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PubMed2000

Hepatitis B and C viruses in the etiology of hepatocellular carcinoma; a study in Greece using third-generation assays.

OBJECTIVES: The purpose of this study was to describe the role of hepatitis B virus (HBV) and hepatitis C virus (HCV) in the etiology of hepatocellular carcinoma (HCC). METHODS: During a 4-year period from January 1995 to December 1998, blood samples and questionnaire data were obtained from 333 incident cases of HCC from Athens, Greece, as well as from patients in two control groups, also from Athens. Controls were 272 metastatic liver cancer (MLC) patients and 360 patients hospitalized for injuries or eye, ear, nose or throat conditions. Coded sera were tested for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) by third-generation enzyme immunoassays. RESULTS: The odds ratios (with 95% confidence intervals) in logistic regression modeling comparing the HCC cases to the combined control series were 48.8 (30.5-78.3) for the presence of HBsAg and 23.2 (11.4-47.3) for the presence of anti-HCV. The odds ratio for concurrent infection with HBV and HCV was 46.2 (9.9-216.6) compared to infection with neither virus. CONCLUSIONS: Although HBV and HCV are both important causes of HCC in this study population the data do not suggest, neither do they conclusively refute, a super-additive interaction between the two infections in the development of this malignancy. In this population, 58% of HCC cases can be attributed to HBV, 12% to HCV, and 3% to dual infection with these viruses.

Adult↗
PubMed2001

Evidence on the infectious etiology of childhood leukemia: the role of low herd immunity (Greece).

OBJECTIVE: Acute lymphoblastic leukemia (ALL) among children may be a rare outcome of a delayed non-specific infection in situations of overall low herd immunity. We evaluated the hypothesis as to whether newly diagnosed ALL cases, compared to their controls, are characterized by lower herd immunity, as reflected in a more seronegative spectrum to several agents, with the exception of a strongly positive response to a single infectious agent, assumed to trigger ALL. METHODS: The study included 94 incident cases of ALL, from all pediatric hematology-oncology units of Greece, and 94, matched for age and gender, controls hospitalized with minor non-infectious conditions. The past exposure to common infections was assessed using 10 serological markers. RESULTS: There was little evidence for an association of ALL with the serology of any of the studied infectious agents among the very young children. In contrast, among children aged 5 years or older, leukemia was inversely associated with seropositivity to Epstein-Barr virus, human herpes virus-6, Mycoplasma pneumoniae and parvovirus B19. CONCLUSIONS: Among children aged 5 years or older the risk of leukemia may be higher when the low herd immunity for several agents is challenged by late infection from an agent that, as a rule, would attack children at a younger age.

Case-Control Studies↗
PubMed2001

Epidemiology of antibiotic resistance of human nontyphoidal salmonellae in Greece during an 8-year period (1990-1997).

The susceptibility patterns of 1027 nontyphoidal Salmonella strains of human origin, isolated in Greece between 1990 and 1997, were determined by broth microdilution. From 1990 to 1995, the overall incindence of resistance for both Salmonella enteritidis and S. typhimurium increased. From 1996 onwards, a decrease was observed, which was more evident for S. enteritidis. Regarding the other examined serotypes a substantial proportion of resistant isolates was found only for S. Virhow and S.

Anti-Bacterial Agents↗
PubMed2001

Bladder cancer mortality in the Epirus district population (Greece).

OBJECTIVE: To describe the pattern of bladder cancer mortality in the Epirus district population (North-Western Greece) and to establish some relationships with cigarette smoking. PATIENTS AND METHODS: Mortality rates of bladder cancer in the Epirus district population were analysed according to the official data from the Department of Statistics of the University Hospital of Ioannina during the last decade (January 1990-January 2000). Age standardization of death rates was done by the direct method, using the world population as a standard. Fisher's test was used as a significance test for linear regression coefficient in time trend analysis of mortality. RESULTS: The average annual standardized mortality rates from bladder cancer during the study period were 5.23 per 100,000 population (96% Confidence Interval--Cl 4.02-5.63) in males and 1.63 per 100,000 population (96% Confidence Interval--CI 1.18-1.96) in females. Significantly increasing trends of the rates were observed in males (y = 2.421 + 0.231x; p < 0.01), but not in females (y = 1.263 + 0.027x: p > 0.05). The greatest increase in age - specific rates in males was observed in the age group of 70 and more years (y = 25.602 + 3.673x; p < 0.01). In females, all age--specific rates except for the group 60-69 years showed significantly increasing tendency. The increasing tendency of bladder cancer mortality is followed by the rise of per capita cigarette consumption among the Epirus district population. CONCLUSION: Further studies are needed for the explanation of the irregularities in the age-specific rates.

