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Trends in breast cancer incidence in Thrace, Greece: an epidemiological assessment.

PURPOSE: In the present study we describe the epidemiologic characteristics of breast cancer in relation to certain risk factors affecting the two major ethnic groups (Christian Orthodox and Muslims) in the area of Thrace, Greece. METHOD: We performed a cross-sectional study of 196 consecutive patients, aged 28-85 years, with breast cancer, who were referred to our clinic for treatment from January 1986 to June 1998. All patients were submitted to clinical, laboratory and mammographic control. Ultrasound examination and aspiration cytology were performed on cystic-like lesions. Epidemiologic characteristics of the patients were abstracted from medical charts. To evaluate the results, we used the direct standardization method (1995 Eur. Population) and chi2 test. RESULTS: Breast cancer incidence for the two study populations (Christian Orthodox and Muslims) was 20.9 and 2.3/100,000, respectively. We did not notice statistically significant differences in most epidemiologic characteristics between the two subject groups. CONCLUSIONS: Although the cumulative breast cancer incidence in Thrace, Greece is comparatively low, the discrepancy observed in the incidence of Christian Orthodox and Muslims suggests that differences in lifestyle between these two ethnic groups might be determinant factors influencing the prevalence of the disease. The appearance of the disease in a considerable number of young and elderly women, make the extension of modern screening methods in the above-mentioned age groups necessary for the improvement of breast cancer prevention and incidence rates.

Adult↗

A prospective cohort study of the outcome of acute whiplash injury in Greece.

OBJECTIVE: An earlier pilot study suggested that the late whiplash syndrome is uncommon in Greece. The purpose of the present study is to extend the evaluation to a larger sample, and include the prevalence of specific symptoms in the evaluation. METHODS: In a prospective, cohort study, a total of 180 accident victims were consecutively recruited following Emergency ward presentation. A standard questionnaire asked about neck pain, headache, shoulder pain, limb numbness or pain, and dizziness. Accident victims were followed for 6 months. RESULTS: In the initial 4 weeks after the accident, accident victims reported neck pain, headache, shoulder pain, arm numbness or pain, and dizziness, but at 4 weeks more than 90% had recovered from these, the remainder of the subjects having minor symptoms (not requiring therapy), and returning to their pre-accident state of health (which included minor symptoms). There were no cases of chronic disability. CONCLUSION: In Greece, symptoms after an acute whiplash injury are self-limiting, brief, and do not appear to evolve into the so-called late whiplash syndrome.

Acute Disease↗

The prevalence of factor V Leiden as a risk factor for venous thromboembolism in the population of North-Western Greece.

BACKGROUND: Many predisposing factors have been associated with the development of venous thromboembolism. Recently, Factor V Leiden has been described as a common genetic risk factor. The geographic distribution of this genetic abnormality in the general population greatly varies. The prevalence of the Factor V Leiden mutation in Europe is high, particularly in Greece, where according to some authors it is especially high. The purpose of this study was to estimate the prevalence of the Factor V Leiden mutation in patients presenting with at least one episode of venous thromboembolism and to compare it with that of the general population. METHODS: Blood samples were drawn from 388 subjects. 240 healthy blood donors (controls) and 148 unselected patients with a history of one or more episodes of venous thrombosis. DNA analysis was performed using the polymerase chain reaction to amplify the factor V gene exon 10, and to detect the Factor V Leiden point mutation. RESULTS: DNA analysis revealed Factor V Leiden mutations in eight (3.3%) control subjects (seven heterozygous and one homozygous) and in twenty-four (16.2%) patients, (twenty-two heterozygous and two homozygous). The difference between the two groups is statistically significant (p<0.0001; chi2 test). CONCLUSIONS: The prevalence of the Factor V Leiden mutation in the general population of North-Western Greece is 3.3%, which is within the same range as that reported for other European countries. The Factor V Leiden mutation is one of the most important predisposing genetic factors in the development of venous thrombosis and was present in 16.2% of our patients.

Factor V↗

Intentional childhood injuries in Greece 1996-97--data from a population-based Emergency Department Injury Surveillance System (EDISS).

