PURPOSE: This study aimed to assess pediatric nurses' knowledge and skills in pain management and examine the factors influencing their proficiency in this area. DESIGN AND METHODS: A cross-sectional study was carried out to assess the knowledge of pediatric nurses in Greece. Data were collected from six public pediatric hospitals using a convenience sampling method, yielding a sample of 154 nurses. The Demographic Information Questionnaire and the Knowledge and Attitudes Survey Regarding Pain (KASRP) were utilized. Statistical analysis was performed using Statistical Product and Service Solutions (SPSS) software. RESULTS: The study found that pediatric nurses had a mean score of 51.98% on the pain management knowledge questionnaire, highlighting significant gaps in understanding, particularly regarding opioid use and pain intensity indicators. Scenario-based decision-making revealed that only a small percentage of participants correctly identified the appropriate dosage for pediatric pain management. Key areas for improvement were identified, especially in the proper use of opioids and pain assessment scales. DISCUSSION: The findings of this study highlight the need for targeted educational interventions and training programs to enhance pediatric nurses' competencies in pain management. Improving nurses' knowledge and clinical decision-making could contribute to more effective pain relief and higher-quality care for pediatric patients.

: High-quality pediatric emergency care requires timely access, effective communication, privacy, pain management, comfort, and child- and family-centered practices; however, implementation may be constrained by several barriers. The aim of the study was to evaluate the quality of pediatric emergency care as perceived by healthcare professionals, with emphasis on child-centered care and variations based on workplace and professional characteristics. : A cross-sectional survey was performed in the emergency departments in two tertiary public pediatric hospitals in Athens, Greece. A study-developed 14-item Quality of Care Assessment Scale with paired ratings of agreement with quality principles and implementation in practice was completed by 162 professionals (122 doctors, 24 nurses, 16 assistant nurses). Independent items evaluated perceived barriers, overall assessments (0-100), and information provided to parents/children (5-point Likert scale). Inferential tests and descriptive statistics were also used ( < 0.05). : There was a significant degree of agreement with quality principles, but there was a constant lack of implementation (principle-practice gap). The primary perceived weakness was waiting times; child-friendly settings and privacy during examinations and information-giving were also lacking. Internal consistency ranged from good to acceptable (implementation α = 0.800; agreement α = 0.711). Children were most frequently rated as "moderately informed" (48.1%), while parents were most frequently rated as "quite informed" (50.0%). Compared to the organization of care (mean 60.85), perceived safety was higher (mean 73.27). Perceptions varied by age, educational level, profession, department, shift rotations, and hospital. The main barriers were workload (30.2%), poor coordination (34.0%), and lack of resources (46.9%). : Health professionals seem to perceive that consistent delivery of child-centered care is impaired by organizational and structural limitations. Reducing the standards-to-practice gap requires targeted system-level interventions that focus on staffing, care organization, environment, and professional support.

INTRODUCTION: Quality of life measures from the patient's subjective experience are important, since it capture how the treatment affects their daily life, functional abilities, and emotional well-being. This study aimed to measure patients' QoL prior and after Transcatheter Aortic Valve Implantation (TAVI) procedure. METHODS: This prospective study was conducted from November 2022 to December 2024 in a sample of 302 TAVI patients from three public Hospitals in Greece. Patients were recruited and followed up at the point of discharge and six months after discharge. Patient-reported quality of life was recorded using both the generic EQ-5D-5L and KCCQ a disease-specific HRQoL instrument. Descriptive statistical analysis was performed using SPSSv.29. RESULTS: The results of the study indicate excellent clinical outcomes with low mortality rates and low incidence of severe complications. Improvements in TAVI techniques and patient selection have led to decreased mortality rates. Six months follow-up confirms the great clinical outcome, and readmission rates were limited to two cases. From the patients' perspective, the overall outcome was rated as acceptable or favourable by most of them, with movement problems and pain being commonly stated. After discharge, the patients stated better outcomes both regarding their daily living, mobility and psychological state, reporting less stress and depression. CONCLUSION: QoL assessments help determine the true benefit of TAVI beyond just survival rates. Further research is needed to stress the main determinants of QoL in these patients and to guide the everyday clinical practice.

