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Ethical issues arising in pharmacoepidemiologic research in a community hospital in Crete, Greece.

This paper presents the various issues encountered in planning, designing, performing, and reporting pharmacoepidemiologic research. Five hundred and fifty-one indigent patients insured by Social Care visited the Hospital Pharmacy of Chania General Hospital, and were compared with 551 patients insured under Social Security funds who visited three community pharmacies. The study had no external funding. Before we started the study, we officially sought approval from the Scientific Committee of our Hospital and from the local Pharmaceutical Association. We asked also for approval from the Medical School of the University of Crete. Patient privacy was of great concern in the design and performance of the study. The law in Greece, according to the directives of European Union, affects the way we use records in hospitals and protect patient rights. After these studies were completed, we made proposals to the authorities concerning continuous health education for both patients and health workers. Pharmacoepidemiologic research is difficult in hospitals outside universities or institutions, because of the lack of adequate funding and grants to support research staff.

Bioethics↗

Report on the 1st International Conference of the Hellenic Proteomics Society in Athens, Greece.

The First International Conference of the Hellenic Proteomics Society took place at the Foundation for Biomedical Research of the Academy of Athens, Athens, Greece, 22-25 May 2005. Scientists from about 20 countries attended this conference where proceedings in proteomics methodologies, advances in mass spectrometry, proteomics applications, disease diagnostics and bioinformatics were presented. The relatively small size of the meeting gave the opportunity for the attendees to interact and discuss projects and collaborations. The event was completely financed by companies which exhibited their products and services related to proteomics research.

Computational Biology↗

Incidence of anencephalus and spina bifida in Greece.

A cross-sectional national survey of 11,048 births in the whole of Greece in April 1984 identified 7 cases of anencephalus and 9 of spina bifida. There was thus an incidence of 1.45 neural tube defects per 1,000 total births. This is the first geographically defined population study from southern Europe. In comparison with hospital-based data from the 2 countries on its borders, the Greek rates are rather similar to those of Yugoslavia but much lower than reports from Turkey.

Anencephaly↗

Polycyclic aromatic hydrocarbon contamination and LUMIStox solvent extract toxicity of marine sediments in the North Aegean Sea, Greece.

Organic extracts of surface marine sediment collected from six sites within the bay of Kavala (north Aegean Sea, Greece) were used for determining priority pollutant polycyclic aromatic hydrocarbons (PAHs) and doing toxicity testing. PAH analyses and LUMIStox acute toxicity measurements were conducted in two sediment grain-size fractions: silt/clay (< 63 microm) and sand (63-2000 microm). Sixteen PAH concentrations were found at low- to moderate levels, ranging from 44 to 166 ng/g dry weight in the fine fraction and from 45 to 148 ng/g dry weight in the coarse fraction. Molecular indices revealed that PAHs in the bay sediment originate mainly from pyrolytic sources, but some petroleum influence was also evident. A comparison of sedimentary PAH levels with sediment quality guidelines (SQGs) indicated an absence of acutely toxic concentrations. However, all sediment extracts were found to be toxic with the LUMIStox acute toxicity test, with 15-min EC(50)s in the ranges of 1.0-4.0 and 1.1-4.5 mg of dry sediment/mL for the fine and the coarse fractions, respectively. No significant correlations between EC(50)s and concentrations of individual or total PAHs was found, suggesting that chemical analysis of PAHs alone cannot be considered a reliable indicator of sediment toxicity.

Animals↗

Heavy metals in aquatic plants and sediments from water systems in Macedonia, Greece.

