Papers by Chariklia Tziraki Segal
The design of age-friendly homes benefits vulnerable groups, such as frail people and older adult... more The design of age-friendly homes benefits vulnerable groups, such as frail people and older adults. Advances in smart home technologies, including robots, have important synergies with homes designed for health needs. Yet, focus on environmental and sustainable housing design and improvements misses important opportunities for collective impact. Stronger involvement of disciplines, such as those from the built environment for technological integration within homes and effects on space and the community, is needed. There is a need for a unified framework integrating the needs and factors of the resident, smart home technologies and robots, and the built environment, and that includes the concept of a “home”. With the remodeling of housing towards sustainable and environmental targets, as well as advances in smart home technologies such as robots, the timeliness of shared input for the benefit of residents now and in the future is of the essence. This would help target future research into effective and optimized cohabitation with technology within homes for the purpose of improving the wellbeing of residents.
Alzheimers & Dementia, Dec 1, 2021
The Covid‐19 pandemic has created social isolation across all age groups. Literature reports that... more The Covid‐19 pandemic has created social isolation across all age groups. Literature reports that persons with dementia experience significant social isolation resulting in stress and anxiety for their caregivers as well. Interactive communication technologies like Zoom have been employed to reduce the impact of the pandemic. However, we find no reports using this technology with persons with dementia. Our study used the Zoom platform to maintain social connectivity with 16 day center clients who represent an immigrant community identified with mild to moderate cognitive impairment. We hypothesize that by using technology which allows facial recognition and communication and by focusing on the meaning of home, these persons and their carers expressed positive emotional feelings and remained engaged with their social world despite what was going on around them.
Aging Clinical and Experimental Research, Feb 15, 2021
Background Although the burden of influenza infection is the highest in older adults, vaccination... more Background Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake.
Frontiers in Sociology, 2019
Psycho-Oncology
ObjectiveThis study aimed to describe distinct trajectories of anxiety/depression symptoms and ov... more ObjectiveThis study aimed to describe distinct trajectories of anxiety/depression symptoms and overall health status/quality of life over a period of 18 months following a breast cancer diagnosis, and identify the medical, socio‐demographic, lifestyle, and psychological factors that predict these trajectories.Methods474 females (mean age = 55.79 years) were enrolled in the first weeks after surgery or biopsy. Data from seven assessment points over 18 months, at 3‐month intervals, were used. The two outcomes were assessed at all points. Potential predictors were assessed at baseline and the first follow‐up. Machine‐Learning techniques were used to detect latent patterns of change and identify the most important predictors.ResultsFive trajectories were identified for each outcome: stably high, high with fluctuations, recovery, deteriorating/delayed response, and stably poor well‐being (chronic distress). Psychological factors (i.e., negative affect, coping, sense of control, social su...
Translational Medicine @ UniSa, 2019
Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing ... more Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, ...
International Journal of Integrated Care, Nov 4, 2022
Healthcare, Oct 19, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Dementia, 2022
COVID-19 pandemic and subsequent lockdowns created a global public health crisis generating menta... more COVID-19 pandemic and subsequent lockdowns created a global public health crisis generating mental health problems including social isolation, stress, and anxiety especially for persons with dementia and their carers. This article reports on the use of digital technology to maintain social connectivity via a virtual group session that focused on the topic of “what is home.” Participants in this session included 16 day-care center clients representing an immigrant community identified with mild to moderate cognitive impairment. A trained psychodrama therapist conducted the virtual group meeting based on five key techniques: spectrogram, role reversal, doubling, mirroring, and soliloquy. The NVivo software was used for the qualitative analysis of the transcribed video recording to identify key themes based on grounded theory methodology. Zooming from home, clients engaged in significant social interaction. Findings of the NVivo analysis identified the following themes of “what is home...