This prospective study was conducted in four public tertiary hospitals in Greece. Consecutive cardiac patients (AMI or TAVI) (n=912) were registered and followed up at the point of discharge six months and 12 months after discharge. In case of AMI patients [N=610, mean age=63 (SD=11.8), 78.8% men, 48.8% STEMI], the Heart-QoL score was found 2.33 (SD=0.5) at the point of discharge, 2.61 (SD=0.31) six months after discharge and 2.68 (SD=0.3) twelve months after discharge. In case of TAVI patients [N=302, mean age=81 (SD=5), 50.7% men], the Heart-QoL score was found 1.54 (SD=0.38) at the point of discharge and 2.02 (SD=0.46) six months after discharge. Based on the results of the Danish Heart PREMs instrument (0-3), the majority of patients stated positive experiences during the cycle of care. However, positive experiences regarding the information they received about the psychosocial impact of cardiac issues on their lives (mean and organization (mean 1.03, SD =0.33 for AMI and 1.1, SD=0.35 for TAVI patients), were significantly limited. Results underline the necessity for in depth information of cardiac patients about the psychosocial effects of the disease on their lives and more effective coordination of healthcare.

The perioperative management of patients with pulmonary hypertension (PH) undergoing cardiac surgery is challenging, mainly due to the potential risk of right ventricular failure (RVF). Levosimendan is a calcium-sensitizing agent that has primarily been used in the treatment of decompensated heart failure. However, recently levosimendan has been shown to be an effective and safe therapeutic strategy for patients with pulmonary arterial hypertension and PH associated with left heart disease. The aim of this study was to investigate the potential utility of the preemptive administration of levosimendan in cardiac surgical patients with preexisting PH and to compare its effectiveness with milrinone, which represents an already established therapeutic option in the management of PH during cardiac surgery. In this study, 40 adult cardiac surgical patients with PH were randomly assigned to receive either levosimendan intravenously or milrinone via inhalation in a double-blind fashion prior to a cardiopulmonary bypass (CPB). Hemodynamic and echocardiographic parameters were recorded and evaluated before and after the administration of the drugs. The results of this study demonstrated that both levosimendan and milrinone administered before CPB in cardiac surgical patients with PH may offer protective benefits, reducing pulmonary artery pressure and preventing the exacerbation of PH and RVF. Pulmonary vasodilation attributed to levosimendan is of longer duration and greater magnitude compared to pulmonary vasodilation afforded by milrinone.

OBJECTIVE: The digitalization of our daily living has changed dramatically the internet and digital media use among all ages. However, children and adolescents are particularly vulnerable to potential dangers and addiction risks. Our objective was to evaluate the computer and internet addiction levels in children and adolescents through their parents' reports. METHODS: A cross-sectional study was conducted in the region of Megara (Attica, Greece) for two months (September-November 2022). In total, 205 parents (74 fathers, 131 mothers) of school-age children participated, completing the study questionnaire (demographic data and the Adolescent Computer Addiction Scale - parental version (20 items in a 1-5 Likert Scale). RESULTS:  Based on the addiction scale score, only 2.45% (N=5) of the parents rated high scores indicating serious addictive behaviors regarding internet use. The majority were parents of boys (58%) and the mean age of children was 10.92±2.81years (five to 18 years). According to parental reports, the mean age of primary access to a computer or device with internet access was 7.18±2.29 years (two to 13 years). Regarding internet use, 58.5% of the children had access to the internet via smartphone, used the internet one to two hours/day (46.1%), and 62% of children had internet access in their bedroom. Children whose parents used the internet more than five hours/day displayed a greater addiction (F=3.06, df=3.187, p=0.03). A significant positive correlation was also found among children age (r=0.388, p<0.01), computer and internet availability in children's bedrooms, and internet addiction (t=4.43, df=189, p≤0.001 and t=3.88, df=189, p≤0.001, respectively). In summary, parents reported moderate or severe addiction in 7.2% of boys and 5.1% of girls. However, it should be noted that the exact cut-off points were difficult to determine due to a lack of objective criteria for diagnosing addiction severity. CONCLUSIONS: The levels of addiction in our study according to the parents' reports were limited and only a small number of parents reported highly addictive behaviors. However, there is a direct correlation between increased parental internet use that can significantly increase children's addiction levels. Parents act as role models that may increase children's exposure to the internet and lead to addiction.

