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Background The increasing use of the Internet and social network sites (SNS) has created a new domain of socio-emotional development for adolescents. The aim of this cross-sectional study was to explore cybervictimization across seven European countries, in relation to socio-demographic, Internet use and psychosocial variables. Methods A cross-sectional school-based study was conducted in the participating countries: Germany, Greece, Iceland the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control, the Internet Addiction Test and Achenbach’s Youth Self-Report. Results The highest rate of cyber victimization was found in Romania (37.3%) and the lowest in Spain (13.3%). Multiple logistic regression analyses gave differing results between countries. In Romania, Poland and Germany cyberbullying victimization was associated with SNS use, whereas Internet use was associated with increased odds of cybervictimization only in Romania. Cybervictimization was associated with greater internalizing behavior problems in all countries analysed, and with externalizing problems in all except Romania. Conclusions Cyberbullying victimization is an on-going problem, which is subject to country-specific socio-demographic factors and diverse patterns of current Internet use and its development. Preventive measures should emphasize the integration of Internet communication technology education in educational contexts, and focus on the consistent association between cybervictimization and internalizing and externalizing difficulties.

Background We aimed to investigate the immediate respiratory effects of cigar smoking(CS), among young smokers with and without mild asthma. Materials and methods Forty-seven young smokers (18–31years old, 29 males, average pack-years = 3.6 ± 2.8) were enrolled. Twenty-two were mild asthmatics(MA-subgroup) and the remaining 25 were otherwise healthy smokers(HS-subgroup). Exhaled carbon monoxide(eCO), multi-frequency respiratory system impedance(Z), resistance(R), reactance(X), frequency-dependence of resistance(fdr = R5Hz - R20Hz), resonant frequency(f res ), reactance area(AX) and exhaled nitric oxide(FENO) were measured at the aforementioned sequence, before and immediately after 30 min of CS, or equal session in the smoking area while using a sham cigar(control group). Chi-square, student’s t-tests, mixed linear models and Pearson correlation tests were used for the statistical analysis; level of significance was defined as p  < 0.05. Results Immediately after CS, Z5Hz, R5Hz, R10Hz, R20Hz and eCO increased significantly in both subgroups(MA and HS). A greater increase was found for R20 in HS-subgroup. Fdr, f res and AX increased in MA, while decreased in HS. On the contrary, X10 decreased in MA and increased in HS, while X20 showed a greater decrease in MA. Changes in fdr, f res and AX were significantly correlated in both subgroups. No significant FENO alterations were detected in both subgroups. Conclusion CS has immediate effects on pulmonary function. Mild asthma predisposes to higher increase of peripheral resistance(increased fdr). In otherwise healthy smokers, central resistance(R20Hz) is more affected. FENO levels are not significantly affected by CS.

Purpose Worldwide, concern has grown over the expansion of gambling among adolescents, who have an increased likelihood of developing risk-taking behaviors. This study aimed to increase knowledge of problem gambling among adolescents in seven European countries and to assess the effect of demographic and lifestyle factors recorded in the European Network for Addictive Behavior survey ( https://www.eunetadb.eu ). Methods A cross-sectional school-based study ( n  = 13,284) was conducted in Germany, Greece, Iceland, The Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included socio-demographic data, internet usage characteristics, school achievement, parental control, the Internet Addiction Test, the South Oaks Gambling Screen-Revised for Adolescents Test and Achenbach’s Youth Self-Report. Results 12.5% of the participants reported last year gambling activities either online or offline. 3.6% of the study participants and 28.1% of gamblers (either online or offline) were at risk or had a gambling problem. The study results showed that a higher proportion of adolescents was either at risk or had a gambling problem among males, in the older age group, when the parental educational level was lower/middle, and in the absence of siblings. Furthermore, being at risk or having a gambling problem was associated with lower age at first use of the internet, lower school grades, using the internet 6–7 days per week, and problematic internet use. At risk or problem gamblers had higher scores on all scales of problem behavior and lower scores (lower competence) on activities and academic performance. Conclusions Our findings underline the need for better gambling legislation and suggest the importance of developing social responsibility tools that may help diminish adolescent gambling involvement, with special attention to males.

Although the metabolic syndrome (MetS) is associated with adverse cardiovascular disease (CVD) risk in the general population, it is not clear whether its existence is independently associated with CVD in hypertensives. We investigated the presence of MetS in subjects with hypertension and its impact on the incidence of CVD. We prospectively investigated 1007 hypertensive individuals. The MetS was assessed using the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) criteria. The incidence of fatal and nonfatal cardiovascular events was ascertained during a median follow-up period of 2.1 years. The prevalence of MetS was 42.1% (39.0% in men and 44.7% in women). In addition to hypertension, four MetS components were present in 3.6% of the individuals, three in 13.7%, two in 24.8%, and only one in 33.7%. The incidence of cardiac, cerebrovascular, and total cardiovascular events/1000 person-years was higher among MetS subjects than among those without (31.0% v 21.3%, P = .050, 25.5% v 13.7%, P = .045, and 55.4% v 35.8% P = .009, respectively). After adjustment, MetS subjects had higher risk for cardiac, cerebrovascular, and total cardiovascular events (by 72%, 90%, and 75%, respectively). Hypertensive subjects with three or more components of MetS had threefold higher risk for cardiac events, 2.59 for cerebrovascular, and 2.26 for total cardiovascular events compared with those with no other component. The MetS is a significant predictor of cardiovascular morbidity and mortality. The clustering of three or more components of the syndrome in addition to hypertension recognizes a population of even higher cardiovascular risk independently of other traditional risk factors.

