Alexandros Gryparis

Purpose: Dry eye disease (DED) significantly affects quality of life. Commonly used questionnaires such as the Ocular Surface Disease Index (OSDI) and Dry Eye Questionnaire (DEQ-5) have limitations: OSDI does not fully capture patient experience, and DEQ-5’s one-month recall period may introduce bias. This study aimed to evaluate the psychometric properties of the Dry Eye dAily Life (DEAL), designed to assess a broader range of patient perceptions. Materials and Methods: Baseline data from the TEARS cohort (Spain and UK) included 312 patients with DED who were treated with sodium hyaluronate and trehalose. In addition to the OSDI, DEQ-5, and a global satisfaction item, patients completed 19 questions (9 on the subject of DED impact and 10 on their satisfaction with eye drops) developed from a literature review. Items used 4- or 5-point Likert scales, and a 3-day recall period. Results: The mean age of patients involved in the study was 57.9± 15.2 years; 82.4% were women. Four of the questions were removed due to high inter-item correlation (3 items) or poor factor loading (1). Principal Component Analysis identified a stable 4-factor structure: 1/ impact on daily activities (6 items/questions); 2/ relief/being comfortable/duration with eye drops (4); 3/ mood/sleep impact (3); and 4/ ease of use (2). Cronbach’s alpha ranged from 0.67 to 0.86. The review of logical correlations between the 4 dimensions with OSDI, DEQ-5, and global satisfaction supported the validity. The DEAL global score correlated only moderately with OSDI (r=0.44) suggesting additional patient-relevant information which is not addressed by OSDI alone. Conclusions: The 15-item, 4-dimension DEAL questionnaire shows promising preliminary psychometric properties and captures patient-relevant concepts not currently addressed by existing tools. The 4-dimension structure is internally coherent. Independent replication, assessment of responsiveness, and further work on the ease-of-use dimension and the optional contact-lens item are needed.

Type 1 diabetes (T1D) constitutes a chronic metabolic disorder attributed to the autoimmune destruction of insulin-producing pancreatic β cells, which most frequently occurs in childhood. Long-term complications of T1D are expected to occur mainly in adult life, whereas cognitive dysfunction can also occur in children and adolescents with T1D. Most studies demonstrate mild cognitive impairment, especially in the domains of memory, attention and executive functions, all of which affect academic performance, which may also negatively influence adherence to appropriate glucose monitoring and insulin treatment in children and adolescents with T1D. As a result, mild cognitive dysfunction can be an obstacle to both optimal glycemic control during childhood and adolescence and academic achievements for young individuals with T1D. The major metabolic changes occurring around the onset of diabetes, such as severe hyperglycemia and diabetic ketoacidosis, may have a negative impact on brain plasticity during this vulnerable period of neurodevelopment, especially in children diagnosed at a younger age. The pathophysiological mechanisms involved are closely related to increased oxidative stress and the accumulation of advanced glycation end products in the brain, thus leading to neuron cell damage and apoptosis. On the other hand, hypoglycemic episodes and glucose fluctuations may also impair neuronal integrity. The aim of the current narrative review is therefore to present the existing literature data on the clinical aspects, risk factors and molecular mechanisms associated with cognitive dysfunction in children and adolescents with T1D.

Feeding and swallowing disorders (FSDs) are common in both typically developing children and those with complex medical or developmental needs, leading to health issues and significant strain on parents/caregivers. This study aimed to translate and adapt the Feeding and Swallowing Impact Survey into Greek, providing a validated tool to assess the impact of these disorders on caregivers’ quality of life. The study group included 92 parents and caregivers of children with FSDs, whereas the control group consisted of 90 parents/caregivers of typically developing children. Participants completed the Greek‐translated survey twice over a 10‐day period, with clinical data collected from medical records. The Greek version of the survey demonstrated excellent internal consistency (Cronbach's alpha = 0.939) and strong test–retest reliability (Spearman correlation coefficient = 0.924–0.986). Confirmatory factor analysis confirmed the instrument's validity, with comparative fit index = 0.837, Tucker–Lewis's index = 0.811 and root mean square error of approximation = 0.146. The Greek version successfully distinguished between the study and control groups, as well as different types of FSDs. These findings confirm that the Greek‐translated and adapted survey is a reliable and valid tool for assessing the impact of FSDs on caregivers’ quality of life.

