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PubMed2006

Natural course of autoimmune thyroiditis after elimination of iodine deficiency in northwestern Greece.

We have previously reported the elimination of iodine deficiency and increasing prevalence of autoimmune thyroiditis (AIT) among schoolchildren in northwestern Greece. This study followed up 29 children (12-18 years old) with AIT for 5 years to track its course in the postiodination era. At diagnosis, thyroid peroxidase autoantibodies (TPOAbs) were positive in 25 children (86%) and became positive in all children during follow-up. Thyroglobulin autoantibodies (TgAbs) were positive in 17 children at diagnosis (59%) and became positive in 3 more children (69%). Both antibody types increased by the end of the observation period (p < 0.005). Regarding thyroid function, 7 children (24%) at diagnosis had subclinical hypothyroidism that persisted and 4 more children developed subclinical hypothyroidism during the study period (38%). Only 5 of these children (45%) had positive TgAbs. There was an increase in thyrotropin (TSH) so that at the end of the study all children had TSH greater than 2.5 mU/L but none developed overt hypothyroidism. Thyroid hypoechogenicity that increased over time was seen in all children, especially in those with subclinical hypothyroidism. In conclusion, both antibody types increased in frequency and level, but TPOAbs were the predominant autoimmunity marker predictive of impending thyroid failure in children with AIT, as was thyroid hypoechogenicity on ultrasound.

Adolescent↗
PubMed1989

Nutrition during pregnancy: the effects of an educational intervention program in Greece.

An intervention program was undertaken to assess dietary habits and the impact of nutrition education among pregnant women in the rural county of Florina, northern Greece. Analysis of dietary habits, nutrient intake, hemoglobin, and serum vitamin concentrations in an intervention and control group indicated that the population was adequately nourished although nutrient intake was below recommended levels for pregnant women. Nutrition counseling was associated with improvements in dietary intake and significantly greater maternal weight gain (p less than 0.05). Mean birth weight was slightly higher in the intervention group but so was the incidence of low birth weight (4.5% vs 3.9%). The prematurity rate was marginally lower in the intervention group (p less than 0.04), as was the number of perinatal deaths (9 vs 11). The results indicate that nutrition counseling during pregnancy can improve dietary intake and maternal weight gain but the mediating influence on low frequency pregnancy outcomes is indeterminate in a population that is not nutritionally at risk.

Adult↗
PubMed1995

Childhood bacterial meningitis in Southwestern Greece: a population-based study.

During the 5-year period from 1990 through 1994, we investigated the incidence of childhood bacterial meningitis (beyond the neonatal period) in southwestern Greece. Thirty-seven cases of bacterial meningitis were identified. Fifty-one percent of the cases were caused by Neisseria meningitidis, 41% by Haemophilus influenzae type b (Hib), and 8% by Streptococcus pneumoniae. Fifty-eight percent and 73% of cases of meningococcal and Hib meningitis, respectively, involved children younger than 2 years of age. The average yearly incidences of meningococcal and Hib meningitis were 9.7 and 8 cases, respectively, per 100,000 children < 5 years of age. The main difference between findings in this study and those in other studies in Western European countries is the lower incidence of Hib meningitis observed in our area. This low incidence of Hib meningitis cannot be attributed to the use of vaccine because the Hib vaccine was first introduced in May 1994 and used infrequently through December 1994.

Adolescent↗
PubMed1998

Assessment of vaccine coverage of schoolchildren in three primary health care areas in rural Crete, Greece.

OBJECTIVE: A school-based immunization survey was used to assess vaccination coverage of a population of children in the region of three Primary Health Care Centres in rural Crete. METHODS: The medical charts of 771 (92.6% of the total) students attending primary schools at the municipalities of Archanes and Hersonissos in the district of Heraklion, and Neapolis in the district of Lasithi, as well as the charts of 438 (68.9% of the total) students attending the secondary school at Neapolis, Lasithi, were obtained. The immunization records from these charts were then compiled and analysed. All information was based on the standardized procedures of the Spili Health Centre, Crete. The age-specific vaccination rate was calculated for children of both primary and secondary school age. RESULTS: The vaccination coverage against diphtheria and tetanus was high (82%, 1035 pupils had received the fifth dose) for both groups of students, while the coverage for pertussis was incomplete, especially the fifth dose, which had been received by only 17% (n = 131) of the children of primary school age and 4.3% (n = 19) of the children of secondary school age. In total, 638 of the children of primary school age (82.7%) and 257 (58.7%) of the children of secondary school age were immunized against measles. The corresponding numbers and the percentages of children of primary and secondary school age immunized against mumps and rubella were: 75.6% (n = 583) and 36.3% (n = 159) for mumps, and 74.7% (n = 576) and 32% (n = 140) for rubella. CONCLUSION: Immunization coverage of schoolchildren in the studied areas is inadequate in a number of instances. This appears to be most pronounced in children of secondary school age. The school-based immunization survey, which is an accurate and inexpensive tool for assessing vaccination coverage, is suggested as an appropriate means for primary health care workers in Greece to develop further and increase the immunization rate.

