The association between depression and quality of life in the elderly

Background

Depression is the most common cause of emotional disorder in older adults causing functional impairment and leading to lower quality of life (QOL). The aim of the study was to investigate the prevalence of depression, measure the perceived QOL and evaluate the impact of depression on life quality of older people in the community.

Methods

We conducted a cross-sectional study in older people, enrolled in open day care centers and other healthcare facilities. To all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied to screen for depressive symptoms and the EQ-5D-5L scale to estimate their self-reported health status.

Results

A total of 634 seniors participated in the study, 53% were females, mean age 78 years. 45.6% of the participants showed moderate to severe depression. Those who suffered from at least two chronic diseases (75.6%) were more likely to develop moderate or severe depressive symptoms compared to those with only one (19.3%) or none (2.2%) chronic disease. Increased risk of depression was observed in people with Parkinson’s disease (56.5%), mental illness (47.1%), respiratory disease (40%) and stroke (35.1%). Regarding the EQ-5D-5L scale, 72% reported slight to extreme anxiety or depression, 68.2% slight to extreme pain or discomfort, 59.8% slight to extreme problems in performing usual activities, 59.8% in mobility and 40.1% in self-care, respectively. Significant differences were found between people with or without depression. Specifically, participants who reported slight to severe problems in all five domains of the EQ-5D-5L, showed higher levels of depression in the GDS-15.

Conclusions

Our results revealed that elderly with depressive symptoms have a lower quality of life. Given the mutual relationship between chronic diseases, lower life quality and depression, assessment of depressive symptoms are needed in elderly population, mainly in people with multiple chronic diseases.

Key messages

• Depression can be a predictor of poorer quality of life in older population.

Women’s knowledge, awareness and prevention of cervical cancer and infection from HPV in Greece

Background

Cervical cancer prevention can be obtained by regular screening with Papanicolaou test. However, in recent years HPV DNA test and mRNA HPV test are available for the screening for cervical cancer. The HPV vaccine helps protect against HPV- related cancers. Our aim was to investigate the beliefs and knowledge of women living in a city in northwestern Thessaly, Greece, regarding the prevention of cervical cancer.

Methods

A cross sectional study was conducted among 119 women, 18-65 years old and living in Trikala, Greece. They completed a 45-item self-administered questionnaire, investigating their knowledge, perceptions, and behaviors regarding the prevention of cervical cancer, the infection with HPV, the Papanicolaou test and vaccination. Furthermore, associations between knowledge and behaviors as well as with various demographic factors were explored.

Results

Most of the women had at least university education (77%). More than 90% declared to visit an obstetrician-gynecologist at least once a year and 68.4% regularly have a Pap smear once a year. 95.8% were aware of the importance of a Pap smear and 82% declared a positive attitude regarding HPV vaccination. Higher knowledge regarding examination and vaccination, was associated with marital status (married) (p = 0.002) and educational level (higher educational level) (p = 0.001).

Conclusions

The majority of women in our sample know why they should do the Pap test; however, they need to be further informed with additional details about the diagnostic test. Although most of the women were aware about the importance of testing, one third of them were not regularly tested for cervical cancer detection or had lacked knowledge about vaccination.

Key messages

A high percentage of women is aware about the benefits of cervical cancer screening. However, information campaigns and establishment of national screening programs are required to facilitate the access to such programs for all women.

Monitoring the health status of the elderly in an urban area in Athens, Greece

Background

Aging of population brings changes in needs and capacities. People live longer and chronic diseases appear to be a potential risk of major causes of disability and functional dependency. The aim of this study was to investigate the physical and mental health of the elderly residing in an urban area in Athens,Greece.

Methods

In this population-based study using a convenience sampling, seniors aged ≥65 years old, under no medical treatment were selected from Korydalos area, Athens, Greece. A translated version of the General Health Questionnaire (GHQ-28) was used and associations with other parameters were performed. Higher GHQ-28 scores indicate higher levels of distress.

Results

A total of 100 seniors participated in the study, 64% females, mean age 71.4 years. 51% were married, 40% lived alone and 82% had primary or secondary education. 59% received a pension from the state, out of them 42% between 601-1000 euros and 33% between 301-600 euros, monthly. The mean GHQ-28 score, for a potential mental disorder in the somatization, anxiety, social dysfunction, and depression factors, was 24.3, 29.1, 42.9 and 10.2, respectively. Females presented higher scores in total GHQ score (p = 0.018), in somatization (p = 0.019) and in social dysfunction (p = 0.001). Higher age was associated with higher total GHQ score (p = 0.001), higher anxiety (p = 0,006) and higher dysfunction (p = 0.006). Seniors with lower educational level had higher total GHQ score (p = 0.032) and higher social dysfunction (p < 0.001). Low financial status was associated with higher social dysfunction (p = 0.005).