Objectives: Inappropriate mealtime procedures can complicate a child’s feeding process and lead to behavioral issues, emphasizing the importance of parents’ perceptions of their child’s feeding behaviors. This study aimed to translate and validate the Mealtime Behavior Questionnaire (MBQ) into Greek and examine the mealtime behaviors of Greek Cypriot children and families. Methods: The sample included 200 monolingual Greek Cypriot parents. It was divided into two groups: parents ( N = 100) whose children exhibited typical mealtime behavior (tp-MBG) and parents ( N = 100) whose children displayed non-typical mealtime behavior (ntp-MBG). They were selected from Cypriot public and special public schools, and speech-language clinics. The children’s parents completed the MBQ questionnaire, which was re-administered in 10 days. Results: MBQ-GR showed good discrimination between the tp-MBG and ntp-MBG groups [ t (198) = 10.810, p 0.001]. It had high internal consistency [Cronbach’s α = 0.944], very good test-retest reliability (ICC= 0.933 [95%, CI: 0.918–0.946]), and external criterion validity ( r = 0.820, p 0.001). MBQ cutoff was equal to 57.00 [sensitivity of 0.660 and 1-specificity of 0.07-AUC 0.870, (95% CI: 0.822–0.918), p 0.001]. A confirmatory factor analysis (CFA) was performed on the four factors originally suggested, using a robust weighted least squares estimator with mean and variance adjustments, accounting for the data’s ordinal and highly skewed characteristics. The resulting estimates suggested a very good fit of the data to the CFA model. Conclusions: MBQ-GR has great reliability and validity and can be utilized to evaluate preliminary feeding behavioral issues related to feeding challenges in children of Greek-Cypriot cultural background.

Background/Objective: Pediatric feeding problems are becoming more widespread. They represent a synthesis of social, behavioral, and biological issues. Inevitably, the multifaceted nature of these problems has to be evaluated through one multidimensional tool. The Pediatric Assessment Scale for Severe Feeding Problems is designed to assess these complex issues and represents the first attempt to associate these factors into a single multidimensional measure. The aim of this study is to translate and culturally adapt the Pediatric Assessment Scale for Severe Feeding Problems into Greek and to assess its psychometric properties for use among a Greek Cypriot pediatric sample. Methods: This study involved 142 parents of children with symptoms of feeding problems. It included parents of children who were oral-fed (n = 65), partially oral-fed with supplementation (n = 62), and tube-fed (n = 15). The sample of parents was recruited from mainstream and special education schools in Cyprus and were asked to complete a Greek-translated version of the PASS-FP. Results: The PASS-FP-Gr demonstrated excellent psychometric properties. Internal consistency was good, and test–retest reliability showed a perfect Spearman’s rank correlation with high significance. The tool exhibited strong discriminatory ability, with statistically significant differences in median scores across the three feeding groups. Conclusions: The PASS-FP appears sensitive to the Greek Cypriot population and presents satisfactory psychometric features. It demonstrated excellent discriminatory ability, as evidenced by the participants’ consistent response patterns.

Background/Objectives: Autism Spectrum Disorder (ASD) includes significant feeding difficulties, behavioral issues, and communication deficits that are linked to serious medical complications and developmental challenges. The Brief Autism Mealtime Behavior Inventory (BAMBI) is a commonly used tool to screen for mealtime behavior problems in children with ASD; however, it lacks validation for use within the Greek-Cypriot population. The current study sought to present the translation, cultural adaptation, and validation of the BAMBI for Greek-Cypriot parents of children with ASD. Methods: Three bilingual experts translated the inventory into Greek, following the translation guidelines by the World Health Organization. The inventory was then administered to 117 parents: 42 children with ASD and 75 typically developing children. Principal Component Analysis was used to obtain the tool’s statistical reliability and validity. Results: BAMBI-Gr demonstrated strong internal consistency, as indicated by a Cronbach’s alpha of 0.755, and showed excellent test–retest reliability, with an intraclass correlation coefficient of 0.999. PCA identified three key factors: General Refusals, Refusing Food, and Autism-Related Features. Significant differences in BAMBI-Gr scores of the comparative group of parents of children with ASD and parents of typically developing children highlighted the tool’s sensitivity in detecting mealtime behavior problems. Receiver Operating Characteristics analysis set the cut-off points for optimum distinguishing of feeding problems at 46.00 (sensitivity 0.738, 1-specificity 0.000). Conclusions: The Greek-translated version of the BAMBI demonstrates validity and effectiveness as a parent-reported assessment tool for identifying feeding and mealtime difficulties in children with ASD.

