Theodoros Nikolaos Sergentanis

Background: Problematic digital-media use and gaming disorder have emerged as important public health concerns, particularly among adolescents. Along with psychosocial factors, genetic susceptibility and neuroendocrine pathways may contribute to individual vulnerability to problematic digital-media use and gaming-related problems. Objectives: This review aims to summarize current evidence on the genetic polymorphisms and endocrine pathways associated with problematic digital-media use and gaming disorder, with emphasis on dopaminergic reward mechanisms and hypothalamic–pituitary–adrenal (HPA) axis regulation. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar for studies published up to 30 June 2026. Relevant human studies addressing genetic, epigenetic, endocrine, or related neurobiological mechanisms of problematic digital-media use and gaming-related behaviors were identified and narratively synthesized according to the principal biological pathways examined. Results: The available evidence suggests that genetic variants affecting dopaminergic neurotransmission (DRD2, COMT, DAT1, and DRD4), stress regulation (CRHR1, FKBP5), serotonergic signaling (SLC6A4), sleep-circadian regulation and other pathways (CHRNA4, NTRK3) may increase susceptibility to problematic Internet and gaming use. Excessive digital media exposure has been associated with alterations in dopaminergic signaling, stress and sleep–circadian regulation, including changes in hypothalamic–pituitary–adrenal axis activity, cortisol secretion and melatonin secretion. These alterations may be related to differences in reward processing, sleep, and emotional regulation, as well as to compulsive digital behaviors. Bidirectional associations have also been reported between problematic digital-media use and depression, anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD). Conclusions: Genetic and endocrine factors may contribute to a broader biopsychosocial vulnerability to problematic digital-media use and gaming-related problems. However, current evidence is insufficient to establish individual genetic variants or endocrine measures as clinically actionable biomarkers. Future research should prioritize large, adequately powered longitudinal studies with harmonized phenotypes, objective behavioral measures, genome-wide approaches, and independent replication to clarify the clinical relevance of biological markers and their potential role in risk prediction and personalized intervention.

Background: The Academic Resilience Scale-30 (ARS-30) was originally developed to assess cognitive, emotional, and behavioral responses following negative academic evaluation. Because structured performance appraisal has recently become an established component of the Greek public healthcare system, the present study examined whether this evaluative response framework could be meaningfully adapted to occupational performance evaluation. Methods: Test–retest reliability and descriptive analyses were conducted in an initial sample of 140 public healthcare employees, while EFA, internal-consistency analyses, and CFA were conducted in a separate larger sample of 483 employees. Results: Test–retest reliability was very high to excellent across items (ICC = 0.904–1.000). Internal consistency was acceptable for the total score (α = 0.799), good for Performance-Oriented Coping (α = 0.889), and acceptable for Negative Emotional Reactions/Passive Coping (α = 0.767). Positive Reappraisal/Growth Orientation (α = 0.705) and Acute Negative Emotional Reaction (α = 0.707) demonstrated marginally acceptable internal consistency and should therefore be interpreted cautiously. Item 23 was reverse-coded based on its semantic and conceptual direction. Exploratory factor analysis identified a preliminary four-component solution explaining 42.17% of the variance. However, the rotated solution included cross-loadings, and confirmatory factor analysis did not provide adequate support for the prespecified four-factor structure (CFI = 0.661, TLI = 0.629, RMSEA = 0.105, and SRMR = 0.105). Conclusions: Although some reliability findings were encouraging, the hypothesized four-factor structure was not supported by CFA and cannot currently be considered structurally validated. Further psychometric evaluation and model development are therefore required.

Objective: This systematic review will aim to evaluate the effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) on implantation rate, clinical pregnancy rate, live birth rate, and clinical miscarriage rate compared to standard in vitro fertilization/intracytoplasmic sperm insemination (IVF/ICSI) in women with recurrent implantation failure. Introduction: Recurrent implantation failure is a complex condition in assisted reproductive technology, attributed to multifactorial causes, with chromosomal aneuploidy being a leading contributor. PGT-A has been proposed as a strategy for selecting euploid embryos, but its effectiveness on reproductive outcomes remains unclear due to conflicting evidence. Eligibility criteria: This review will include clinical trials and observational studies comparing PGT-A to standard IVF/ICSI in women with recurrent implantation failure. The review will assess the implantation rate, clinical pregnancy rate, live birth rate, and clinical miscarriage rate as outcomes. Methods: This review will follow the JBI methodology for systematic reviews of effectiveness. A systematic search will be conducted in PubMed, Scopus, and Embase (Embase.com). Two reviewers will independently screen titles, abstracts, and full texts. Data will be extracted using Excel software, and methodological quality will be assessed. Meta-analysis will be performed using a random effects model, with heterogeneity assessed by I2 , and publication bias will be evaluated. Evidence certainty will be rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. English-language studies will be included from the earliest searchable date of each database until January 19, 2026. Systematic review registration number: PROSPERO CRD420251029623.

