Anastasia Papaioannou's scientific contributions

Background: The COVID-19 pandemic has disrupted global daily life, including the world of elite athletes. This paper examines the multifaceted impact the COVID-19 pandemic had on elite swimmers and water polo athletes, specifically their mental health, their concerns over the virus, their intentions of getting vaccinated, and sleep disturbances that they may have faced. Methods: We conducted a cross-sectional study on elite swimmers and water polo players, using an anonymous questionnaire. Results: A total of 200 elite athletes participated. The majority of the participants reported a negative impact on their mental health, screened positive for insomnia (n = 107 (53.5%), with females (n = 101; 57.7%), swimmers (n = 100, 66.7%), and university students (n = 71, 71.7%) being more vulnerable (p < 0.001). Concerns about contracting the disease especially during important training or tournament periods and potential career disruption also affected their psychological well-being. While the majority (75%) had the intention of getting vaccinated, an alarming percentage was yet uncertain over its decision. Conclusions: This study highlights the significant psychological distress faced by elite aquatic athletes during the pandemic. It emphasizes the difficulties faced by elite swimmers and water polo athletes and determines not only the importance of addressing the vaccination intentions of athletes, but also how critical it is to confront the challenges they face both for their personal health and for the restoration of world sports to their pre-pandemic state. More large-scale studies are required to inform policies targeted at minimizing disruption to the athletes’ career, provision of information on preventive measures and vaccination, and improvement in psychological well-being in case of similar major public health issues in the future. Additionally, this study calls for further research to explore the unique challenges faced by aquatic athletes, such as those related to their training environments and fear of contagion, to better support them in future public health crises.

Background and Objectives: Prediabetes is associated with a high risk of developing diabetes and cardiovascular disease. Early treatment with exercise and dietary interventions can reduce the progression of prediabetes to diabetes or even lead to a return of glucose levels to normal. The aim of the study was to evaluate the effect of a dietary supplement with Portulaca oleracea and titrated Cistus creticus extract on the glycemic profile of people with prediabetes. Materials and Methods: Participants were assigned to a dietary supplement with Portulaca oleracea and titrated Cistus creticus extract, along with vitamins and minerals, received once daily for 90 days. Demographics and medical history were obtained, and a complete clinical examination, measurement of somatometric characteristics, and laboratory parameters were performed at baseline. The measurement of somatometric characteristics and laboratory tests were repeated at the end of the study. Results: A total of 26 people with prediabetes participated, 11 females and 15 males. There was a tendency for a decrease in HbA1c after intervention [baseline: 5.9 (5.7–6.1)%; at the end of the study: 5.7 (5.7–6.0)%, p = 0.062] and a significant decrease in fasting glucose levels (from 110.8 ± 7.0 mg/dL to 103.9 ± 10.3, p = 0.005). Fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) decreased significantly [baseline fasting insulin: 20.7 (9.3–34.20) μU/mL; at the end of the study: 15.1 (8.6–19.0) μU/mL, p = 0.028; baseline HOMA-IR: 3.6 (2.5–8.9); at the end of the study: 3.5 (2.0–4.6), p = 0.035]. Significant reductions were observed in alkaline phosphatase and uric acid levels. No significant change was observed in body weight, body mass index, or waist circumference after the intervention. No treatment-emergent adverse events were observed, and all participants completed the study. Conclusions: The dietary supplement from Portulaca oleracea and titrated Cistus creticus extract, along with vitamins and minerals, may improve the metabolic profile of people with prediabetes.

The COVID-19 pandemic has had a major impact on health, economy, society and education. In the effort to return to normalcy, according to the instructions of the Greek Government for the resumption of the operation of schools, a screening Rapid Antigen Detection Test with the method of self-testing is required for students twice per week, for the early identification and isolation of positive cases. We aimed to pivotally investigate the knowledge, attitudes and practices related to self-testing procedures against COVID-19 among Greek students. A questionnaire was distributed to a convenient sample of students in the region of Athens. Information about the vaccination coverage against SARS-CoV-2 was also obtained. Our study included 1000 students, with 70% of them having an average grade at school. Most of the participants were aware of coronavirus (98.6%) and the self-test (95.5%). The vast majority of students (97%) performed self-testing twice per week, with the 70% them being assisted by someone else. Nearly one sixth of the participants had been infected by COVID-19 (14%) while 36% of them have already been vaccinated against SARS-CoV-2. In conclusion, we report high compliance with the COVID-19 self-testing procedure among students in Attica, Greece. Older age adolescents are more likely to not comply with the regulations of self-testing. Consequently, tailored interventions targeted at older age adolescents are warranted in order to increase the acceptability of self-testing.

