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Migrant and refugee women face specific health risks and challenges during the perinatal period, presenting with complex physical, psychological, and mental health issues. Compassionate antenatal and postnatal care is urgently required across Europe given how outcomes during this period determine the health wellbeing throughout a person’s life. The current study aimed to describe the perinatal health care provided to refugee and migrant women in Greece, as well as to identify the barriers to delivering quality health care to these population groups. Data were gathered via qualitative research, and via document analysis, including grey literature research. Two focus groups were convened; one with five midwives in Athens (representing NGOs in refugee camps and public maternity hospitals) and another in Crete with twenty-six representatives of key stakeholder groups involved in the perinatal care of refugees and migrant women. Desk research was conducted with in a stepwise manner comprising two steps: (a) a mapping exercise to identify organizations/institutes of relevance across Greece, i.e., entities involved in perinatal healthcare provision for refugees and migrants; (b) an electronic search across institutional websites and the World Wide Web, for key documents on the perinatal care of refugee and migrant women that were published during the 10-year period prior to the research being conducted and referring to Greece. Analysis of the desk research followed the principles of content analysis, and the analysis of the focus group data followed the principles of an inductive thematic analysis utilizing the actual data to drive the structure analysis. Key findings of the current study indicate that the socioeconomic status, living and working conditions, the legal status in the host country, as well as providers’ cultural competence, attitudes and beliefs and communication challenges, all currently represent major barriers to the efficient and culturally appropriate provision of perinatal care. The low capacity of the healthcare system to meet the needs of women in these population groups in the context of maternal care in a country that has suffered years of austerity has been amply recorded and adds further contextual constraints. Policy reform is urgently required to achieve cultural competence, to improve transcultural care provision across maternity care settings, and to ensure improved maternal and children’s outcomes.

Background Worldwide midwifery educators are passionate about educating the next generation of midwives and prepare them to contribute to public health and the midwifery profession. A redesign and transformation of midwifery education may be needed, focusing on the longterm impact on mothers, families and communities. To meet these challenges, midwifery students are expected to acquire competences in all fields of midwifery according to both national and European legislation and the International Confederation of Midwives (ICM) Global Standards for midwifery education1. The landscape of Higher Education initiated a transparent and easily comparable system of academic degrees in Europe. In 1999, an educational system in three cycles was established (Bachelor’s, Master’s and Doctorate level), by the so called Bologna process2. In recent years, midwifery educational reforms shifted from vocational training to academic education in Europe, which enhanced opportunities for mobility, employability and research. A recent study (2019) confirmed that, in most European countries, midwifery education took place at university (19 at Bachelor’s and in seven at Master’s level). Only four countries still offered vocational diploma level programs3. Nevertheless, midwives from different countries have uneven levels of proficiency, scope of practice, and education. While variation exists, some countries face challenges operating in a European context where midwifery is regulated, measured and documented in a similar way enabling comparison and impact4.

Immigrant families form a quickly changing multicultural context in many European countries and particularly in Greece. This study is a narrative review regarding postpartum depression within the refugee/immigrant population, in an attempt to increase understanding of immigrant women’s mental health care postnatally. First, we provided a brief review regarding the causes and symptoms of postpartum depression; moreover, we presented the already established bibliography concerning the immigrant/refugee population. Finally, we present several coping strategies that can be applied for dealing with such occurrences. Depression rates are higher among immigrants and refugees than in the general population due to their living conditions. New immigrant mothers may often be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. Refugee women’s mental health issues often go unrecognized. Maternity health professionals, especially midwives, should recognize the inequalities and provide culturally sensitive health care services and help to design tailored prevention programs in order to protect women in these population groups from postpartum depression.

The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.