AIM: It has been gradually recognized that intentional injuries among children represent a largely hidden problem in modern societies. With the exception of mortality, population-based data from Greece have not been previously reported. To assess the magnitude and the characteristics of intentional injuries among children aged 0-14 years old, data from the population-based Emergency Department Injury Surveillance System (EDISS) database during the period 1996-97 were used. METHODS: EDISS relies on personal interviews with children and their escorts who contact the emergency departments of three hospitals. Two of these hospitals are district hospitals of the county of Magnesia and the island of Corfu, whereas the other is a university children's hospital that covers the Greater Athens area on alternative days. RESULTS: Among 46.807 children recorded in EDISS, 108 injuries (0.23%) were attributed to acts of violence. Among the 108 intentional injuries, only 11 were caused by firearms or other weapons and only 4 concerned infants. In comparison to unintentional home and leisure injuries, intentional childhood injuries increase significantly with age and they are more common among migrant children. They occur more frequently during late night and early morning hours, they are more serious, and they are more often multiple and concentrated on the head. CONCLUSIONS: In Greece. a problem of violence directed against children does exist. The actual magnitude of this problem is difficult to estimate, but its size appears to be smaller in comparison with that reported in other populations.

Accidents↗

Inflammatory bowel disease in Greece-- a hospital-based clinical study of 172 consecutive patients.

BACKGROUND: It has been suggested that inflammatory bowel disease (IBD) has a milder course in Greece than in other Western countries. The purpose of our study was to assess the clinical picture of IBD in a hospital-based sample of IBD patients, followed from January 1986 to May 2001. MATERIAL/METHODS: Retrospective study of 172 patients: 130 with UC followed up for 1-360 months (mean 66+/-57 months) and 42 with CD for 1-240 months (mean: 51.85+/-63.68 months). RESULTS: 63 UC patients (48%) required hospitalization, 30 (23%) on the first attack; 72 (55%) had left sided colitis and 23 (18%) pancolitis; in 6 cases, (5%), surgical intervention was indicated at onset, 4 (3%) were operated. During FU, 15 patients (11.5%) were operated, 4 (3%) as medical emergencies, 3 (2%) due to colon cancer, the others for intractable colitis or long-standing disease; 5 patients (4%) developed toxic dilation of the colon, 3 (2%) developed colon cancer and 4 (4%) extraintestinal malignancies. 7 patients (5%) died; 2 (1.5%) due to the disease and the remainder for other causes. 19 CD patients (45%) had ileocolitis and 14 (33%) colitis; 22 (52%) needed hospitalization on the first attack. In 12 patients (29%) surgical intervention was required on initial onset or during FU. One patient developed colon cancer (2%). Two men died (5%) from myocardial infarction. CONCLUSIONS: IBD does not have a milder course in Greece than in other European populations.

Adolescent↗

Prevalence and trends in overweight and obesity among children and adolescents in Thessaloniki, Greece.

Obesity is the most prevalent nutrition-related problem in Western societies. Childhood obesity is rapidly emerging as a global epidemic that will have profound public health consequences, as overweight children become overweight adults. The aim of this study was to investigate the prevalence of overweight and obesity among children and adolescents in the city of Thessaloniki, and evaluate the trends in Greece by comparing our results to those of other cross-sectional studies. Data concerning the height and weight of 2,458 schoolchildren aged 6 to 17 years (1,226 6-10 years, 1,232 11-17 years) of 27 primary and secondary public schools were collected. BMI was calculated from the two measurements. In the analyses, the estimations of the prevalence of overweight and obesity are based on recently established international BMI percentile curves and cut-off points from 2-18 years. To investigate the secular trends in obesity in Greece, data of schoolchildren from four successive surveys were used. In the younger group (6-10 yr), the prevalence of overweight and obesity were 25.3% and 5.6%, while for adolescents (11-17 yr) they were 19.0% and 2.6%, respectively. The prevalence was 25.9% and 5.1% for all males, and 19.1% and 3.2% for all females, respectively. As far as trends are concerned, an increase of BMI was found among males when the results of our survey were compared with those of the previous three. However, the trends for girls are different. An increase was found when the results of our study were compared with 1942. A decrease of BMI at most ages was found when the results of our study were compared with those of the 1982 survey, while an increase was recorded only for younger girls below 13 years compared to the 1984-5 study. This study demonstrates that the prevalence of overweight and obesity among schoolchildren is 22.2% and 4.1%, respectively, and has been increasing in the last decades, especially among boys.

