Vasiliki Efthymiou

Background: Exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), whether via infection or vaccination, seems to influence the character of the menstrual cycle by disrupting hormonal and immune function. Methods: The main aim of this cohort study was to explore the association between exposure to SARS-CoV-2—through either vaccination or infection—and menstrual disorders in adolescent females. We also aimed at identifying the most prevalent menstrual disorders observed and assessing potential differences between the exposure groups that may contribute to these conditions. Results: This study included data from adolescent females who visited the Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care due to various menstrual disorders. Data from 92 adolescents, 77 participants exposed to SARS-CoV-2 and 15 controls, were retrieved. Significant associations were found between exposure to SARS-CoV-2 and abnormally frequent uterine bleeding (p = 0.032) and abnormal uterine bleeding (p = 0.025). Adolescents with a past confirmed case of coronavirus disease 2019 (COVID-19) demonstrated significantly lower serum concentrations of fibrinogen (p = 0.023) and iron (p = 0.03), as well as higher γ-GT concentrations (p = 0.028), than those who were non-infected, whereas vaccinated adolescents presented with significantly lower concentrations of coagulation factors VIII (p = 0.002), vWFAg (p = 0.023), and Rcof (p = 0.007) than those of their unvaccinated peers. Overall, adolescents exposed [infection (or/and) vaccination] to SARS-CoV-2 demonstrated increased estradiol (E2) concentrations compared to those of the controls. In conclusion, adolescent exposure to SARS-CoV-2 was strongly linked to abnormal uterine bleeding and polymenorrhea, potentially due to decreased coagulation factors or increased E2 concentrations. Conclusions: Further research involving larger samples and a more sophisticated design is needed to validate these findings.

Background/Objectives: The aim of this study was to translate, culturally adapt, and validate the updated (March 2025) version of the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) in Greek by examining its reliability, validity, and screening efficacy in a Greek sample. Methods: The M-CHAT-R/F was administered to Greek parents/primary caregivers of children aged 16–48 months, with no prior diagnosis of autism spectrum disorder (ASD), severe sensory impairments, or other chronic conditions causing neurodevelopmental delay. Parents/primary caregivers were invited to participate in the nationwide Program “Child and Family Health Promotion through the Paediatric Framework” of the Greek Ministry of Health in collaboration with UNICEF, implemented by the National and Kapodistrian University of Athens. Results: The final sample comprised 280 parents of children 16 to 48 months old (mean age ± SD 24.64 ± 7.75 months) with an almost equal sex distribution. Mean (±SD) parental age was 35.31 (±3.14) years, ranging from 30 to 48 years, and most respondents were mothers (94.3%). The Greek M-CHAT-R/F demonstrated acceptable reliability (KR-20 = 0.789) and acceptable scalability (monotonicity). Conclusions: The present study provides compelling evidence that the Greek M-CHAT-R/F is a reliable, valid, culturally appropriate instrument for screening children for the presence of ASD. The psychometric properties of the Greek version are consistent with previous international reports and warrant its use in routine pediatric practice in Greece.

Background/Objectives: To study the hypothesis that cognitive functions and learning skills are impaired in child/adolescent childhood cancer survivors (CCS). Secondary outcomes included psychosocial parameters and quality of life. Methods: This case–control study was conducted over four years (2017–2021) at the largest pediatric Aghia Sophia Children’s Hospital, in Greece. Eligible participants were children and adolescents in Greece. For CCS, ≥1 year should have elapsed from completion of cancer treatment. Assessments of neurocognitive function, learning and psychosocial skills and health-related quality of life (HRQoL) were performed with validated instruments (WISC-III, LAMDA software, Achenbach CBCL/6-18 and YSR, KIDSCREEN-52, respectively). Results: In total, 219 participants (47.49% males, mean age ± SD 11.72 ± 2.32 years), 70 CCS and 149 controls (matched for age, sex, family income), were included. Cases were CCS of acute lymphoblastic leukemia (n = 25)/brain tumors (n = 19)/lymphoma (n = 17)/nephroblastoma (n = 5)/Ewing sarcoma (n = 3)/rhabdomyosarcoma (n = 1). CCS had worse scores in full-scale Intelligence Quotient (FSIQ) (p = 0.004), verbal IQ (VIQ) (p = 0.005) and all its subscales, performance IQ (PIQ) (p = 0.021), and almost all learning parameters than controls. Attention, working memory, writing/visual–motor coordination, processing accuracy/speed, language acquisition/expression, all psychosocial scales, and HRQoL domains of mood and emotions, were negatively affected in CCS. Female CCS demonstrated lower FSIQ (p = 0.019) and VIQ (p = 0.014) than control females, whereas male CCS retained their total IQ unaffected. Among CCS, those with non-central nervous system (CNS) tumors, higher parental educational level or higher family income had significantly higher IQ than those with CNS tumors, lower parental educational level or lower family income, respectively. Conclusions: CCS in Greece carry a significant burden of cognitive and psychological morbidity. Cognitive/educational and psychosocial support to CCS is imperative.

