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Background The etiologies of chronic neurological diseases, which heavily contribute to global disease burden, remain far from elucidated. Despite available umbrella reviews on single contributing factors or diseases, no study has systematically captured non-purely genetic risk and/or protective factors for chronic neurological diseases. Methods We performed a systematic analysis of umbrella reviews ( meta-umbrella ) published until September 20th, 2018, using broad search terms in MEDLINE, SCOPUS, Web of Science, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations & Theses, JBI Database of Systematic Reviews and Implementation Reports, DARE, and PROSPERO. The PRISMA guidelines were followed for this study. Reference lists of the identified umbrella reviews were also screened, and the methodological details were assessed using the AMSTAR tool. For each non-purely genetic factor association, random effects summary effect size, 95% confidence and prediction intervals, and significance and heterogeneity levels facilitated the assessment of the credibility of the epidemiological evidence identified. Results We identified 2797 potentially relevant reviews, and 14 umbrella reviews (203 unique meta-analyses) were eligible. The median number of primary studies per meta-analysis was 7 (interquartile range (IQR) 7) and that of participants was 8873 (IQR 36,394). The search yielded 115 distinctly named non-genetic risk and protective factors with a significant association, with various strengths of evidence. Mediterranean diet was associated with lower risk of dementia, Alzheimer disease (AD), cognitive impairment, stroke, and neurodegenerative diseases in general. In Parkinson disease (PD) and AD/dementia, coffee consumption, and physical activity were protective factors. Low serum uric acid levels were associated with increased risk of PD. Smoking was associated with elevated risk of multiple sclerosis and dementia but lower risk of PD, while hypertension was associated with lower risk of PD but higher risk of dementia. Chronic occupational exposure to lead was associated with higher risk of amyotrophic lateral sclerosis. Late-life depression was associated with higher risk of AD and any form of dementia. Conclusions We identified several non-genetic risk and protective factors for various neurological diseases relevant to preventive clinical neurology, health policy, and lifestyle counseling. Our findings could offer new perspectives in secondary research ( meta-research ).

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/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: 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.

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.

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/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 (rs = −0.314, p < 0.05), CRP (rs = −0.366, p < 0.005), age (rs = −0.323, p < 0.05) and positively with ALP (rs = 0.328, p < 0.05). Serum irisin was also positively correlated with ApoB and Lpa (rs = 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.

Introduction Bacille Calmette–Guérin (BCG) vaccination has shown promising therapeutic effects for type 1 diabetes (T1D). According to recent studies, immunometabolism modification and regulation of T lymphocytes constitute the proposed mechanisms by which BCG vaccination may delay T1D onset. Clinical trial evidence from Turkey supports that two to three doses of the BCG vaccine in childhood, with the first dose administered in the first year of life, may prevent T1D. In the same study, one or zero vaccinations appeared to have no effect in T1D onset prevention. In Greece, the BCG vaccine was administered in a single dose at the age of 9 years in elementary school. BCG vaccination was not performed on a mandatory basis, creating one BCG vaccinated and one non-vaccinated population. The aim of our study was to investigate the possible effect of a single dose of BCG vaccine, at the age of 9 years, on the time of T1D onset, in a population of BCG vaccinated and non-vaccinated patients with diagnosed T1D. Methods To test this hypothesis, a survey through the Pan-Hellenic Federation of People with Diabetes (PFPD) was performed. In this observational, retrospective study, participating patients provided information regarding age, gender, time of diagnosis, and BCG vaccination status. Patients diagnosed with T1D before the age of 9 years were excluded from the analysis. Results The final sample included 196 patients (73 male and 123 female) with a mean age of 42.2 ± 14.3 years and a mean duration of diabetes of 16.8 ± 12.9 years. Mean age of T1D diagnosis in the BCG vaccinated group was 24.0 ± 19.0 years, while the mean age of T1D diagnosis in the BCG non-vaccinated group was 21.5 ± 14.3 years ( p  = 0.03). No interaction was found between gender and the age of diagnosis for BCG vaccinated and unvaccinated patients ( p  = 0.86). Conclusion The results of our study suggest that a single dose of BCG vaccine, performed at the age of 9 years, may delay the onset of T1D by 2.5 years. Additional studies of children receiving multiple doses of BCG should be conducted to possibly prove prolongation of the disease-free interval.

Factors that may affect the performance of healthcare professionals performing resuscitation include stress, social profile, fatigue, empathy, and resilience. Interpersonal skills are required for better performance. This study aimed at evaluating the change in empathy and mental resilience in health professionals who have the status of instructor potential achieved after successfully completing a certified training/intervention course and want to develop/certify as course instructors. Healthcare professionals attended the Generic Instructor Course (GIC), a two-day course training instructor candidates from different training courses. Empathy and the cultivation of mental resilience of adult healthcare professional trainers were measured in order to investigate whether participation in a simulated training process can influence these characteristics of the trainer and how these characteristics interact with the training process. Four measurements were recorded: (i) baseline (before the GIC course), (ii) after the course, (iii) follow-up after one month, and (iv) follow-up after three months. Ninety participants in the GIC course were the study sample. Participants showed statistically higher empathy after participation in the GIC vs. baseline, one-month, and three-month follow-up (p = 0.023). Resilience did not reveal any statistical difference, after the participation in the GIC and follow-up measurements (p = 0.084). For both variables (empathy and resilience), demographics did not have any association with the variables. Besides its primary aim of training and certifying future instructors in resuscitation courses, the GIC also had a positive impact on the participants' empathy.