Community In Greece Research Articles

Transferability of vaccination interventions from a community perspective: One size does not fit all

Abstract Background Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities. Methods Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Results We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable. Conclusions Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.

8.N. Scientific session: Transferability and adaptation of vaccination interventions: Learning from underserved communities

Abstract Removing barriers in the health system that make it difficult for cultural, religious or ethnic minorities to access vaccinations is an urgent concern in order to prevent infectious diseases in the future. Childhood vaccine uptake for MMR and HPV in most underserved communities is lower than in the general population. The project RIVER-EU (Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities) engages the migrant community in Greece, females with a Turkish or Moroccan migration background in the Netherlands, the Ukrainian minority in Poland and marginalized Roma communities in Slovakia to remove health system barriers to vaccination. Barriers include, e.g., lack of culturally and linguistically appropriate information, financial barriers, insufficient capacities, coordination and delivery of health care. Based on a Participatory Action Research (PAR) approach we selected and adapted potentially transferable evidence-based interventions in partnership with the communities. First, we pre-selected 6 useful interventions from a realist review on 36 effective vaccine uptake interventions. Second, we assessed them in depth for their transferability. Building a bridge between evidence on interventions and community needs is not an easy task: We involved various stakeholders in a longitudinal process under consideration of contextual conditions in the primary intervention context and the context of the respective underserved community. We co-created knowledge through 25 workshops and 39 interviews or focus groups for decision-making and determining need for adaptation of selected interventions. The aim of this workshop is to present the results of this co-creative process in each country. Special attention is payed to facilitators and barriers for transferability of evidence-based interventions from the perspective of underserved communities, and contextual commonalities and differences that lead to a specific intervention tailoring. This workshop will contribute to an improved understanding of how to consider contextual needs underserved communities have to remove health system barriers to vaccination on the one hand and suitable evidence on interventions to improve their situation on the other hand. The workshop will include five presentations of eight minutes and a questions and answers session to involve the audience. First, an introductory presentation on transferability of interventions for HPV and MMR vaccine uptake to underserved communities in specific contexts will be given. Then each country will present the intervention(s) to address health system barriers adapted to their context. Thereby, we will underline common key elements that have potential for transferability in all countries. After all presentations, we will discuss the need for context-based decision-making on evidence-based interventions and intervention tailoring to improve vaccine uptake for cultural, religious or ethnic minorities. Key messages • Improving vaccine uptake in underserved communities requires local solutions with tailored interventions. Trusted partnerships with various stakeholders are key to reducing health system barriers. • Participatory approaches to evidence-informed decision-making build bridges between evidence on interventions and needs of underserved communities to understand the transferability of interventions.

Qualitative Insights Into Healthcare Professionals’ Perceived Barriers in Providing Equitable and Patient-Centered Care to Members of the LGBTQI+ Community in Greece

LGBTQI+ individuals often face health disparities, with encumbered outcomes. We investigated the perspectives of a wide range of Greek health professionals using a battery of questionnaires examining LGBTQI+ health-related knowledge, attitudes, and clinical preparedness, while exploring the potential challenges they face when providing care for LGBTQI+ patients via qualitative analysis of their free text answers. In total, 220 health professionals participated, including physicians, nurses, dentists, physiotherapists, social workers, nutritionists, medical laboratory professionals, pharmacists, radiographers, and health promotion specialists. Four main themes were revealed concerning the barriers to providing equitable and patient-centered care to LGBTQI+ individuals: (1) Inadequate knowledge (1a. Distinctive health issues of the LGBTQI+ community, 1b. Community-related terminology), (2) Insufficient communication skills (2a. General approach of LGBTQI+ patients, 2b. Addressing LGBTQI+ individuals, 2c. Managing critical attitudes of colleagues/third parties), (3) Personal perceptions (3a. Attitudes toward the LGBTQI+ community, 3b. Perceptions on the necessity of sexual health history), and (4) Ambiguous bureaucratic procedures. Self-identification, contact with community members in personal life, as well as LGBTQI+ patients’ openness during the encounter were reportedly enabling inclusive care. Most participants (83.2%) expressed willingness for further training on LGBTQI+ health issues. Going forward, study participants identified this field, in conjunction with communication skills, as important areas of focus for training health providers and empowering them to provide equitable, patient-centered, high-quality care to the LGBTQI+ community.

