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Alcohol-related cancers in Mediterranean countries.

In most countries bordering the Mediterranean, alcohol ranks second to tobacco as a risk factor for cancer. It is directly implicated in cancer of the mouth, larynx, hypopharynx and esophagus. For all these cancers a dose-response relationship has been demonstrated as well as a combination with the effect of tobacco, the two effects being multiplicative. Alcohol is also responsible for liver cancer developing on alcoholic cirrhosis. In addition, it has been suggested that alcohol consumption may be related to an increased risk of breast cancer.

Alcohol Drinking↗

Therapeutic strategies against epilepsy in Mediterranean countries: a report from an international collaborative survey.

A collaborative survey was performed to compare prescribing strategies for the treatment of epilepsy in Mediterranean countries, based on analysis of 500 questionnaires compiled by physicians in 14 different countries. For partial seizures, carbamazepine was the drug of choice in most countries, whereas the second choice of drug differed widely. For primarily generalized tonic-clonic seizures, valproic acid was usually preferred, but other drugs used widely in some countries included phenobarbital, phenytoin and carbamazepine. Lamotrigine was the most popular second-line drug for primarily generalized tonic-clonic seizures in the European countries. In patients where the initial drug failed, switching to an alternative monotherapy was usually the preferred strategy, but advocates of early use of combination therapy exceeded 30% in the respondents of seven countries. Most respondents, in all countries except Turkey, did not prescribe drugs to prevent recurrence of febrile seizures; however, intermittent prophylaxis with a benzodiazepine was advocated by a considerable number of physicians, and continuous prophylaxis was prescribed by a significant minority of respondents in France, Syria and Tunisia. New drugs were rarely used as first-line treatment due to high cost and inadequate experience. Overall, this survey indicates that there is a wide variability in therapeutic practices between and within countries. This information may be useful for the implementation of national educational activities and for the design of pragmatic trials aimed at comparing different therapeutic strategies.

Adult↗

High resistance to Bacillus sphaericus binary toxin in culex pipiens (Diptera: Culicidae): the complex situation of west Mediterranean countries.

This study was aimed at clarifying the nature of the resistance to Bacillus sphaericus Neide (Bs) that Culex pipiens L. has developed in west Mediterranean countries, France, and Tunisia. Two recessive and sex-linked mutants, sp-1R and sp-2R, were previously detected in southern France. Here, the Tunisian resistance was also shown to involve a single recessive and sex-linked gene that was temporarily named sp-T(R). In addition, sp-1R, sp-2R, and sp-T(R) were shown to separately confer a similar high resistance level (> 5,000-fold) in the homozygous state. Knowing that sp-1R resistance does not alter the binding of Bs binary toxin to its specific receptor, we investigated this character in sp-2RR and sp-T(RR) homozygotes. This was performed by in vitro experiments in which larval brush border membrane fractions (BBMF) were exposed to the 125I-Bin2 toxin of B. sphaericus strain 1593. The toxin-receptor binding was found disrupted by sp-2R but not by sp-T(R). Comparing the binding kinetics among nine Culex pipiens strains of diverse origins revealed that the Bs receptors of sp-1RR and Sp-T(RR) homozygous larvae were displaying the highest affinity toward Bs binary toxins. These results are discussed with regard to alternative assumptions on the dynamics of high Bs-resistance and on the emerging possibilities to test them in a near future.

Animals↗

Changes in diet and mortality from selected cancers in southern Mediterranean countries, 1960-1989.

Mortality trends of breast, colorectal, ovarian and prostate cancer in Spain, Italy, Greece, Yugoslavia, and England and Wales are presented. Figures are discussed with regard to patterns of consumption of fat-containing foods in these countries. An increase of all cancer site mortality is shown in southern European countries, whereas in England and Wales a decrease in ovarian and colorectal cancer among women is observed. Consumption of milk, meat and animal fat products increased in all Mediterranean countries but decreased in England and Wales. Some differences regarding cancer mortality and food consumption patterns among southern European countries are pointed out. This markedly divergent fat consumption pattern between northern and southern Europe appears to antedate and be associated with their substantial differences in ovarian and colorectal cancer mortality trends, and to a lesser extent with breast cancer.

Adult↗

Types of fat intake and body mass index in a Mediterranean country.