Background/Objectives: The study aimed to investigate how cognitive variables (performance IQ, verbal short-term memory, working memory, and ADHD symptomatology) impact lexical representations in children with high-functioning autism spectrum disorder (HF-ASD). Methods: Participants were two groups (n1 = n2 = 20) of monolingual Greek-speaking children, aged 7 to 12 years, with and without HF-ASD matched in age, gender, and cognitive skills. Results: Overall, the HF-ASD group had more immature lexical representations than the control group, even though the two groups were similar in naming. In both groups, naming was correlated moderately with verbal short-term memory but only age predicted significantly semantic knowledge. In the ASD group, a bilateral predictive relationship was revealed between output motor programming skills and stored phonological knowledge, supporting theoretical assumptions of the psycholinguistic model of speech. Finally, a different pattern of interrelations was observed between cognitive and lexical variables in the two groups. Conclusions: The findings of the current study indicate that ASD children may map and process new vocabulary differently compared to typically developing peers.

Background/Objectives: The Distress Thermometer for Parents represents an excellent tool for the rapid assessment of emotional distress in parents of children with a variety of chronic diseases. This study aimed to evaluate the efficacy of the Distress Thermometer for Parents in assessing emotional distress in parents and caregivers of children with feeding and swallowing difficulties feeding swallowing disorders or, dysphagia, in the Greek Cypriot community. Methods: It involved 200 Greek Cypriot participants: 100 parents/caregivers of children with FSD and 100 parents/caregivers of children without such difficulties. Demographic and clinical data were collected and test–retest reliability was evaluated. Results: The DT-P demonstrated excellent reliability (Cronbach’s α = 0.928) and strong test–retest consistency (r = 1.00, p < 0.001). ROC analysis showed strong discrimination for detecting distress, with an AUC of 0.76 for parents of children under 24 months and 0.77 for parents of children over 2 years (p < 0.01). Parents reported a medium level of distress (M = 3.67, SD = 2.89), with “Emotional Problems” (M = 2.03, SD = 2.28) and “Practical Problems” (M = 1.79, SD = 2.12) contributing most significantly. Independent t-tests revealed significantly higher distress levels in parents in the clinical group compared to the parents in the typical group (p < 0.001), confirming the DT-P’s sensitivity and validity. Conclusions: The Greek version of the DT-P is a reliable and valid tool assessing distress in parents of children with PFD. This study highlights significantly higher distress levels in these parents compared to those of typically developing children, emphasizing the need for targeted support.

Background: Parents’ reports are frequently utilized to evaluate children with eating difficulties. To forecast a child's eating pattern, information on feeding skills is crucial. The Children's Eating Behavior Inventory (CEBI) is a valuable questionnaire addressing child-parent behavior during mealtimes. Objective: This study intended to validate the Greek version of CEBI by the Greek Cypriot parents, of preschool and school-aged populations with or without feeding difficulties. Methods: 100 Greek Cypriot parents of children with typical eating behaviors (c-teb) and 100 parents of children with non-typical eating behaviors (c-nteb) participated in this study. All participants completed the Greek-translated version of the CEBI questionnaire. RESULTS: Statistically significant differences were found between the c-teb and the c-nteb groups [t (198) = −1.628 p < 0.005] for the CEBI total score. The instrument has strong internal consistency with Cronbach-a 0.854, intraclass correlation coefficient (ICC) = 0.843–0.859), strong test-retest reliability (r = 0.999, p  < 0.001), and good external criterion validity [MCH-FS (r = −0.712, p < .001) and the AYCE r = −0.660, p < .001)]. The Receiver Operating Characteristic (ROC) analysis estimated a cut-off = 83.00 (sensitivity of 0.870 and a 1-specificity of 0.250) with Area Under the Curve, AUC  = 0.848, (95% CI: 0.792–0.905), p  < 0.001. Conclusions: The Greek CEBI revealed excellent sensitivity, reliability, and clinical validity, which can support healthcare providers in Greek Cypriot settings.