Heavy metal concentrations were surveyed in several species of aquatic macrophytes and in sediments of a lake and four rivers from Macedonia, northern Greece. Acid digestion of sediments and plant material and the subsequent use of atomic absorption spectrometry were the analytical methodologies followed for the analysis. Values were variable within each species while differences in metal contamination among the studied water ecosystem were also found. The lake was less contaminated than the rivers, the contamination of which is dependent on the metal species. Sediment had greater Cu, Pb, and Ni contamination than the aquatic plants, whereas the reverse was the case for Zn, Cd, and Mn. The mean heavy metal contents of the sediments and aquatic plants were in the descending order of Mn > Zn > Ni > Cu > Pb > Cd, whereas in the accumulation of metals by plant tissues, the corresponding order was root > rhizomes > leaf > flower > stem > seed.

Fresh Water↗

Short-term effects of air pollution on childhood respiratory illness in Piraeus, Greece, 1987-1992: nonparametric stochastic dynamic analysis.

The short-term effects of air pollution on childhood respiratory illness are analyzed for the city of Piraeus, Greece during the 1987-1992 period using a distinct, nonparametric, stochastic dynamical system approach. This approach accounts for the time continuity of the phenomenon, including contemporaneous, lagged, and unstructured cumulative effects. It also accounts for the presence of autocorrelation and nonstationary structures in the series and aims at revealing the potentially subtle relationships among the examined pollutants (smoke, CO, SO(2), NO(2), O(3)), meteorological factors (temperature, humidity), and hospital admissions. The approach is also capable of assessing the individual effects of any isolated pollutant, as well as the total effects of all measured pollutants. The study is based upon 4042 hospital admissions, and its results indicate statistically significant effects of each individual pollutant, as well as meteorological factor, on hospital admissions. It is interesting that these effects appear stronger for the second half of the examined period, despite declines in the observed mean concentrations for most pollutants. The total effects of the four pollutants (excluding O(3)) are characterized by multiple coherence measures of 18.37 and 21.66% in the first and second halves of the examined period, respectively, and are confirmed as statistically significant.

Air Pollution↗

Spatially resolved hazard and exposure assessments: an example of lead in soil at Lavrion, Greece.

Spatially resolved hazard assessment (SRHA) and spatially resolved exposure assessment (SREA) are methodologies that have been devised for assessing child exposure to soil containing environmental pollutants. These are based on either a quantitative or a semiquantitative approach. The feasibility of the methodologies has been demonstrated in a study assessing child exposure to Pb accessible in soil at the town of Lavrion in Greece. Using a quantitative approach, both measured and kriged concentrations of Pb in soil are compared with an "established" statutory threshold value. The probabilistic approach gives a refined classification of the contaminated land, since it takes into consideration the uncertainty in both the actual measurement and estimated kriged values. Two exposure assessment models (i.e., IEUBK and HESP) are used as the basis of the quantitative SREA methodologies. The significant correlation between the blood-Pb predictions, using the IEUBK model, and measured concentrations provides a partial validation of the method, because it allows for the uncertainty in the measurements and the lack of some site-specific measurements. The semiquantitative applications of SRHA and SREA incorporate both qualitative information (e.g., land use and dustiness of waste) and quantitative information (e.g., distance from wastes and distance from industry). The significant correlation between the results of these assessments and the measured blood-Pb levels confirms the robust nature of this approach. Successful application of these methodologies could reduce the cost of the assessment and allow areas to be prioritized for further investigation, remediation, or risk management.

Adult↗

Local people's perceptions of planning and management issues in Prespes Lakes National Park, Greece.

Local people's perceptions of planning and management issues were investigated in Prespes Lakes National Park in north-western Greece, 24 years after designation. Ensued conflicts due to lack of local community participation in the designation procedure and in the decision-making process thereafter necessitated this research. Knowledge of the park and its aims, source of information about aims, necessity for works and facilities, attitudes toward certain policies, and effectiveness of administration and management scheme, were studied by means of a questionnaire survey. Respondents were contacted by systematic sampling, which resulted in 201 cases for analysis. Poor knowledge of aims associated with education of people was revealed and the managing authority (the Forest Service) as source of information was mentioned in only one case. Forest recreation facilities and improvement of accessibility were considered of high priority, as means of possible tourism development of the area. A policy of non-intensive agriculture with compensation for loss of income, if the wetlands of the park were in danger, seems acceptable, younger ages accepting it more easily. The need for a new administration and management scheme with the participation of local communities in the decision-making process was revealed, supported mainly by the younger age groups. Finally, the results indicated that the information derived from such research could help managers of protected areas to resolve arising conflicts.

