Biomedical subjects

D Trichopoulos

Publications and source records attributed to D Trichopoulos.

At least 163 records · Page 9Linked to original sources

PubMed1998

Fatalities from non-use of seat belts and helmets in Greece: a nationwide appraisal. Hellenic Road Traffic Police.

It has been established that seat belt use by car occupants and helmet use by motorcycle riders substantially reduces the risk of serious and fatal injuries following accidents. No study, however, has evaluated the motor vehicle deaths that could be prevented in Greece by general use of these devices, even though this country has the highest mortality from motor vehicle accidents in the European Union. We have estimated the odds ratios (OR) for death rather than injury in a motor vehicle accident by seat belt use among occupants of passenger cars or helmet use among motorcycle riders, using a nationwide database in which persons killed or injured in road traffic accidents in 1985 and 1994 were recorded. The study base included 910 dead and 19,511 injured persons for 1985 and 1203 dead and 22,186 injured persons for 1994. The OR and 95% confidence intervals (CI) for death rather than injury was 0.69 (CI: 0.58 to 0.81, p < 10(-5)) for seat belt users versus non-users and 0.64 (CI: 0.51 to 0.81; p < 10(-3)) for helmet users versus non-users. There was evidence that the protective effect of these passive safety devices increased from 1985 to 1994 probably reflecting technological improvements. The proportion of all deaths that could have been avoided if all car occupants used seat belts was estimated to 27%, whereas 38% of motorcycle deaths could have been avoided if all motorcycle riders used helmets. These proportions translate to about 500 deaths per year, mostly deaths among young men.

Accidents, Traffic↗

PubMed1998

Risk factors for childhood burn injuries: a case-control study from Greece.

During a 12-month period 239 children who presented with a burn injury at the Emergency Department of a teaching children's hospital in Athens, with city-wide coverage, and 239 gender- and age-matched controls with minor non-injury ailments were interviewed. The questionnaire covered sociodemographic characteristics of the children and their families, information allowing the construction of a burn avoidance index in their homes and items from the Achenback scale that were synthesized into a child activity score. The data were analyzed through conditional logistic regression. In general, socio-demographic variables were not of overwhelming importance, although some of the findings indicate that supervision lapses and barefoot walking of gypsy children increase the risk of burn injuries. The kitchen in an inherently high risk place for injuries and the powerful inverse association of the burn avoidance index with burn injury risk points towards steps that could be easily taken and impart substantial protection. There was no evidence in this study of burn injury proneness or that hyperactivity of the child increased the risk of burn injury; indeed, the results point in the opposite direction. Our results strongly support the view that childhood burn injuries are largely environmentally conditioned and, accordingly, easily preventable.

Burns↗

PubMed1998

Predictors of sex hormone levels among the elderly: a study in Greece.

This study examines the relationship between a series of epidemiologic parameters (age, height, body mass index (BMI), smoking, alcohol consumption, and coffee drinking) and serum concentrations of testosterone, estradiol, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEAS). Among 52 healthy, elderly Greek men, we observed that serum levels of DHEAS decreased with increasing age [19% decline per 5-year increase in age, 95% CI, -2.1-(-33.5)], obesity [48% decline for BMI >30 kg/m2 compared to <27 kg/m2, CI, -15.7-(-68.7)], and current smoking [37% decline compared to nonsmokers, CI, -9.5-(-57.2)]. Estradiol concentrations increased with increasing BMI [77.1% increase for BMI >30 kg/m2 compared to <27 kg/m2, CI, -12.0-256.3], alcohol drinking [66% increase for > or = 7 glasses/week compared to <7 glasses/week, CI, 4.4-164.4], and coffee drinking [59% increase for > or = 14 cups/week compared to > or = 14 cups/ week, CI, -0.5-155.9], and decreased among current smokers [40% decline compared to nonsmokers, CI, -64.9-0.8]. SHBG was marginally positively associated with increasing age [13% increase per 5 years, CI, -0.5-29.6]. Testosterone was significantly related only to current smoking [27% decline compared to nonsmokers, CI, -45.4-(-3.1)]. These findings suggest that several variables appear to be associated with sex steroid levels and the influence of these findings on the occurrence of hormone-related conditions warrants further exploration.