Adolescent↗
PubMed1991

Establishment of research in primary health care in Greece. Experiences of Greek-Swedish collaboration.

The last few decades have seen great changes in health care and medical care in Greece, as well as in the Greek university system. A new law on health care and medical care has come into force, a new university hospital and new health centres have been built, and a faculty of medicine has been established at Heraklion in Crete. People are speaking of a change of paradigm. Simultaneous with the introduction of the new national health care system, the Department of Family and Social Medicine (DFSM) in Crete started a major project on public health, known as the Primary Health Care and Nutrition Programs (abbreviated as PPD). The purpose was to chart the state of health and living conditions of the Cretan population in the period 1986-1990. Cooperation in research and training began between DFSM and the Dalby Health Sciences Centre, Lund University in 1987. This was natural since there was a shared interest in research into family medicine and social medicine. In addition, a new Health Care Act had come into force in Sweden in 1982. The establishment phase of primary health care started in Sweden at the end of the 1960s. In the 1970s health centres were established, along with research and training in family medicine, in a way that is comparable in many respects to the situation in which Crete found itself a decade later. This paper concerns the organization and implementation of PPD and the research cooperation between Greek and Swedish institutions. This can be seen as an expression of the internationalization of research for which the two universities have striven.

Adolescent↗
PubMed1991

Is health insurance in Greece in need of reform?

This paper aims to assess the relationship between insurance contributions and health benefits in Greece by using information from sickness funds' accounts. The paper argues that the fragmentation of social health insurance, and the particular ways in which sickness funds' financial services are organized, are a major source of inequity and are grossly inefficient. The survival of these systems in the 1990s cannot be explained except on grounds of inertia and corporate resistance.

Financial Management↗
PubMed1989

Risk factors of peripheral arterial occlusive disease: a case-control study in Greece.

A case-control study concerning peripheral arterial occlusive disease (PAOD) was conducted in Athens, Greece. The case series consisted of 100 patients with PAOD as principle diagnosis admitted consecutively to a major teaching hospital in Athens during an 18-month period. The controls were patients hospitalized in the same hospital during the same period as the index cases for conditions requiring minor surgical care. All cases and controls were interviewed by the same person about several socioeconomic, demographic and medical variables; blood pressure and blood glucose values were also recorded. Data were analysed using multiple logistic regression procedures, controlling for age, sex and years of schooling. Tobacco smoking, systolic blood pressure, diabetes mellitus, heavy alcohol drinking and excessive coffee consumption were all strong independent risk factors with eight-fold or more differences in risk. It appears that PAOD as an atherosclerotic disease with low short-term fatality reveals in more contrasting terms the aetiological importance of factors involved in the atherosclerotic process as compared to atherosclerotic conditions with higher short-term fatality like coronary heart disease (CHD) which may also have stronger thrombotic components.

Adult↗
PubMed1992

A case-control study of coronary heart disease in Athens, Greece.

A case-control study of coronary heart disease (CHD) was conducted in Athens, Greece. The case series consisted of 329 patients with electrocardiographically confirmed coronary infarct or a diagnostic coronary arteriogram, or both, who were admitted during a 16-month period to a major teaching hospital. Controls were 570 patients admitted to the same hospital just before or after the CHD cases for minor surgery; eye, ear, nose or minor urological problems; or chest problems definitely shown to be unrelated to CHD. All cases and controls were interviewed in the hospital wards and selected laboratory data were abstracted. The main analysis was done by modelling through multiple logistic regression, controlling for demographic variables as well as for the mutual confounding effects of the investigated risk factors. Obesity, hypertension, diabetes mellitus, elevated blood cholesterol and excessive coffee intake were significant (P < 0.02) independent risk factors with relative risk estimates in the 2- to 3-fold range. Non-significant positive associations were found with respect to tobacco smoking and modest coffee consumption, whereas non-significant negative associations were noted with respect to alcohol intake and regular exercise. A negative association with duration of afternoon siesta was of borderline statistical significance.