Aim The purpose of this study is to investigate conflicts and identify the factors that cause the creation of conflicts in the operating room as well as coping strategies for conflict resolution. Background The operating room is a special and changeable working environment, which is constantly evolving and requires interdisciplinary team collaboration. Therefore, it is an environment that may cause conflict among employees METHOD: The study was conducted at three Public Hospitals of Athens, during the period from 1/4/2018 to 15/6/2018. The research tool used to conduct the research was the questionnaire of Kontogianni et al. (2011). The questionnaire consisted of four sections dealing with conflict issues and their management. The sample consisted of 185 nurses and medical staff. The level of statistical significance was set equal to 0.05. The questions were analyzed through the statistical package SPSS 20. Results Τhe majority of participants had conflicts with colleagues (79%), with doctors (69.5%) and with nurses (43.7%). Τhe majority of the sample was unaware of conflict management strategies (60%). One of the important factors that intensify the conflicts is the burdensome workload in combination with the unsatisfactory salary. Avoidance is the preferred conflict management strategy (64.7%), followed by mutual benefit trading (55.4%.) Acceptance is the least appropriate strategy (10.9%). Conclusions In order to deal with conflicts in the operating room effectively, it is necessary for nurses and physicians to be trained in conflict management. Implications for nursing management Nursing managers should support the training of nurses in conflict management in order to create a climate of cooperation and reduce conflicts.

Background The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The “Operational Refugee and Migrant Maternal Approach” (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives’ experiences of the training and providing care within the ORAMMA project. Methods Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives’ experiences of the training and of caring for migrant women within the ORAMMA project. Results A significant improvement of the median score pre to post-test was observed for midwives’ knowledge (17 to 20, p p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives’ experiences of the training revealed themes of “appropriate and applicable”, “made a difference” and “training gaps” and data from ORAMMA project experiences identified three further themes; “supportive care”, “working alongside peer supporters” and “challenges faced”. Conclusions The training improved midwives’ knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters’ roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

Introduction Rising rates of caesarean section (CS) is an issue of particular concern. Recently, there has been research supporting Vaginal Births After Caesarean (VBAC), which is controversial. In Greece, over half of births in the country are by CS, placing Greece among countries with the highest CS rates. The aim of this study was to investigate the prevalence and the factors associated with VBACs and to compare the maternal/neonatal outcomes with a 'non-caesarean' control group. Methods The data were evaluated and retrospectively gathered on archived singleton births, from medical records of a midwifery-led team, between May 2006 and May 2013. The target group of the study included mothers with a previous CS, who had a second birth. The sample consisted of 71 VBAC women and 583 who had normal spontaneous vaginal delivery (NSVD) as the 'non-caesarean' control group. Results The duration of labour was longer for the VBACs compared with first-time mothers who gave birth naturally (for duration 481-720 min, 27% vs 10.3%, respectively), episiotomy was more common for VBAC (20.7% vs 7.9%), and epidural analgesia was more often for VBAC (68.4% vs 10%). The percentage of 1-min Apgar score in the range 0-7 in the VBAC group was 5%, and there was no significant difference in women who had NSVD (3.6%). The Apgar score in the 5th minute was always above 8 for both groups. Conclusions Severe maternal and neonatal complications are infrequent, and therefore the necessity arises for further continuous studies to ascertain the safety of VBAC.

Introduction This paper is a report of a systematic review to identify and analyze studies of the measurement of empathy in midwives and other health professionals. Empathy has been recognized as an important factor in patient care, with positive outcomes for both patients and health professionals. There is a debate on the definition of empathy, on its measurement and on the possibility of improvement. Methods Searches were made of the CINAHL, SCOPUS, PubMed and PsychINFO databases using the terms empathy, clinical, midwifery, nursing, medical students, measurement, and health professionals, singly or in combination, to identify literature published in English between 2002-2015. The included papers were critically reviewed and a narrative synthesis was conducted. Results In all, 22 papers met the inclusion criteria by studies that were conducted to measure the levels of empathy in a variety of health professionals and students. Their scores were analyzed in correlation with their sociodemographic factors. Conclusions Despite numerous studies, many correlations but also differences exist, indicating the complexity of empathy and the need to further study it.

Migrant and refugee pregnant women constitute a highly vulnerable group to mental disorders. The rates of mental illness of migrants and refugees are higher than those of host populations, with migrant women being more likely to suffer from prenatal depression. A Policy Paper was developed based on a literature review conducted in Medline, Scopus and Google Scholar. Filtering criteria were: year of publication (2002–2017), study topic relevance, and English language. A total of 63 documents were identified. Most of the documents were scientific papers while a large number of documents were reports of EU committees and networks on migrant issues or annual reports of international bodies. From the analysis of existing evidence, four major topics emerged for the perinatal health of migrant women: 1) Prevalence and risk factors for antenatal mental disorders, 2) Assessment of mental disorders, 3) Healthcare professionals’ training on supporting migrant and refugee pregnant women, and 4) Interventions for the mental health of migrant women. Midwives and other members of interdisciplinary teams have to be trained and culturally competent to successfully meet the needs of migrant and refugee pregnant women.