Rural Environmental Governance: A Communal Irrigation System in Greece through the Social–Ecological System Framework

This article delves into the enduring self-governing nature of a traditional irrigation system in a rural community in Greece through the lens of the social–ecological system (SES) framework. The aim is to analyze the variables and interactions that have sustained this community-based governance structure over a century. This study underscores the critical role of social capital, where social networks and effective communication facilitate self-governance in the management of this common pool resource. The findings reveal how actors coordinate social and physical capital when performing daily activities, enabling them to collectively solve common dilemmas. By examining the institutional arrangements and operational dynamics of the irrigation system, the study illuminates the community-led social processes that drive its sustainability. This analysis enhances the understanding of the importance of integrating social and physical capital in governance through collective action to achieve resilience. This study provides insights into alternative pathways for building resilience and discusses an irrigation system as a communal autonomous space that prioritizes social equity, democratic decision-making, and social–ecological contacts.

7.O. Workshop: A participatory approach to identifying vaccine uptake interventions with underserved communities

Abstract Resilient and equitable health systems should respond to the needs of their populations and remove barriers specific to cultural, religious, or ethnic minorities. Vaccination should be accessible to all in order to prevent infectious diseases. The EU funded project ‘Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities’ (RIVER-EU) aims to improve access to childhood vaccination in the migrant community in Greece (focus on MMR and HPV), the Turkish females and Moroccan females in the Netherlands (focus on HPV), the Ukrainian minority in Poland (focus on MMR and HPV), and marginalized Roma communities in Slovakia (focus on HPV). Considerable health system barriers to vaccination were identified in all underserved communities, such as a lack of culturally and linguistically appropriate information, insufficient capacities, coordination and delivery of health care, and financial costs. Based on a realist review, 36 publications on evidence-based interventions that aim at increasing vaccination coverage of MMR and HPV in underserved communities were considered in RIVER-EU. In order to identify useful and transferable interventions that tackle the health system barriers perceived by underserved communities, an in-depth understanding of context is needed. Moreover, it is of essential importance to involve various stakeholders of the underserved communities to investigate which interventions have the potential for sustainable improvement of access to vaccination. RIVER-EU relies on the Participatory Action Research (PAR) approach to identify and develop interventions in partnership with underserved communities. The building of trustful collaboration with stakeholders for intervention identification and decision-making often remains a black box in the literature. This is, however, a prerequisite for overcoming health system barriers to vaccination. For participatory transferability analysis, we conducted an assessment of evidence-based interventions, interviews and focus groups with various stakeholders. The aim of this workshop is to open the black box on developing trustful relationships with stakeholders from underserved migrant communities and ethnic minorities to identify potentially transferable interventions. We aim to discuss strategies on how to involve underserved communities, barriers and enablers to the involvement of the different stakeholders and lessons learned. The workshop will be structured into 5 presentations of 10 minutes, including moderated questions and answers sessions involving the audience to share their experiences. After all presentations, there will be a moderated concluding discussion on common elements of relationship building in the different contexts, and on contextual particularities when co-creating knowledge with the underserved communities. Key messages • Trustful knowledge co-creation with underserved communities for identification, selection and adaptation of interventions is crucial to tackle health system barriers to vaccination. • Participatory transferability analysis is a structured approach to face complexity of context and guide a decision-making process on interventions. It builds a basis for successful implementation.

Participatory transferability analysis of vaccination interventions with underserved communities

Abstract Background The Horizon 2020 project RIVER-EU will remove health system barriers to childhood vaccination in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. In order to identify transferable vaccination interventions for HPV and MMR, our aim was to establish a collaboration with various stakeholders from these communities. Methods For the transferability analysis, we used the participatory action approach (PAR) to stimulate meaningful participation of different key stakeholder groups in discussing evidence-based interventions and the specific contextual conditions of the underserved communities. Based on the PIET-T models, we collaboratively explored characteristics of the populations (P), interventions (I), environments (E) as well as options for intervention transfer (T) to understand transferability (T), need for intervention adaptations or new interventions. Results Six interventions were pre-selected for decision-making. These addressed elements of involving community members to support vaccination, education in schools, providers’ vaccine communication, and educational videos. All partners co-created knowledge through their expertise: Community members contributed through their experiences with vaccination services, provided valuable arguments for or against interventions, as well as ideas for improvement. Country coordinators in each context were mediators for knowledge-co-creation between all partners involved. Transferability researchers guided the process and analysed the results of discussions through workshops, interviews and focus groups. Conclusions Establishing trust between partners was a key issue in all contexts. Participatory transferability analysis required the consideration of a complex interplay between understanding content of interventions, context, and the specific characteristics and contributions of stakeholders.