Adult↗
PubMed2003

Mortality among pilots and cabin crew in Greece, 1960-1997.

BACKGROUND: Specific health hazards, among them radiation of cosmic origin, have caused some concern among aircrew in civil aviation in recent years. Several cohort studies in Northern countries have investigated mortality and cancer incidence among aircrew. Our goal was to study the pattern of mortality among Greek commercial airline cockpit and cabin crew. METHODS: We performed a retrospective cohort study including 843 Olympic Airways cockpit crew and 1835 cabin attendants. Standardized mortality ratios (SMR) were calculated based on death rates of the Greek population. Duration of employment as a proxy for occupational exposure was used to stratify the cohort. RESULTS: For cockpit crew, the overall SMR was 0.7 (n = 65, 95% CI: 0.5-0.9). The SMR for all cancers was also significantly decreased (n = 17; SMR = 0.6; 95% CI: 0.3-0.9). Most of this reduction was due to a large deficit in lung cancer deaths (SMR = 0.1; 95% CI: 0.0-0.5). Slight but non-significant increases were noted for brain and liver cancer. The SMR for cardiovascular death was close to unity. Among female cabin attendants the SMR for all causes was 0.8 (95% CI: 0.4-1.3). The SMR for all cancers was 0.8 (95% CI: 0.3-1.7). Mortality from breast cancer was not increased. Among male cabin crew, SMR for all causes was 0.5 (95% CI: 0.3-0.9). Analyses according to duration of employment showed no pattern. CONCLUSIONS: In this first-ever occupational cohort study in Greece, Greek aircrew had a low overall and cancer mortality. Due to the small number of events, the strength of our study is limited. The Greek data will be included in a pooled analysis of European studies.

Aerospace Medicine↗
PubMed1993

Penicillin-binding protein 2 genes of chromosomally-mediated penicillin-resistant Neisseria gonorrhoeae from Greece: screening for codon Asp-345A.

Low affinity of penicillin for altered penicillin-binding protein 2 (PBP 2) of Neisseria gonorrhoeae that are chromosomally resistant to penicillin (CMRNG) has been attributed, at least partly to the insertion of an additional aspartic acid (Asp-35A) codon in the penA gene. Oligonucleotide probes were used to detect the presence or absence of this extra amino-acid residue in 34 non-penicillinase producing N. gonorrhoeae with decreased susceptibility to penicillin (MICs 0.25-2 mg/L) and 11 strains sensitive to penicillin (MIC < or = 0.06 mg/L) isolated in Greece and previously characterized by auxotype and serovar. The Asp-345A codon was found in all CMRNG strains as well as in strains with intermediate resistance to penicillin, but was absent from all strains exhibiting an MIC of penicillin of < or = 0.03 mg/L. No association of the Asp-345A insertion to any particular auxotype or serovar was found. These results expand the previously reported correlation between the presence of the Asp-345A codon and reduced sensitivity to penicillin, and shows that this particular mutation is common among epidemiologically distinct CMRNG strains.

Amino Acid Sequence↗
PubMed2004

erm(C) is the predominant genetic determinant for the expression of resistance to macrolides among methicillin-resistant Staphylococcus aureus clinical isolates in Greece.

OBJECTIVES: Macrolide, lincosamide and streptogramin type B (MLS(B)) resistance was determined in Staphylococcus aureus clinical isolates from two University Hospitals. METHODS: Antibiotic resistance was investigated by double disc diffusion and MIC determination. Resistance determinants were detected by PCR and DNA hybridization, while clonal types were identified by pulsed-field gel electrophoresis (PFGE) analysis of SmaI DNA fragments. RESULTS: Among methicillin-susceptible S. aureus (MSSA) isolates, inducible and MS phenotypes were detected, with the predominance of the erm(A) gene, followed by the msr(A) and erm(C) genes. The majority of methicillin-resistant S. aureus (MRSA) isolates expressed the constitutive phenotype and carried the erm(C) gene. PFGE revealed the dissemination of two major clones among the MRSA in both hospitals. CONCLUSIONS: erm(C) is the predominant genetic determinant for the expression of MLS(B) resistance among S. aureus isolates, especially MRSA, in Greece. This is due to the spread of two major clones in the country.

