Promotion of Immunizations for Health Professionals in Europe: A Qualitative Study in Seven European Member States

Health Care Workers (HCWs) are a high-risk group for contracting Vaccine-Preventable Diseases who, despite legislation and guidance, remain undervaccinated. In order to understand their barriers and needs, focus groups were formed with 278 physicians, nurses, infection-control personnel, and policy-makers in 7 EU MS. Several implications for the development of promotional initiatives were identified including the need to overcome organizational barriers, to sensitize HCWs about the importance of immunization and to provide specific up-to-date information about vaccinations covering prevalence of diseases, protection years, side effects, administration times, antibody examinations, costs and immunization settings.     

Right superior vena cava draining into the left atrium in a patient with sinus venosus defect

Right superior vena cava draining into the left atrium is an extremely rare anomaly of systemic venous return. It can be isolated or it can be associated with other congenital heart defects, thus clinical presentation may vary. A case of a 9-year-old asymptomatic patient with sinus venous defect and bilateral superior vena cava with the right-sided draining into the left atrium is described.     

Serum interleukin (IL)-1, IL-2, sIL-2Ra, IL-6 and thrombopoietin levels in patients with chronic myeloproliferative diseases

A number of growth factors are involved in clonal haematopoietic expansion and their clinical significance in patients with chronic myeloproliferative diseases requires further evaluation. Using enzyme-linked immunosorbent assays, we analysed serum levels of interleukin (IL)-1a, IL-1b, IL-2, IL-6, the soluble IL-2 receptor alpha (sIL-2Ra), and thrombopoietin (TPO), in 25 individuals with myelofibrosis with myeloid metaplasia (MMM), 40 with essential thrombocythaemia (ET), eight with polycythaemia vera (PV), 10 patients with chronic myeloid leukaemia (CML) and 27 normal controls. These were correlated with clinicopathological characteristics including overall survival, and histopathological bone marrow features, including angiogenesis. The serum derived from patients with MMM, ET, PV and CML contained significantly higher IL-2 and sIL-2Ra than healthy subjects, while IL-6 levels were higher only in MMM and CML than controls. IL-2, sIL-2Ra and IL-6 levels were raised during the transformation phase of CML, during progression of MMM to AML, and ET and PV to myelofibrosis (P < 0.001). There was a positive correlation between IL-2, sIL-2Ra, IL-6 and angiogenesis in bone marrow samples. Cytokines may be useful markers for predicting clinical evolution, reflecting increased angiogenesis. This requires further evaluation to guide diagnostic and therapeutic options.     

Comparison of six radionuclidic and non-radionuclidic methods for the assessment of glomerular filtration rate in patients with chronic renal failure