BACKGROUND: Although the fatty acid fractions provide similar metabolizable energy, the type of dietary fat consumed could be relevant to the development of obesity. OBJECTIVE: To investigate the relationship between body mass index (BMI), obesity and the consumption of different types of fat and olive oil in a Mediterranean country with high prevalence of obesity, and high intake of monounsaturated fatty acids (MUFA) and olive oil. SUBJECTS: The study was carried out in Spain among 23 289 women and 14 374 men, aged 29-69 years, who were participants of a large European prospective cohort. METHODS: : Information on usual food intake was collected by interviewers by means of a dietary history questionnaire. The association between obesity (BMI >/= 30 kg m2), dietary fat, other dietary patterns and other non-dietary factors were tested using multilinear regression analysis. The ratio of reported energy intake to energy requirement was used as an estimation of dietary underreporting. RESULTS: The association between fatty acid fractions intake (saturated fatty acids (SFA) in women, and MUFA and polyunsaturated fatty acids (PUFA) in both sexes) and BMI was very weak, accounting for less than 1% of variance. All dietary and non-dietary variables accounted for 21% of variance in the measurement of BMI in women and only 6.7% of variance in men. Estimated underreporting of energy intake was 17.5% in obese women and 5.5% in obese men. CONCLUSIONS: The association between consumption of specific types of dietary fat, olive oil and obesity in Spain is not very important. However, because of the cross-sectional design and some level of underreporting of energy intake observed in overweight subjects and overreporting in underweight subjects, systematic bias cannot be completely discarded.

Adipose Tissue↗

Fibrolamellar hepatocellular carcinoma "it is not a ordinary case for Mediterranean countries".

The fibrolamellar variant of hepatocellular carcinoma (HCC) is an uncommon tumour with distinctive clinical and histological features. Although the first case of fibrolamellar hepatocellular carcinoma (FI-HCC) was described by Edmondson in 1956, and later confirmed in five patients by Peters, the majority of reports followed those of Berman et al. and Craig et al. A case of FI-HCC, which is rarely diagnosed in Mediterranean countries including Turkey, is presented in the following report.

Adult↗

"Mints", smells and traditional uses in Thessaloniki (Greece) and other Mediterranean countries.

The herbs of the "mint" group traded in the herbal market of Thessaloniki include eight taxa, members of two genera, Acinos (two species) and Mentha (four species and two hybrids). The essential oil content of 72 samples examined ranged from traces up to 1.69ml/100g of dry weight. Besides three almost scentless samples, the different "mints" are distinguished according to their prominent smell differences, i.e. samples with a pungent, musty and sweet type of smell. As a result, the commercial names attributed to them correspond to a particular type of smell and not to a particular taxon. A number of 29 medicinal uses were recorded in total. In most cases uses were not associated with particular taxa but were rather determined by plant smells. A literature survey has shown that the "mints" traded in Thessaloniki are also used as herbal medicines all over the Mediterranean area, with 67 different therapeutic uses. Among them the 22 uses, already mentioned by Dioscurides, show that the utilization of "mints" as herbal medicines in the Mediterranean countries has a long tradition.

Commerce↗

Relative and population attributable risk of traffic injuries in relation to blood-alcohol levels in a Mediterranean country.

Blood samples were taken from, and interviews were conducted with, 76 persons injured in motor vehicle crashes, and from 126 controls with a home and leisure injury. The analysis was undertaken by modelling the data through conditional logistic regression, controlling for gender- and age-matched variables and other potentially confounding variables, including education and visual acuity. Detectable alcohol levels were associated with a 4.9 relative risk (95% confidence intervals 1.4 to 16.8). The population attributable fraction was about 10% with wide confidence intervals. There was no evidence for a safe threshold in these data. The increased injury risk associated with detectable blood-alcohol levels was disproportionally, albeit non-significantly, elevated among occasional drinkers in comparison to regular drinkers. We conclude that alcohol intake is an important cause of road traffic injuries even in the context of the Mediterranean countries where alcohol is taken in moderation and mainly in the form of wine during meals.

Accidents, Traffic↗

Melanoma/skin cancer screening in a Mediterranean country: results of the Euromelanoma Screening Day Campaign in Greece.

BACKGROUND: Since the year 2000 a melanoma/skin cancer screening campaign has been organized annually in Greece in the context of the Euromelanoma Screening Day Campaign. OBJECTIVES: We aimed to analyse the characteristics of the screened population, to recognize relevant risk factors and to identify the cases of histologically confirmed malignant melanoma (MM) in individuals with suspicious skin lesions. METHODS: An analysis of the completed screening forms from the years 2000-2004 was performed with respect to relevant demographic, epidemiological and clinical data. RESULTS: A total of 9723 individuals were screened, most of whom where below the age of 50 years (71%), female (59%), and of skin phototype II and III (76%). Sunburn during childhood was reported in 47% of participants, while 5% of the screened population had a personal or family history of melanoma. On clinical examination, 14.4% had actinic keratoses, 31.2% had dysplastic nevi, while 6.4% carried a presumptive diagnosis of non-melanoma skin cancer. In the 2003-2004 screening campaign, 19 out of the 171 clinically suspicious lesions were histologically proven to be MM, the majority of which (58%) were 'thin' melanomas (Breslow's thickness of<or=1 mm) of the superficial spreading type. CONCLUSIONS: Our study suggested that, a melanoma/skin cancer screening programme in a Mediterranean country, supported by an intense publicity campaign, attracted many individuals at risk for skin cancer and detected mostly thin melanomas of the superficial spreading type.