BACKGROUND: Mitral valve surgery in octogenarians is a clinical challenge due to the impact of inherent, age-related comorbidities. Within the context of an aging population, the number of mitral surgery candidates over 80 has been gradually increasing. We sought to evaluate our institutional experience with mitral valve surgery in octogenarians to identify factors that may prove useful during the process of clinical decision-making. METHODS: We retrospectively reviewed our institutional database for all patients over 80 years of age who underwent mitral valve surgery in our department from October 2002 up to February 2021. The primary endpoints of our study were 30-day all-cause mortality and long-term survival after the first postoperative month. RESULTS: In total, 99 octogenarians underwent mitral valve surgery for various types of mitral pathology. In particular, 70 patients underwent mitral valve replacement with or without concomitant procedures and 29 underwent mitral valve repair with or without concomitant procedures. There was no difference between the two approaches in terms of 30-day mortality and long-term survival. Chronic kidney disease and total operative time were independent predicting factors for 30-day mortality. Etiology of mitral valve pathology and EuroSCORE II was independent predicting factors for long-term survival. CONCLUSIONS: The type of mitral valve surgery did not affect 30-day and long-term mortality rates in our study. Renal impairment and EuroSCORE II were independent predictors of 30-day mortality and long-term prognosis, respectively. Rheumatic valve disease was also associated with a poorer prognosis.

Fontan circulation is a well-established palliation in patients with functional single ventricles. Absence of a sub-pulmonary pumping chamber creates a unique physiology in which blood flow is mainly guided by negative intrathoracic and elevated central venous pressures. Various pulmonary anatomic or pathophysiologic changes can jeopardize optimal Fontan circulation. Long-term survival of patients who have undergone the contemporary total cavopulmonary connection is satisfactory. Thorough literature review in conjunction with accumulated clinical experience can lead clinicians to extract conclusions regarding Fontan and lung interactions indicating the purpose of this review.

Several lines of evidence suggest that binding SARS-CoV-2 antibodies such as anti-SARS-CoV-2 RBD IgG (anti-RBD) and neutralising antibodies (NA) are correlates of protection against SARS-CoV-2, and the correlation of anti-RBD and NA is very high. The effectiveness (VE) of BNT162b2 in preventing SARS-CoV-2 infection wanes over time, and this reduction is mainly associated with waning immunity, suggesting that the kinetics of antibodies reduction might be of interest to predict VE. In a study of 97 health care workers (HCWs) vaccinated with the BNT162b2 vaccine, we assessed the kinetics of anti-RBD 30-250 days after vaccination using 388 individually matched plasma samples. Anti-RBD levels declined by 85%, 92%, and 95% at the 4th, 6th, and 8th month from the peak, respectively. The kinetics were estimated using the trajectories of anti-RBD by various models. The restricted cubic splines model had a better fit to the observed data. The trajectories of anti-RBD declines were statistically significantly lower for risk factors of severe COVID-19 and the absence of vaccination side effects. Moreover, previous SARS-CoV-2 infection was associated with divergent trajectories consistent with a slower anti-RBD decline over time. These results suggest that anti-RBD may serve as a harbinger for vaccine effectiveness (VE), and it should be explored as a predictor of breakthrough infections and VE.

BACKGROUND:  Coarctation of the aorta (CoA) is a congenital cardiovascular malformation involving narrowing of the thoracic aorta just distal to the left subclavian artery. The aim of our study was to evaluate the hemodynamic effects of endovascular treatment for CoA by using invasive aortic catheterization. METHODS:  All patients with CoA who underwent treatment by aortic stent implantation between September 1, 2003, and February 1, 2019, at the "Onassis Cardiac Surgery Center," in Athens, Greece, were evaluated. Patients were treated with either bare (uncovered) Cheatham-Platinum (bCP) or covered Cheatham-Platinum (cCP) stent implantations. Invasive aortic pressure measurements were recorded before and after the endovascular intervention. RESULTS:  A total of 48, eight zig CP stents, comprising 24 bCP and 24 cCP stents were implanted in 47 patients. The mean aortic diameter (mm) at the CoA lesion increased from 9.7 ± 3.3 to 19.2 ± 2.9 mm ( <0.01) after the endovascular procedure. The invasive mean blood pressure (BP; mm Hg) from catheterization in the descending aorta increased (before = 114.2 ± 12.8 vs. after = 135.5 ± 28.1; <0.01), while the invasive mean BP (mm Hg) from catheterization in the ascending aorta was decreased (before = 156.8 ± 25.0 vs. after = 138.4 ± 27.5; <0.01) after the intervention. The mean aortic BP gradient decreased in both types of stents after intervention (BP gradient among patients with cCP stents = 30.9 +/- 23.6 mmHg and BP gradient among patients with bCP stents = 38.0 +/-23.1 mmHg). However, there was no statistically significant difference between the two types of stents;  = 0.36. CONCLUSIONS:  Invasive aortic catheterization provided evidence that endovascular stenting with either bare or covered stents is efficient in treating patients with CoA.

