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Objectives To examine if family ties are strong predictors of functional limitation in older adults in Europe. Methods Cross sectional data were used and included 14 European countries from the second wave (w2) of the survey on Health, Ageing, and Retirement in Europe. 13,974 adults aged 50+ (45.2% males and 54.8%females) were included in the study. Functional limitation was assessed using activities of daily living (ADL), instrumental activities of daily living (i-ADL) and mobility sensory index. Family ties were based on a customized model of family structural aspects. Multiple logistic regression analyses were used to examine the risk of functional limitations. Results Functional limitation was associated with females, age, self-rated health, and an increased number of chronic conditions, disease symptoms and depressive symptoms but not with few family ties. After controlling for potential confounders, respondents with lower family contacts showed higher risk for functional limitation. Southern and Mediterranean countries have both closer family ties and adults with higher functional limitation. Conclusion Functional limitation is associated with biological and demographic factors as well as little contact with family members. Further longitudinal research is required in order to determine the association and the causal relationship between functional limitation and family ties.

Introduction Suicide risk begins to increase among adolescents and young adults representing the leading cause of death in this age group. The aim of this study was to assess associations between sleep complaints, suicidal ideation and depression in a large, representative sample of adolescents and young adults of the general population in Greece. Methods A structured telephone questionnaire was conducted in a representative sample of 2.741 young Greeks aged 15–24 years, including sociodemographic variables, life-style habits, and substance use. symptoms were assessed using the PhQ-9. Suicidal ideation and sleep complaints, i.e. insomnia/ hypersomnia symptoms, were assessed based on the relevant questions of the PhQ-9 questionnaire. We conducted a direct and indirect effect analysis between the modified PhQ-7 scale, sleep complaints and suicidality controlling for gender, family income, education and substance use. Results In our sample prevalence of suicidal ideation was 7.8%, while 47.9% reported sleep complaints. The mean PhQ-7 score was 6.15±4.11. The direct paths from depression to sleep, as well as from sleep to ideation were both statistically significant with p-values Conclusion Our study supports that among youth there is direct associations between depression, sleep complaints and suicidal ideation. Furthermore, we found an indirect effect of depression on suicidal ideation mediated by sleep complaints. Our findings highlight the presence of complex interactions between subjective psychiatric symptoms and perceived sleep problems to account for suicidal ideation Therefore, treatment of sleep among youth with depression may significantly independently further reduce suicidal risk. Support (if any) EEA/Norwegian Financial Mechanism 2009–2014, under Project Contract n° EEA Grants/ GR07- 3757

Background Depression is a frequent and serious disease often undiagnosed in elderly. We aimed to examine (1) the prevalence/correlates associated with depression and (2) the magnitude of depression underdiagnosis/related factors, in a large community-dwelling elderly population in Crete/Greece visiting Primary Health Care (PHC) settings. Methods A sub-sample of 2428 non-demented individuals with Mini Mental State Examination (MMSE)>19 were recruited from a population-based cohort of 3140 elderly (>60 years). In phase I, all participants were assessed with a structured questionnaire including demographics, life-style, sleep, physical health and cognitive function. Diagnosis of depression was based on history/treatment of depression. In phase II, in a sub-sample of 293 participants, depression was diagnosed after a thorough extensive neuropsychiatric/neuropsychological evaluation. Results In phase I, 10.8% reported a diagnosis/treatment of depression. In multivariate analysis, female gender, lack of physical activity, caregiver dependence and use of benzodiazepines were associated with depression. In phase II, depression was prevalent in 28.7% of our sample, whereas about 61% of those diagnosed with depression were undetected in phase I. Factors associated with non-detection of depression were sleep complaints/subjective short sleep, low MMSE and medical comorbidities. Two screening questions related to mood increased possibility to detect undiagnosed depression up to 90%. Limitations Due to the cross-sectional design, causality between correlated factors cannot be examined. Conclusion Prevalence of depression is high and largely underdiagnosed in elderly in Crete/Greece. Sleep and memory complaints appear to be surrogate markers of depression, whereas screening mood in PHC settings may significantly increase detection of depression in elders.

Increasing evidence suggests that different patterns of activity participation confer several positive well-being outcomes through the later years of life. The aim of the present study is to examine the likelihood of higher well-being linked with a socially engaged lifestyle with a view to extending prior research. Data on a nationally representative sample of adults aged 65 and older from eleven European countries (n = 7025) was drawn from the first Wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/5). Socially and productively oriented activities were administered as salient aspects of activity participation and were rated on frequency of involvement. Well-being was defined by the clustering of six indicators including life satisfaction, quality of life, self-rated health, psychological distress, chronic diseases and Body Mass Index (BMI). The effect of activity participation on the clustering of well-being indicators was estimated according to complex samples ordinal regression models. The overall pattern was that of a significantly increased likelihood for frequently active participants to present multiple presence of positive well-being outcomes (p

Aim The current study aims to assess the relationship between behavioral risk factors (BRFs) for chronic diseases and preventive health services utilization among European adults. Subjects and Methods We used data from 16,125 adults, aged 50+ years, from 11 countries participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Prevalence of BRFs (high body weight, smoking, physical inactivity and risky alcohol consumption) was examined in relation to preventive health services utilization, which was assessed via a 12-component score (PHSUs) (scale: 0–100). Estimations were based on the complex study design. Results Of the participants, 90.7% were seeing a general practitioner (GP) and 52.7% had 2+ BRFs. Adults with high body weight had lower odds of seeing a dentist (0.75, p p p p p p p p = 0.001), smokers (p = 0.001) and risky drinkers (p = 0.008), while PHSUs did not differ by BRF clusters (p = 0.218). In adults with 2+ BRFs, Greece was the country with the lowest mean PHSUs (28.0, p Conclusion Adults with high body weight, those who smoked and were risky drinkers used fewer preventive health services. Primary prevention programs should be developed to reduce BRF prevalence and promote preventive health services use in this population.