Although vaccination is one of the most cost-effective ways of preventing disease, vaccine hesitancy has been included among the ten threats of global health. Addressing low adult vaccination rates requires an adequate understanding of people's views. We explored perceived barriers to immunization among under-vaccinated adults to identify potential differences among vaccine supporters, refuters, and those who are undecided. We conducted a multi-center, mixed-methods study at 23 primary care practices in Greece. Each day, we asked three new randomly-selected adult healthcare users who attended the practice over the course of 30 consecutive working days. We used thematic content analysis to analyze their written answers to open-ended questions that addressed reasons for not getting vaccinated. Out of 1571 participants, two-thirds reported they were under-vaccinated as adults, thus accounting for three out of five of the supporters and the vast majority of the undecided and refuters. “Concerns/fears,” a “perception of low susceptibility to disease due to good health status,” the “absence of healthcare professional’s recommendation,” and “previous negative experiences” were four themes common to all three groups. Additional barriers reported by supporters and the undecided included “knowledge gaps about the necessity of adult vaccination,” “negligence,” and lack of “accessibility.” Among refuters, additional themes identified were “mistrust in pharmaceutical companies” and “disbelief in vaccine effectiveness.” In conclusion, under-vaccination is common, not only among refuters or the undecided, but also among supporters of adult vaccination. We found similarities and differences in under-vaccinated adults’ perceived barriers, depending on their individual perspectives. Physicians and public health services should take into consideration the impact of the wide range of attitudes and beliefs in their effort to address the underlying barriers to vaccination compliance as they attempt to increase vaccination coverage in adults.

There are limited data on the prevalence and determinants of COVID-19 vaccination coverage among physicians. A cross-sectional, questionnaire-based, online study was conducted among the members of the Athens Medical Association (I.S.A.) over the period 25 February to 13 March 2021. All members of I.S.A. were invited to participate in the anonymous online survey. A structured, anonymous questionnaire was used. Overall, 1993 physicians participated in the survey. The reported vaccination coverage was 85.3%. The main reasons of no vaccination were pending vaccination appointment followed by safety concerns. Participants being informed about the COVID-19 vaccines by social media resulted in lower COVID-19 vaccination coverage than health workers being informed by other sources. Logistic regression analysis demonstrated that no fear over COVID-19 vaccination-related side effects, history of influenza vaccination for flu season 2020–2021, and the perception that the information on COVID-19 vaccination from the national public health authorities is reliable, were independent factors of reported COVID-19 vaccination coverage. Our results demonstrate a considerable improvement of the COVID-19 vaccination uptake among Greek physicians. The finding that participants reported high reliability of the information related to COVID-19 vaccination provided by the Greek public health authorities is an opportunity which should be broadly exploited by policymakers in order to combat vaccination hesitancy, and further improve COVID-19 vaccination uptake and coverage among physicians/HCWs, and the general population.

Despite the unequivocal value of vaccination in reducing the global burden of infectious diseases, the anti-vaccination movement thrives. The vast majority of the existing validated tools explore attitudes regarding vaccination in children. The aim of our study was to develop and validate a scale assessing attitudes towards adult immunisation. This national cross-sectional study included adult healthcare users who visited 23 Greek Primary Healthcare Units. The development of the scale was the result of literature review, semi-structured interviews and pilot testing of its preliminary versions. The initial version contained 15 items measuring respondents' attitudes on a 6-point Likert scale. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales; confirmatory factor analysis was used in the second sample to assess goodness of fit. Moreover, concurrent validity, internal consistency reliability, test-retest reliability and ceiling and floor effects were explored. The total sample consisted of 1,571 individuals. Overall 'Cronbach's alpha' (0.821) indicated good internal consistency. The initial exploratory factor analysis resulted in a three-factor model. The subsequent confirmatory factor analysis indicated that an 11-item version of the scale provided the best fit of the model to the data (RMSEA = 0.050, SRMR = 0.053, TLI = 0.937, CFI = 0.955, AIC = 24,999.949). All subscales ('value of adult vaccination', 'safety concerns' and 'perceived barriers') demonstrated strong concurrent associations with participants' attitudes and behaviour regarding vaccination (p < .001). No ceiling or floor effects were noted for any of the subscales (0.13%, 2.61% and 0.51%; 0.13%, 0.57% and 0.45% respectively). The 11-item ATAVAC scale proved to be a reliable and valid tool, suitable for assessing attitudes towards adult vaccination.

Objective: Seasonal influenza vaccination is the main method for influenza prevention. The main objective of this study is to estimate the frequency of vaccinations in patients with chronic illnesses presented to a primary health care (PHC) centre. Methods: This cross-sectional study was performed in patients admitted to the Kapandriti Health Centre. Their vaccination status with an influenza vaccine and their underlying diseases were recorded. Results: 34.8% of the subjects had been vaccinated against seasonal influenza. Vaccination coverage was found to be 53.9% in pulmonary, 55.6% in chronic kidney disease, 43.7% in cardiovascular disorders, 40.6% in diabetes, 40.6% in any kind of malignancy, and finally 33.3% in neurological patients. The most significant predictors for vaccination were the age group of 60 to 79 years (OR = 3.08, 95% CI: 1.79-5.29), age over 80 years (OR = 2.91, 95% CI: 1.58-5.36), respiratory disease (OR = 2.25, 95% CI: 1.33-3.76), cardiovascular disorder (OR = 1.46, 95% CI: 1.02-2.10), and 3 to 5 visits to the unit annually (OR = 1.57, 95% CI: 1.12-2.24). Finally, it was discovered that coexistence of one to three diseases reduced the likelihood ratio for vaccine uptake (OR = 0.15, 95% CI: 0.03-0.79, p < 0.05). Conclusions: The influenza vaccination rate for the population of the present study has been found higher than that reported previously in literature. We believe that there is a need to implement new and more effective strategies such as educating vulnerable groups on the benefits of vaccination and so reducing the incidence of influenza and its complications especially in vulnerable groups.