Age Factors↗

PubMed1998

Diet during pregnancy in relation to birthweight in healthy singletons.

We have investigated the relationship between consumption of food groups and intake of energy-generating macronutrients on the one hand, and birthweight on the other among apparently healthy singleton, term babies. Three hundred and sixty-eight women who delivered in six maternity clinics in two Greek cities during specified days over an 8-month period completed a 190-item, interviewer-administered, validated, semiquantitative food frequency questionnaire. Study participants also provided information on sociodemographic, reproductive and lifestyle variables. Data were analysed using multiple regression modelling. Nutritional variables were energy-adjusted, and non-nutritional correlates of birthweight were accounted for. The analysis revealed most of the established non-nutritional associations of birthweight -- an indication of study validity. Among food groups, meat and meat products and fish and sea food were suggestively associated with increased birthweight (two tailed P-values 0.08 and 0.16, respectively). Among energy-generating nutrients, monounsaturated fat was positively associated with birthweight and significantly so in several of the models. We consider our findings are considered as compatible with hypotheses linking fish and meat intake to fetal growth and as indicative of a positive association between intake of monounsaturated fat and birthweight.

Adult↗

PubMed1998

Diet during pregnancy and the risk of cerebral palsy.

The role of maternal diet in the development of the fetal brain has not been adequately explored. Marine n-3 fatty acids have, however, been proposed to be important for brain development. The present case-control study aimed to investigate the relationship between dietary intake during pregnancy and the occurrence of cerebral palsy (CP) in the offspring. Children with CP (n 109), born between 1984 and 1988 to mothers residing in the Greater Athens area, were identified at any time in 1991 or 1992 through institutions delivering care and rehabilitation. Successful nutritional interviews were conducted with ninety-one of these children. Controls were chosen among the neighbours of the CP cases or were healthy siblings of children with neurological diseases other than CP, seen by the same neurologists as the children with CP. A total of 278 control children were chosen, and 246 of them were included in the nutritional study. Guardians of all children were interviewed in person on the basis of a questionnaire covering obstetric, perinatal socioeconomic and environmental variables. A validated semiquantitative food-frequency questionnaire of 111 food items was used to estimate maternal dietary intake during pregnancy. Statistical analysis was done by modelling the data through logistic regression. Food groups controlling for energy intake were alternatively and simultaneously introduced in a core model containing non-nutritional confounding variables. Consumption of cereals (mostly bread) and fish intake were inversely associated with CP (P < 0.05 and P < 0.09 respectively) whereas consumption of meat was associated with increased risk (P < 0.02). A protective effect of fish consumption and a detrimental effect of meat intake have been suggested on the basis of earlier work and appear to be biologically plausible. If corroborated by other studies, these results could contribute to our understanding of the nutritional influences on fetal brain development.

Adult↗

PubMed1998

Risk of breast cancer in men with liver cirrhosis.

OBJECTIVE: Liver cirrhosis is associated with increased levels of estrogens, which may be causally related to breast cancer. Because background estrogen levels are lower in men than in women, an estrogen-mediated link between liver cirrhosis and breast cancer would be easier to detect in men. METHODS: Men hospitalized with liver cirrhosis in Denmark from January 1, 1977, to December 31, 1989, were followed up, through record linkage, until the end of December 1993 for the possible occurrence of breast cancer. RESULTS: A total of 11,642 men with liver cirrhosis were identified and were followed for a mean period of 4.3 yr, for a total of 49,687 person-years. Three cases of male breast cancer were observed whereas 0.75 was expected, for a standardized incidence ratio of 4.0 (95% confidence interval, 0.8-11.7). CONCLUSIONS: Cirrhosis, possibly via high levels of endogenous estrogens, increases the risk of breast cancer in men.