INTRODUCTION Maternal smoking constitutes a significant risk to the fetus and is associated with multiple adverse pregnancy outcomes. Despite this, an estimated 6–19% of women in Europe smoke during pregnancy. We conducted a pilot study to examine the feasibility and effectiveness of the clinical practice recommendations of the 2017 Tobacco Cessation Guidelines for High-Risk Groups (TOB-G) for pregnant and postpartum women in an outpatient obstetrics setting. METHODS The guideline recommendations were tested on a sample of 67 pregnant women recruited from obstetrics outpatient visits. Pregnant women who smoked received three behavioural counselling sessions through a combination of face-toface and telephone consultations by a midwife trained in the TOBG tobacco treatment recommendations. Smoking status was assessed at 1 month and at 6 months follow-up via self-report. RESULTS Seventy-one per cent of pregnant smokers screened agreed to participate in the counselling intervention. Pregnant women participants (mean age, M=31.73 years, SD±6.09) smoked for an average of 12.2 (SD±6.55) years. Women reported smoking an average of 4.82 (SD±4.14) cigarettes per day with 51% reporting smoking within 30 minutes of waking, an indicator of higher levels of nicotine addiction. Rates of smoking abstinence among pregnant women undergoing the counselling intervention were 43.9% and 45.6% at the 1 month and at 6 months follow-up, respectively. Replacing those participants with missing data as smokers, the quit rates were 26.9% and 38.8% at the 1 month and 6 months follow-up, respectively. CONCLUSIONS The counselling intervention delivered to pregnant women who smoke was feasible to implement in a manner that was consistent with the TOB-G guideline recommendations in an outpatient obstetrics setting. Future work should focus on increasing uptake of evidence-based tobacco treatment recommendations in outpatient obstetrics settings.

Introduction: Despite the magnitude of the risks associated with tobacco use during pregnancy, an estimated 6-19% of woman in Europe will continue to smoke during pregnancy and a large portion of woman who quit will return to smoking following pregnancy. The purpose of the pilot study was toexamine the effectiveness of the Tobacco Cessation Guidelines for High-risk Groups (TOB-G) for Pregnant and Post-Partum women on aiding cessation during pregnancy Methods: The intervention was based on the TOB-G project guidelines d in a sample of 67 pregnant women recruited from obstetrics outpatient visitsand was delivered based on an adaptation of the 5As models for smoking cessation. A research assistant contacted participants by phone at 1 and 6-months to document smoking status. Participants received three behavioural counselling sessions through a combination of face-to-face and telephone consultation. Results: A significant increase in self-reported smoking abstinence was documented following the intervention with 43.9% and 45.6% of participants abstinent at the 1 and 6-month follow-up respectively. In a conservative analysis if we assume missing data for participants we were unable to reach for follow-up as active smokers the quit rates are 26.9% and 38.8% at the 1 and 6-month follow-up respectively. Conclusion: The counselling intervention based on the TOB-G guidelines was associated with significant increase in smoking abstinence among pregnant women. Further research with larger sample sizes is needed.

Introduction It is observed that delivery does not completely eliminate the risk of developing symptoms of preeclampsia, as well as its impending complications. The postpartum period is often associated with a high risk of developing preeclampsia, eclampsia and HELLP syndrome. Yet, there is neither an established standard, nor specific guidelines for peripartum fluid management. Our purpose is to study during the first four days of the postpartum period the differences in fluid balance on: normal pregnancies, pregnancies with preeclampsia and pregnancies with oedema and proteinuria. Methods The setting was the Gaia private maternity clinic in Athens, where 100 women in the postpartum period took part in the study and were requested to fill in a data collection-sheet, specially developed for the study. They were recruited between January 2014 and November 2014 and were divided into three groups. Group I consisted of all normal pregnancies, Group II those with oedema and proteinuria, and Group III those with preeclampsia. The demographic and clinical characteristics of the women and fetuses were initially recorded. Subsequently, daily records of fluid balance, as well as body weight, were kept for four days after labor. Descriptive statistics were used to analyze the demographic data of the sampled women. We compared the fluid balances among the three groups using t-test association and one-way Anova. Results The mean age of the women was 32.48±4.38 years. Out of a total of 100 women, 59 of them had a normal pregnancy (Group I), 24 developed oedema and proteinuria (Group II) and 17 developed preeclampsia (Group III). All three groups had a positive fluid balance on the first day postpartum and only the first group had a negative cumulative fluid balance from the second day postpartum and onwards. The second group despite having started to discard a small volume of fluid, from the second day postpartum, the balance remained positive throughout the next two days. The third group however, had a negative fluid balance only during the fourth day after labor. Conclusions ur results indicate a difference in the kinetics of fluids in women with preeclampsia, compared to those that had a normal pregnancy and postpartum period. Consequently, there appears to be a need for more rational management and follow up on fluid balance throughout labor.