Adolescent↗
PubMed1997

Aggregation of childhood leukemia in geographic areas of Greece.

A total of 872 children aged up to 14 years, who were diagnosed with leukemia in Greece during the decade 1980-89, were allocated by place of residence to the 601 administrative districts of the country. Evaluation of spatial clustering was done using the Potthoff-Whittinghill method, which validly assesses heterogeneity of leukemia risk among districts with variable expected numbers of cases. There was highly significant evidence for spatial clustering occurring particularly among children living in urban and, to a lesser extent, semi-urban areas. The evidence was stronger for children younger than 10 years old, applied also to children in different five-year age groups, and persisted when cases of acute lymphoblastic leukemia were analyzed separately. These findings provide support to the hypothesis that localized environmental exposures could contribute to the etiology of childhood leukemia, but they cannot distinguish between exposures of physical or chemical nature, nor can they exclude socially conditioned patterns of exposure to infectious agents.

Adolescent↗
PubMed2002

Risk factors for myelodysplastic syndromes: a case-control study in Greece.

OBJECTIVE: The etiology of most cases of myelodysplastic syndromes (MDS) has not been elucidated. We have undertaken an investigation in Greece to determine the risk profile of adult de-novo MDS. METHODS: A case-control investigation was conducted in a large Veterans' hospital over a five-year period, covering 84 MDS cases and 84 age- and gender-matched controls with minor non-neoplastic non-infectious conditions from the same study base. Cases and controls reported to the medically trained principal investigator lifestyle characteristics and medical histories, with emphasis on autoimmune disorders and allergic conditions. RESULTS: Alcohol intake and tobacco smoking jointly increased significantly the risk of MDS (odd ratio contrasting ever smokers and regular drinkers of at least one glass per day to never smokers and drinkers of less than one glass per day: 9.54. 95% CI 3.52-25.82) whereas each of these factors alone had limited effect. There was also evidence that autoimmune conditions, but not allergic disorders, were positively associated with MDS risk, irrespective of their occurrence during the recent (less than ten years) or the remote (more than ten years) past (OR 3.34, 95% CI 1.15-9.74; OR 3.50, 95% CI 1.19-10.26, respectively). CONCLUSION: We found evidence that both exogenous and endogenous factors may play a role in the etiology of the so-called "de novo" myelodysplastic syndromes, but these findings need further confirmation.

Age Distribution↗
PubMed2001

Diapause induction and termination in the predatory mite Euseius finlandicus in peach orchards in northern Greece.

The course of diapause induction as well as of diapause termination in females of the predatory mite Euseius (Amblyseius) finlandicus Oudemans (Acari: Phytoseiidae) in Northern Greece was determined by transferring females during winter and early spring from peach trees to a short day (LD 8:16) or a long day (LD 16:8) photoperiod both at 20 degrees C. The first diapause females were found in mid September and by the first week of October all the females were in diapause. The mean number of days required for diapause termination under the short day photoperiod LD 8:16 was gradually reduced from 93.7 days in the beginning of October to less than 20 days in mid February and early March. Under the long day photoperiod of LD 16:8 diapause was terminated in less than 20 days irrespective of the date of collection. These results indicate that by mid February photoperiodic sensitivity of females was lost and diapause was terminated. However, females were found in their overwintering sites until the second half of March, probably because of the prevailing relatively low temperatures and lack of adequate food.

Animals↗
PubMed2003

Air pollution in relation to manifestations of chronic pulmonary disease: a nested case-control study in Athens, Greece.

Chronic pulmonary diseases are a major cause of morbidity and mortality worldwide. The present study is a case-control study nested in a defined cohort, undertaken in Athens, Greece, in order to investigate the association between long-term exposure to ambient air pollution and the development of chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD). Individualized personal exposure assessment has been applied based on long-term residential and occupational subject history linked with geographical air pollution distribution. The first consecutive 3904 participants from the European Prospective Study into Cancer and Nutrition (EPIC), all residents of Athens, were asked to complete a questionnaire. One hundred and sixty-eight participants reporting a history of COPD symptomatology and 168 healthy controls recruited from the same study base individually matched for age and gender, were visited by a physician at their homes for conducting spirometry and a medical interview. Eighty-four of the 168 self-identified as cases were diagnosed as having chronic bronchitis, emphysema or COPD. Logistic regression models were used for statistical evaluation. Cases were more exposed to air pollution compared to controls. The estimated odds ratio (OR) indicates an increase of 37% in the risk of medically confirmed cases per exposure quartile (p = 0.02). When most of the subjects exposed are considered vs. all others, there is a twofold increase in disease risk (p = 0.03). Our findings provide evidence that long-term exposure to air pollution is an important factor in the development of chronic respiratory diseases.