The Greek Connection: The Life of Elias Demetracopoulos and the Untold Story of Watergate by James H. Barron, and: Ένα σκοτεινό δωμάτιο, 1967–1974: Ο Ιωαννίδης και η παγίδα της Κύπρου—Τα πετρέλαια στο Αιγαίο—Ο ρόλος των Αμερικανών [A dark room, 1967–1974: Ioannidis and the Cyprus trap—Aegean oil—The role of the Americans]. by Alexis Papahelas (Αλέξης Παπαχελάς)

Reviewed by: The Greek Connection: The Life of Elias Demetracopoulos and the Untold Story of Watergate by James H. Barron, and: Ένα σκοτεινό δωμάτιο, 1967–1974: Ο Ιωαννίδης και η παγίδα της Κύπρου—Τα πετρέλαια στο Αιγαίο—Ο ρόλος των Αμερικανών [A dark room, 1967–1974: Ioannidis and the Cyprus trap—Aegean oil—The role of the Americans]. by Alexis Papahelas (Αλέξης Παπαχελάς) Konstantina E. Botsiou (bio) James H. Barron, The Greek Connection: The Life of Elias Demetracopoulos and the Untold Story of Watergate. New York: Melville House. 2020. Pp. xiii + 482. 21 illustrations. Hardcover $31.67. Alexis Papahelas (Αλέξης Παπαχελάς), Ένα σκοτεινό δωμάτιο, 1967–1974: Ο Ιωαννίδης και η παγίδα της Κύπρου—Τα πετρέλαια στο Αιγαίο—Ο ρόλος των Αμερικανών[A dark room, 1967–1974: Ioannidis and the Cyprus trap—Aegean oil—The role of the Americans]. Athens: Metechmio, 2021. Pp. 630. Cloth €18.90. Due to a scarcity of archival sources and the aversion of historians, the foreign and defense policies of the seven-year Greek military dictatorship (1967–1974) have not been systematically researched. Although more widely explored than most of the dictatorship’s foreign connections, Greek-American relations during this period are no exception to the rule. Ideologically driven interpretations or “what ifs” hardly substitute for structured analyses of alliances, animosities, and political decisions. As a matter of fact, they strengthen the superficial perception of the junta as a tragic parenthesis in the history of postwar Greece. This tendency is changing, however, and two recent publications are especially noteworthy. James H. Barron and Alexis Papahelas both present detailed accounts of the dictators’ worldviews and actions. They also offer thorough overviews of the Greek political ecosystem in the 1950s and 1960s, where the future dictators thrived. Various continuities and discontinuities with the earlier period place the dictatorship in a historical context driven by anticommunism—and its local version, εθνικοφροσύνη (ethnikofrosyni)—which the colonels took up as their mission when Greek politicians loosened their grip in the era of international détente. Committed to the zeitgeist of bipolarity, the colonels baptized personal competitors as enemies of the state. Barron’s story of Elias Demetracopoulos’s multiple persecutions by Greek and American officials before and during the dictatorship captivates the reader. Demetracopoulos suffered the various types of character assassination that an [End Page 137] assertive journalist posing inconvenient questions would undergo. A prominent example of his research concerned the stationing of nuclear missiles on Greek soil as a result of the “Sputnik effect.” Demetracopoulos maintained many doubts about the Greek government’s denial of any participation in the US program of intercontinental ballistic missiles (ICBMs), which had involved Italy and Turkey before the Cuban Missile Crisis of October 1962. He believed that Greek participation in the ICBM program would be vital for alleviating the West’s feeling of technological inferiority after the Soviet Union launched Sputnik 1, the world’s first artificial satellite, which suggested that the American soil became vulnerable to a potential Soviet attack (105–110). The refusal to accept the Greek government’s denials severely damaged Demetracopoulos’s relations with the Greek premier Konstantinos Karamanlis (1955–1963). Similar difficulties awaited Demetracopoulos in the US. His close ties with top American public figures were frequently undermined by unforgiving cold warriors who saw in Demetracopoulos a threat to the dominant narrative of law and order. These contradictions underscore the difference that personality can make in any given historical situation. Barron paints a comprehensive portrait of Demetracopoulos, a devoted journalist who earned exceptional resistance credentials as a teenager during the Axis occupation. He later spent his adult life in the twilight zone between censure and shelter by Greek and American agencies and individuals who ranged from committed friends and acquaintances to various top politicians such as Konstantinos Karamanlis, George Papandreou, and Ted Kennedy. In the 1950s, Demetracopoulos had built a reputation as a trustworthy liaison between the Greek media and the American community in Greece. Shortly after the establishment of the military dictatorship he sought refuge in the US via Denmark, acting out of a justified fear that assassination attempts would no longer be limited to his character. Barron’s book stresses for American audiences the Greek dimension of the Watergate scandal. Fate reserved for Demetracopoulos a crucial part in the history of both the junta and the Nixon administration, since it was he who came to reveal the Nixon administration’s “Greek connection.” According to his reports at the...