Introduction The Birth Satisfaction Scale (BSS) is an important screening instrument that is used with mothers during the postpartum period for the identification of postnatal birth satisfaction. The purpose of this study was to validate and adapt the Greek version of the BSS to test its sensitivity, specificity and predictive values. Methods Childbearing women (n=310) were recruited from the perinatal care registers of the Maternity Departments of 3 Hospitals of Athens municipality (public Maternity Departments) in 2014. Inclusion criteria included fluency in spoken and written Greek language, within 1-4 postpartum days, and delivery of a healthy infant. Exploratory Factor Analysis (EFA) on the 30-items on the BSS revealed 7 orthogonal factors (KMO measure of sampling adequacy=0.856 and Bartlett’s test of sphericity=2999.806, df=435, p

In recent years, a growing number of studies report on the importance of empathy to women’s care. The Midwifery Empathy Scale (M.E.S) was developed in order to study and record the levels of empathy of professional and student midwives. The purpose of our study was to validate this instrument and determine the factor structure and reliability. The study sample (n = 242) consisted of professional (n = 114) and student midwives (n = 128) of 3 Maternity Hospitals (public and private) of Athens. The exploratory factor analysis on the 25 item of Midwifery Empathy Scale (MES) revealed seven orthogonal factors (KMO Measure of Sample Adequacy = 0.817 and Bartlett’s test of sphericity = 1508.169, df = 300, p

Active and passive smoking during the perinatal period is one of the most important preventable causes of a variety of unfavorable pregnancy outcomes. Despite being informed about the risks at least one third of women still smoke during pregnancy. Greece has a smoking prevalence of 38%. It is essential for midwives to be trained in smoking cessation in order to help pregnant effectively to quit. Most women who quit smoking during pregnancy without following a smoking cessation program usually resume smoking within 6 months after delivery. We surveyed 294 midwives in Athens (professionals & students) in 2015 using a questionnaire to ascertain their perception and knowledge on: · the risks of active and passive smoking in pregnancy · smoking cessation in general · smoking cessation as part of their duty · the kind of information and help they should provide to pregnant smokers. Results: 1. Almost all participants reported that they routinely inform pregnant smokers about the risks of active and passive smoking. 2. The vast majority (97%) believe that smoking cessation is an important part of their role. 3. Only 51.7% reported feeling comfortable in offering quitting support. 4. 87.4% reported that pregnant women were not well informed about the risks of active and passive smoking. 5. Both professional and student midwives have insufficient knowledge on the effects of smoking during pregnancy and lactation (only 1% answered correctly all relevant questions). We conclude that midwives want to efficiently advise pregnant and breastfeeding smokers to quit. In order to be effective in this role they should be adequately educated on the effects of smoking during pregnancy and lactation and trained in smoking cessation strategies.