Adolescent↗

Factors determining migrant remittances: the case of Greece.

"In this study we review the literature regarding the theory and the empirical evidence regarding migrants' remittance behavior, and we examine the flow and determinants of remittances from Greek migrants for the period 1961 to 1991. The main body of data is for remittances to Greece from Germany, but for some years data are available for remittances from Belgium and Sweden as well. The objective of this study is to test the significance of certain factors in terms of their effects on remittances to Greece. These factors are the migrant's income, the migrant's family income, the rate of unemployment, the rate of interest, the exchange rate, and the rate of inflation. The study attempts to see if these factors have had any effect on the volume of remittances. It also attempts to see if there are any structural changes during this period that affect migrants' propensity to remit."

Belgium↗

Sludge utilisation in agriculture: possibilities and prospects in Greece.

The paper presents the prospects for agricultural utilisation of the sludge produced from wastewater treatment plants in Greece and more specifically focuses on a critical review of the legislatory framework, determination of the quantitative and qualitative characteristics of the produced sludges, examination of possible sludge treatment methods and evaluation of the possibilities and prospects of sludge utilisation on the basis of the above considerations. Landfilling is practically the only route to sludge disposal in Greece. However, in view of the anticipated future restrictions for landfilling within the European Union, this method is clearly a short-term solution and alternative options, including agricultural reuse, must be implemented. The results of a recent survey are presented and discussed in relation to this need.

Agriculture↗

The impact of Greece's childhood tuberculosis screening programme on the epidemiological indexes in the greater Athens area.

SETTING: A hospital referral centre for childhood tuberculosis in Athens. OBJECTIVE: To evaluate the effectiveness of the screening programme implemented for childhood tuberculosis, through its impact on the epidemiological index. DESIGN: In Greece, tuberculosis has been systematically screened for in children since 1991 using the tuberculin skin test. The epidemiological and clinical profiles of all tuberculous children who attended the TB clinic were compared. The children were divided into those who attended in 1982-1990 and those who did so in 1991-1999. RESULTS: A total of 1122 TB patients were screened. In the second period there was an increase in numbers of immigrant children (3% vs. 28%, P = 0.0001), the rate of extra-pulmonary TB decreased (16% vs. 7.6%, P = 0.0001), patients identified by the screening programme increased (19% vs. 57%, P = 0.0001) and the number of symptomatic children fell (51% vs. 16%, P = 0.0001). The proportion of children who failed to attend for regular follow-up was lower during the second period (20% vs. 7%, P = 0.0001). CONCLUSIONS: Our study suggests that the screening programme applied in Greece during the last decade has contributed to the early identification of tuberculosis, and the limitation of symptomatic patients and extrapulmonary TB cases.

Adolescent↗

Epidemiology of systemic lupus erythematosus in northwest Greece 1982-2001.

OBJECTIVE: To investigate the frequency, distribution, and mortality of systemic lupus erythematosus (SLE) in a defined area of northwest Greece. METHODS: Cases were recorded from 3 sources: inpatients and outpatients referred to the rheumatology clinic of the Ioannina University Hospital; inpatients and outpatients referred to the rheumatology clinic of Ioannina General Hospital; and patients referred to private rheumatologists practicing in the study area. All patients identified between January 1, 1982, and December 31, 2001, resident in the study area were included. Diagnosis was confirmed by the 1982 revised criteria of the American College of Rheumatology. Incidence and prevalence rates were calculated as number of cases per hundred thousand inhabitants. Population data were based on the 1981, 1991, and 2001 National Census. RESULTS: A total of 178 cases of SLE were diagnosed during the study period, giving a mean annual incidence rate of 1.9 cases/100,000 inhabitants (95% CI 1.49-2.31). The female/male ratio was 7.4. A significant variation of SLE rates among different districts of the study area was observed. Incidence rates were higher for the urban population. The peak of incidence was observed in the 30-49 age group for both sexes. There was a slight increase in the incidence of SLE during the study period. The 5 year survival rate was 96.8% and the 10 year survival rate was 90.3%. CONCLUSION: We found a relatively low frequency of SLE in northwest Greece. Age at diagnosis was younger than expected.

Adolescent↗

Prevalence of rheumatic diseases in Greece: a cross-sectional population based epidemiological study. The ESORDIG Study.