The Implementation of a Health Care Worker Screening Program Based on the Advanta RT-qPCR Saliva Assay in a Tertiary Care Referral Hospital in Northern Greece.

Health care workers are at increased risk of acquiring SARS-CoV-2 infection due to different exposures in the community and in hospital settings. Interventions implemented to avoid nosocomial outbreaks include preventive testing strategies. In this report, we present results from the mass screening program applied in our hospital to all professionals, irrespective of symptoms or risk of exposure. We processed saliva specimens with real-time reverse transcription polymerase chain reaction. The total number of samples received was 43,726. Positive results were 672 and average positivity rate was 1.21%. The average positivity rate was similar to the positivity rate in the community in Greece and EU. More specifically, 80.5% of the positive participants care for patients in their daily activities, 31% experienced no symptoms before receiving the positive result, 46.1% reported a close contact with a patient or infected coworkers and 32.8% reported a close contact with infected family members. We believe that the identification of asymptomatic carriers has proved the effectiveness of the screening program by preventing the putative nosocomial spread of the virus and the depletion of workforce. In conclusion, in times of high incidence in the community, the periodic testing of health care personnel is wise and relevant for implementation costs.

Assessment of needs-based usefulness of interventions to address system barriers to HPV vaccination

Abstract Background Adolescents of underserved communities face multiple health system barriers to access HPV vaccination. The Horizon 2020 project RIVER-EU will implement interventions to address these barriers in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian community in Poland and the Roma community in Slovakia. The objective of this study was to identify promising evidence-based interventions that potentially meet the specific contextual needs of the target groups, as a basis for assessing their transferability. Methods Based on the PIET-T models of transferability, we developed a methodology to assess the needs-based usefulness of an intervention for a target context. Criteria of intervention usefulness addressed specific aspects of the health issue, population, intervention content, outcomes, up-to-datedness, applicability, quality and usefulness of the evidence-base. Guided by methodological workshops, country members with their local advisory boards performed a rating of 32 interventions identified from a systematic literature search. Results Through independent assessment in each country, 5 of 32 interventions were selected as useful, with overlap: 2 interventions were selected by all countries, and 1 by 2 countries. In all countries, trained community members to support HPV vaccination were seen as promising. In Greece and the Netherlands, an educational programme in schools was included. Further, the Netherlands chose an intervention addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Discussion The feedback of the country members on the assessment emphasised the structured way to face complexity of understanding the potential usefulness of an intervention from the perspective of the target country. Critical discussions on the interventions enabled to specify needs for further clarification, for adaptations, and alternatives to consider for transferability analyses. Key messages

Sleep Quality and Mental Health Consequences of COVID-19 Pandemic in the Aviation Community in Greece.

The aim of this study was to assess the mental health and sleep quality of aviation workers in Greece during the pandemic. A cross-sectional study of aviation workers in Greece was conducted. Sleep disturbances were observed in 25.4% of our 548 participants, whereas 8.2% and 5.8% reported at least mild depressive and anxiety symptoms, respectively. The impact of the pandemic on their mental health was their primary concern, which increased for many active pilots according to their workload. Those infected mainly faced daily tiredness and fatigue. Smoking habits and high body mass index were a predisposition for more physical symptoms. Cabin crew and women generally yielded worse scores than the other groups. Fear of infection could explain mental health issues, whereas physical symptoms of those infected could be attributed to long-COVID (coronavirus disease) syndrome. Flight attendants' lower ratings may be due to more occupational exposure.