European Geriatric Medicine, 2017
European Geriatric Medicine xxx (2017) xxx-xxx Abbreviations: AHA, active and healthy ageing; AIR... more European Geriatric Medicine xxx (2017) xxx-xxx Abbreviations: AHA, active and healthy ageing; AIRWAYS ICPs, integrated care pathways for airway diseases; CARSAT, Caisse d'assurance retraite et de la santé au travail (retirement and occupational health insurance agencies); EIP on AHA, European innovation partnership on active and healthy ageing; EUGMS, European geriatric medicine, the official organ of the European Union Geriatric Medical Society; ICT, information communication technology; IRV, Regional Ageing Institute; MACVIA-LR, contre les maladies chroniques pour un vieillissement actif en Languedoc-Roussillon; REIF, repré sentation des institutions françaises de sé curité sociale auprè s de l'Union europé enne (representation of French Social Security Institutions for the EU).
Translational Medicine @ UniSa, 2021
The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action... more The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe. The study design is a mixed method approach. Based on data analysis from a cohort of communitydwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report. All working groups agreed on a common understanding that integration of care means personcentered integration of health and social care, longitudinally provided across primary and secondary health care including citizens' individual social, economic and human resources. Elements for consideration during care for prefrail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery. The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach.
It is commonly accepted that frailty and dementia-related cognitive decline are strongly associat... more It is commonly accepted that frailty and dementia-related cognitive decline are strongly associated. However, degree of this association is often debated, especially in homebound elders with disabilities. Therefore, this study aimed to investigate the association of frailty on cognitive function in older adults receiving homecare. A screening for frailty and cognitive function was conducted at 12 primary healthcare settings of the nationally funded program "Help at Home" in Heraklion Crete, Greece. Cognitive function and frailty were assessed using the Montreal Cognitive Assessment questionnaire and the SHARE-f index, respectively. Barthel-Activities of Daily Living and the Charlson Comorbidity Index were also used for the identification of disability and comorbidity, respectively. The mean age of the 192 participants (66% female) was 78.04 ± 8.01 years old. In depth-analysis using multiple linear regression, revealed that frailty was not significantly associated with cognitive decline (frail vs. non-frail (B'=-2.39, p=0.246) even after adjusting for depression and multi-comorbidity. Importantly, as protective factors for cognitive decline progression and thus dementia development, was scientifically correlated with annual individual income >4500 (B'=2.31, p=0.005)poverty threshold-compared to those with <4500 and, higher education level as compared to Uneducated (B'=2.94, p=0.019). However, depression was associated with cognitive decline regardless of socioeconomic variables. In conclusion, our results suggest that health professionals caring for frail people with cognitive impairment, must focus on early recognition and management of depression.
The National Cancer Institute (NCI) developed a manual to guide primary care practices in structu... more The National Cancer Institute (NCI) developed a manual to guide primary care practices in structuring their office environment and routine visits so as to enhance nutrition screening, advice/referral, and follow-up for cancer prevention. The adoption of the manual's recommendations by primary care practices was evaluated by examining two strategies: physician training on how to implement the manual's recommendations versus simple mailing of the manual. This article reports on the results of a randomized controlled trial to evaluate the effectiveness of these two strategies. DESIGN: A three-arm, randomized, controlled study. SETTING: Free-standing primary care physician practices in Pennsylvania and New Jersey. INTERVENTION: Each study practice was randomly assigned to one of three groups. The training group practices were invited to send one member from their practice of their choosing to a 3-hour "train-a-trainer" workshop, the manual-onlygroup practices were mailed the nutrition manual, and the control group practices received no intervention. For training group practices, training was provided in the four major components of the nutrition manual: how to organize the office environment to support cancer prevention nutrition-related activities; how to screen patient adherence to the NCI dietary guidelines; how to provide dietary advice/referral; and how to implement a patient follow-up system to support patients in making changes in their nutrition-related behaviors. MEASUREMENTS: The primary outcomes of the study were derived from two evaluation instruments. The observation instrument documented the tools and procedures recommended by the nutrition manual and adopted in patient charts and the office environment. The in-person structured interview evaluated the physician and staff's self-reported nutrition-related activities reflecting the nutrition manual's recommendations. Data from these two instruments were used to construct four adherence scores corresponding to the areas: office organization, nutrition screening, nutrition advice/referral, and patient follow-up. MAIN RESULTS: The adoption of the manual's recommendations was highest among the practices in the training group as reflected by their higher adherence scores. They organized their office (P ؍ .005) and screened their patients regarding their eating habits (P ؍ .046) significantly more closely to the recommendations of the nutrition manual than practices in the manual-only group. However, despite being the highest in compliance, the training group practices were only 54.9% adherent to the manual's recommendations regarding nutrition advice/referral, and 28.5% adherent to its recommendations on office organization, 23.5% adherent to its recommendations on nutrition screening, and 14.6% adherent to its patient follow-up recommendations. CONCLUSIONS: Primary care practices exposed to the nutrition manual in a training session adopted more of the manual's recommendations. Specifically, practices invited to training were more likely to perform nutrition screening and to structure their office environment to be conducive to providing nutrition-related services for cancer prevention. The impact of the training was moderate and not statistically significant for nutrition advice/referral or patient follow-up, which are important in achieving long-term dietary changes in patients. The overall low adherence scores to nutritionrelated activities demonstrates that there is plenty of room for improvement among the practices in the training group.