Adult↗

Risk stratification of coronary heart disease in Greece: final results from the CARDIO2000 Epidemiological Study.

BACKGROUND: In past years several risk factors have been associated with the incidence of coronary heart disease. The aim of this study was to investigate the associations between the risk of developing acute coronary syndromes and several risk factors in Greece. METHODS: During 2000-2002, 700 male (59 +/- 10 years old) and 148 female (65 +/- 9 years old) patients with the first event of an acute coronary syndrome were randomly selected from cardiological clinics of all Greek regions. Afterward, 1,078 population-based controls were randomly selected from the same hospitals and matched to the patients by sex and age. Detailed information regarding their medical and psychosocial status and various lifestyle habits related to coronary risk was recorded. RESULTS: The frequency ratio between males and females in the case series of patients was 4:1. The statistical analysis showed that smoking (odds ratio = 1.61, P < 0.001), hypertension (odds ratio = 1.99, P < 0.001), hypercholesterolemia (odds ratio = 3.53, P < 0.001), diabetes mellitus (odds ratio = 2.44, P < 0.01), family history of CHD (odds ratio = 3.19, P < 0.001), exposure to passive cigarette smoking (odds ratio = 1.54, P < 0.01), and depressive episodes (odds ratio = 1.35, P < 0.01) were associated with an increased coronary risk, while physical activity (odds ratio = 0.81, P = 0.01), adoption of Mediterranean diet (odds ratio = 0.80, P < 0.05), and high education (odds ratio = 0.81, P < 0.001) were associated with a significant reduction of the coronary risk. Also, a J-shape association was found between alcohol intake and coronary risk. CONCLUSION: Several emerging lifestyle risk factors (education, depression, diet, passive smoking), in addition to the conventional ones, may contribute to the risk of coronary events in this population.

Aged↗

An overview of classic Kaposi's sarcoma in Greece.

Classic Kaposi's sarcoma (CKS) is a rare tumor affecting mainly the elderly and running a chronic and indolent course. CKS in Greece is not uncommon with an estimated annual incidence of 0.47/1000,000 population, representing 1.35% of all malignant neoplasms. Furthermore, it is characterised by endemic clustering and clinico-epidemiological peculiaritis, supporting the speculation that it may represent a distinct form, the Mediterranean Kaposi's sarcoma, or a subtype of CKS. Kaposi's sarcoma is a multicentric angiomatous tumor of obscure etiopathogenesis and histogenesis. Based on clinical and epidemiological grounds, four distinct forms have been recognized: classic or sporadic, African or endemic, iatrogenic and epidemics or AIDS-associated KS [1].

Greece↗

Prevalence study of different hepatitis markers among pregnant Albanian refugees in Greece.

Aim of the study was to record the prevalence of the various types of viral hepatitis, especially hepatitis B, in pregnant Albanian refugees in Greece. The study comprised 500 pregnant refugees of mean age 25.1 +/- 4.6 years. In Albania, all women had lived in overcrowded houses and had been exposed to non throw-away needles and syringes. Various indices for all hepatitis types were determined. The prevalence of HBsAg was 13.4%, of anti-HBs 53%, of total anti-HBc 70.8%, of anti-HBc IgM 0.4%, of HBeAg 1.2%, of anti-HBe 58.6%, of anti-HAV 96.2%, of anti-HAV IgM 1%, of anti-HDV 0.4%, of anti-HCV 0.6% and of anti-HEV 2%. HBeAg was found positive in 7.5% of HBsAg carriers. Prevalence of hepatitis B markers, as determined by HBsAg and/or anti-HBs and/or total anti-HBc was significantly higher in those with a history of previous hospitalization in Albania (p = 0.01) and those with previous history of hepatitis (p = 0.02). The high prevalence of hepatitis B markers in pregnant Albanian refugees proves that HBV infection is highly endemic in Albania and the possibility of perinatal transmission to the offsprings urges for HBV vaccination programmes. On the other hand improvements in the socioeconomic conditions and the sanitation system in Albania is anticipated to reduce the incidence of HAV and HBV infections.