BNT162b2 has proven to be highly effective, but there is a paucity of data regarding immunogenicity factors and comparison between response to vaccination and natural infection. This study included 871 vaccinated healthcare workers (HCW) and 181 patients with natural infection. Immunogenicity was assessed by measuring anti-SARS-CoV-2 against the RBD domain of the spike protein (anti-RBD). Samples were collected 1-2 weeks after vaccination or 15-59 days post-onset of symptoms. Post-vaccine anti-RBD concentrations were associated with age, gender, vaccination side-effects (VSE) and prior infection (Pr-CoV). Anti-RBD median levels (95%CI) were lower by 2466 (651-5583), 6228 (3254-9203) and 7651 (4479-10,823) AU/mL in 35-44, 45-54, 55-70 yrs, respectively, compared with the 18-34 yrs group. In females, the median levels were higher by 2823 (859-4787), 5024 (3122-6926) in individuals with VSE, and 9971 (5158-14,783) AU/mL in HCWs with Pr-CoV. The ratio of anti-RBD in vaccinated individuals versus those with natural infection varied from 1.0 to 19.4. The high immunogenicity of BNT162b2 is verified, although its sustainability has yet to be elucidated. The use of comparative data from natural infection serological panels, expressing the clinical heterogeneity of natural infection, may facilitate early decisions for candidate vaccines to be evaluated in clinical trials.

INTRODUCTION: Greece is a country with limited spread of SARS-CoV-2 and cumulative infection attack rate of 0.12% (95% CI 0.06-0.26). Health care workers (HCWs) are a well-recognized risk group for COVID-19. The study aimed to estimate the seroprevalence of antibodies to SARS-CoV-2 in a nosocomial setting and assess potential risk factors. METHODS: HCWs from two hospitals participated in the study. Hospital-1 was a tertiary university affiliated center, involved in the care of COVID-19 patients while hospital-2 was a tertiary specialized cardiac surgery center not involved in the care of these patients. A validated, CE, rapid, IgM/IgG antibody point-of-care test was used. Comparative performance with a reference globally available assay was assessed. RESULTS: 1,495 individuals consented to participate (response rate 77%). The anti-SARS-CoV-2 weighted prevalence was 1.26% (95% CI 0.43, 3.26) overall and 0.53% (95% CI 0.06, 2.78) and 2.70% (95% CI 0.57, 9.19) in hospital-1 and hospital-2, respectively although the study was underpowered to detect statistically significant differences. The overall, hospital-1, and hospital-2 seroprevalence was 10, 4 and 22 times higher than the estimated infection attack rate in general population, respectively. Suboptimal use of personal protective equipment was noted in both hospitals. CONCLUSIONS: These data have implications for the preparedness of a second wave of COVID-19 epidemic, given the low burden of SARS-CoV-2 infection rate, in concordance with national projections.

empyema in nonimmunocompromised children is rare. A case of surgical management of invasive aspergillosis in a previously healthy 3-year-old child is presented. The patient was initially admitted to a hospital with severe respiratory deterioration and clinical instability, originally attributed to sepsis. After surgical intervention and the diagnosis of invasive aspergillosis, intravenous therapy with voriconazole was initiated. During postoperative care, the patient's condition remained stable with mild functional respiratory deficits. The diagnosis and treatment of empyema remains challenging, especially in cases that the recognition of aspergillosis is delayed and urgent surgical management of the empyema is required due to rapid clinical deterioration of the patient. The early initiation, prolonged administration, and close monitoring of high-dose antifungal treatment are highly recommended.

This study aims to assess lead exposure and associated risk factors among newly arrived migrant (M) (immigrant and refugees) children in Greece and a matched control of native (N) children. A prospective, cross-sectional study was performed in an outpatient clinic of a tertiary children’s hospital. From 2010 to 2014, 598 children (M/N: 349/249) with a mean age of 6.96 years old (range 1⁻14, SD 3.76) were enrolled. Blood lead levels (BLLs) ranged from 0.7 to 21 μg/dL in migrant and from 0.4 to 10 μg/dL in native Greek children. Elevated BLLs ≥ 5 μg/dL were detected in 27.7% of migrants and 1.2% of natives ( < 0.001). A significant association was found between EBLLs and childrens’ age (≤5 years) (OR: 1.8, -value 0.02) and EBLLs with Asian origin (OR: 3.63, -value 0.023). New migrant children presented with increased BLLs when compared to their age- and sex-matched controls. Younger age and Asian origin were significant risk factors associated with elevated BLLs among children. Early screening, secondary prevention, and regular follow-up could prove useful in this vulnerable population.

