Anna Deltsidou

Breast cancer during pregnancy presents unique therapeutic challenges, as effective maternal treatment must be balanced against potential risks to fetal and neonatal health. This systematic review aims to evaluate current evidence regarding the safety and effectiveness of chemotherapy during pregnancy in women with breast cancer (BC). This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in PubMed, Google Scholar, Scopus, and the Open Inter-university Consortium for Political and Social Research databases. Following the search and selection process, a total of 14 articles met the inclusion criteria. Risk of bias was assessed using design-specific Joanna Briggs Institute critical appraisal tools. The administration of specific chemotherapy regimens, mainly anthracyclines, after the first trimester was generally not associated with an apparent increase in congenital abnormalities or perinatal mortality. However, an increased risk of preterm birth was observed, with a substantial proportion of preterm deliveries being iatrogenic. Furthermore, available comparative evidence did not indicate substantially worse maternal oncological outcomes attributable to pregnancy itself. Taken together, these findings suggest that chemotherapy for BC during pregnancy can be administered with relative safety after the first trimester, within an individualized treatment approach and close collaboration among obstetricians, oncologists, and neonatologists. Nevertheless, further multicenter studies are required to fully elucidate long-term neonatal outcomes.

Aim: This study aimed to explore the experiences of midwives providing care in primary care walk-in clinics (PCWCs) within refugee camps, examining the challenges they encounter, and the relevance the ORAMMA framework. Background: Refugee camps present a complex environment for maternal care provision, due to limited resources, high population mobility, cultural and linguistic diversity, and increased psychosocial vulnerability among women. Midwives often being the primary providers of maternal care, must address both social and clinical needs. The ORAMMA framework was developed to support culturally sensitive and equitable maternity care for migrant and refugee populations. However, limited evidence exists regarding field experiences of ORAMMA-guided midwifery practice. Methods: A qualitative study design was employed to capture midwives’ in-depth experiences. Data were collected from 22 ORAMMA-trained registered midwives working in refugee camp PCWCs. Data were collected using semi-structured individual interviews ( n = 15) and two focus groups ( n = 7). Data were thematically analysed to identify recurring patterns and key themes. Findings: Midwives reported persistent challenges, including inadequate infrastructure, shortages of essential medical supplies and disrupted care continuity. Language and cultural barriers limited effective communication, trust-building, and clinical decision-making. Despite these constraints, midwives demonstrated adaptability and professional resilience, through collaborative teamwork, creative problem-solving, and culturally sensitive care. ORAMMA training strengthened their confidence and awareness in providing care, although participants emphasised the need for enhanced material resources, interpreter services, and psychosocial support. Overall, findings highlight the value of ORAMMA-guided capacity-building to support midwives’ resilience and commitment to quality care delivery.

Background/Objectives: Greece has been a major host country for refugee populations, operating under conditions of limited resources and strained healthcare services. Refugee women residing in accommodation facilities face barriers to accessing primary prevention and health promotion services, including limited health literacy and cultural and linguistic challenges. This study aimed to assess the level of primary prevention and health promotion among refugee women living in accommodation facilities in Greece and to identify their health needs and barriers to accessing healthcare services. Methods: A quantitative cross-sectional study was conducted among 150 adult refugee women residing in the Malakasa accommodation facility in Greece. Participants voluntarily agreed to take part in the study. Data were collected between December 2024 and March 2025 using a structured questionnaire assessing sociodemographic characteristics, primary prevention, health promotion, and barriers to healthcare access. Descriptive statistical analysis was performed. The study was approved by the relevant ethics committee, and informed consent was obtained from all participants. Results: The study included 150 refugee women, primarily young adults with low educational attainment. Familiarity with primary prevention was reported as moderate or lower by the majority of participants, with only 24% indicating high or excellent familiarity, while familiarity with health promotion was even lower (8%). Participation in preventive practices varied, with 42.7% reporting frequent health check-ups; however, uptake of key preventive behaviors remained limited, including vaccination (30%) and adoption of a healthy diet (32.7%). During their stay in Greece, 97.3% participated in regular health check-ups, 32.7% adopted a healthy diet and 30% were vaccinated. Cardiovascular and gynecological conditions were the most frequently reported health problems (76.7% and 73.3%, respectively). The most prominent barrier to healthcare access was long distance from health facilities (97.3%), followed by lack of information or health education (24.7%). Conclusions: The study identified low levels of preventive health knowledge and limited uptake of key preventive practices among refugee women, alongside persistent barriers to healthcare access, underscoring the need for targeted and culturally sensitive health promotion interventions.

