effectively control haemorrhage at the pre-hospital level and improve patient outcomes, but further investigation is needed.

Keywords: External hemorrhage, external injury, prehospital, tourniquet, hemostatic agents, hemostatic dressings

The Application of N.A.V.A. to pediatric patients | 190-210

Christiana Laina , Ioannis Koutelekos

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Introduction: Neural Adjusted Ventilatory Assist (NAVA) is a new mode of ventilation that was recently applied in the PICUs recently. NAVA provides a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort.

Aim: To review the recent international literature on the use of NAVA to patients, admitted to the Peadiatric Intensive Care Unit (PICU) and the impact of NAVA on respiratory and hemodynamic parameters, as well as on the outcome of these patients.

Material and Method: International bibliography was searched for studies published until August 2019 in the PUBMED database with the following keywords: "Neurally Adjusted Ventilator Assist" "ventilation", "Paediatric Intensive Care Unit", "Child" and "Infant”. The review included primary studies written in English concerning the application of NAVA to children admitted to the PICU.

Results: The initial search resulted in 58 articles, and after reading the title, abstract, and the overall text, 11 articles were included in the review. The application of NAVA to infants and children in the PICU was associated with a significant improvement in patient-ventilator synchronization, a reduction in peak and mean airway pressures, a reduction of oxygen concentration. Also, one study found that the amount of sedation was significantly lower when NAVA was applied to non-surgical patients. NAVA was also associated with a significantly higher COFMORT scale rating.

Conclusions: The application of NAVA appears to be safe for PICU patients, and well tolerated and improves patient-respirator synchronization. However, it is necessary to carry out randomized clinical trials with a larger sample of patients to confirm the results.

Keywords: Neurally Adjusted Ventilatory Assist, N.A.V.A., children intensive care unit

Physiotherapy in cerebral palsy | 211-242

Evangelos Prekas

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Introduction: Cerebral Palsy (CP) is the leading cause of childhood disability. The heterogeneity and diversity of its clinical image makes the recovery difficult and complex.

Aim: The aim of the present study is to outline the physiotherapeutic approaches and practices currently used to problems of CP.

Material and Methods: Literature review and search of international databases PubMed, Google Scholar, Medscape, Elsevier, NICE guidelines, American Academy of Pediatrics, Scientific Research Publishing has been made. The articles were published from 2001 to 2019 and are written in English and Greek. According to the criteria, 39 publications were included.

Results: Neurodevelopmental approaches influenced by the neurodevelopmental theory were the first form of physiotherapeutic intervention for children with CP. The development of dynamic systems theory has led to the creation of a more modern approach, the functional approach and has forced other methods to be adapted to the new scientific data of rehabilitation of CP. In the recent years at the forefront of the rehabilitation of children with CP is the selective approach, where the physiotherapist combines knowledge of different methods and approaches. Muscle strengthening, therapeutic swimming, the use of ankle-foot orthoses, pediatric standers and evaluation-classification tools of the CP, contribute significantly to the physiotherapy treatment.

Conclusions: Neurodevelopmental approaches, functional and selective approach, are the forms of physiotherapeutic intervention of the CP to date. In recent years, the rehabilitation has expanded to other areas that make a significant contribution to physiotherapy of CP.

Keywords: Cerebral palsy, physiotherapy, Rehabilitation

Knowledge, attitudes, and practices of healthcare works towards COVID-19: A systematic review | 243-253

Maria Gamvrouli , Christos Triantafyllou

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Introduction: Coronavirus disease 2019 (COVID-19) is a global health and societal emergency respiratory disease that is caused by SARS-CoV-2. A poor understanding of the disease among Healthcare Workers (HCWs) can result in delayed identification and treatment leading to rapid spread of infections.

Aim: The investigation of the knowledge, attitude and practices (KAP) of HCWs toward COVID-19.

Material and Methods: Search was performed on PubMed for studies published from January 1, 2020 to June 30, 2020 with the key-words: “knowledge”, “attitude», “practice”, “COVID19”, ”healthcare workers” and “HCW”, which were searched in the title and abstract of the studies. Studies were excluded if they were not published in English language, were conducted on animals and were case studies, editorials, and letters to the editor.

Results: Of the scientific papers retrieved, 5 were included in the systematic review. Regarding the rate of knowledge of HCWs toward COVID-19, it ranged from 62.6 % to 89%. The rate of HCWs that had good practices and positive attitudes toward COVID-19 ranged from 74% to 89.7% and from 21% to 88.5%, respectively. The factors that positively affected (increase the rate) in statistically significant level the knowledge, attitudes and practices were the age of 40 years old and more, the higher level of education (possession of Master of Science Degree and/or Doctor of Philosophy), the medical profession and the more years of experience.

Conclusions: Continuing professional education is advised among HCWs to improve knowledge of HCWs hence averting negative attitudes and promoting positive preventive and therapeutic practices.

Keywords: knowledge, attitudes, Practice, HCWs, COVID-19

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