Adolescent↗

Plasmid profile of penicillinase-producing Neisseria gonorrhoeae in Greece.

Four plasmid patterns were detected in thirteen strains of beta-lactamase-producing Neisseria gonorrhoeae isolated in Greece. Nine strains harbored the 4.5 Mdal penicillin-resistance plasmid with or without a 24.5 Mdal conjugative plasmid, two strains carried the 3.2 Mdal penicillin-resistance plasmid and two strains the new combination of the 3.2 Mdal penicillin-resistance plasmid and the conjugative plasmid (24.5 Mdal). Conjugal transfer experiments between Neisseria gonorrhoeae and E. coli revealed that beta-lactamase activity was acquired by recipient E. coli. The 4.5 and 3.2 Mdal penicillin-resistance plasmids were detected in the transconjugants by agarose gel electrophoresis, but co-transfer of the conjugative plasmid did not occur. The auxotypes and plasmid profiles were also compared.

Acute Disease↗

Familial cystinuria in Ioannina District (Greece). Diagnosis and treatment.

The "Urocystin Test" has been used as a screening procedure for the diagnosis of the incidence of cystinuria in Ioannina District (Northwest Greece). From the 210 investigated urine samples, eight were positive and four of them were also L-cystine stone formers. All positive cases belong to two cystinuric families. The pedigree in village "Kato-Lapsista" is a genetic type of a "completely recessive cystinuria" while the other one in "Marmara" is the type of an "incompletely recessive cystinuria". All patients with L-cystine urolithiasis, except one child, were treated with the drug Thiola.

Adolescent↗

Rheumatoid arthritis in Greece. Manifestations in different age groups.

A high frequency of anti-Ro (SSA) circulating antibodies and lack of HLA-DR4 association described recently in Greek rheumatoid arthritis (RA) patients, prompted us to study their clinical and laboratory picture and compare it with that described in the literature. One hundred and ninety seven patients with definite or classical RA were divided into three groups A, B, and C with age at disease onset below 39, between 40 and 59, and above 60 years respectively. Disease duration below 5 and above 5 years resulted in further division of each group into subgroups 1 and 2. With few exceptions, there were no significant differences between the groups in terms of maximal articular index, lymphadenopathy, splenomegaly, hepatomegaly, frequency of rheumatoid nodules and lowest hematocrit, highest erythrocyte sedimentation rate, and C-reactive protein values. The presence of rheumatoid factor, antinuclear antibodies, cryoglobulins, and elevated levels of globulins, C3 and C4 in patients' sera were not significantly different among the groups. A statistically significant radiologic deterioration was observed with disease duration, common in all groups. Diffuse interstitial lung disease was the most common pulmonary abnormality noted. There were no differences between the groups. Penicillamine toxicity was independent of age and disease duration. This study suggests that the clinical picture of RA in Greece is similar to that in other populations and that there are no significant differences in general among its age groups.

Adult↗

Chromosomal polymorphism in the house mouse (Mus domesticus) of Greece and Yugoslavia.