Breast Neoplasms, Male↗

PubMed1998

Car restraints and seating position for prevention of motor vehicle injuries in Greece.

The protective effect of child restraint and the relative safety of front and rear seating in a population where children often travel unrestrained was assessed in a population based case-control study. The cases were all 129 children aged 0-11 years injured as car passengers in a motor vehicle accident who contacted, during 1996, one of the two major children's hospitals in Athens; emergency cases are accepted by the two hospitals on alternate days throughout the year, thus generating a random sample of children injured as car passengers. The prevalence of the studied exposures in the study base was estimated from an inspection survey comprising a random sample of 191 children of the same age who travelled in passenger cars. The survey was conducted by medical staff from our centre in collaboration with the road traffic police. Odds ratios (ORs) were calculated after adjustment for confounding factors through the Mantel-Haenszel procedure. The OR for injury was 3.3 among unrestrained children compared with restrained children (comparison essentially limited to children aged 0-4 years) and 5.0 for children seated in the front compared with those seated in the rear (comparison essentially limited among unrestrained children). Protective effect estimates derived from this analytical study suggest that in Greece about two thirds of all childhood injuries from car crashes could have been avoided through the regular use of a proper child restraint. The data also indicate that, in the absence of a child restraint system, a rear seating position conveys substantial protection and could explain the low mortality of children as car passengers in Greece, a country which is characterised by a high overall road traffic mortality as well as a high childhood accident mortality.

Accidents, Traffic↗

PubMed1998

Perinatal determinants of adult cardiovascular disease and cancer.

Interest in perinatal factors, especially birthweight, as determinants of adult-onset diseases has been steadily growing. Low birthweight has been associated with increased risk of cardiovascular disease, and high birthweight has been linked to higher risk of breast and possibly other cancers. Most mechanistic hypotheses that have been advanced to explain the empirical evidence linking perinatal conditions to adult-life disease in humans have invoked modulation of physiological processes by exogenous factors or poorly specified "programming" during fetal life. A form of programming that has a strong biological foundation and has recently been suggested for further study is genomic imprinting, which involves non-permanent DNA modifications and allows for influences that span three generations. The subject of the perinatal origin of adult-onset disease has profound implications and a large and reliable body of evidence needs to be assembled for biological theories to be validly evaluated against.

Adult↗

PubMed1998

Outcome prediction in Greek neonatal intensive care units using a score for neonatal acute physiology (SNAP)

OBJECTIVES: This study was undertaken to evaluate the performance of the score for neonatal acute physiology (SNAP) in Greece, to examine the predictive power of SNAP calculated during the 12 hours after admission in comparison with customarily calculated SNAP during the first 24 hours, and to assess SNAP during the second 12 hours from admission as a measure of response to treatment. METHODOLOGY: A total of 579 newborns admitted to three neonatal intensive care units (NICUs) from two cities in Greece were enrolled in the study; SNAP was determined during the first 12 hours, the second 12 hours, and the first 24 hours from admission to the NICU and calculated using an algorithm based on deviations from normal values of 26 physiologic parameters. RESULTS: All three variants of SNAP were powerful predictors of vital status at discharge, as well as of duration of stay among survivors. A five-point increase in SNAP in the first 12 hours corresponds to a more than twofold ratio in the odds for death, whereas a five-unit difference in SNAP from the second 12 hours corresponds to a more than threefold ratio. The combined 24-hour score was similar to that for the first 12 hours. A considerable advantage of SNAP was its independence from more traditional predictors of neonatal death, notably gestational age, birth weight, and Apgar score. The combination of all of these predictors improved further the overall predictive potential. CONCLUSIONS: SNAP is a useful tool in medical research and can be applied in different population groups. Its independence from birth weight underlines its added value to predict fatality ratios. Moreover, the results of the present study indicate that SNAP can be estimated without loss of predictive efficiency during the first 12 hours from admission to the NICU, whereas SNAP during the second 12 hours adequately reflects the effectiveness of early medical interventions.