Background: Human papillomavirus (HPV) has been identified as the causative agent of cervical cancer and other cancers of the genital area, head and neck, on a worldwide scale. Despite the proven effectiveness of the vaccine in preventing HPV-related diseases, vaccination uptake remains low in many countries. It is crucial to understand how adolescents and young adults perceive HPV and its vaccine in order to design effective public health strategies and targeted awareness campaigns. Aim: This systematic review examined the attitudes, perceptions, and opinions of young people regarding HPV and HPV vaccination, with the goal of identifying factors that shape vaccine acceptance. Methods: A systematic literature search of PubMed and Scopus identified 293 articles published between January 2014 and February 2025. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Eligible studies included primary qualitative and analytical cross-sectional research published in English that explored views on HPV and vaccination among individuals aged 15–24 years. Due to substantial heterogeneity in study design and outcome measures, findings were synthesized narratively and no meta-analysis was performed. The methodological quality and risk of bias of the included studies were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists (2017) for qualitative and analytical cross-sectional designs. Results: Ten studies met the eligibility criteria, representing 15,776 young people across six countries. The included studies comprised eight cross-sectional surveys and two qualitative studies. Across these studies, knowledge and awareness of HPV and its vaccine were generally moderate, while vaccination coverage remained low. The highest awareness levels were reported in the United States (95.3% for HPV; 90.6% for the vaccine), whereas lower levels were noted in Brazil, Greece, and Italy. Influential factors associated with vaccine acceptance included parental attitudes, healthcare-provider recommendations, cultural norms, and the presence of misinformation. Conclusions: The level of awareness regarding HPV among adolescents and young adults in the included countries is moderate, yet the vaccination coverage remains low across the included countries. The provision of targeted educational interventions, in conjunction with the consistent guidance and training provided by healthcare professionals, is of considerable importance in order to increase vaccination rates. Findings should be interpreted in light of heterogeneity across studies and reliance on self-reported outcomes. Future research should adopt a mixed-methods approach to more effectively address the social, cultural and informational influences shaping young people’s perceptions, and to develop more effective communication strategies that promote HPV vaccination.

Introduction: Urinary incontinence (UI) is one of the most common pelvic floor disorders after childbirth and depends on hormonal changes, anatomical damage that occurs after childbirth, muscle and connective tissue weakness, fascia and nerves. UI is distinguished into three subtypes, including stress urinary incontinence (SUI), urgent urinary incontinence (UUI) and mixed urinary incontinence (MUI). Aim: The purpose of this review is to collect and summarize the results of studies related to the risk factors of urinary incontinence, to disseminate this information to scientists so that this major issue can be prevented, identified and managed. Methodology: This review followed the methodology of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PECO eligibility criteria were used. We included studies published up to 2025 and not before 2019. The review was limited to studies published within the last six years in order to reflect contemporary diagnostic criteria, assessment tools and current postpartum care practices related to urinary incontinence. We searched PubMed, Google Scholar and Scopus for studies concerning the relationship between risk factors and postpartum UI. Results: A total of 1321 citations were identified. Following our exclusion criteria, 36 papers were selected to identify the risk factors for UI. All the research focused on the associated factors of any type of urinary incontinence. Vaginal and instrumental delivery, obesity, maternal age and the neonate’s birth weight were the main risk factors. The multiparity and incontinence symptoms before and during pregnancy were also strong risk factors. Heterogeneity across studies in assessment tools, in outcome measures and timing of postpartum assessment are some of the limitations of the study. Restriction to English-language publications and the absence of protocol registration were some of the additional limitations of the study. Conclusions: This problem affects the inclusion of women in society, the family, limits social activities and even their ability to work. Detection of the type of urinary incontinence by healthcare professionals, lifestyle modifications, monitoring women’s body weight and encouraging them to follow a program of pelvic floor muscle exercises should be a priority for professionals. The strategy of developing prognostic models in the coming years will be the only way to ensure the early identification and follow-up of women at high risk for urinary disorders.