Anti-Bacterial Agents↗
PubMed2000

Colonization of Phlebotomus neglectus (Diptera: Psychodidae), the major vector of visceral leishmaniasis in Greece.

Colonization of Phlebotomus neglectus Tonnoir, the major vector of visceral leishmaniasis, in Greece is reported for the first time. Starting with wild-caught specimens, a small closed colony was established that was maintained for 17 mo or 10 generations. Gonotrophic discordance, stenogamic mating behavior, low fecundity, and dormancy because of low temperature were the most important findings that characterized the colony.

Animal Feed↗
PubMed2006

Molecular and morphological characterization of Aedes albopictus in northwestern Greece and differentiation from Aedes cretinus and Aedes aegypti.

The presence of Aedes albopictus (Skuse) was recently confirmed for the first time in northwestern Greece. This location is within the distribution range of a morphologically similar species, Aedes cretinus Edwards, and is a potentially favorable region for the reintroduction of Aedes aegypti (L.). It was thus compelling to use methods in addition to morphology-based keys to correctly identify specimens badly damaged, rubbed, or otherwise altered in their external characteristics. It was decided to use molecular techniques as a novel and reliable method for differentiating the three Stegomyia species. The nuclear internal transcribed spacer 2 (ITS2) fragments from morphologically identified Ae. albopictus and Ae. cretinus specimens were amplified, and their sequences were compared with those in GenBank for Ae. albopictus, Ae. cretinus, and Ae. aegypti. Also, mitochondrial cytochrome oxidase I (COI) fragments were amplified for Ae. albopictus and Ae. cretinus (so far not available in GenBank) and compared with Ae. aegypti fragments. ITS2 and COI sequences generated in our study were deposited in GenBank and could be useful in future studies of mosquitoes by other research workers.

Aedes↗
PubMed1998

Dietary iron and coronary heart disease risk: a study from Greece.

The authors investigated the association between dietary iron intake and risk of coronary heart disease by means of a case-control study conducted in Athens, Greece, in January 1990 to April 1991. The case series comprised 329 patients with electrocardiographically confirmed first coronary infarct, or a first positive coronary arteriogram, or both, while the controls were 570 patients from the same study base who presented with minor conditions believed to be unrelated to diet. After adjustment by logistic regression for 14 potentially confounding variables of sociodemographic, life-style and nutritional nature, dietary iron intake was found to be positively associated with risk for coronary disease among men aged 60 years or older (odds ratio (OR) for a monthly increment of 50 mg of iron = 1.47, with 95% confidence interval (CI) 1.02-2.12) and particularly women aged 60 years or older (OR for a similar increment of iron = 3.61, with 95% CI 1.45-9.01). Additional adjustment for blood cholesterol, as well as systolic blood pressure and blood glucose level, reduced the iron regression coefficient among older men from 1.47 to 1.36, and among older women from 3.61 to 3.51; however, it is not clear whether the change reflects control of residual confounding or blocking of an intermediate pathway. These data are compatible with the hypothesis that excess dietary iron intake increases the risk of coronary heart disease, particularly among older women and men.

Age Factors↗
PubMed2001

Estimation of doses received by patients undergoing radiological examinations in Greece.

This study deals with the estimation of doses received by patients undergoing radiological examinations in order to establish diagnostic reference levels (DRLs) within the process of optimisation of patients' exposure in Greece. Six large hospitals in Athens were selected and 385 patients made up the sample. The entrance surface doses (ESDs) to patients undertaking five common X ray examinations (chest, cervical spine, lumbar spine AP and LAT, pelvis) were estimated using both thermoluminescence dosemeters (TLDs) attached to the patient's skin and an ionisation chamber for air kerma measurements. Exposure settings and patient's data were recorded. Results concerning the kilovoltage and focus-to-film-distance (FFD) settings and the ESD values were analysed and compared to those recommended by the EU. Discrepancies in the patient doses and techniques used for the examinations studied were found among the different hospitals denoting the importance of establishing a national quality assurance programme and examination protocols to ensure patient doses are kept as low as possible. All the examinations studied fulfilled the EU recommendations except that for the chest where the doses were considerably higher due to the use of low kVP settings.