Adult↗
PubMed2003

Epidemiology of human brucellosis in a rural area of north-western Peloponnese in Greece.

A case-control study was conducted in a rural area of Achaia in western Greece to examine the risk factors of brucellosis. The participants in the study were 414 (7.5% of the whole population of the investigated municipality). The cases (n = 140) were defined by clinical symptoms and confirmed by a positive standard agglutination test (SAT). All cases have been diagnosed between January 1997 and March 1999 either by physicians of the Local Health Center or by private practitioners. Two criteria were basic to establish the disease. The first one was clinical symptoms such as fever, fatigue, arthralgia and generalized aches and the second was a titer of SAT at least 1:160. Controls (n = 274) were matched with cases for age and gender in a 1:2 ratio. Approximately collection of controls was performed among those presented to the local Health Center for other diseases. Data were collected by the same physician via a personal interview and analyzed by logistic regression models. The overall incidence of the disease in the region was found to be 1110/100,000. Taking 'no ownership of animals' and 'no contact of animals' as the reference category, the strongest risk factor was trauma during animal delivery with an odds ratio (OR): 24.3; 95% confidence interval (CI): 8.8-67.5 following by absence of stables (OR: 14.4; 95% CI: 4.7-44.1). After application of multivariate stepwise analysis the adjusted risk factors remaining in the model were the place of residence (OR: 1.8; 95% CI: 1.1-3.1), professional occupation with animals (OR: 2.4; 95% CI: 1.2-4.8), absence of stables (OR: 9.1; 95% CI: 2.2-38.7) and trauma during animal delivery (OR: 11.2; 95% CI: 3.2-39.1). Consumption of cheese from pasteurized milk or consumption of cheese matured for over 3 months was found to be a protective factor (OR: 0.27; 95% CI: 0.11-0.67). The detection of brucellosis in animals is essential for the prevention of the disease. In addition efficient preventive measures should be established in order to eliminate the disease.

Animals↗
PubMed2003

Heat-stable antigen serotyping of Campylobacter jejuni strains isolated from hospitalized children in Athens, Greece.

A hundred and twentynine Campylobacter jejuni strains isolated from hospitalized children with gastroenteritis were serotyped by the heat-stable antigen scheme (HS, Penner's method). Isolates belonged to two different periods. Group A contained strains isolated in 1987-1988 and group B contained strains which were isolated in 1998-2000. A variety of serotypes was found. Serotype HS:2 was predominant, followed by the HS:4 complex and HS:1,44. Many clinically important Guillain-Barré Syndrome associated serotypes--like HS:19--were identified. There were no significant differences in the distribution of serotypes between the two periods. The present report provides reference data, as this is the first C. jejuni serotyping study ever made in Greece.

Adolescent↗
PubMed2003

Serological survey of immunity to tetanus in adult population of Northern Halkidiki, Greece.

BACKGROUND: Despite the implementation of the obligatory anti-tetanus vaccination, the tetanus cases in Greece are not eliminated. Because of the increased possibility of Clostridium tetani infection of the Northern Halkidiki population--like any other rural population the evaluation of the immunity to tetanus in the area is considered necessary. METHODS: The tetanus antitoxin levels were determined using the enzyme-linked immunosorbent assay (ELISA) in 405 healthy adult individuals attending the health center for routine laboratory tests. RESULTS: 64.4% of the studied population was found protected (tetanus antitoxin levels > or = 0.1 IU/ml). The percentage of protected people decreased as age increased from 83.3% in the 21-30 to 51.2% in the > 60 age group. 82.1% of the tested males and 52.6% of the tested females had tetanus antitoxin levels > or = 0.1 IU/ml (p < 0.0001). The percentages of immune men (100-66.2% in various age groups) were found higher than those of women (80.8-35.5% in the respective age groups). The geometrical mean titres (GMTs) were 0.44 in all of 261 immune people, 0.53 in 133 immune men and 0.37 in 128 immune women (p = 0.0021). CONCLUSION: The proportion of protection among men over 60 and women over 30 years old is inadequate, the levels of tetanus antitoxin decline with age and a significant difference was found between the proportion of protection of males and females.