Background: Perioperative care is an integral part of the procedure of a surgical operation, with strictly defined rules. The need to upgrade and improve some individual long-term processes aims at optimal patient care and the provision of high-level health services. Therefore, preoperative care is drawn up with new data resulting from the evolution of technology to upgrade the procedures that need improvement. According to the international literature, a factor considered to be of major importance is high preoperative anxiety and its effects on the patient’s postoperative course. High preoperative anxiety is postoperatively responsible for prolonged hospital stays, increased postoperative pain, decreased effect of anesthetic agents, increased amounts of analgesics, delayed healing of surgical wounds, and increased risk of infections. The use of Virtual Reality technology appears as a new method of managing preoperative anxiety. Objective: This study investigates the effect and effectiveness of Virtual Reality (VR) technology in managing preoperative anxiety in adult patients. Methods: A literature review was performed on 193 articles, published between 2017 and 2024, sourced from the scientific databases PubMed and Cochrane, as well as the trial registry ClinicalTrials, with a screening and exclusion process to meet the criterion of investigating VR technology’s effectiveness in managing preoperative anxiety in adult patients. This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Results: Out of the 193 articles, 29 were selected. All articles examined the efficacy of VR in adult patients (≥18) undergoing various types of surgery. The studies represent a total of 2.354 participants from 15 countries. There are two types of VR applications: distraction therapy and patient education. From the studies, 14 (48%) used the distraction VR intervention, 14 (48%) used the training VR intervention, and 1 (4%) used both VR interventions, using a range of validated anxiety scales such as the STAI, VAS-A, APAIS, and HADS. Among the 29 studies reviewed, 25 (86%) demonstrated statistically significant reductions in preoperative anxiety levels following the implementation of VR interventions. VR technology appears to manage preoperative anxiety effectively. It is a non-invasive and non-pharmacological intervention with minimal side effects. Conclusions: Based on the review, the management of preoperative anxiety with VR technology shows good levels of effectiveness. Further investigation of the efficacy by more studies and randomized controlled trials, with a larger patient population, is recommended to establish and universally apply VR technology in the preoperative care process as an effective method of managing preoperative anxiety.

Background: Breast cancer significantly impacts the social relationships and self-efficacy of affected patients. Purpose: To investigate the role of self-efficacy and the ability to maintain social relationships in breast cancer patients during the postoperative period. Method: This study is a brief intervention study in the same population group (within-subjects intervention study), in two measurements (pre-test and post-test), conducted in 58 breast cancer patients hospitalized in oncology hospitals in Athens (February 2021–November 2021). The following validated scales were used: the Social Relationship Coping Efficacy Scale (SRCE), the Family Support Scale (FS-12), and the Family Problem Solving Communication Scale (FPSC). Results: The mean age of the participants was 52 years. No statistically significant differences were observed in the scales after the intervention. The degree of change in the scales had minimal differences across all types of treatment. However, there was a statistically significant correlation between the change in the SRCE and the FPSC (p = 0.043), which suggests that the improvement in the ability to maintain social relationships is related to the strengthening of family communication. Conclusions: The intervention had a positive effect on maintaining social relationships and improving communication for problemsolving ability, although the overall changes in the scales were not statistically significant.

This longitudinal study investigated changes in family resilience, support, and functionality among breast cancer patients during the pre-operative and post-operative phases. The study was grounded in McCubbin’s model, emphasizing the psychosocial impact of illness and the cultural dynamics of the Greek family system. A longitudinal cohort study was conducted on women diagnosed with breast cancer, aged over 18, undergoing mastectomy, fluent in Greek, and capable of completing questionnaires at two time points, pre- and post-operatively. Standardized instruments were used: the Family Assessment Device (FAD), the Family Crisis Oriented Personal Evaluation Scales (F-COPES), the Family Problem Solving Communication Scale (FPSC), and the Family Support Scale (FS-13). Data were analyzed using paired t-tests, ANOVA, and partial correlations. The sample consisted of 58 women with breast cancer. The mean age of participants was 52 years. According to post-operative measurements, the scales that had a significant change were FS-13 (change −12 and SD = 6.9, paired t-test, p < 0.001), and the subscale “Problem Solving” of FAD (change 0.13 and SD = 0.44, paired t-test, p = 0.048). The remaining scales did not change significantly post-operatively. Depending on the type of treatment, the scales that had a significant difference post-operatively regarded the participants, who had undergone chemotherapy in the dimension “Acquiring Social Support” (ANOVA = 0.173, p = 0.030), the participants, who had undergone radiotherapy in the dimension “Seeking spiritual support” (ANOVA = 0.122, p = 0.035), and in the FS-13 scale across all treatment types (ANOVA = 0.458, p < 0.001). The post-operative phase of breast cancer was a psychosocially vulnerable time, accompanied by an increase in family dysfunction and a significant decrease in family support across all types of treatments, while patients receiving chemotherapy or radiotherapy experienced a corresponding decrease in social and spiritual support. Finally, enhanced family support was associated with improved family resilience, highlighting the need for targeted psychosocial interventions during this period.