Purpose: Child sexual abuse (CSA) is a major public health and forensic concern, often involving delayed disclosure that limits evidence collection and affects judicial outcomes. This study analyzed disclosure patterns, victim–perpetrator characteristics, and forensic findings in CSA cases evaluated in Greece, contributing to the limited Southern European evidence base. Material and Methods: A retrospective review of 89 CSA cases (2014–2024) examined by a certified forensic physician at the Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, was conducted. Data from official medico-legal reports included demographics, abuse context, forensic findings, and disclosure interval. Statistical analyses explored factors associated with delayed disclosure (>7 days). Results: Victims were predominantly female (69.7%) with a mean age of 9.8 years. Most perpetrators were adult males, and over half of cases (53.9%) involved intrafamilial abuse. The mean delay in disclosure was 79 days; only 29.2% reported within one week. Recurrent abuse correlated with delayed disclosure (p = 0.006), while early disclosure was associated with biological evidence collection (p < 0.001). Physical injuries were observed in 23.6% of victims, genital findings in 17%, and anal findings in 3.4%. Conclusions: Delayed disclosure was common and significantly reduced the likelihood of identifying forensic evidence. The early application of trauma-informed examinations, which adopt a child-centered approach emphasizing safety, emotional regulation, and the prevention of re-traumatization, is essential for the medical and forensic evaluation of abused children. Adopting hospital-based multidisciplinary units could improve forensic documentation, interagency coordination, and psychosocial care in Greece.

Background: Learning disabilities have a significant impact on children’s and adolescents’ academic progress; thus, early detection is of great importance. Parents play a key role, as they can provide valuable and unique information regarding their offspring’s learning challenges. The Colorado Learning Difficulties Questionnaire (CLDQ) is a quick and easy-to-use parent-report rating questionnaire evaluating specific areas of functioning that are most affected in children and adolescents with learning difficulties, such as reading, mathematics, social cognition, spatial abilities, and memory. This study aimed to examine the validity and reliability of the Greek version of the CLDQ. Methods: A cross-sectional design was employed in a sample of Greek parents and caregivers to test the Greek version of the CLDQ. The 20-item questionnaire was translated into Greek using the appropriate forward-backward translation. Results: The final sample consisted of 303 parents/caregivers of children and adolescents aged 11–17 years with learning difficulties. Analysis was consistent with the original scale and revealed five major factors labeled Reading, Mathematics, Social Cognition, Social Anxiety, and Spatial Problems. Contrary to the original version, two items loaded on two separate factors. Conclusions: The Greek version of the CLDQ demonstrated acceptable reliability and good validity. Consistent with the original version, exploratory factor analysis identified five distinct factors. These findings support the Greek version of the CLDQ as a valid and reliable tool for assessing and screening students with learning difficulties in Greece.

Background: Telomere attrition has been implicated in immune function and vulnerability to infectious diseases. However, the relation between telomere length and COVID-19 severity remains unclear. Methods: In this cross-sectional study, patients aged 30–75 years, with confirmed SARS-CoV-2 infection, as well as age- and BMI-matched controls without COVID-19, were recruited over a period of 1 year (2021–2022) from the outpatient clinics and wards of the General Hospitals “Laiko” and “Elpis” in Athens, Greece. Telomere length, expressed as a telomere to single-copy gene (T/S) ratio, was measured in all participants using a quantitative PCR-based method. Participants’ clinical, biochemical, demographic, and respiratory parameters were assessed in relation to their telomere length. Results: Study participants included a total of 139 individuals divided into three groups: controls (n = 34), patients with non-severe COVID-19 (n = 50), and patients with severe COVID-19 (n = 55). Patients with severe COVID-19 had significantly shorter telomeres when compared to both the non-severe COVID-19 group and controls (p < 0.001). Logistic regression analysis confirmed that telomere length was independently associated with disease severity (p < 0.001). Females demonstrated longer telomeres than males (p = 0.039), but no significant correlation was found between telomere length and age. When patients with non-severe and severe COVID-19 were analyzed together, no significant difference in telomere length was observed compared to controls (p = 0.727). Conclusions: Shortened telomeres may be linked to more severe forms of COVID-19, suggesting a potential role for telomere biology in disease progression. Results highlight the need for further research into telomere dynamics as a biomarker for disease susceptibility and outcome in viral infections.