The Sustainable Development Goals (SDGs) lay the foundations for supporting global health yet the... more The Sustainable Development Goals (SDGs) lay the foundations for supporting global health yet the rate of meeting the SDGs is slow and complex. In order to meet these transactional and multidisciplinary challenges a paradigm shift from operating in silos is needed, to include a more interdisciplinary approach (top down as well as bottom up approaches). This paper reports top down and bottom up approaches that were used to address health and wellbeing in a middle-eastern multi-cultural city. In this retrospective roadmap, we highlight the key pillars that appear to have assisted in progress in achieving SDG3, Good Health and Well-being. The roadmap includes the development of the key pillars: 1) a common agenda, 2) shared measurement system, 3) mutually reinforcing activities, 4) continuous communication and 5) backbone support. Highlighting condition 4, continuous communication, of the model, we discuss the creation, use and importance of a “communication tool” used for Healthy Urban Planning. This tool developed cooperatively with relevant municipality departments, national government, and multidisciplinary community shareholders, led to organizational changes and the creation of the Sustainability Department of the municipality. This retrospective roadmap appears to reflect the collective impact framework appropriate for solving complex challenges such as achieving SDGs.
KEYWORDS: # Health & wellbeing #sustainable development goals #collective impact # communication too #lhealthy urban planning #health equity
It is commonly accepted that frailty and dementia-related cognitive decline are strongly associat... more It is commonly accepted that frailty and dementia-related cognitive decline are strongly associated. However, degree of this association is often debated, especially in homebound elders with disabilities. Therefore, this study aimed to investigate the association of frailty on cognitive function in older adults receiving homecare. A screening for frailty and cognitive function was conducted at 12 primary healthcare settings of the nationally funded program “Help at Home” in Heraklion Crete, Greece. Cognitive function and frailty were assessed using the Montreal Cognitive Assessment questionnaire and the SHARE-f index, respectively. Barthel-Activities of Daily Living and the Charlson Comorbidity Index were also used for the identification of disability and comorbidity, respectively. The mean age of the 192 participants (66% female) was 78.04 ± 8.01 years old. In depth-analysis using multiple linear regression, revealed that frailty was not significantly associated with cognitive decl...
Objectives Cognitive impairment is known to have a significant impact on the quality of life of i... more Objectives Cognitive impairment is known to have a significant impact on the quality of life of individuals and their caregivers, yet it is often underdiagnosed. The objective of this study is to assess the extent of cognitive impairment among elders visiting primary healthcare (PHC) practice settings, to explore associated risk factors and discuss current care challenges for PHC providers. Design A cross-sectional study was conducted between March 2013 and May 2014. Setting Fourteen PHC units located in rural and urban areas of the Heraklion district in Crete, Greece. Participants Consecutive visitors aged at least 60 years attending selected PHC practices. Primary and secondary outcome measures The Mini-Mental State Examination (MMSE) was used to indicate cognitive status. Associations of low MMSE scores (≤23/24, adjusted for education level) with 12 socio-demographic factors, comorbidities and lifestyle factors were assessed. Results A total of 3140 PHC patients met inclusion cri...
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Papers by Chariklia Tziraki Segal
KEYWORDS: # Health & wellbeing #sustainable development goals #collective impact # communication too #lhealthy urban planning #health equity
KEYWORDS: # Health & wellbeing #sustainable development goals #collective impact # communication too #lhealthy urban planning #health equity