We describe a case of a 43-year old woman with Marfan's syndrome, tricuspid valve regurgitation and severe pectus excavatum who required an aortic root replacement and valvuloplasty for an ascending aortic aneurism with aortic valve regurgitation and tricuspid valve regurgitation. There was a severe angulation of the sternum which was close to 1.5 cm to the column vertebrae. Such cases are quite rare and always a challenge for surgeons to achieve adequate exposure of the heart and prevent excessive cardiac compression. We present our access, a safe and efficient exposure of the heart in order to achieve the best outcome.

UNLABELLED: Theme: Complex health care and chronic disease management. INTRODUCTION: Congenital heart disease (CHD) may have a very important impact on central nervous system function and neurodevelopment. PURPOSE: Critical evaluation of literature concerning the neurodevelopmental outcomes following congenital heart surgery. METHODS: Systematic review of 28 articles published after 2000 in PubMed, Scopus and CINAHL. RESULTS: Neurodevelopment morbidities can have a negative impact on early childhood development, academic performance and later transition to adulthood. The spectrum of neurodevelopment impairment is wide, depending on the complexity of CHD and it is characterized by mild cognitive impairment, impaired social interaction, and impairments in core communication skills, including pragmatic language, as well as inattention, impulsive behavior and impaired executive function. A number of important determinants are presented. CONCLUSIONS: Children with CHD are at increased risk for neurodevelopmental delay. Screening and evaluation of neurodevelopmental delay, along with regular follow up, are essential steps to guide appropriate interventions to optimize their overall development.

UNLABELLED: Theme: Cardiology Introduction: Measuring quality of life (QoL) in children and adolescents with congenital heart disease (CHD) is of great clinical importance. OBJECTIVE: The aim of the study was: (a) to adapt the PedsQL Cardiac Module for children aged two to 18 years with CHD in a sample of the Greek population; (b) to determine its reliability and validity. METHODS: Forward and backward translation methodology was used. Parents and children completed the instrument during: (a) hospitalization and (b) visits in the paediatric cardiology outpatient department. Cross-informant variance between children and parents was thoroughly assessed. RESULTS: Missing item responses did not exceed 5%. All internal consistency reliability coefficients for the inventory exceeded the minimum standards for group comparisons, over 0.75. Hypothesized correlations between cardiac module and core scales were statistically significant, (p<0.05). Agreement between children and parents was relatively high. Pilot study results will be additionally presented. CONCLUSION: The findings support the feasibility, reliability and validity of the Greek translation of the PedsQL Cardiac Module in children with congenital heart defect (CHD).

UNLABELLED: Theme: Parenting/parenthood. INTRODUCTION: The diagnosis of complex CHD impacts the psychosocial status of parents and their functioning. PURPOSE: A critical evaluation of the literature concerning the psychosocial parental response to their infant's diagnosis of complex CHD. METHODS: Systematic review of 18 articles published after 2000 in PubMed and CINAHL. RESULTS: The impact of an infant's CHD on the family functioning is determined both by child's medical condition and family's psychosocial factors. The majority of parents experience intense loss and numerous stressors. Nurses and physicians need to be sensitive to the needs, thoughts and experiences of the parents when discussing treatment options. Families with poor social support networks may have the greatest need for professional interventions. CONCLUSIONS: Appropriate interventions assist the majority of parents to adapt to the diagnosis of complex CHD. However, there are a number of parents with an increased psychosocial risk associated with higher rates of emotional distress.

Congenital lobar emphysema (CLE) is a rare lung congenital malformation. Differential diagnosis of the disease remains challenging in an infant with acute respiratory distress. We report a case of a 3-week-old female infant with a weight of 2.1 kg who presented respiratory distress related to CLE. Left upper lobectomy was performed and she had an uneventful recovery.

PURPOSE: This review aims to outline a systematic approach for the assessment of quality of life in children and adolescents with CHD and to cite its main determinants. METHODS: A systematic critical literature search in PubMed, Scopus, and Cinahl databases resulted in 954 papers published after 2000. After the quality assessment, 32 original articles met the inclusion criteria. RESULTS: Methodological quality of the included studies varied greatly, showing a moderate quality. Impaired quality of life was associated with more severe cardiac lesions. Children with CHD, after cardiac surgery, reported diminished quality of life concerning physical, psycho-social, emotional, and school functioning. The majority of clinical studies showed significant differences among children and their parents' responses regarding their quality of life, with a tendency of children to report greater quality of life scores than their parents. According to our analysis, concerning children with CHD, the most cited determinants of their quality of life were as follows: (a) parental support; (b) lower socio-economic status; (c) limitations due to physical impairment; (d) sense of coherence; as well as (e) the level of child's everyday anxiety and depression. These findings suggest that differences in quality of life issues may exist across lesion severities. CONCLUSION: Quality of life in children with CHD should be assessed according to age; severity; therapeutic approach; acceptance of the disease; and personality features. Effective management and early recognition of significant impairments in quality of life could impact clinical outcomes in children with CHD.