Active and passive smoking during pregnancy is the most important preventable cause of unfavorable pregnancy outcomes. We evaluated exposure to tobacco smoke (active/passive) and quitting methods using a questionnaire and depression using EPDS (Greek validated version of Edinburgh Postnatal Depression Scale questionnaire) of pregnant. 300 women were recruited from the perinatal care registers of 2 Public Maternity Departments in Athens during 2014. The questionnaires were administered on the 3rd postnatal day. 48% of mothers were smokers beginning their pregnancy.Among them 83,3% tried to quit but less than half (21,7%) managed to. Thus, finally 73.7% reported being non-smokers during pregnancy, but none in a smoke-free environment. The ones that failed to quit (26.3%) mostly (55.8%) felt unable. There were statistically significant differences between smokers and non smokers in pregnancy and fetal problems (χ2=11.41; df=5; p The mean EPDS score for smokers was 9.72 (SD=6.28;Std Error Mean 0.52) and for quitters 8.04 (SD=5.17;Std Error Mean:0.41). Smokers had significantly more depressive symptoms than quitters [Levene9s Test for equality of variances and homogeneity (F=43.059, P=0.0005) (t=2.403 df=298 Sig.(2-tailed)=0.0005]. Information about risks of active/passive smoking were given from internet/books (37.1%), midwives/doctors (32,1%) and family/friends (30,7%). We conclude that it is essential both pregnant and their partners/families are informed on the health risks of active and passive smoking. Only smoke-free environments will sufficiently promote optimal perinatal health for the woman and her fetus/newborn.

The Maternal Adjustment and Maternal Attitudes Scale is a self- administered scale, designed for use in primary care settings to identify postpartum maternal adjustment problems regarding body image, sex, somatic symptoms, and marital relationships. Women were recruited within four weeks of giving birth. Responses to the Maternal Adjustment and Maternal Attitudes Scale were compared for agreement with responses to the Edinburgh Postnatal Depression Scale as a gold standard. Psychometric measurements included: reliability coefficients, explanatory factor analysis, and confirmatory analysis by linear structural relations. A receiver operating characteristic analysis was carried out to evaluate the global functioning of the scale. Of 300 mothers screened, 121 (40.7%) were experiencing difficulties in maternal adjustment and maternal attitudes. Scores on the Maternal Adjustment and Maternal Attitudes Scale correlated well with those on the Edinburgh Postnatal Depression Scale. The internal consistency of the Maternal Adjustment and Maternal Attitudes Scale, Greek version-tested using Cronbach's alpha coefficient-was 0.859, and that of Guttman split-half coefficient was 0.820. Findings confirmed the multidimensionality of the Maternal Adjustment and Maternal Attitudes Scale, demonstrating a six-factor structure. The area under the receiver operating characteristic curve was 0.610, and the logistic estimate for the threshold score of 57/58 fitted the model sensitivity at 68% and model specificity at 64.6%. Data confirmed that the Greek version of the Maternal Adjustment and Maternal Attitudes Scale is a reliable and valid screening tool for both clinical practice and research purposes to detect postpartum adjustment difficulties.

Recent findings suggest a significant association between the antioxidant status of pregnant women and of their children during the first years of life and the development of allergic disease during childhood. The aim of this review was to identify all studies that estimated the effect of intake of antioxidants in pregnant women and their children on the development of allergic disease during early childhood. A systematic review was conducted of epidemiological studies featuring original peer-reviewed data on the association between dietary antioxidant status and allergic disease during childhood. A systematic search was performed following the Meta-analysis of Observational Studies in Epidemiology Guidelines. A comprehensive search of the literature yielded 225 studies, 18 of which were selected for the extraction of results and were related to antioxidant status and allergic disease. The systematic review included five prospective cohort studies, four cross-sectional studies, and nine case-control studies. Eight studies reported an important association between antioxidant status and asthma onset during childhood. Similarly, wheezing and eczema were studied as an outcome in six and in five studies, respectively. Recent observational studies suggest that a higher intake of antioxidant vitamins, zinc, and selenium during pregnancy and childhood reduces the likelihood of childhood asthma, wheezing, and eczema.

Research has highlighted the wide impact of intimate partner violence (IPV) and the public health role of community health professionals in detection of victimized women. The purpose of this study was to identify postpartum emotional and physical abuse and to validate the Greek version of the Women Abuse Screening Tool (WAST) along with its sensitivity and specificity. Five hundred seventy-nine mothers within 12 weeks postpartum were recruited from the perinatal care registers of the Maternity Departments of two public hospitals in Athens, Greece. Participants were randomly selected by clinic or shift. The WAST and the Partner Violence Screen (PVS) surveys were administered in random order to the mothers from September 2007 to January 2008. The WAST was compared with the PVS as a criterion standard. Agreement between the screening instruments was examined. The psychometric measurements that were performed included: two independent sample t tests, reliability coefficients, explanatory factor analysis using a Varimax rotation, and Principal Components Method. Confirmatory analysis-also called structural equation modeling-of principal components was conducted by Linear Structural Relations. A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. Two hundred four (35.6%) of the mothers screened were identified as experiencing IPV. Scores on the WAST correlated well with those on the PVS; the internal consistency of the WAST Greek version-tested using Cronbach's alpha coefficient-was found to be 0.926 and that of Guttman's split-half coefficient was 0.924. Our findings confirm the multidimensionality of the WAST, demonstrating a two-factor structure. The area under ROC curve (AUC) was found to be 0.824, and the logistic estimate for the threshold score of 0/1 fitted the model sensitivity at 99.7% and model specificity at 64.4%. Our data confirm the validity of the Greek version of the WAST in identifying IPV. The validated Greek WAST scale could be used for screening purposes in both clinical practice and research.