Adolescent↗
PubMed1999

Economic comparison of nimesulide and diclofenac, and the incidence of adverse events in the treatment of rheumatic disease in Greece.

In Greece a 15-day treatment of rheumatic disease with diclofenac costs 56% more than treatment with nimesulide. This is due to the lower incidence of gastrointestinal adverse events with nimesulide, and the absence of serious gastrointestinal complications leading to hospitalization, which more than offset the higher acquisition cost of nimesulide. The average saving by using nimesulide instead of diclofenac is about US$21 per patient for a 15-day treatment period.

Ambulatory Care↗
PubMed2004

Epidemiology of ankylosing spondylitis in Northwest Greece, 1983-2002.

OBJECTIVE: To investigate the incidence and the prevalence of ankylosing spondylitis (AS) in a defined area of northwest Greece with a total population of about 500,000 inhabitants. METHODS: AS cases were recorded from (i) in- and out-patients referred to the rheumatology clinics of the Ioannina university hospital and the Ioannina general hospital, and (ii) patients referred to private rheumatologists practising in the study area. An incident case was defined as any patient with AS, diagnosed during the period between 1 January 1983 and 31 December 2002 who were resident in the study area for at least 1 yr before the diagnosis. A prevalent case was defined as any patient with AS who was a resident of the study area on 31 December 2002. Diagnosis was based on the modified New York criteria for AS. Population data were based on the 1981, 1991 and 2001 National Censuses. RESULTS: A total of 113 cases were diagnosed among the population of the area studied during the period 1983-2002. Men constituted a 4.65-fold higher number of patients than women, and had a significantly higher mean age at diagnosis. All patients presented bilateral sacroiliitis, 40 patients (35.9%) had peripheral joint involvement and 15 patients presented extra-articular manifestations (13.27%). HLA-B27 antigen was found in 80.5% of our patients. The age-adjusted mean annual incidence rate for the population aged > or =16 yr was 1.5 cases per 10(5) inhabitants [95% confidence interval (CI) 0.4-2.5], and the age-adjusted prevalence rate on 31 December 2002 was 29.5 cases per 10(5) inhabitants (95% CI 25.9-33.1). The incidence rates were higher in the age group 35-44 yr for men and in the age group 25-34 yr for women. CONCLUSION: The incidence and prevalence of AS in the area studied were significantly lower than in other white populations and higher than in the Japanese population.

Adolescent↗
PubMed2005

Epidemiology of primary Sjögren's syndrome in north-west Greece, 1982-2003.

OBJECTIVES: To investigate the incidence and prevalence, as well as the mortality and survival rates, of primary Sjögren's syndrome (pSS) in a defined area of north-west Greece with a population of about 500 000 inhabitants. METHODS: Cases were recorded from the following sources: (i) in- and out-patients referred to the rheumatology clinics of the Ioannina University Hospital and the Ioannina General Hospital; and (ii) patients referred to private rheumatologists practising in the study area. All patients diagnosed between 1 January 1982 and 31 December 2003 who were resident in the study area were included as incident cases. Diagnosis was based on the American-European consensus criteria for SS. Incidence and prevalence rates were calculated as numbers of cases per 10(5) inhabitants. Population data were based on the National Censuses of 1981, 1991 and 2001. RESULTS: A total of 422 incident cases were identified for the study period 1982-2003. Age-adjusted mean annual incidence rate for this period was 5.3 (95% confidence interval [CI] 4.5-6.1) cases per 10(5) adult inhabitants. The female/male ratio of incident cases was about 20/1. The age-adjusted prevalence rate for the adult population was 92.8 (95% CI 83.7-101.9) cases per 10(5) inhabitants on 31 December 2003. The 5-yr survival rate in the incidence cohort was 96.6% and the 10-yr survival rate 92.8%. The standardized mortality ratio in comparison with the general population of the study area was 1.02 (95% CI 0.4-2.0). The main causes of death were cardiovascular diseases and cancer. The occurrence of the disease shows a slightly decreasing, but not statistically significant, trend with time. CONCLUSIONS: The estimated incidence and prevalence of pSS in this study were slightly higher in comparison with data from other studies based on physician-diagnosed cases. The prevalence was significantly lower when compared with the findings of studies based on the examination of a sample of the general population. Mortality rates did not differ significantly between pSS patients and the general population.

Adolescent↗