The aim of the study was to investigate the physician and nursing perceptions regarding communication and collaboration as well as the factors that may influence these activities. A self-administered questionnaire survey was sent to a random sample of 93 physicians and 197 nurses based in two large public hospitals in Athens, Greece. Descriptive statistics, t-test and chi square test were performed with the SPSS 19.0 statistical package. Years of experience, the size of the clinic, the university degree and the postgraduate studies were found to be significant factors according to nurses' view (p < 0.05). For the physicians, age, sex, years of experience and the size of clinic affected the communication and collaboration with the nursing staff significantly (p < 0.05). In summary, these findings suggest that nurses and physicians do not share the same views concerning the effectiveness of their communication and nurses' role in the decision-making process of the patients' care. The most important barrier for the establishment of good relations between these professions, according to the physicians, was that they did not recognize the nurses' professional role. The study also indicated that the absence of interprofessional collaboration may result in a higher possibility of errors and omissions in patients' care. Therefore, in everyday practice, both nurses and physicians should acknowledge the importance of their effective communication and they should develop and implement interprofessional teamwork interventions to improve collaboration. Moreover, nurses have to constantly consolidate their role in the decision process and patients' care, especially in countries with limited interprofessional collaboration culture. In addition, factors that improve physicians' attitudes toward collaboration and effective communication should be further explored.

BACKGROUND: HRQoL in children with asthma depends on multiple factors, among which asthma severity and level of control are believed to play a vital role. The determinants of the connection between asthma severity and asthma control with quality of life remain unclear. AIMS: Primary aim of the study was to evaluate the HRQoL in children with asthma and to determine the factors that affect it. MATERIALS AND METHODS: In total 504 children and one of their parents were recruited during a regular follow up visit in an outpatient asthma clinic. The measures used were the DISABKIDS smiley measure (DSmM), chronic generic measure-long form (DCGM-37) and the Condition-specific modules for asthma along with a special form for collecting demographic and clinical characteristics. RESULTS: Three hundred fifteen children with mean age 5.35 years (Group A) and 189 with mean age 10.79 years (Group B), were recruited. Children with controlled asthma had significant higher mean score than the other asthma control groups (P < 0.001). Corticosteroid use, asthma severity, number of visits in doctor's office and lack of asthma control were significantly associated with the DCGM-37 scores as well as Impact Scale and Worry Scale. Lack of Asthma Control was the only factor that was associated with negative HRQoL in all the multiple regression models, controlling for the effect of the other covariates, in both age groups. CONCLUSIONS: In conclusion, the evaluation of asthma HRQoL independently reflects the asthma control state and a dimension of its severity. These results highlight the need to modify asthma management strategy.

BACKGROUND: Diabetes is a significant challenge for pediatric health care professionals because it affects youths' psychoemotional functioning and, consequently, the quality of life (QOL). The aim of the present study was to evaluate the QOL in young patients with diabetes, as well as the factors affecting it. METHODS: The study was conducted from April to September 2008 in 98 young patients, 11-18 years of age, who were under the supervision of Diabetological Center, General Pediatric Hospital (Athens, Greece). The Diabetes Quality of Life for Youths Questionnaire was used to evaluate the QOL of youths with diabetes. RESULTS: The mean QOL score was 97.5. There was a negative correlation between the QOL and age (P = 0.02), the duration of diabetes (P = 0.05), body mass index (BMI; P = 0.04), and comorbidities (P = 0.03). In contrast, there was a positive correlation between QOL and increased metabolic control (P = 0.03), participating in sports activities (P = 0.007), and a greater number of insulin infusions (P = 0.04). CONCLUSIONS: The QOL of young diabetics was influenced by demographic, somatometric, and other characteristics of diabetes. Increased metabolic control, participating in sports activities, and a greater number of insulin infusions resulted in better QOL. Increased patient age, duration of diabetes, HbA1c values, BMI, and the coexistence of various health problems, as well as the use of an insulin pump, decreased QOL.