Conclusions

The study revealed an overall moderate emotional distress in elderly. However, a high risk in social dysfunction is obvious, whereas risk of depression is very low. Age, educational level and financial status are associated with various dimensions of distress and psychiatric disorders. GHQ-28 is a suitable screening tool and can be used to prevent chronic disease and mental disorder

Key messages

GHQ-28 can be used as a screening tool in elderly in urban communities to assess psychological well-being and detect possible psychiatric morbidity and to improve their overall health.

Women’s postnatal care satisfaction during COVID-19 pandemic in public hospitals in Northwest Greece

Background

Patient satisfaction is an important process for investigating patients' needs, views, and suggestions about the health services provided by a health care facility. The aim of this study was to investigate women's postnatal satisfaction with healthcare services during COVID-19 pandemic, provided at two regional public hospitals in Ioannina, Greece.

Methods

Using a purposive and snowball sampling technique, a cross-sectional study was performed among women who gave birth in two regional Greek hospitals, during October 2020. An online self-administered 32-item questionnaire was distributed personally, as well as, in social media groups related to young mothers and baby feeding.

Results

A total of 106 women answered the questionnaire, mean age 34 years old, 58.5% had higher education and for 40.6% it was the first birth. 63.2% declared having visited the same hospital already in the past for gynecological services and 69.6% being satisfied with doctors' and nurses' communication, their interaction, behavior giving guidance, and the time they dedicated to the mothers. 60% were satisfied with hospital cleanliness, organization, adequacy, easy access, orientation and 63.6% from the administrative services. 23.8% were not satisfied with waiting times between appointment schedule and medical examination; however, 61.6% indicated that they would either use or suggest the services again. Higher satisfaction was associated with being married and employed, having no previous experience, and being in good health status.

Conclusions

In general, a moderate satisfaction with various dimensions of provided health services was observed. The study highlights the importance of the postnatal care provided by healthcare professionals and health services. Improving the parameters which affect women's satisfaction would increase the quality of postnatal care.

Key messages

Assessing patient satisfaction is an important indicator of measuring the quality of health services.

Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lockdown in Greece

Objectives

The coronavirus disease 2019 (COVID-19) outbreak, along with implementation of lockdown and strict public movement restrictions, in Greece has affected hospital visits and admissions. We aimed to investigate trends of cardiac disease admissions during the outbreak of the pandemic and possible associations with the applied restrictive measures.

Study design

This is a retrospective observational study.

Methods

Data for 4970 patients admitted via the cardiology emergency department (ED) across 3 large-volume urban hospitals in Athens and 2 regional/rural hospitals from February 3, 2020, up to April 12 were recorded. Data from the equivalent (for the COVID-19 outbreak) time period of 2019 and from the postlockdown time period were also collected.

Results

A falling trend of cardiology ED visits and hospital admissions was observed starting from the week when the restrictive measures due to COVID-19 were implemented. Compared with the pre–COVID-19 outbreak time period, acute coronary syndrome (ACS) [145 (29/week) vs. 60 (12/week), −59%, P < 0.001], ST elevation myocardial infarction [46 (9.2/week) vs. 21 (4.2/week), −54%, P = 0.002], and non-ST elevation ACS [99 cases (19.8/week) vs. 39 (7.8/week), −60% P < 0.001] were reduced at the COVID-19 outbreak time period. Reductions were also noted for heart failure worsening and arrhythmias. The ED visits in the postlockdown period were significantly higher than in the COVID-19 outbreak time period (1511 vs 660; P < 0.05).

Conclusion

Our data show significant drops in cardiology visits and admissions during the COVID-19 outbreak time period. Whether this results from restrictive measures or depicts a true reduction of cardiac disease cases warrants further investigation.

•

The coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented health system overload.

•

The restrictive measures in Greece resulted in a low number of COVID-19 cases.

•

Hospital visits and cardiovascular events have diminished after implementation of restrictive measures.

•

Acute coronary syndromes reduced by approximately 55%, despite limited incidence of COVID-19.

•

The multifactorial etiology of this finding should be thoroughly investigated.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Postpartum Depression in a Public Hospital in Cyprus. Prevalence, Risk Factors

Introduction

Postpartum depression (PPD) is a serious mental health condition. Untreated PPD places the mother and infant at risk and is associated with significant long-term effects on child development and behavior.

Objectives

Appropriate screening for and prompt recognition and treatment of depression after the birth of a child are essential for maternal and child well-being.