This systematic review evaluates the efficacy of interventions designed to enhance self-compassion in parents of children with neurodevelopmental disorders (NDDs), a population documented to experience elevated levels of parenting stress. Adhering to PRISMA guidelines, a search of PubMed, Scopus, and PsycINFO (covering the period 2015 to 2025) identified studies evaluating self-compassion educational programs, training, or workshops for parents of children with NDDs. Eligible studies included Randomized Controlled Trials (RCTs) and pre-post designs using a quantitative measure of self-compassion as the outcome. Eight studies were included, featuring varied interventions like Acceptance and Commitment Therapy (ACT), psychoeducation, and Mindfulness-Based approaches. The results suggest that these interventions are generally associated with significant short-term improvements in parental self-compassion and secondary outcomes including reduced stress and depression. However, the current evidence base is limited by methodological heterogeneity. Future research must prioritize rigorous RCTs and longitudinal follow-up to establish sustainable, evidence-based practices for this population.

Background: Preterm birth is a significant early-life stressor associated with increased psychiatric vulnerability and long-term functional impairments in school-aged children. Objective: To compare behavioral–emotional outcomes and functional competence between school-aged preterm and term-born children, examining perinatal, cognitive, and socioeconomic predictors. Methods: 140 children aged 6–10 (70 preterm, 70 age-matched controls) were assessed using the Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ). Functional competence—defined as participation in daily activities, social interactions, and school performance—was examined alongside behavioral–emotional outcomes. Predictors included gestational age, birth weight, SES, and cognitive ability. Results: Preterm birth was associated with higher SDQ scores in emotional problems, hyperactivity, and peer problems. CBCL results showed lower total functional competence scores, specifically in activities, social participation, and school performance. Longer NICU stay predicted higher internalizing problems and lower social participation. Cognitive ability was linked to lower SDQ externalizing and internalizing scores. SES was not a significant predictor. Conclusions: Preterm birth and prolonged NICU hospitalization are linked to persistent behavioral–emotional and functional vulnerabilities. These findings underscore the need for early, integrated developmental monitoring within a preventive psychiatry framework to identify psychiatric vulnerability and support functional participation.

Background/Objectives: Adolescents and university students appear to be at increased risk for internet addiction (IA), while disordered eating behavior (DEB) is common in these age groups. At the same time, adherence to the Mediterranean diet (MD) has declined in many countries. This study aimed to explore the potential association between IA, DEB and MD compliance among high school and university students. Methods: A total of 212 students aged 15–24 years participated in this cross-sectional study conducted in Greece. Data were collected via an online questionnaire including the Internet Addiction Test (IAT), KIDMED, and EAT-26 scales. Descriptive statistics, chi-square tests, and univariate and multivariate logistic regression analyses were performed. Results: Most participants demonstrated normal internet use (69.8%), while 23.1% showed mild IA and 7.1% moderate IA. Regarding dietary habits, 9.4% had low MD adherence, 52.8% moderate and 37.7% high adherence. A total of 15.6% scored above the EAT-26 cut-off, indicating risk for disordered eating behavior. IA was only significantly associated with urbanization (p = 0.014). MD adherence was not associated with gender, urbanization, financial or education status. Multivariate logistic regression showed that female gender (OR = 9.28, 95% CI: 2.10–40.91, p = 0.003) and moderate IA (OR = 6.70, 95% CI: 1.71–26.35, p = 0.006) were significant predictors of disordered eating, while educational status and MD adherence were not significant predictors. Conclusions: Moderate IA and female gender were strongly associated with an increased risk for disordered eating. Further qualitative and clinical studies are needed to better understand the interaction between IA, eating behaviors, and dietary patterns in young people.