AIM: To explore parents' satisfaction concerning their child's care during hospitalization and its determinants. METHODS: A descriptive, non-experimental correlational design was used. The data collection was based on interviews using a 63 item questionnaire, the Swedish Pyramid Questionnaire. The parents of 206 children (hospitalized in two pediatric and two surgical units) participated in the study. RESULTS: The independent t-test results demonstrated that the parents showed greater satisfaction with staff attitudes and medical treatment, whereas they were less satisfied with the information concerning routines and the staff work environment. The stepwise multiple regression analysis revealed that adequacy of care, adequate pain management, parents' involvement in care, a trusting relationship, and staff attitudes were the most important determinants of parental satisfaction. CONCLUSION: Interventions in pediatric care should include measurements of parental and child satisfaction as a tool to assess the quality of care.

BACKGROUND: Direct assessment of health-related quality of life (HRQοL) is necessary to understand the impact of a disease on patients' well-being and to evaluate clinical interventions. There is substantial debate in the literature on pediatric health outcomes concerning who is the most appropriate respondent when assessing children's HRQoL. OBJECTIVE: To evaluate the level of agreement between child self-reports and parent proxy-reports concerning HRQoL in children with asthma. METHODS: A total of 504 children with asthma and their parents who were referred to outpatient asthma clinic participated in this study. Subjects were divided into two age groups (4-7- and 8-14-year-olds). The DISABKIDS chronic generic measure-long form (DCGM-37), the DISABKIDS smiley measure (DSM), and the DISABKIDS condition-specific modules for asthma were used. The level of agreement between children and parents was evaluated using intra-class correlation coefficients and Bland-Altman analysis. RESULTS: A satisfactory level of agreement between younger children and their parents except those with severe asthma with both methods was observed; the level of agreement in the older ones was moderate with the exception of general subscale. Asthmatic children's mean HRQoL scores were significantly lower than their parents for all subscales, except children with severe asthma in the older group, who stated lower HRQoL than their parents in most of the domains except those of Impact and Worry that were in close agreement. Fathers' assessment of HRQoL score was closer to their children's self-assessment in both groups. Families with higher family income showed a greater level of agreement. CONCLUSIONS: Our study illustrated that parents overestimate HRQoL of their children with asthma even though moderate agreement between child self-reports and parent proxy-reports on HRQoL was noticed. Fathers seem to be better proxy-reporters than mothers. Any evaluation of current approaches to measuring children's HRQoL needs to allow both parent and child to give their own perspective.

BACKGROUND: The aim of the present study was to evaluate any possible negative effect of diabetes on the self-esteem of children and adolescents with diabetes. METHODS: Self-esteem was evaluated using the Culture-Free Self-Esteem Inventory (CFSEI-2) in 144 patients with Type 1 diabetes mellitus (T1DM; 7-18 years of age) treated in a diabetes center and compared against that of 136 healthy children and adolescents. RESULTS: Self-esteem was correlated with age (P = 0.017), but not with diabetes (P = 0.886). The median CFSEI-2 score for both healthy and diabetic children was 22. There was no significant correlation between self-esteem and sex, body mass index (BMI), physical exercise, HbA1c or parental educational level. According to Spearman's rank correlation coefficient (r(s)), there was a significant association between age and self-esteem (r(s) = -0.15). Conversely, although BMI (r(s) = -0.09) and treatment duration (r(s) = -0.107) had a slight negative effect on self-esteem and the duration of physical exercise (r(s) = 0.11) and parental education (r(s) = 0.07) seemed to have a positive effect, the associations did not reach statistical significance. CONCLUSIONS: Self-esteem in diabetic children is mainly affected by their age, level of physical activity and level of family support. These findings emphasize the need to discriminate between glycemic control and diabetic adjustment.

BACKGROUND: Asthma may influence children's health-related quality of life (QoL) differently by various symptoms, at different severity. The primary aim of this study was to evaluate the QoL in children with asthma and describe the impact of each asthma symptom on the child's well-being at different severity levels. MATERIAL AND METHODS: Two hundred randomly selected children and one of their parents who consulted an outpatient asthma clinic, participated in the study. Qol was assessed with DISABKIDS-Smiley measure for children aged 4-7 years and with DISABKIDS DCGM-37 and Asthma Module for children 8-14 year old. RESULTS: Most of the children suffered from mild or moderate persistent asthma. Children with uncontrolled asthma stated lower QoL compared to partly controlled or controlled in both age groups (p < 0.05 in all domains). Cough appeared to affect QoL of 8-14 year olds more than other symptoms, especially in girls. In younger children, sex (boys, p = 0.039), age (p = 0.045), proxy sex (father, p = 0.048), frequency of doctor visits (4-6 months, p = 0.001), use of beta-2 agonists (p = 0.007) and father's smoking habits (p = 0.015) were associated with the QoL of coughing children but no correlation between cough and QoL was detected. In the 8-14 year age group coughers reported lower QoL compared to their counterparts; moreover, cough was found to affect QoL more than other symptoms (p < 0.05 in all domains). CONCLUSIONS: Cough has a direct effect on asthmatic children's QoL but there is still an obvious need for research to reveal all the determinats of this effect.