Oxidative stress is present in patients with Inflammatory Bowel Disease (IBD), and natural supplements with antioxidant properties have been investigated as a non-pharmacological approach. The objective of the present study was to assess the effects of a natural Pistacia lentiscus (PL) supplement on oxidative stress biomarkers and to characterise the plasma-free amino acid (AA) profiles of patients with active IBD (Crohn’s disease (CD) N = 40, ulcerative colitis (UC) N = 20). The activity was determined according to 5 ≤ Harvey Bradshaw Index ≤ 16 or 2 ≤ Partial Mayo Score ≤ 6. This is a randomised, double-blind, placebo-controlled clinical trial. IBD patients (N = 60) were randomly allocated to PL (2.8 g/day) or to placebo for 3 months being under no treatment (N = 21) or under stable medical treatment (mesalamine N = 24, azathioprine N = 14, and corticosteroids N = 23) that was either single medication (N = 22) or combined medication (N = 17). Plasma oxidised, low-density lipoprotein (oxLDL), total serum oxidisability, and serum uric acid were evaluated at baseline and follow-up. OxLDL/LDL and oxLDL/High-Density Lipoprotein (HDL) ratios were calculated. The plasma-free AA profile was determined by applying a gas chromatography/mass spectrometry analysis. oxLDL (p = 0.031), oxLDL/HDL (p = 0.020), and oxLDL/LDL (p = 0.005) decreased significantly in the intervention group. The mean change differed significantly in CD between groups for oxLDL/LDL (p = 0.01), and, in the total sample, both oxLDL/LDL (p = 0.015) and oxLDL/HDL (p = 0.044) differed significantly. Several changes were reported in AA levels. PL ameliorated a decrease in plasma-free AAs seen in patients with UC taking placebo. In conclusion, this intervention resulted in favourable changes in oxidative stress biomarkers in active IBD.

Various factors such as family relationships, socioeconomic indicators, socio-cultural aspects, mental health problems and demographic variables, have been associated with internalizing problems in adolescence. The purpose of this study was to examine the prevalence of internalizing problems in adolescents from five European countries in comparison with risk factors. Using data from the European Network for Adolescent Behavior (EU NET ADB) survey, a cross-sectional school-based study of adolescents (from 14 to 17.9 years) was conducted. Data were retrieved from self-report questionnaires derived from Greece, Spain, the Netherlands, Iceland and Romania. Multiple logistic regression analysis overall and by country was held through estimation of odds ratios (OR) and 95% confidence intervals (95% CI). A total of 8952 adolescents participated in the study. According to the results, Greece (7.6%) and Romania (2.4%) presented with the lowest rates of internalizing problems, while Iceland presented the highest (11.1%). Internalizing problems were associated with lower school grades (adjusted OR = 1.21, 95% CI: 1.08–1.36), while the higher education level of parents was associated with lower odds of internalizing problems (adjusted OR = 0.75, 95% CI: 0.62–0.92). In country-specific analyses, factors that affected the likelihood of internalizing problems were gender, age, maternal and paternal unemployment. Variations detected in adolescents’ internalizing problems were determined by the socio-cultural context of each country. Cultural differences should be addressed thoroughly in further research, in order to better understand and intervene in aspects of internalizing problems in adolescence.

Introduction Primary care providers' (PCPs) compliance to self-immunization is important for their protection and the protection of their colleagues and patients and has been associated with the coverage of the general public. In this study, we aim to investigate the vaccination coverage of PCPs. Methods A questionnaire-based cross-sectional survey was conducted among physicians, nurses and pharmacists employed in public or private primary care settings in Greece. Demographic and occupational characteristics as well as vaccination coverage data for influenza, tetanus, pneumococcal pneumonia and herpes zoster were collected. Statistical significance was set at 0.05. Results In total, 748 (61.7% response rate) PCPs participated. Vaccination rates were 66.4% (496/747) for influenza (2019/2020 flu season), 62.9% (469/746) for tetanus (10-year Td or Tdap booster dose), 70% (14/20) for pneumococcal pneumonia (≥ 1 dose of PPSV23 or PCV13) and 12.3% (10/81) for herpes zoster. Multiple logistic regression revealed that nurses had significantly lower probability of being vaccinated against influenza [odds ratio ( OR ) = 0.25; 95% confidence interval ( CI ) = 0.14–0.45] and pharmacists had significantly lower probability of being vaccinated against both influenza ( OR = 0.44; 95% CI = 0.31–0.62) and influenza & tetanus ( OR = 0.52; 95% CI = 0.37–0.73) compared to physicians. Older age (>40 years) was an independent risk factor for not receiving a tetanus vaccine (40–49 vs . 19–39; OR = 0.42; 95% CI = 0.28–0.63, over 50 years old vs . 19–39; OR = 0.54; 95% CI = 0.36–0.79). Conclusions The results revealed suboptimal vaccination rates among health providers who are in the frontline of adult immunization. Individualized and targeted measures to improve their vaccination coverage and indirectly the vaccination coverage of their patients, are therefore required.