Introduction: Patients undergoing surgery are exposed to various stressors that may increase psychological distress during the perioperative period. These repercussions may be substantial, affecting both physical and mental health, as well as the ability to resume regular activities and overall quality of life. Aim: This study aimed to compare the preoperative psychological distress levels of patients admitted to long-term preoperative hospitalization (LONG) to those of patients admitted to day care (DC) facilities for ambulatory surgery within an oncology hospital and to examine potential sociodemographic predictors. Methods: This was a prospective observational study that included 176 individuals who underwent surgery in two cohorts. Patients in the DC cohort (n = 88) were treated in a day care surgery clinic, whereas patients in the LONG cohort (n = 88) were treated in a long-term oncology hospital. Demographic and clinical data were collected. Patients’ psychological distress (depression, anxiety, and stress) was preoperatively evaluated using the DASS-42. Univariate and multivariate logistic regression analyses were performed. Results: The DASS-42 scale’s Cronbach’s alpha was 0.923. There was no significant difference between the cohorts in terms of age; however, waiting time before surgery differed significantly (U = 2884, p = 0.002). Stress levels differed significantly between the two cohorts (p = 0.05). Conclusions: Health managers and health care providers should consider gender, surgical severity, and rural/urban residence as factors associated with preoperative psychological distress. Studies assessing gender-specific dynamics, as well as mixed-methods approaches, could provide deeper insights into patients’ experiences and the correlations of distress and highlight implications for oncology nursing practice across different hospitalization models.

Background/Objectives: Machiavellianism has long been associated with unethical tendencies and behaviors. High-Mach people have been stereotyped to choose business-related professions, contrary to low-Mach individuals choosing the helping professions. There has been a clear shift in scholarly focus, such as Machiavellian leadership and Machiavellian personality traits in healthcare. The objective of this narrative literature review was to provide a structured synthesis of empirical evidence on Machiavellianism within healthcare settings, focusing on its prevalence, manifestations, and organizational implications, while identifying conceptual and research gaps in the field. Methods: Literature research was conducted for articles published in PubMed, Scopus, and Google Scholar from 2014 until 2025. Articles written in English, examining Machiavellian traits in healthcare workers and students, were included in this review. Results: The search strategy produced 347 items, of which 11 original studies were included. Machiavellianism was described as a personality trait featuring emotional coldness and manipulativeness for the achievement of one’s own ends; individuals exhibiting those traits may prioritize personal gain over collective welfare. Machiavellian tendencies manifesting in organizational culture often lead to a toxic work environment where manipulation might become normalized. Machiavellians show high commitment to their careers, but low commitment to their current organizations, supervisors, and teams. Conclusions: Machiavellianism emerges as a relevant but underexplored personality trait in healthcare, associated with unethical behaviors, reduced organizational commitment, and toxic work environments. Addressing its impact requires ethical leadership development, supportive organizational environments, and early identification during professional training to safeguard workforce well-being and patient safety.

Background: Drowning deaths constitute a rather significant public health issue according to the W.H.O. Demographic factors, substance intake, and psre-existing pathologic conditions seem to affect the incidence of drowning deaths, which occur during various activities and manifest via various manners of death. The objective of this paper is to describe the characteristics of drowning deaths in Athens, Greece, focusing on several demographic factors, as well as behavioral and pathological conditions. Results: We conducted a retrospective analysis of drowning death cases examined between 2021 and 2023. A total of 98 autopsies, all performed by the authors, were included. Statistical analysis was conducted using STATA/SE version 16 (Stata Corp., College Station, TX, USA). Statistical significance was defined as a two-sided P value less than 0.05. Descriptive statistics were presented for each variable, using numbers and percentages to summarize categorical data. To compare categorical variables, the Pearson chi-square test was used. In cases where the sample size was small and the conditions for the Pearson chi-square test were not met, Fisher's exact test was employed instead. Statistical analysis revealed that most victims were male and over 67 years of age. The older group (over 67 years old) victims were recovered during daytime ( p = 0.017) and mainly during the weekdays ( p = 0.009). Cardiovascular conditions were diagnosed both in the older group ( p = 0.029) and in the obese victim group (Fisher’s 0.005), while psychiatric conditions were more common in females ( p = 0.05). Toxicological analysis of the younger group (< 67 years old) was more commonly positive for substance use ( p = 0.029). Regarding the place of drowning, the seashore was the most common location (89.80%), with the obese group being especially recovered from this specific location (Fisher’s 0.048) during swimming (Fisher’s 0.032). Conclusion: Drowning was found to be primarily a random event with a male predominance. Most individuals died by drowning while swimming near the seashore, during the warmer months of the year. Females were more often diagnosed with psychiatric pathologies. Younger individuals drowned more commonly during nighttime and weekends when they are off work, in contrast to older individuals. Additionally, they used substances affecting the central nervous system more often.