Introduction Active smoking and exposure to passive smoke are responsible for numerous adverse pregnancy outcomes for women and their infants. The aim of this study was to explore the perceptions, attitudes, patterns of personal tobacco use and exposure to environmental smoke among a sample of pregnant women in Greece. Material and Methods A cross sectional survey was undertaken of 300 women identified from the perinatal care records of the Maternity Departments of two hospitals in Athens between February 2013 and May 2013. Data on active and passive maternal smoking status in the first, second, and third trimesters of pregnancy, fetal and neonatal tobacco related complications, exposure to environmental tobacco smoke during pregnancy, quit attempts, behaviors towards avoiding passive smoking and beliefs towards smoking cessation during pregnancy were collected using self-administered questionnaires on the 3rd postnatal day. Women also completed the Edinburgh Postnatal Depression Scale (EPDS). Results Of 300 women recruited to the study 48 % reported tobacco use during the first trimester of pregnancy. Amongst participants who were tobacco users, 83.3 % reported making an attempt to quit but less than half (45.1 %) were successful. Among women who continued to smoke during pregnancy the majority (55.8 %) reported that they felt unable to quit, and 9.3 % reported that they considered smoking cessation was not an important health issue for them. Participants who continued to smoke during pregnancy were more likely to report fetal (χ2 = 11.41; df = 5; p

AIM: To translate into Greek and validate the chronic liver disease questionnaire (CLDQ). METHODS: Two hundred and six consecutive adult patients with the diagnosis of a chronic liver disease from 2 general hospitals in Athens were enrolled in the study from May to September 2008. In order to assess their quality of life (QOL) the CLDQ was applied. The instrument was translated from English, back translated and reviewed in focus groups within the framework of a large multicenter study. The measurements that were performed included: 2 independent sample t tests, one-way analysis of variance, reliability coefficients, explanatory factor analysis using a varimax rotation and the principal components method. RESULTS: One hundred and twenty five (61%) patients were men, half were aged 40-59 years and > 33% were > 60 years old. Among the patients, 48 (23%) were hospitalized and 97 (47%) were cirrhotic according to the Child-Pugh score. The internal consistency of the Greek CLDQ version using Cronbach’s alpha coefficient was found to be 0.93. Exploratory factor analysis identified 7 domains accounting for 65% of the variance of CLDQ items and only partially overlapping with those found in the original version. The area under the receiver operating characteristics curve was calculated at 0.813 and the logistic estimate for the threshold score of 167.50 provided a sensitivity of 74.3% and a specificity of 71.6% for the model. CONCLUSION: Our data confirmed the validity of the Greek version of the CLDQ in identifying the QOL among patients with chronic liver disease.

We aimed to provide a summary of the existing published knowledge on the association between adverse birth outcomes and the development of wheezing during the first two years of life. We carried out a systematic review of epidemiological studies within the MEDLINE database. Epidemiological studies on human subjects, published in English, were included in the review. A comprehensive literature search yielded 72 studies for further consideration. Following the application of the eligibility criteria we identified nine studies. A positive association and an excess risk of wheezing during the first two years of life were revealed for adverse birth outcomes.