A total of 88 wild mice from the Dalmatian coast of Yugoslavia (35 animals), and Peloponnesus (30 animals) and Thebes (23 animals) on mainland Greece were karyotyped. In all but five animals Robertsonian translations were found. Mice from the Dalmatian region were homozygous for translocations Rb(5.15), Rb(6.12), Rb(8.17), Rb(9.13), and Rb(10.14); they were homo- or heterozygous for the translocation Rb(1.11). Some of them lacked the Rb(1.11) translocation altogether so that the diploid numbers in the Yugoslavian mice were 2n = 28, 29, 30, or 40. The mice from the vicinity of Olympia in northwestern Peloponnesus were homozygous for eight Robertsonian translocations: Rb(1.3), Rb(2.5), Rb(4.6), Rb(8.12), Rb(9.16), Rb(10.14), Rb(11.17), and Rb(13.15). Their diploid chromosome number was therefore 2n = 24. Mice from the vicinity of Patras in northwest Peloponnesus carried all except the first three of these eight translocations; their chromosome number was 2n = 30. Finally, the mice from Thebes were homozygous for translocations Rb(2.15), Rb(4.14), Rb(5.12), and Rb(10.13). They were homo- or heterozygous for Rb(6.9), Rb(8.17), and Rb(1.11); some mice lacked the Tb(1.11) translocation altogether. The translocations Rb(6.9)40Tu and Rb(10.13)42Tu represent new arm combinations not found previously in any wild mouse population. The remaining translocations have previously been found in different Mediterranean countries, in Scotland and in southern Germany. The findings suggest that each translocation arose only once and that different translocations have come together in different populations to generate a unique karyotype characterizing this population.

Animals↗

Neonatal screening for hypothyroidism in Greece.

One year's experience in screening for congenital hypothyroidism in Greece is reported. Thyroid stimulating hormone (TSH) determination by a radioimmunoassay on dried blood spots was selected as the screening method. During the first year of screening 75,879 newborn infants were tested from Guthrie blood spots taken on the 5th day of life. Eighteen cases of primary congenital hypothyroidism with serum TSH levels over 100 microIU/ml were detected, giving an incidence of 1: 4200. One case had already been diagnosed clinically. Replacement treatment was started between the 22nd and the 50th days of life.

Congenital Hypothyroidism↗

Changes in the prevalence of symptoms of depression and depression across Greece.

This paper reports on the regional prevalence of symptoms of depression and clinical depression (current major depressive episodes) in Greece in the years 1978 and 1984. Prevalence rates were estimated from two extensive, nationwide cross-sectional home surveys on psychosocial issues and health, carried out in four geographical areas: the Greater Athens area, the Greater Thessaloniki area, the rest of the urban areas and rural areas. The methodology used, the sampling procedure and the screening instrument (The Center for Epidemiologic Studies-Depression Scale) were the same in both surveys. Within the 6-year period a substantial increase in the prevalence of symptoms of depression in all geographic areas was observed, with the Athenian respondents expressing a higher number of symptoms of depression than their counterparts from the other areas. The prevalence of current major depressive episodes, according to specific criteria matched with criteria from the DSM III R, was increased in 1984 in Athens and in the rural areas only. We suggest that economic instability between 1978 and 1984 probably contributed to the changes in the rates of depressive disorders.

Adult↗

Help-seeking behaviour for psychiatric disorder from physicians or psychiatrists in Greece.

A nationwide home survey on the identification of possible factors affecting help-seeking behaviour for psychiatric reasons and the prevalence of related psychosocial problems was carried out in a sample of 3754 adults in Greece. Of the total of 570 respondents who reported at the personal interview that they had a serious mental health problem, only 40.8% reported that they had attended a physician or a psychiatrist. A significant proportion of this population (42.5%) had sought the help of a physician. Multivariate analysis revealed two opposite groups of factors determining help-seeking behaviour. Respondents with a serious psychopathological profile (suicidal, depressive and a history of hospitalization) tended to be under psychiatric care. Respondents of lower socio-economic status expressing psychosomatic symptoms were usually the clientelle of physicians. The results are discussed in relation to the need for the development of strategies and techniques in reaching out to mentally ill patients by the appropriate specialists.

Adolescent↗