OBJECTIVE: To assess the prevalence of rheumatic diseases in Greek urban, suburban, and rural adult general populations. METHODS: This cross-sectional population based epidemiological study of rheumatic diseases in Greece (the ESORDIG Study) was conducted on the total adult population of 2 urban, one suburban, and 4 rural communities (8547 subjects), as well as on 2100 out of 5686 randomly selected subjects in one suburban and one rural community. The study, based on a standardized questionnaire and clinical evaluation and laboratory investigation when necessary, was carried out by rheumatologists who visited the target population at their homes. Either established classification criteria or criteria set for the purposes of the study were used for diagnosis. RESULTS: A total of 8740 subjects participated in the study (response rate 82.1%). The overall age and sex adjusted prevalence (prevalence(asa)) of rheumatic diseases in the total target adult population was 26.9% (95% CI 26.2-27.6), being significantly higher among women (33.7%) than men (19.9%) (p < 0.0005). Disease prevalence(asa) increased significantly with age (p < 0.0005). The most common disease group was low back pain, with a prevalence(asa) of 11.0%, followed by symptomatic peripheral osteoarthritis (7.9%), neck pain (4.8%), miscellaneous rheumatic disorders (4.4%), soft tissue rheumatism disorders (4.3%), and inflammatory rheumatic disease (2.1%). Logistic regression analysis showed a significant positive association of female or male sex, age >or= 50 years, high body mass index, low level of education, moderate or heavy alcohol consumption, and high socioeconomic level with particular diseases or disease groups. CONCLUSION: These findings indicate rheumatic diseases are very common in the general adult population of Greece; 26.9% of adults currently have active or chronic rheumatic disease in remission.

Adult↗

Susceptibility of malaria vectors to DDT in Greece; laboratory findings.

The authors describe an investigation, started in Greece in the autumn of 1953 and continued during the 1954 malaria-transmission season, to determine the variations in the susceptibility to DDT of the anophelines in different localities, with a view to establishing a point of departure which would make it possible to follow any future changes in susceptibility to this insecticide.The degree of susceptibility of the mosquitos to DDT was assessed numerically by both the technique of topical application of microdoses of the insecticide and the technique devised by Busvine & Nash. The villages of Elos and Asterion (Skála area), the Agoulinitsa area, and the Georgioupolis (Crete) area were chosen for the investigation.The findings disclosed considerable differences in the susceptibility to DDT in the above areas, but showed that, on the whole, the tendency for anophelines to acquire resistance to DDT seemed to be continuing in Greece.

Animals↗

[Chronic hemodialysis treatment of patients older than 74 years. An epidemiological study in 16 renal units in Northern Greece].

In a review of 1057 patients who started receiving chronic haemodialysis treatment during the last decade in 16 renal units of Northern Greece only 25 patients (2.36%) were found to be older than 74 years at start of haemodialysis treatment. The most common cardiovascular problems in these elderly patients were angina pectoris in 9 and difficulties in fistula creation in 10 patients. Arterial hypertension was present in 7 patients. The first year survival rate was 55.5%. Cardiovascular episodes were the commonest cause of death among the 14 patients who died. We conclude that during the last decade in Northern Greece, among patients receiving chronic haemodialysis treatment, only a few started treatment after the age of 74 years and although they had significant cardiac and vascular problems their first year survival rate was acceptable.

Age Factors↗

Epidemiology of psoriatic arthritis in northwest Greece, 1982-2001.

OBJECTIVE: To investigate the frequency and distribution of psoriatic arthritis (PsA) in a defined area of Northwest Greece, with a population of about 500,000 inhabitants. METHODS: Cases were recorded from in- and outpatients referred to the Rheumatology Clinics of the Ioannina University Hospital and the Ioannina General Hospital, and from patients referred to private rheumatologists practicing in the study area. All patients recorded between January 1, 1982, and December 31, 2001, resident in the study area, were included. The study area included the Department of Epirus and the northern part of the Department of Ionian Islands. Diagnosis was based on the European Spondylarthropathy Study Group criteria. Incidence and prevalence rates were calculated as number of cases per 100,000 inhabitants. Population data were based on the National Census. RESULTS: The age-adjusted prevalence of PsA was 56.6 cases per 100,000 adults on December 31, 2001. A total of 221 new cases were diagnosed during the study period, giving an age-adjusted mean incidence rate of 3.02 cases per 100,000 adults. There was no significant difference observed between men and women. The peak of incidence was observed in the age group 45-64 years. Incidence of diagnosed PsA increased during the study period. CONCLUSION: The incidence and prevalence of PsA in Northwest Greece was roughly half that reported in studies from the US and Northern Europe. This frequency tended to increase in the last decade.