From Labour Migrants to a Diaspora Community? The Case of Ukrainian Migrants in Greece

This paper discusses transnational labour migration from Ukraine to Greece since the end of the Cold War. It examines the migration context, motivations, and expectations. It then discusses the actual experiences of Ukrainian migrants, in Greek society and beyond, and their visions for the future. The paper touches upon the 2008 crisis in Greece and its impact on migrants and their choices. The paper also discusses the social organisation of Ukrainian migrants in Greece, as well as identity and belonging, in a globalised world. Whereas many Ukrainian migrants continue to perceive their stay in Greece as temporary, the emergence of a Ukrainian diaspora community in Greece is imminent. The paper is based on primary research conducted by the author in greater Athens, as well as secondary sources.

Open Research Data and Open Peer Review: Perceptions of a Medical and Health Sciences Community in Greece

Recently significant initiatives have been launched for the dissemination of Open Access as part of the Open Science movement. Nevertheless, two other major pillars of Open Science such as Open Research Data (ORD) and Open Peer Review (OPR) are still in an early stage of development among the communities of researchers and stakeholders. The present study sought to unveil the perceptions of a medical and health sciences community about these issues. Through the investigation of researchers‘ attitudes, valuable conclusions can be drawn, especially in the field of medicine and health sciences, where an explosive growth of scientific publishing exists. A quantitative survey was conducted based on a structured questionnaire, with 179 valid responses. The participants in the survey agreed with the Open Peer Review principles. However, they ignored basic terms like FAIR (Findable, Accessible, Interoperable, and Reusable) and appeared incentivized to permit the exploitation of their data. Regarding Open Peer Review (OPR), participants expressed their agreement, implying their support for a trustworthy evaluation system. Conclusively, researchers need to receive proper training for both Open Research Data principles and Open Peer Review processes which combined with a reformed evaluation system will enable them to take full advantage of the opportunities that arise from the new scholarly publishing and communication landscape.

Designing a tool for evaluating programs for environmental education

Persons in the field of Environmental Education (EE) often have difficulty identifying and selecting educational programs that have the potential to best maximize needed resources to implement and achieve desired outcomes due, in part, to their lack of expertise in evaluation knowledge and practice. This article presents an approach for using a set of criteria and a process to evaluate the potential of an EE program. For this purpose, the proposed approach uses a combination of two multicriteria decision-making techniques to implement a front-end evaluation of available projects and rank them in order to help instructors select one. The proposed approach has been applied to evaluate the Environmental Education programs in Greece. As a result, we discuss the results and make useful conclusions about the quality of these programs available to the school community in Greece.

Editorial

This is the second issue of the Open Schools Journal for Open Science created an interest in the education community in Greece and in other European countries. The organisers of the Student Conference on Research and Science that took place in Greece in 2018 after the success of presenting the conference’ findings of their first conference expressed again their interest to present the valuable work that has been presented during the 2nd Student Conference on Research and Science. This is the first of a series of four issues which will be published until July 2020 and it contains 22 articles written by students from across Greece in collaboration with their teachers/mentors. Have a look at the welcome note from the programme committee of the conference.All articles in this special issue are written in Greek.

Europeanisation as Legitimacy to Identify as a ‘National Minority’: The Turkish Community in Greece

The issue of national minorities has never ranked high on the European Union’s (eu’s) agenda. No legal or policy measures to protect Europe’s national minorities have been developed, reducing scholarly attention on the potential of Europeanisation of national minority politics to the minimum. This article addresses this misconception and argues that Europeanisation of national minority politics does occur, however, not where originally expected. By shifting attention to a poorly studied area - minority actors and their activities at the eu level – the article illustrates how minority actors create own change, how they are influenced by their own ‘usages of Europe’ and how this process helps to advance our knowledge of Europeanisation of today’s national minority politics.

Special Issue from the 1st Greek Student Conference on Research and Science

The first issue of the Open Schools Journal for Open Science created an interest in the education community in Greece and other European countries. The organisers of the 1st Student Conference on Research and Science that took place in Greece in March 2017 contacted the Journal editorial committee expressing their interest to present the conference findings to the wider journal community. This issue presents 44 articles written by students from across Greece in collaboration with their teachers/mentors. Below you will find a welcome note from the programme committee of the conference. All articles in this special issue are written in Greek.