The assessment of renal function in patients with chronic renal failure has a significant impact on both prognosis and treatment. We were unable to find a study, comparing six radionuclidic and non-radionuclidic methods as tested in this study on the same patients for the assessment of renal function in order to evaluate the relative significance of each method. In this study 82 patients were enrolled, 31 females with an age range 18-73 y (mean: 46 y) and 51 males with an age range 20-77 y (mean: 48 y). The level of renal function of these subjects ranged between normal, and mild to severe renal failure with serum creatinine levels: 2.7+/-2.2 mg/dl (mean+/-SD). The methods used for the glomerular filtration rate (GFR) were: (a) the clearance of inulin; (b) the technetium 99m labeled-diethyleno triamine pentacetic acid (99m)Tc-DTPA plasma disappearance curve; (c) the UV/P formula, not corrected for the residual urine volume in the bladder [DTPA(-)]; (d) the UV/P formula corrected for the residual urine volume in the bladder [DTPA(+)]; (e) plasma clearance of creatinine by the Cockcroft-Gault formula; and (f) plasma clearance of creatinine by using a 24-hour urine collection. In a subgroup of 13/82 patients, GFR was assessed by the radionuclidic and non-radionuclidic methods and compared against clearance of inulin, which was considered to be the gold standard. Moreover, we evaluated in our results the impact of age, gender, cause and stage of renal failure and the effect of the residual urine volume in the bladder. Fifteen of our patients were re-evaluated after 19-21 weeks. Spearman's correlation was used for statistical analysis; a two-sided P value < 0.05 was considered as statistically significant. Our results have shown that: the DTPA(+) method displayed the best correlation with the clearance of inulin (r=0.996) and was considered as the reference method in this study. The radionuclidic methods (99m)Tc-DTPA) plasma disappearance curve and DTPA(-) gave similar and comparable results with DTPA(+) (r=0.98, r=0.96), while the non-radionuclidic methods(plasma clearance of creatinine by using a 24-hour urine collection and plasma clearance of creatinine by the Cockcroft-Gault formula) tended to overestimate GFR respectively(r=0.91, r=0.79). Patient's age and gender had no impact on the calculated GFR values. With regards to the chronic renal failure cause, the above-mentioned tendencies were confirmed in primary and secondary glomerulonephritis, in diabetic nephropathy, and in hereditary renal diseases. On the contrary, in patients with renal disease of unknown cause, all methods -- isotopic and non-isotopic -- gave comparable results. The DTPA(-) method is simple to use and reliable, however, due to the fact that it does not consider the residual urine volume in the bladder, it seems to overestimate GFR in elderly men with prostate hypertrophy and increased residual urine volume in the bladder. The DTPA(+) method is reliable in a wide range of renal function levels, from mild to significant renal impairment. The radionuclidic methods DTPA(+), DTPA(-) and the (99m)Tc-DTPA plasma disappearance curves showed a very good reproducibility (r =0.97, r =0.96, r = 0.87) when were reperformed after 19-21 weeks, as compared to creatinine clearance with 24-hour urine collection (r=0.83). In conclusion, the radionuclidic methods in patients with chronic renal failure are reliable and reproducible, closely resembling those of inulin clearance. The among all radionuclidic methods, (99m)Tc-DTPA(+) shows the best results.     

Acute bronchiolitis in a paediatric emergency department of Northern Greece. Comparisons between two decades

Introduction

Acute bronchiolitis is the most common lower respiratory tract infection in infants and toddlers concerning small bronchi or bronchioli. This retrospective study aimed to evaluate the incidence of acute bronchiolitis and the use of β₂-agonists between two different decades.

Material and methods

During 1990-1991 and 2001-2002, the files of the 2^nd Paediatric Emergency Department of Aristotle University of Thessaloniki, AHEPA Hospital were reviewed and cases of acute bronchiolitis were recorded and analysed.

Results

During 1990-1991, 14 538 children were identified with respiratory infections and bronchiolitis was diagnosed in 519/14 538 children (3.56%). Only 34 out of 519 patients received nebulised salbutamol (6.6%) and 221/519 were hospitalized (42.6%). During 2001-2002, 9001 children were found to have respiratory tract infections and acute bronchiolitis was diagnosed in 641/9001 of them (7.12%). In total, 411/641 children (64.1%) received salbutamol and ipratropium, and 89/641 patients (13.88%) were hospitalized. There was a predominance of male sex in both decades (p = 0.509). There was a statistically significant difference (p < 0.001) concerning the use of nebulised salbutamol with nebulised ipratropium between the two decades. Finally, during 2001-2002, the use of bronchodilators with or without corticosteroids was more frequent and it appears to be correlated with the reduced number of admissions to hospital (p < 0.05) compared with 1990-1991.

Conclusions

There was an increase in the incidence of acute bronchiolitis during the last decade. The admission rate decreased probably due to the use of nebulized salbutamol and ipratropium, but further multicentre comparative trials are required to define the role of bronchodilators in the treatment of acute bronchiolitis.     