Adolescent↗

[Public health nursing in Greece].

Nursing is considered, as the main profession that covers the need for primary health care services, in cooperation with physicians and other health and social care professions. In Greece, public or community health nursing as a concept exists since the beginning of professional nursing in the seconf half og the 19 century. There are three professions in Greece that are mainly involved in the provision of community nursing services. These are general nurses, health visitors, and midwives. General nurses are educated at degree level in the university or polytechnics. Health visitors and midwives are separate professions, also educated at degree level in polytechnics. Although all general nurses are prepared to work at any level of health care provision, they are not considered adequately educated to perform their full role in the community, with just their existing knowledge and experience. It is therefore essencial that further education or specialization is needed, in order that they could practice independently or as members of the primary health care teams effectively, and be able to respond to public health needs of the population

Education, Nursing↗

Organ and tissue transplantation in Greece: the law and an insight into the social context.

Advances in biological sciences and medicine have revolutionized current practice and opened new horizons. Tissue and organ transplantation is a miracle and an action of love and sacrifice for the sake of fellow human beings. Organ transplantation has been commonplace over the last decade but Greece still remains the lowest numerically among European countries in this field because of the lack of organ donation although it is highest in traffic accidents. Despite this, the legal framework regulating transplantation was enacted late in comparison to other European countries, and was not the only obstacle to the development of organ donation. Several other factors such as philosophy, culture, traditional and religious attitudes, lack of public information and lack of the relevant social fabric, have all contributed to the current sad situation. This article aims to present a critical view on the evolution of the legal framework in the field of tissue and organ transplantation in Greece. Issues that still deter organ donation are discussed along with an insight into the current situation in the Greek social context in order to make a constructive contribution to future perspectives.

Greece↗

Epidemiology of rubella and congenital rubella syndrome in Greece, 1994-2003.

In 1993, there was a large epidemic of rubella and congenital rubella syndrome (CRS) in Greece. The epidemiology of rubella and CRS after 1993 is described in this paper using information from surveillance data and published studies and reports. The incidence of rubella fell sharply after 1993, but a smaller outbreak occurred in 1999, mainly in young adults, and four CRS cases (4.0 per 100,000 live births) were recorded. A very high proportion of the child population in Greece are currently vaccinated for rubella, while teenagers are inadequately covered (60-80% in different studies). A substantial proportion of women of childbearing age are susceptible to rubella (10-20% in urban areas). This could lead to local or more extended outbreaks. This situation shows that a comprehensive preventive policy should be implemented.

Adolescent↗

Comparison of C-erbB2 (HER-2/Neu) immunohistochemistry results on invasive breast carcinomas. Experience of 2 Pathology departments in Turkey and Greece.

OBJECTIVE: To compare c-erbB2 (HER-2/Neu) immunohistochemical staining results obtained in 2 pathology departments and evaluate the reproducibility of staining and assessments. STUDY DESIGN: Ninety primary invasive ductal carcinoma cases constituted the material of this study. For concordant assessment, serial sections from the same tissue blocks were prepared in both Turkey and Greece and were sent to each other. Evaluation of c-erbB2 (HER-2/Neu) staining was done independently in 2 departments by experienced pathologists. Stained slides were evaluated semiquantitatively in Turkey and both semiquantitatively and automatically in Greece. RESULTS: There was complete agreement on staining density in 58 (64.4%) cases in both centers. In 15 cases there were major discordances in staining degrees, and in 17 cases there was a major discordance. Hypothetical treatment decisions based on these results showed that 82% of patients would have been handled the same way. CONCLUSION: Comparison of immunostaining patterns performed at 2 centers provided valuable data that may be used in the development of quality assurance policies. The present study showed the usefulness of multicenter comparative studies in initiating the development of guidelines.

Breast Neoplasms↗