Adult↗
PubMed2002

Calcium intake in relation to diet and health indicators in Cretan primary and high school pupils, Greece.

In recent years, the issue of dietary calcium (Ca) requirements is said to have caused more controversy than requirements for any other nutrient. There is little published data on dietary Ca intake levels in Greek children and relationships with other health indicators. Pupils at twenty primary and ten high schools in Crete, Greece, were examined as part of a wider study of the dietary habits and health status of children and adolescents. A total of 1054 children participated: 583 9- to 12-year-olds and 471 14- to 16-year-olds. "High" and "low" Ca intake in each age group was defined using upper and lower Ca intake quartiles for each sex. Multiple regression techniques were used to examine associations after adjustment for energy intake. No statistical association was observed between calcium intake and serum lipoproteins, anthropometric measurements, or physical activity status. Energy-adjusted Ca intakes were positively associated with intakes of protein, saturated fatty acid (SFA), magnesium, phosphorus, vitamin A, and vitamin B2, whereas higher Ca intakes were associated with lower monounsaturated fatty acid (MUFA) and omega-6 fatty acid intakes. In both age groups, pupils with high Ca intake had higher intakes of the food groups "milk and milk products" and "grains and grain products" than those with low Ca intake, although even "high" Ca intake in older female Cretan pupils (with a 75th percentile cut-off of 999 mg/day) may not be at adequate levels.

Adolescent↗
PubMed2005

Fruit and vegetables consumption in relation to health and diet of medical students in Crete, Greece.

In Greece, prevalence of cardiovascular disease has been increasing during the last few decades. From a public health point of view, it is important to identify lifestyle practices associated with cardiovascular disease risk factors. As part of the Clinical Nutrition course at the University of Crete School of Medicine, 507 medical students (292 men, 215 women) were examined during the period 1995-2001. Individual 24-hour dietary recalls were taken, lifestyle questionnaires were completed, and anthropometric and serum lipid measurements were performed. Fruits and vegetables were consumed by 90% of men (370 +/- 275 g/day) and 94% of women (354 +/- 283 g/day). Among non/ex-smokers who ate fruit and vegetables, 41% consumed > or = 400 g/day, compared to 31% of current smokers (p = 0.05). The risk for high-density lipoprotein cholesterol (HDL-C) < 35 mg/dL, low-density lipoprotein cholesterol (LDL-C) > 130 mg/dL, and total cholesterol/HDL-C ratio (TC:HDL-C) > or = 5 decreased with increasing quartile of fruit and vegetables consumption (trend p < 0.01). Fruit and vegetable intake was favorably related to intake of dietary fiber, calcium, magnesium, potassium, folate, and vitamins C, E, A, B1 and B6, and inversely related to saturated and trans fatty acids and cholesterol. Prospective studies should be performed within the general young adult population to assess the long-term effects of fruit and vegetable consumption on chronic disease risk development.

Adult↗
PubMed1990

New hominid skull material from the late Miocene of Macedonia in northern Greece.

Miocene hominoid material is very scarce and has previously only been reported as cranial fragments in the Old World. Here we describe a new specimen of Ouranopithecus macedoniensis, which consists of the right part of the face of an adult male with a portion of the frontal bone, a portion of the left part of the face and the maxilla with complete dentition except the right third molar. The characters of this specimen are not congruent with those of Sivapithecus and the pongids, but are more primitive and plesiomorphic for the recent hominid clade (Gorilla, Pan and Homo). The dental characters differ morphologically and metrically from those of the recent great apes and fit better with Australopithecus afarensis. Ouranopithecus now seems the best candidate forerunner of the Plio-pleistocene Homininae (Australopithecus and Homo). This specimen was discovered in September 1989, in the late Miocene deposits of central Macedonia (G.K., L. de B. and G.B.), and prepared by G.K. in Thessaloniki and G. Mouchelin in Poitiers. It comes from the new locality of Xirochori in the red sandstone of the Nea Messimbria formation. The fossil is the property of the University of Thessaloniki, Greece (catalogue number XIR-1).

Adult↗
PubMed1976

Geographic correlation between mortality from primary hepatic carcinoma and prevalence of hepatitis B surface antigen in Greece.