Background Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument that is used routinely with mothers during the postpartum period for early identification of postnatal depression. The purpose of this study was to validate the Greek version of EPDS along with sensitivity, specificity and predictive values. Methods 120 mothers within 12 weeks postpartum were recruited from the perinatal care registers of the Maternity Departments of 4 Hospitals of Heraklion municipality, Greece. EPDS and Beck Depression Inventory-II (BDI-II) surveys were administered in random order to the mothers. Each mother was diagnosed with depression according to the validated Greek version of BDI-II. The psychometric measurements that were performed included: two independent samples t-tests, One-way analysis of variance (ANOVA), reliability coefficients, Explanatory factor analysis using a Varimax rotation and Principal Components Method. Confirmatory analysis -known as structural equation modelling- of principal components was conducted by LISREL (Linear Structural Relations). A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. Results 8 (6.7%) of the mothers were diagnosed with major postnatal depression, 14 (11.7%) with moderate and 38 (31.7%) with mild depression on the basis of BDI-II scores. The internal consistency of the EPDS Greek version -using Chronbach's alpha coefficient- was found 0.804 and that of Guttman split-half coefficient 0.742. Our findings confirm the multidimensionality of EPDS, demonstrating a two-factor structure which contained subscales reflecting depressive symptoms and anxiety. The Confirmatory Factor analysis demonstrated that the two factor model offered a very good fit to our data. The area under ROC curve AUC was found 0.7470 and the logistic estimate for the threshold score of 8/9 fitted the model sensitivity at 76.7% and model specificity at 68.3%. Conclusion Our data confirm the validity of the Greek version of the EPDS in identifying postnatal depression. The Greek EPDS scale could be used as a useful instrument in both clinical practice and research.

INTRODUCTION Cervical screening programs have been introduced in many countries and are generally regarded as the most appropriate and effective method currently available for preventing cervical cancer. Although action has been undertaken by some rural practitioners, especially by district midwives, there are still few published data on the effectiveness of community-oriented cervical screening programs in Greece. OBJECTIVE To explore an innovative approach in a primary-care setting in rural Crete. This study reports on the effectiveness of a health education meeting in recruiting women for a cervical screening program. METHODS At a centre for the elderly, 16 women participated in an educational discussion meeting organised to promote cervical screening. The women who participated in the discussion meeting were invited to organise a group visit to a rural primary healthcare centre, in order to be screened as a team during the following 15 days. The theoretical model underpinning the development of this intervention was based on the 'social learning theory'. Emphasis was placed up individual and social responsibility regarding cervical cancer. RESULTS A total number of 48 women (average age 62 years) including all those who participated in the educational discussion meeting, visited the Spili Health Center, Crete, 15 days after the discussion meeting. The main finding was the high compliance rate of the women who participated in the educational discussion meeting, resulting in recruiting all the initial participants. Moreover, the lay women who participated in the small group discussion meeting, in the capacity of key messengers convinced an additional 32 women to participate in a screening program for cervical cancer as members of a team, rather than individually. The majority (52.1%, n = 25 out of 48) of the women had not been previously screened for cervical cancer. CONCLUSIONS Health education is an important factor in the process of health promotion, and health professionals should consider the dynamics of a specific group in order to carry out their work effectively. Awareness of the special characteristics of an individual as a member of a defined group can contribute to increasing the motivation for participation in health programs as a member of that group. It is suggested that more educational programs take place in rural Crete in order to augment the compliance rate of women in cervical screening programs.

BACKGROUND: The changes in the organization of mental health care services have made the role of the family even more important in caring for patients with mental disorders. Caring may have serious consequences for family caregivers, with a great impact on the quality of family life. This study reports on the translation, cultural adaptation, and validation of the Involvement Evaluation Questionnaire-European Union (IEQ-EU) into the Greek language. METHODS: Caregivers of patients with major mental disorders were interviewed to test a modified version of the IEQ-EU questionnaire. Psychometric measurements included reliability coefficients, exploratory factor analysis and confirmatory analysis by linear structural relations. To measure the concurrent validity we used the Nottingham Health Profile (NHP). RESULTS: Most caregivers were female (83 %), mainly mothers living with the patient (80 %), with quite a high level of burden. The Greek version of the IEQ-EU (G-IEQ-EU) demonstrated a good reliability with high internal consistency (alpha = 0.88), Guttman split-half correlation of 0.71, high test-retest reliability (ICC = 0.82) and good concurrent validity with the NHP. A four-factor structure was confirmed for the G-IEQ-EU, slightly different from the original IEQ. The confirmatory factor analysis demonstrated that the four-factor model offered modest fit to our data. CONCLUSIONS: The G-IEQ-EU is a reasonably valid and reliable tool for use in both clinical and research contexts in order to assess the burden of caregivers of patients with mental disorders