Aims

The purpose of the present study was to estimate the prevalence of PPD in the first 5 days after the birth of a neonate and to investigate associations with several risk factors.

Methods

A cross-sectional study was conducted among 150 mothers, in a public obstetric hospital in Nicosia, Cyprus. A questionnaire was administered including socio-demographic characteristics. The Greek version of the Edinburgh postnatal depression scale (EPDS), a 10–item questionnaire to identifying women who are at risk of PPD, was used to estimate depression among the participants.

Results

According to EPDS, 42% of the mothers screened positive for risk of developing PPD. Higher risk was observed in very young mothers (<20 years) (66.6% vs 15%), in women with history of psychological disorders (86.95% vs 33.85%), in single mothers (71.69% vs 22.8%), in women with serious problems during the pregnancy (74% vs 23.95%) and in mothers with not healthy neonate (75.7% vs 32.4%).

Conclusion

The study reveals a high prevalence of PPD and identifies various risk factors associated with developing PPD. The use of maternal depression screening programs such as the EPDS may help to recognize an elevated risk of postpartum depression and to ensure a healthier mother-child relationship.

The impact of emotional intelligence on the emotional state of nurses in public hospitals in Cyprus

Introduction

The term emotional intelligence (EI) has gained more and more popularity in the last two decades and has been studied in various workplace settings.

Objectives/aims

The purpose of the present study was to estimate the EI in nursing personnel, to examine which factors are associated with EI and how EI correlates with their emotional state.

Methods

A cross-sectional study was conducted from April to May 2016 in a representative sample of nursing personnel from seven public hospitals of Cyprus. A total of 585 nurses completed the Greek Emotional Intelligence Scale (GEIS), consisting of 52 items measuring four basic emotional skills and scored on a 5-point Likert scale (from low (52) to high (260) EI). Furthermore, the Depression, Anxiety, and Stress Scale (DASS 21) was applied. Statistical analyses were performed using the SPSS v.20.0.

Results

Overall mean EI scores were 184.11 for males and 184.82 for females. Being married and having children as well as having leading position was associated with higher EI (P = 0.024, P = 0.002, P = 0.012, respectively). The highest EI scores were identified between the middle aged nurses (36–50 years, EI = 191.5, P = 0.000) and nurses with more years of work (> 12 years, EI = 189.59, P = 0.000). The overall EI scores have moderate negative correlation with the emotional state of the nurses (P = 0.000).

Conclusions

The present study reveals under-optimal EI scores and confirms the negative relationship with the emotional state of nurses. Based on the literature, the EI can be developed, thus suitable programs could substantially improve the emotional skills in nursing personnel.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Frequency of depressive disorders in a representative sample of Nicosia, Cyprus

Introduction

“Health Profile” of Nicosia was conducted in 2013–2014, within the framework of the program “Healthy Cities” in order to collect and analyse information on the state of health and health-related behaviors of the citizens of Nicosia in Cyprus.

Aims

To estimate the frequency of self-reported depressive disorders and examine burdening as well as factors influencing it.

Methods

Based on the 2011 census, a cross-sectional study was carried out on a representative random stratified sample, which was selected to be interviewed, including 477 men and 525 women, from the city area. Participants answered a questionnaire, which required among other items on self-perceived physical and mental health. Participants were also asked the following questions: “Do you have/had in the past depression or/and anxiety?” and “Have you received a medical diagnosis for this disorder?”

Results

Approximately 70% of the sample reported they had experienced anxiety and depression (37% moderate and 33% severe episodes). Diagnosed depression was reported by 4%. Severe depressive disorders were more frequently reported by women (41%, P < 0.001), older aged citizens (70.2%, P < 0.001) widowed/divorced (45.5%, P < 0.001), persons with lower family income (< 1000 €, 79.7%, P < 0.001) and among people with chronic diseases (45.3%, P < 0.001).

Conclusions

The self-reported prevalence of anxiety and depression in the citizens of Nicosia is very high – probably reflecting a negative effect of the economic crisis –, and contrariwise diagnosis of the disorder is rarely provided and consequently therapy rarely offered. Specific population groups, such as women, elderly citizens, patients with chronic diseases are more vulnerable to depressive disorders requiring specialized medical attention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Jejunojejunal lipoma causing intussusception

Jejunojejunal intussusception and jejunojejunal lipomas are both very rare clinical entities. The present case report describes this event in an adult patient with severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was not made preoperatively, as none of the endoscopic findings were pathognomonic and, furthermore, CT scans could not rule out malignancy. Exploratory laparotomy was mandatory and at surgery a jejunojejunal intussusception secondary to a lipoma was found. Segmental resection and primary reanastomosis were performed in the presence of evidence of bowel ischemia.