Apgar Score↗

PubMed1998

Awareness and use of prenatal diagnosis among Greek women: a national survey.

The prevention of genetic diseases through prenatal diagnosis depends to a large extent on the awareness and acceptance of available methods by the public. A national survey was conducted among Greek women in order to explore their attitudes towards and their use of prenatal diagnosis in relation to their lifestyle. The survey was originally addressed to 3000 Greek women 18-65 years of age. Using as a criterion having a child 5 years old or younger, 350 women were eligible for the study. It was noted that 52 per cent of the respondents were adequately informed, while 48 per cent had either superficial knowledge of the subject or no knowledge at all. Amniocentesis was the method that most women were familiar with. The majority said that they were informed by their doctors and the media, and 13 per cent of the participants had prenatal diagnosis during a previous pregnancy. Twenty-two per cent of those who were not tested were over 35 years of age at the time of pregnancy. There was a significant positive correlation between awareness and acceptance of prenatal diagnosis, on the one hand, and the social, educational and financial profile of the women, on the other. Women aware of prenatal diagnosis adhered more closely to a healthy lifestyle and lived a family-centred life.

Adolescent↗

PubMed1998

Risk factors for breast cancer in women with a breast cancer family history.

Family history (FH) is an important indicator of a woman's future risk of developing breast cancer. Using data collected in a large population-based case-control study (6705 cases and 9341 controls), we examined the associations of breast cancer with known risk factors in women reporting a first-degree FH (mother or sister), with an emphasis on lifestyle determinants that may be altered to reduce risk. First-degree FH was reported by 18.4% (n = 1234) of cases and 11.3% (n = 1058) of controls; the overall relative risk (RR) for breast cancer associated with a positive history was 1.70 [95% confidence interval (CI), 1.55-1.87] and 2.34 (95% CI, 1.80-3.02) for breast cancer at age 45 years or younger. Among women with a FH, statistically significant inverse associations were observed for increasing parity (RR per birth = 0.90; P < 0.0001), intake of carotene-rich foods (RR for >2000 IU/day = 0.73; P = 0.02), and strenuous activity as a young adult (RR per episode/week = 0.93; P = 0.02). Recent alcohol consumption increased risk (RR per 13 g/week = 1.21; P = 0.02), as did weight gain during adult life in postmenopausal women (RR per 5 kg = 1.08; P = 0.001). Breast-feeding for any duration was associated with a lower RR in parous, premenopausal women (RR = 0.59; P = 0.04). Associations for most risk factors with breast cancer were similar among women with and without a FH of breast cancer; however, a stronger inverse association was observed for parity in women with a positive history (P for interaction = 0.04). Based on these data, women with a FH may reduce their excess risk of breast cancer through adjustments in lifestyle and reproductive choices. The risk associated with FH of breast cancer seems to be largely independent of other known risk factors.

Adolescent↗

PubMed1998

Insulin-like growth factor-I in relation to premenopausal ductal carcinoma in situ of the breast.

We evaluated the association of plasma insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) with risk of breast cancer in a study of 94 cases of premenopausal ductal carcinoma in situ and 76 controls. Compared with women in the lowest tertile of IGF-I, women in the upper two tertiles of IGF-I had an elevated risk for ductal carcinoma in situ. Conversely, compared with women in the lowest tertile of IGFBP-3, women in the upper two tertiles of IGFBP-3 had a decreased risk for ductal carcinoma in situ. After grouping women on the basis of both IGF-I and IGFBP-3, women in the highest two tertiles of IGF-I and the lowest tertile of IGFBP-3 were at notably higher risk than women in the lowest tertile of IGF-I and the highest two tertiles of IGFBP-3 (odds ratio = 3.7; 95% confidence interval = 1.1-12.2). We conclude that the combination of high IGF-I and low IGFBP-3 may increase the risk of premenopausal ductal carcinoma in situ.

Adult↗

PubMed1998

Transient exposures and the risk of childhood injury: a case-crossover study in Greece.