Average annual age-adjusted mortality rates per 100,000 from primary hepatic carcinoma (PHC) among males for 1971-1973 in the urban and rural areas of the 9 geographical regions of Greece were estimated. Hepatitis-B surface antigen (HBsAg) prevalence by region and area was evaluated in a sample of 22,844 Greek Air Force recruits from all parts of the country. Mortality from PHC was found significantly higher in urban areas (28-30 vs. 18-81) whereas prevalence of HBsAg was higher in rural areas (5-3% vs. 3-90%). Nevertheless further statistical analysis showed that there is a strong correlation between HBsAg prevalence and mortality from PHC, which is higher in rural (r = + 0-88) than in urban (+ 0-57) areas. The latter findings indicate that hepatitis B infection and PHC may be causally related.

Greece↗
PubMed1996

Dietary factors and the risk of endometrial cancer: a case--control study in Greece.

In a hospital-based case-control study of endometrial cancer undertaken in Athens (1992-94), 145 women residents of Greater Athens with confirmed cancer of the endometrium were compared with 298 control patients with orthopaedic diseases. Personal interviews were conducted in the hospital setting, and diet was assessed using a validated semiquantitative food frequency questionnaire. Nutrient intakes for individuals were calculated by multiplying the nutrient intake of a typical portion size for each specified food item by the frequency at which the food was consumed per month and summing these estimates for all food items. Data were modelled through logistic regression, controlling for demographic, reproductive and somatometric risk factors for endometrial cancer as well as for total energy intake. No macronutrient was significantly associated with endometrial cancer risk, but increasing intake of monounsaturated fat, mostly olive oil, by about one standard deviation was associated with a 26% risk reduction (odds ratio = 0.74; 95% confidence interval 0.54-1.3). Among micronutrients, only calcium intake was significantly inversely associated with endometrial cancer risk, whereas there was evidence against retinol and zinc imparting protection against the disease. With respect to food groups, there was weak and non-significant evidence that vegetables are protective, whereas consumption of pulses was positively associated with disease possibly because they contribute substantially in Greece to energy intake in excess of physical activity-dependent requirements.

Case-Control Studies↗
PubMed1997

The risk profile of childhood leukaemia in Greece: a nationwide case-control study.

The risk profile of childhood leukaemia in Greece was studied through a case-control investigation that included all 153 incident cases of the disease, ascertained throughout the country during 1993 and 1994, and two hospital controls for every case matched for gender, age and place of residence. The data were analysed using conditional logistic regression and the associations are expressed in terms of adjusted odds ratios (OR) and their 95% confidence intervals. Cases were born to mothers of a higher standard education, the OR for an increment of four schooling years being 1.48 (1.17-1.87) and had higher birth weight, the OR for an increment of 500g being 1.36 (1.04-1.77). Pet ownership and birth after a pregnancy with anaemia were associated with increased risk, the ORs being 2.18 (1.14-4.16) and 2.60 (1.39-4.86) respectively. From the frequency analyses, indicative inverse associations were found with birth order, household crowding and previous hospitalization with allergic diseases, whereas indicative positive associations were found with diabetes mellitus during pregnancy and with neonatal jaundice. Substantial or significant elevations were not found with respect to maternal smoking and coffee drinking during pregnancy, diagnostic radiography and ultrasonographic examinations or blood transfusions. A significant inverse association with maternal consumption of alcohol could be due to multiple comparisons, but a detrimental effect can probably be excluded. A non-significant positive association with total shots of viral vaccinations and a weak non-significant inverse association with breast feeding were also found. We interpret the findings of this study as being compatible with acute childhood leukaemia being linked with delayed development of herd immunity to fairly common infectious agents, in conjunction with accelerated perinatal and early post-natal growth.

Adolescent↗
PubMed2000

Compliance and viewpoint of glaucoma patients in Greece.

PURPOSE: To document the prevalence of non-compliance and to investigate patients' perceptions concerning glaucoma in a Greek cohort. METHODS: We investigated 100 consecutive patients referred to our glaucoma clinic and already treated for chronic glaucoma. Compliance and patients' insight were ascertained by two independent observers by means of a predetermined questionnaire. All patients were subsequently assessed for their ability to instil their eyedrops accurately. RESULTS: Fifty one per cent of our patients were not aware of the nature of glaucoma, but 80% were afraid it might lead to blindness. Clinically significant non-compliance (more than two doses missed per week) was established in 44% of our patients. Men and those using eyedrops more than 4 times a day were more likely to default. Non-compliant patients exhibited higher mean intraocular pressure (22.9 vs 18.5 mmHg; p > 0.001) and worse visual field loss (10.8 vs 7.0 dB; p = 0.008) compared with compliant patients. Involuntary non-compliance was also common in our group, with only 53% instilling their eye drops accurately. CONCLUSION: Non-compliance is a significant limiting factor in glaucoma therapy in Greece.

Adult↗