Depression in diabetic foot ulcer: Associated factors and the impact of perceived social support and anxiety on depression

Diabetic foot ulcer (DFU) exerts a heavy physical and emotional burden on patients with diabetes mellitus. The purpose of the present study was to explore the impact of anxiety and perceived social support on depression of DFU patients well as patients'' characteristics associated with depression. The sample of the study consisted of 180 DFU patients. Data collected by the completion of “Self‐rating Depression/Anxiety Scale‐ Zung” (SDS/SAS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients had moderate levels of anxiety and depression (median: 36, 42, respectively) and high levels of perceived social support from their significant ones, their family and friends (median: 24, 24, 17, respectively). After multiple regression factors that were found to have an impact on depression after taking into account all other factors, were patient''s age of above 70 years, patient''s anxiety and the social support they received from their significant ones. More specifically, patients aged above 70 years had 9.51 points higher depression than patients aged <50 years of age (β = 9.51, 95% CI: [0.76, 18.25], P = .034). Moreover, one point increase in patient''s anxiety score indicated an increase of 0.71 points in patient''s depression (β = 0.71, 95% CI: [0.43, 1.00], P = .001). On the contrary, one point increase in patient''s social support from their significant ones indicated a decrease of 1.52 points in patient''s depression (β = −1.52, 95% CI: [−0.25, −2.79], P = .020). Clinically, a better understanding of factors having an impact on depression on DFU may provide an essential in planning cost effective interventions.     

Diet-Related Behaviors and Diet Quality among School-Aged Adolescents Living in Greece

Prevalence of diet-related behaviors (i.e., breakfast consumption, eating with the family) and their association with a 17-point diet quality score, constructed on the basis of reported frequency (in days/week) of vegetable, fruit, sweets and sugar-sweetened beverages consumption, was investigated among 3525 adolescents (51.5% girls) aged 11, 13 and 15 years, who were participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) cross-sectional study, during 2018. Almost one-third (32.9%) of the sample had breakfast ≤1 day/weekdays, 20.2% rarely ate with the family, 26.1% had a meal while watching TV ≥5 days/week, 31.7% had a snack in front of a screen ≥5 days/week and 24.1% ate in fast-food restaurants at least once/week. Multivariable ordinal logistic regression revealed that eating breakfast ≤1 day/weekdays compared to 4–5 days/weekdays (Odds ratio (OR): 1.56, 95% con-fidence interval (CI): 1.34–1.82), eating rarely with the family compared to almost every day (OR: 1.35, 95% CI: 1.13–1.60) and eating in fast-food restaurants ≥2 times/week vs. rarely (OR: 4.59, 95% CI: 3.14–6.70) were associated with higher odds of having poor diet quality. High frequency of having meals/snacks in front of a screen/TV was also associated with poor diet quality. Efforts to prevent or modify these behaviors during adolescence may contribute to healthier diet.     

Personalized diet management can optimize compliance to a high-fiber, high-water diet in children with refractory functional constipation

Diet modification to increase water and fiber consumption is considered an important component in the management of constipation. This prospective randomized study aimed to evaluate the compliance of 86 children with refractory functional constipation (mean age 4.4 years, range 1 to 11 years)-to a high-fiber, high-water diet following either physician's dietary advice (PI group) (n=42) or physician's dietary advice plus personalized diet management by a registered dietitian (DM group) (n=44). Dietary intake was assessed by a 24-hour dietary recall at baseline and 1 month later. The changes in water and fiber consumption were used as compliance criteria. DM group had comparable anthropometric measurements; sex distribution; and baseline intakes of energy, macronutrient, water, and dietary fiber compared with the PI group. Comparison of nutrient intakes between the two visits within each group showed a significant increase in fiber consumption in both groups that was more pronounced in the DM group. Water, energy, and carbohydrate consumption increased significantly only in the DM group. Multivariate regression analysis revealed that the intervention group was the only significant independent predictor for the change in fiber and water consumption after controlling for age, sex, and weight-for-age z score. Children receiving personalized diet management for refractory functional constipation achieved better compliance in increasing fiber and water consumption.     

Prostitution Policies and Attitudes Toward Prostitutes

Archives of Sexual Behavior - The present study examined whether regulatory attitudes toward prostitution are related to agency attributed to prostitutes and moral outrage. A Spanish sample...