We used a case-crossover design to evaluate short-term effects of several exposures on the risk of childhood accident. One hundred fifty-six hospitalized children with injuries responded to an interviewer-administered questionnaire that included, among other variables, information concerning transient exposures that had terminated within 26 hours before the occurrence of the accident. We considered the 2-hour interval preceding the accident as the likely effect period and made within-individual comparisons between this period and the remaining 2-hour intervals during which the child was awake. We used conditional logistic regression analyses to evaluate the effect of the transient exposures on the occurrence of childhood accidents. We present univariate and multivariate analyses adjusting for possible within-person confounding by exposure to more than one exposure simultaneously and for clock time. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were as follows: for strenuous physical activity, OR = 24.2, 95% CI = 10.8-54.4; for intellectual exertion, OR = 9.0, 95% CI = 1.9-25.8; for involvement in family quarrels, OR = 2.6, 95% CI = 0.4-16.9; for school examination, OR = 3.8, 95% CI = 1.5-9.4; and for a pleasing event, OR = 3.4, 95% CI = 1.5-8.2. Other transient exposures were not associated with increased accident risk. Comparison of the overall frequency of reported transient events between the first of the control intervals (3rd and 4th hours before the accident) and the 2-hour interval covering the 25th and 26th hours before the accident suggested that information bias may have led to slight overreporting of transient exposures during the period most proximal to the accident; this bias, however, was too small to explain the marked risk elevations associated with the indicated transient exposures. We conclude that several transient exposures are important component causes in the occurrence of childhood accidents.

Accidents↗

PubMed1997

Electrical power lines and childhood leukemia: a study from Greece.

Residential proximity to electrical power lines of different voltage in relation to childhood leukemia was investigated through a case-control study undertaken in Greece during 1993-1994. The study comprised 117 incident cases of childhood leukemia and 202 age-, gender- and place-of-residence-matched controls. Four measures of exposure to magnetic fields were developed, using data provided by the Public Power Corporation of Greece: Voltage (V) divided by the distance (d), V/d2, V/d3 and an adaptation of the Wertheimer-Leeper code. Conditional-logistic-regression modeling was used to adjust for potential confounding influences of 18 variables. No significant trends of childhood leukemia risk with increasing exposure levels were noted, nor were there statistically significant elevations of disease risk at the higher exposure levels in each measure of exposure. These results do not support a causal link between residential proximity to electrical high-voltage wires and childhood leukemia risk, but in themselves do not refute a weak empirical association.

Adolescent↗

PubMed1997

Changing seasonality of mortality from coronary heart disease.

CONTEXT: Coronary heart disease is the major cause of mortality in the United States. Factors associated with coronary risk are important to identify. Coronary mortality is greater during the winter months. OBJECTIVE: To investigate whether declining coronary mortality has been accompanied by a change in the seasonal pattern and to investigate the hypothesis that diminishing exposures to environmental cold and heat have affected the seasonal pattern. DESIGN: We used published data on coronary mortality by year to evaluate the time trend in the seasonal pattern. We fit a sine curve to the monthly frequency of deaths in each year and examined the trend over time in the ratio of the peak to the trough of the curve. SETTING: We used monthly coronary deaths in the United States from 1937 through 1991. Deaths by cause and month were not available by geographic area within the United States, but we were able to examine total monthly deaths in 2 regions with contrasting climates, New England and the South. OUTCOME MEASURES: We used the yearly peak-to-trough ratio as our primary outcome and assessed its trend over time by linear regression. We also depicted the time trends using polynomial smoothing. RESULTS: The peak-to-trough ratio diminished by about 2% per year until around 1970, when the trend reversed. In New England, the decline was steeper than in the South, as measured from all deaths. CONCLUSION: Seasonal patterns in coronary mortality in the United States have changed with time. These changes are compatible with the gradual expansion of adequate heating and the subsequent increased use of air-conditioning. Microclimatic influences on coronary mortality could explain in part the socioeconomic gradient of cardiovascular mortality.