BACKGROUND: Human sexuality is a complex part of life and is considered a multidimensional phenomenon. Therefore there is an increased need for adequate and comprehensive sex education, especially for teenagers and young adults. AIM: The main aim of the study was to evaluate the level of students' sexual knowledge, as well as to identify their sources of information regarding sexual life and reproduction. POPULATION AND METHOD: A cross-sectional study using a designed self-report questionnaire was performed. The study population consisted of 936 students who were attending 10 high schools and four medical schools in Attica. Data were collected after obtaining permission from the Pedagogic Institute of the Greek Ministry of Education. FINDINGS: The main sources of students' sexual information about reproduction were friends (29.1%) and parents (24.0%), whereas school was reported by 14.3% of them. The preferred sources of information, according to students' perceptions, were sex education specialists (65.6%), followed by school (39.1%), parents (32.2%) and friends (27.7%). CONCLUSIONS: The importance of school, peer and parent support upon adolescents' sexual life was revealed by the results of the study. Students' knowledge level on sex topics is not satisfactory and therefore there is a need for sex education specialists and special courses regarding sex education in Greek schools.

The aim of this study was to explore the complications related to Hickman-Broviac central venous catheters (Hickman-Broviac CVCs) in children with cancer, their incidence, and possible associations of complications and premature removal of CVCs with a number of risk factors. During the study period (1 Jan 2000-31 Dec 2003), 223 CVCs were inserted in 198 children (117 boys, 81 girls) at a mean age of 5.73 years (95% CI 5.19-6.27, SE 0.275). In total, 76 (38.4%) children suffered from solid tumors and 122 (61.6%) from leukemia. The mean follow-up after CVC insertion was 232.5 days (95% CI 214.9-250.2, SE 8.94) for a total of 51,839 catheter-days. A complication occurred in 20.8% of them and in 9.6% the complication led to the removal of the catheter. The most frequent complications were infection (63.9%), obstruction (26.2%), accidental failure (8.2%), and rupture (1.6%). An overall incidence of 1.17 (0.38 and 0.79 for mechanical complication and infection, respectively) per 1000 catheter days for the development of a complication was recorded. Additionally, the study revealed more nonelective removals in cases of leukemia compared to those of solid tumors. Systemic use of CVC does not appear to increase significantly the number of complications, and thus CVC remains an effective and safe tool for the management of childhood malignancies.

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses' opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be 'paper tigers' with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.

AIM: This paper is a report of a study exploring the use of ethical codes and obstacles to their use in nursing practice as perceived by Finnish, Greek and Italian nurses. BACKGROUND: In all European countries nurses are responsible for the well-being of patients, for their own technical and ethical competence and, for their own part, for the high standard of health care in society. These points illustrate the central content areas of nursing codes of ethics. Recent advances in medical technology have added to the complexity of nursing. Nurses today are increasingly confronted with ethical dilemmas, underlining the role and meaning of ethical codes in their decision-making. However, there is only very limited research literature on codes of ethics, their use in nursing practice and obstacles to their use. METHODS: Twenty-three focus group interviews were conducted in 2003 with a total of 138 Registered Nurses: 35 in Finland, 54 in Greece and 49 in Italy. The data were content analysed. FINDINGS: Two main categories emerged from our analysis of the use of ethical codes: (1) conscious and (2) unconscious use. Seven main categories described the obstacles to the use of ethical codes: (1) the codes themselves, (2) nurses themselves, (3) multiprofessional teamwork, (4) patients' family members, (5) the organization, (6) the nursing profession and (7) society/healthcare policy. Participants in all three countries were firmly committed to the values expressed in ethical nursing codes. Nonetheless, continued efforts are needed in all these countries to remove the remaining obstacles so that nursing care can be provided in keeping with the requirements of ethical codes. CONCLUSION: The use of codes is connected with the changes in nursing profession and in society at large. The core of nursing, however, has remained stable. Future studies should be conducted in order to generalize the findings to a broader population.