Aiming towards hepatitis C virus elimination in Greece.

There are estimated to be 74,000-134,000 patients living with chronic hepatitis C in Greece, but only 20-30% of them are aware of their disease status. In July 2017, the Hellenic National Plan for Hepatitis C was announced in alignment with the World Health Organization goals for the eradication of hepatitis C virus (HCV) by the year 2030. This article discusses the epidemiology and current treatment of chronic hepatitis C in Greece. Additionally the authors propose actions on how to bring back to care diagnosed patients lost to follow up, optimize access to care for HCV-infected people who inject drugs, and increase HCV screening in the general population. The medical community in Greece can play a pivotal role in the implementation of the HCV National Plan and in the efforts to reach the goal of HCV elimination.

My Alma: A Digital App Supporting Metastatic Breast Cancer Patients in Greece

Background: Current research has shown that women with MBC patients feel ashamed and isolated. In Greece, “Alma Zois”, as a patient group, has made several attempts to provide support, but with a moderate success. Nevertheless, MBC patients have unmet needs that consist of better information and knowledge about MBC, better support for physical and emotional impact of MBC and better quality of life. Especially when it comes to younger women, these needs seem to be less covered. The development of a specially designed digital application (app) will cover the gap between support services and MBC patients by embracing the digital era in a country where 66% of the population uses smartphones. Aim: The development of the app aims at: 1) providing useful information about metastatic breast cancer, 2) reaching out to MBC patients, 3) improving the quality of life, 4) increasing healthy behaviors, and 5) increasing compliance. Methods: The project “My Alma App” is designed according to three major pillars: 1) Awareness, 2) Support 3) Communication. The 1st part AWARENESS includes: information about MBC. Calendar - Daily record of healthy behaviors (walking, nutrition, etc.). The 2nd part SUPPORT includes: 1) Psychological advice provided by psycho-oncologists, 2) Emotional-meter: issue the daily question “How are you feeling today?” and based on the patient's answer, the app can provide multiple suggestions/call to action. The 3rd part COMMUNICATION includes: personalized motivation, calendar with reminders of medication, therapies and events that might be of interest according to each patient's profile. Results: To achieve the best quality for the project: 1) A technical development of the app is been held, 2) The app will be tested by a group of patients as a pilot study and 3) Updates and improvements based on users feedback (metastatic breast cancer patients) and latest scientific data will be made. After the official launch, a short satisfaction survey will be addressed to every registered user. Finally, to motivate patients to use the app, a special social media campaign about the app will be launched. Conclusion: It is expected that the app will provide to MBC patients ways and methods to deal with the emotional challenges, distress and ways to improve their daily activities and their quality of life. Upon the end of the launch of the app, it is expected that a number of 500 Stage III and IV breast cancer patients will start using the app. The number of people who will download the app, the data provided by app users and the ratings and answers on “emotion-meter” during a period of time will be indexes of impact of the project to the MBC community in Greece.

Access to health services for the refugee community in Greece: lessons learned

• Primary health care (PHC) within the refugee camps is essential when access to existing MoH structures is cumbersome. • On site mental health and reproductive health services should be added to the basic PHC service. • Access to secondary health care in hospitals should be facilitated by: 1. native speaker social workers/nurses who can make appointments with the hospital out-patient departments 2. organized transport 3. interpreters accompanying the patients or based in the hospitals.

Surplus, storage and status in a rural Greek community

ABSTRACTThis study draws on a range of nineteenth- and twentieth-century ethnographic materials from an agrarian community in Greece to explore the links between a nexus of behaviours related to avoiding subsistence risk. Producing a ‘normal surplus’, along with storage strategies and the growing of a wide range of crops, was part of a mix of risk-avoidance behaviours. Ultimately, however, the success of these behaviours depended on access to sufficient agricultural land. A lack of intra-community status differentiation based on land ownership noted during ethnographic fieldwork in the later twentieth century partly resulted from two historical factors: (1) households lacking sufficient land to produce an adequate ‘normal surplus’ left the community to take up other lower status activities in the wider (‘complex’) society of Greece; (2) wealthier households, unable to generate substantial wealth from sales of agricultural surpluses beyond the community, sold their property to generate capital for participation in other economic activities elsewhere.