Cold Temperature↗

PubMed1997

Baldness and other correlates of sex hormones in relation to testicular cancer.

There is evidence that sex hormones and intrauterine factors are involved in the etiology of testicular cancer. We evaluated the importance of perinatal and adult life correlates of sex hormones as risk factors for testicular cancer in a case control study of 97 incident, histologically confirmed cases, residents of the Greater Athens area and environs, who were diagnosed in the 3 specialized cancer hospitals and the major General Hospital in Athens during the 2 year period 1993-94. Cases were age-matched to 2 healthy controls from the same study base. Both cases and controls as well as their mothers were interviewed by the same investigator and the data were analyzed through conditional logistic regression. The odds ratio for testicular cancer was elevated among persons born after a pregnancy characterized by severe nausea. Among the adult life factors, higher body mass was associated with reduced risk, as was evidence of baldness. To the extent that nausea during pregnancy reflects higher levels of pregnancy estrogens on the one hand, and baldness is linked to androgens on the other, our data suggest that estrogens in the intrauterine life and androgens at later stages may have sequential opposing effects for the development of testicular cancer.

Adult↗

PubMed1997

The association between lactation and breast cancer in an international case-control study: a re-analysis by menopausal status.

In the large, hospital-based, international case-control study of breast cancer conducted by MacMahon and colleagues in the 1960s, no protective effect of lactation was observed. However, more recent reports have suggested that such an association may be limited to pre-menopausal women. Therefore, a re-analysis of the data from that original study was performed by menopausal status and with control for additional breast-cancer risk factors since identified. Overall, data from 4,671 parous pre-menopausal and 7,200 parous post-menopausal women were analyzed, from 7 different sites representing areas of high risk (Glamorgan, Wales; Boston, USA), moderate risk (Athens, Greece; Slovenia, ex-Yugoslavia; São Paolo, Brazil), and low risk (Tokyo, Japan; Taipei, Taiwan) of breast cancer. No significant effect of lactation was found for pre-menopausal or post-menopausal women from the high-, moderate-, or low-risk areas; the center-adjusted, combined odds ratio (OR) for having breast-fed was 1.05 (95% confidence interval, 0.86-1.29) among pre-menopausal and 1.04 (0.88-1.24) among post-menopausal women. Moreover, examination of cumulative duration of lactation did not support an inverse association between breast cancer and increased length of total breast-feeding. In conclusion, re-analysis of these data, by menopausal status and adjusting for age at first parity, age at menarche, age at menopause, body-mass index and years of schooling, did not reveal a protective effect of lactation or duration of lactation against breast-cancer occurrence among the pre-menopausal, parous women.

Adult↗

PubMed1997

Pregnancy and risk of non-Hodgkin's lymphoma: a prospective study.

The etiology of non-Hodgkin's lymphomas (NHL), including chronic lymphocytic leukemia (CLL), is likely to be related to immune function. In the light of the established immunologic effects of a pregnancy, we decided to examine the risk of NHL and CLL in relationship to full-term pregnancies. Within a nationwide cohort we identified 1,546 women with NHL and 198 women with CLL, all 15 years or older, born 1925-1972. Five age-matched controls were selected for each case patient. Conditional logistic regression was used to estimate the odds ratios after mutual adjustment for number of births and age at first birth. We found a weak, negative association between parity and risk of NHL (p for trend 0.11) and a transient, 10-40% decrease in risk within 5-14 years after the last birth among women with various parity status. The risk of CLL decreased more markedly, and orderly with increasing parity, but the trend was not significant (p = 0.18). Small numbers of cases with CLL prevented more detailed analyses of temporal relationships. Age at first birth appeared unrelated to the risk of both NHL and CLL. We conclude that the immunologic alterations associated with a pregnancy have limited, if any, relevance to the etiology of NHL and CLL; changing reproductive pattern is an unlikely contributor to the marked increase in incidence of NHL seen in many populations.

Adult↗