Adolescent↗

Spectrum of idiopathic photodermatoses in a Mediterranean country.

BACKGROUND: Idiopathic photodermatoses are considered to be common disorders in the population of northern latitude countries, presumably because of the dominance of more "sun-sensitive" individuals with a light-skinned complexion. The incidence of these disorders in the Mediterranean or tropical countries is often under-appreciated because of the higher degree of perennial presence of sunlight and the prevalence of darker skin-type individuals who are seemingly more resistant to the development of sun sensitivity. METHODS: We performed a retrospective, chart-based review of all patients who were diagnosed with idiopathic photodermatoses at a photodermatology referral center in Athens, Greece, during a period of 10 years. Our aim was to assess the pattern of idiopathic photosensitivity disorders in a Mediterranean country and to determine their epidemiological, clinical, and photobiological profile. RESULTS: A total of 310 patients were referred to our center with symptoms of photosensitivity. One hundred and forty-six patients (47.0%) were diagnosed with an idiopathic photosensitivity disorder by means of history, clinical examination, biochemical screening, histology, and phototesting. The most prevalent disorder was polymorphous light eruption, which was diagnosed in 95 patients (65.0%) of our cohort. Chronic actinic dermatitis occurred in 15 patients (10.2%), solar urticaria in 26 patients (17.8%), actinic prurigo in three patients (2.0%), hydroa vacciniforme in one patient (0.6%) and juvenile spring eruption in six patients (4.1%). CONCLUSIONS: Compared with the results of other studies, the prevalence of idiopathic photodermatoses appears to have a similar trend to that of higher latitude countries. Distinct features in our series include the higher incidence of idiopathic photosensitivity in patients with a fair-skinned complexion (skin types II-III) and the frequent appearance of photo-induced eruptions during sunny weather breaks in the winter period.

Adolescent↗

The epidemiology of osteoporotic fractures in a Mediterranean country.

A population study was carried out over a period of 3 years (1987-1989) to determine the incidence of osteoporotic fractures. Fractures diagnosed in the two acute hospitals of the Maltese Islands were collected and classified according to the fracture site, age, sex, and patient's residence. Fractures in the Maltese Islands can only be diagnosed and adequately treated in these two general hospitals. A total of 8780 fractures were examined. Fracture of the neck of the femur was the most common fracture for which patients were admitted to the hospital. There were twice (1.96) as many females as males hospitalized for this fracture, giving an annual incidence of 262/100,000 females to 134/100,000 males over the age of 45. The fracture incidence was 2-3 times less than that found in North European countries, but was similar to the fracture rates obtained in Mediterranean studies. Fracture radius was the most frequent fracture treated on an outpatients basis. In over 45-year-olds, the female predominance persisted, giving a ratio of 3.65:1. This gave an annual incidence of 452/100,000 females to 150/100,000 males. Again, the fracture incidence obtained was significantly lower than that of Northern European countries. Other long bones showed a similar female to male (F:M) ratio in the cohort over 45 years of age. The bones showing this F:M ratio were the humerus (3.9:1), fibula (1.89:1), and tibia (1.6:1). Below 45 years of age males had more fractures than females for any bone studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Kaposi's sarcoma and non-Hodgkin's lymphoma in European AIDS cases. No excess risk of Kaposi's sarcoma in Mediterranean countries.

Prior to the AIDS epidemic, Kaposi's sarcoma (non-AIDS-KS) in Europe was mainly a disease of elderly Mediterranean men. In 1989 AIDS data from 15 European countries were collected to study proportional trends in AIDS-related Kaposi's sarcoma (AIDS-KS) in order to determine whether specific factors in Southern Europe might be important in the development of KS among AIDS patients. Another AIDS-related cancer, non-Hodgkin's lymphoma (NHL) was included as a malignancy control. Of 22,367 AIDS cases reported, 3,779 (16.9%) were KS and 741 (3.3%) were NHL. A significant, continuous fall in the percentage of AIDS-KS was seen for both homosexual men and other members of exposure groups during the period 1981-89 (p-trend less than 0.0001). The proportion with AIDS-KS decreased from 40.5% in 1983 to 26.5% in 1988 in homosexual men and from 12.2 to 3.6% in other exposure groups, respectively. No significant change was observed in the proportion of NHL cases among any of the risk groups over time, although a tendency towards a slight increase was noted for homosexual men. Comparing proportional trends of KS and NHL geographically, no significant difference was found overall, by time or by exposure group. In conclusion, a specific decline is observed over time for AIDS-KS. However, if geographically-restricted factors are important in the development of non-AIDS-KS in Europe, the same factors do not appear to affect the risk of AIDS-KS.

Acquired Immunodeficiency Syndrome↗