BackgroundSeveral measures recommended by the WHO Framework Convention on Tobacco Control have not been implemented in the European Union, despite changes in the legislation such as the Tobacco Products Directive (TPD). This study aims to understand smokers’ and recent quitters’ levels of support for tobacco control measures that go beyond the TPD during and after its implementation.MethodsData from wave 1 (2016, n=6011) and wave 2 (2018, n=6027) of the EUREST-PLUS International Tobacco Control Policy Evaluation Project Six European Countries Survey, a cohort of adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain were used to estimate the level of support for seven different tobacco control measures, overall and by country.ResultsIn 2018, the highest support was for implementing measures to further regulate tobacco products (50.5%) and for holding tobacco companies accountable for the harm caused by smoking (48.8%). Additionally, in 2018, 40% of smokers and recent quitters supported a total ban on cigarettes and other tobacco products within ten years, if assistance to quit smoking is provided. Overall, support for tobacco control measures among smokers and recent quitters after the implementation of the TPD remained stable over time.ConclusionThere is considerable support among smokers and recent quitters for tobacco control measures that go beyond the current measures implemented. A significant percentage of smokers would support a ban on tobacco products in the future if the government provided assistance to quit smoking. This highlights the importance of implementing measures to increase smoking cessation in conjunction with other policies.

Abstract Background The EUREST-PLUS ITC Europe surveys aim to evaluate the impact of the European Union’s Tobacco Products Directive (EU TPD) implementation within the context of the WHO FCTC. This article describes the methodology of the 2016 (Wave 1) and 2018 (Wave 2) International Tobacco Control 6 European (6E) Country Survey in Germany, Greece, Hungary, Poland, Romania and Spain; the England arm of the 2016 (Wave 1) and 2018 (Wave 2) ITC 4 Country Smoking and Vaping (4CV) Survey; and the 2016 (Wave 10) and 2017 (Wave 11) ITC Netherlands (NL) Survey. All three ITC surveys covering a total of eight countries are prospective cohort studies with nationally representative samples of smokers. Methods In the three surveys across the eight countries, the recruited respondents were cigarette smokers who smoked at least monthly, and were aged 18 and older. At each survey wave, eligible cohort members from the previous waves were retained, regardless of smoking status, and dropouts were replaced by a replenishment sample. Results Retention rates between the two waves of the ITC 6E Survey by country were 70.5% for Germany, 41.3% for Greece, 35.7% for Hungary, 45.6% for Poland, 54.4% for Romania and 71.3% for Spain. The retention rate for England between ITC 4CV1 and ITC 4CV2 was 39.1%; the retention rates for the ITC Netherlands Survey were 76.6% at Wave 10 (2016) and 80.9% at Wave 11 (2017). Conclusion The ITC sampling design and data collection methods in these three ITC surveys allow analyses to examine prospectively the impact of policy environment changes on the use of cigarettes and other tobacco products in each country, to make comparisons across the eight countries.

Abstract Background We examined quit attempts, use of cessation assistance, quitting beliefs and intentions among smokers who participated in the 2018 International Tobacco Control (ITC) Europe Surveys in eight European Union Member States (England, Germany, Greece, Hungary, the Netherlands, Poland, Romania and Spain). Methods Cross-sectional data from 11 543 smokers were collected from Wave 2 of the ITC Six European Country (6E) Survey (Germany, Greece, Hungary, Poland, Romania and Spain—2018), the ITC Netherlands Survey (the Netherlands—late 2017) and the Four Countries Smoking and Vaping (4CV1) Survey (England—2018). Logistic regression was used to examine associations between smokers’ characteristics and recent quit attempts. Results Quit attempts in the past 12 months were more frequently reported by respondents in the Netherlands (33.0%) and England (29.3%) and least frequently in Hungary (11.5%), Greece (14.7%), Poland (16.7%) and Germany (16.7%). With the exception of England (35.9%), the majority (56–84%) of recent quit attempts was unaided. Making a quit attempt was associated with younger age, higher education and income, having a smoking-related illness and living in England. In all countries, the majority of continuing smokers did not intend to quit in the next 6 months, had moderate to high levels of nicotine dependence and perceived quitting to be difficult. Conclusions Apart from England and the Netherlands, smokers made few quit attempts in the past year and had low intentions to quit in the near future. The use of cessation assistance was sub-optimal. There is a need to examine approaches to supporting quitting among the significant proportion of tobacco users in Europe and increase the use of cessation support as part of quit attempts