Introduction Noncommunicable diseases are the leading cause of illness and death worldwide; behavioral risk factors (BRFs) contribute to these diseases. We assessed the presence of multiple BRFs among European adults according to their physical and mental health status. Methods We used data from 26,026 adults aged 50 years or older from 11 countries that participated in the Survey of Health, Ageing and Retirement in Europe (2004-2005). BRFs (overweight or obesity, smoking, physical inactivity, and risky alcohol consumption) were assessed according to physical health (ie, presence of chronic diseases, disease symptoms, or limitations in activities of daily living) and mental health (depression) through multiple regression estimations. Results Overweight or obesity in men and physical inactivity in women were the most prevalent BRFs. Compared with physically active adults, physically inactive adults had a higher mean number of chronic diseases (1.33 vs 1.26) and chronic disease symptoms (1.55 vs 1.47). Risky alcohol consumption (≥4 servings of an alcohol beverage ≥3 times a week) was associated with a higher mean depression score (2.84 vs 2.47). Compared with adults with 0 or 1 BRF, adults with 2 or more BRFs had significantly higher odds of having 1 or more chronic diseases (men: 1.52; women: 1.73) and functional limitations (men: 1.65; women: 1.79) and higher prevalence of high blood pressure (37.8% vs 28.2). Belgian adults with BRFs had the highest mean number of chronic diseases or functional limitations among those who were overweight or obese and the highest mean number of chronic diseases and disease symptoms among those who smoked and were physically inactive. Conclusion We found revealed significant positive associations between BRFs and poor health among middle-aged and older European adults. Primary health care intervention programs should focus on developing ways to reduce BRF prevalence in this population.

Background The aim of our study was to validate a Greek translation of the Berlin Questionnaire (BQ) for obstructive sleep apnoea syndrome (OSAS) and to explore whether this screening questionnaire could be used to help identify primary care patients at greater risk of having OSAS. Methods We recruited 189 patients visiting a primary health care setting on the island of Crete, Greece. They all completed the Greek Version of the BQ. Patients were then referred to a Sleep Disorders Unit for evaluation of suspected sleep-disordered breathing. Results A PSG study was performed in 129 of the 189 subjects (68.3%). BQ identified 74.4% (n = 96) of the patients as high-risk for OSAS and the remaining 25.6% (n = 33) as low-risk. The sensitivity and specificity of BQ for OSAS diagnosis were 76% and 40%, respectively, for an apnoea–hypopnoea index (AHI) ≥5 per hour but 30 per hour. Conclusions In conclusion, the Greek Version of the BQ is a useful instrument for identifying patients at risk for OSAS in primary health care in Greece. The findings of our study confirm that such screening tools should be used by primary care clinicians for OSAS prediction.

During pregnancy, women are at particular risk for sleep deprivation and snoring because of the physiologic and hormonal changes of pregnancy. There is limited evidence for the association between sleep patterns in pregnancy and adverse birth outcomes. We examined the association of sleep duration and snoring in late pregnancy with the risk of preterm birth and fetal growth restriction.We used data from the prospective mother-child cohort "Rhea" study in Crete, Greece 2007-2009. The analysis included 1091 women with singleton pregnancies, providing complete data on sleeping habits at the third trimester of gestation and birth outcomes. Fetal growth restriction was based on a customized model, and multivariate log-binomial regression models were used to adjust for confounders.Women with severe snoring were at high risk for low birth weight (relative risk = 2.6 [95% confidence interval = 1.2-5.4]), and fetal-growth-restricted neonates (2.0 [1.0-3.9]) after adjusting for maternal age, education, smoking during pregnancy, and prepregnancy body mass index (BMI). Women with sleep deprivation (≤5 hours sleep) were at high risk for preterm births (1.7 [1.1-2.8]), with the highest risk observed for medically indicated preterm births (2.4 [1.0-6.4]) after adjusting for maternal age, education, parity, smoking during pregnancy, and prepregnancy BMI.These findings suggest that women with severe snoring in late pregnancy have a higher risk for fetal-growth-restricted neonates; and women with sleep deprivation have a higher risk for preterm births. The mechanisms underlying these associations remain unclear.

Objective: Cultural adaptation and validation of the Beliefs about Medicines Questionnaire in Primary Health Care patients in Greece. Methods: For the assessment of the psychometric properties of the Greek version of the Beliefs about Medicines Questionnaire, 150 chronic patients visiting primary healthcare settings throughout the island of Crete, Greece, were recruited. They all completed both BMQ-general and BMQ-specific scales of the BMQ version which was previously culturally adapted and translated into the Greek language. Results: The subscales of the Beliefs about Medicines Questionnaire demonstrated adequate internal consistency with Cronbach’s alphas of 0.852 for Specific Necessity, 0.763 for Specific Concern, 0.784 for General Harm and 0.676 for General Overuse. On both parts of the BMQ, the inter-item correlations were found to be sufficient. Factor analysis revealed identical patterns for all questions between the Greek and the original scales. Conclusion: The Greek Version of the Beliefs about Medicines Questionnaire is a valid and reliable instrument for evaluating patients’ beliefs about medicines in primary healthcare in Greece. Further research is needed in order to study the relationship between beliefs about medication and non-adherence to medications.