Background/Objectives: Childhood cancer survivors (CCS) experience chronic health problems and significant metabolic burden. Timely identification of CCS at higher metabolic risk requires novel biomarkers. Irisin, a novel myokine/adipokine has been associated with metabolic, bone and reproductive diseases, but its role in the health of CCS is unknown. The aim of this study was to examine irisin concentrations in children and adolescent CCS (vs. controls) and their association with metabolic, bone and hormonal parameters. Methods: Children and adolescent CCS, aged 8–18 years, as well as healthy controls, underwent a detailed physical, body composition, biochemical, hormonal and serum irisin assessment at least 6 months post-treatment. Results: A total of 59 children and adolescents (36 CCS, 23 controls; mean age ± SD 12.8 ± 2.9 years; 10 prepubertal, 49 pubertal) participated in the study. Serum irisin concentrations (ng/mL) were significantly lower in CCS than controls [median (IQR) 6.54 (4.12) vs. 11.70 (8.75) ng/mL, respectively, p < 0.001]. In the total study sample, serum irisin was correlated negatively with LH (r_s = −0.314, p < 0.05), CRP (r_s = −0.366, p < 0.005), age (r_s = −0.323, p < 0.05) and positively with ALP (r_s = 0.328, p < 0.05). Serum irisin was also positively correlated with ApoB and Lpa (r_s = 0.410 and 0.421, respectively, p < 0.05) in CCS, and with PTH (r = 0.542, p < 0.005) in controls. Multivariate linear regression analysis indicated parathyroid hormone (PTH) as the only independent variable affecting irisin concentrations. Conclusions: Study results reinforce the irisin–PTH interplay hypothesis. Future studies are needed to clarify the potential role of irisin as a bone biomarker of CCS in childhood and adolescence.

Background/Objectives: Resilience—a complex phenomenon embracing a number of factors on various levels—seems to be a most important skill to survive this vulnerable phase. One major factor is the perceived social support during adolescence. Recognizing gaps in perceived social support may lead to prevention of serious social and medical problems, including juvenile delinquency and stress-related diseases. Screening questionnaires to identify the gaps in perceived social support in Greek adolescents are lacking. The purpose of this study was to validate a Greek version of the Multidimensional Scale of Perceived Social Support (MSPSS), a self-report scale of perceived social support of the family, significant others, and friends. Methods: The MSPSS was translated into Greek and was administered to students of 15 to 18 years of age from several areas of Greece. Psychometric properties of the MSPSS tool were investigated by Exploratory Factor Analysis (EFA), using principal component analysis with the Varimax Rotation Method. For Confirmatory Factor Analysis (CFA), the Comparative Fit Index (CFI), Tucker–Lewis index (TLI), and the Root Mean Square Error of Approximation (RMSEA) were used. Results: A total of 999 students completed the MSPSS anonymously. The Greek version of the MSPSS scale exhibited large internal consistency (Cronbach’s α of 0.932, McDonald’s Omega of 0.926). Three of the factors explained 80.80% of total variance. Conclusions: The Greek adaptation of the MSPSS is a valid instrument, and professionals can apply it as a screening tool for perceived social support in adolescents.

Aims: Human recombinant insulin is currently the only therapy for children and adolescents with type 1 diabetes (T1D), although not always efficient for the glycemic control of these individuals. The interrelation between the gut microbiome and the glycemic control of apparently healthy populations, as well as various populations with diabetes, is undeniable. Probiotics are biotherapeutics that deliver active components to various targets, primarily the gastrointestinal tract. This systematic review and meta-analysis examined the effect of the administration of probiotics on the glycemic control of pediatric and adolescent individuals with T1D. Materials and Methods: Randomized controlled trials employing the administration of probiotics in children and adolescents with T1D (with ≥10 individuals per treatment arm), written in English, providing parameters of glycemic control, such as mean glucose concentrations and glycosylated hemoglobin (HbA1c), were deemed eligible. Results: The search strategy resulted in six papers with contradictory findings. Ultimately, five studies of acceptable quality, comprising 388 children and adolescents with T1D, were included in the meta-analysis. Employing a random and fixed effects model revealed statistically significant negative effect sizes of probiotics on the glycemic control of those individuals, i.e., higher concentrations of glucose and HbA1c than controls. Conclusions: Children and adolescents with T1D who received probiotics demonstrated worse glycemic control than controls after the intervention. Adequately powered studies, with extended follow-up periods, along with monitoring of compliance and employing the proper strains, are required to unravel the mechanisms of action and the relative effects of probiotics, particularly concerning diabetes-related complications and metabolic outcomes.

The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well as at a personal level, for the appropriate management of an older person’s health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes, this is very solid, but in other cases, there is a considerable gap in terms of accurate and well-grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as, for instance, Program of Research on Integration of Services for the Maintenance of Autonomy 7 (PRISMA 7), the gold standard tool of Fried criteria, is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale (CFS) has been validated for translation but not for the capacity to detect frailty. The aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). Seventy-four male and female participants (mean age 80.47 years SD = ±7.45 years, minimum–maximum age = 65–95) have been evaluated for their frailty status using different tools. We observed that the PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥2 and indicates a sensitivity of 88.1% and specificity of 99.9% with a good correlation with SPPB measurements (r = −0.858; p < 0.001). When CFS was validated using SPPB, it demonstrated a very good correlation (r = −0.838; p < 0.001 respectively) as was the case for the modified Fried Criteria (r = −0.725; p < 0.001). All items demonstrated a good correlation between them. We here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek, and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing item 6 of the questionnaire.