Introduction: Treated but uncontrolled hypertension is a worldwide challenge. Exploring patient perspectives in different cultures and contexts could contribute to a more comprehensive understanding of poor blood pressure (BP) control. This study aimed to investigate patients' knowledge and attitudes towards BP management in order to identify possible barriers to achieving effective control. Methods: A mixed-methods study, using both quantitative and qualitative research methodology, was conducted by 12 general practitioners working in rural areas in five different prefectures in Greece. A 42-item, pre-tested questionnaire was completed by the hypertensive patients who visited the practices and were included among the first 20 patients for 20 consecutive working days. Included participants were patients who (a) had diagnosed hypertension and received BP-lowering medication, (b) were aged over 18 years, (c) had physical and mental ability to participate in an interview, (d) had adequate understanding of the Greek language and (e) provided signed, informed consent. The open-ended questions used to identify the patient-related barriers in hypertension control were analyzed using thematic content analysis. Results: A total of 613 hypertensive patients were recruited (response rate 91%); mean age was 71.5 years (SD 9.4, range 34-100) and 39.5% (242) were male. Uncontrolled BP was found in 41.3% (253), of which 67.6% (171) considered their BP controlled, 18.6% (47) uncontrolled, while 13.8% (35) were unaware of their status. Women were more likely to achieve BP control (OR 1.44, 95% confidence interval 1.04-2.00). As many as 287 (46.8%) patients knew the optimal values for BP. The identified barriers in hypertension control were grouped into six themes: knowledge gaps, intolerance of adverse events, negligence, unmet individual preferences, financial barriers and overtreatment of hypertension. Conclusion: Physicians should be aware of the possible disconnection between their patients' perceived and actual BP control, given frequent overestimation of BP control rates and the lack of knowledge of target BP levels. They should bear in mind that covering their patients' knowledge gaps is essential in empowering their patients to get more actively involved in the management of their chronic condition. Simultaneously, physicians should aim to elicit each patient's attitudes, concerns about adverse events, individual preferences, as well as possible financial barriers and negligence, in an effort to actually see the antihypertensive treatment 'through their patients' eyes' and eliminate possible barriers in medication adherence. The provision of patient-centered care remains the gold standard for eliminating patient-related barriers and achieving higher levels of BP control.

Background: Research in primary care is necessary to empower its role in health systems and improve population health. Objective: The aim of this evaluation study was to assess the experiences of primary care physicians who participated as researchers in a multi-centre, mixed-methodology study on adult vaccination supported by a newly established practice-based research network. Methods: Twenty-three physicians participated as researchers, operating in their own practices in 10 different prefectures of Greece. After the completion of the study, they were asked to reflect on their experiences in the research by providing written responses to the questions on the evaluation tool of the study. The open-ended questions were analyzed using thematic content analysis. Results: Mean age of the researchers was 42.9 years old (±3.9, min 35, max 49) and 11 (47.8%) were male. Six themes emerged as beneficial for the participating researchers: (i) raised awareness of patients' needs, (ii) enhancement of clinical practice and services offered, (iii) positive impact on the doctor-patient relationship, (iv) personal satisfaction, (v) enrichment of their curriculum vitae and (vi) improvement of research skills. All researchers were interested in participating in future studies. Conclusion: The experience of conducting clinical research on adult vaccination in their own practices within a network was reported to be very rewarding. The benefits gained from their participation could be a valuable tool in promoting research and enhancing the quality of primary health care.

Aims To determine the prevalence of type-2 diabetes patients that were initially and currently being treated by primary care physicians (PCPs) or diabetes specialists and assess predictors influencing their choice. Methods This cross-sectional study was conducted in nine Greek primary healthcare units. Patients’ choices were modeled using a bivariate probit analysis. Results A total of 225 patients participated (84% response rate). Only 15.9% and 11.9% of the respondents acknowledged having chosen a diabetes specialist for their initial or current treatment, respectively. The family history of diabetes in siblings and the screening for diabetic retinopathy during the past year were significantly positively associated with choosing a diabetes specialist (initially p = 0.033 or currently p = 0.007), and resulted in a statistically significant reduction of the joint probabilities of choosing a PCP by 15.6% and 13.6%, respectively. Younger age (p = 0.040), female sex (p = 0.017), higher HbA1c (p = 0.004), experience of hypoglycemia (p = 0.029) and low cardiovascular morbidity index (p = 0.016) emerged as important predictors for choosing a diabetes specialist for their treatment. Conclusions Our findings provide a better insight in diabetes patients’ choices regarding the category of their treating physicians and their predictors. More studies are required to replicate them and identify patient subpopulations that may favor diabetes specialists’ guidance.