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PubMed2006

An analysis of factors that influence personal exposure to toluene and xylene in residents of Athens, Greece.

BACKGROUND: Personal exposure to pollutants is influenced by various outdoor and indoor sources. The aim of this study was to evaluate the exposure of Athens citizens to toluene and xylene, excluding exposure from active smoking. METHODS: Passive air samplers were used to monitor volunteers, their homes and various urban sites for one year, resulting in 2400 measurements of toluene and xylene levels. Since both indoor and outdoor pollution contribute significantly to human exposure, volunteers were chosen from occupational groups who spend a lot of time in the streets (traffic policemen, bus drivers and postmen), and from groups who spend more time indoors (teachers and students). Data on individual and house characteristics were obtained using a questionnaire completed at the beginning of the study; a time-location-activity diary was also completed daily by the volunteers in each of the six monitoring campaigns. RESULTS: Average personal toluene exposure varied over the six monitoring campaigns from 53 to 80 microg/m3. Urban and indoor concentrations ranged from 47-84 microg/m3 and 30 - 51 microg/m3, respectively. Average personal xylene exposure varied between 56 and 85 microg/m3 while urban and indoor concentrations ranged from 53-88 microg/m3 and 27-48 microg/m3, respectively. Urban pollution, indoor residential concentrations and personal exposures exhibited the same pattern of variation during the measurement periods. This variation among monitoring campaigns might largely be explained by differences in climate parameters, namely wind speed, humidity and amount of sunlight. CONCLUSION: In Athens, Greece, the time spent outdoors in the city center during work or leisure makes a major contribution to exposure to toluene and xylene among non-smoking citizens. Indoor pollution and means of transportation contribute significantly to individual exposure levels. Other indoor residential characteristics such as recent painting and mode of heating used might also contribute significantly to individual levels. Groups who may be subject to higher exposures (e.g. those who spent more time outdoors because of occupational activities) need to be surveyed and protected against possible adverse health effects.

Adult↗
PubMed2005

Clinical undergraduate training and assessment in primary health care: experiences gained from Crete, Greece.

BACKGROUND: Primary health care (PHC) is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed. METHODS: 284 students' case write-ups from the 6 primary care units (PCUs) where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8) primary qualitative criteria. RESULTS: Internal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale. The number of home visits carried out varied between the various different PCUs (p < 0.001) and more were reported in the write-ups that fulfilled criteria related to the biopsychosocial approach (p < 0.05). Nine quantitative criteria were fulfilled in more than 90% of case reports, but laboratory investigations were reported only in 69.0% of case reports. Statistically significant differences between the PCUs were observed in the fulfilment of criteria related to the community approach, patient assessment and information related to the patient's perception of the illness, but not to those related to aspects of clinical patient management. Differences in reporting laboratory investigations (p < 0.001) are explained by the lack of such facilities in some PCUs. Demographic characteristics of the patients or the students' do not affect the criteria. CONCLUSION: The primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course.

Clinical Laboratory Techniques↗
PubMed1988

Birth order sibship size and socio-economic factors in risk of schizophrenia in Greece.

A case-control study was undertaken to evaluate the effects, if any, of sibship size, birth order and parents' age at birth on the risk of a person's developing schizophrenia. Information was obtained, during an 18-month period, from 221 schizophrenic patients in the only mental-health hospital of the region of Peloponese, Greece, and from an equal number of matched patients. The data were analysed by modelling through logistic regression. No relationship was found between the occurrence of schizophrenia in a patient and either father's or mother's age at patient's birth, or sibship size, or birth order, when demographic and socio-economic variables were accounted for in the analysis. Although patients with schizophrenia were of similar socio-economic status to the comparison patients, they came from families with higher original socio-economic status, a fact which appears to reflect the decline of both schizophrenic and pre-schizophrenic people in the social ladder.

Birth Order↗
PubMed1991

Suicide among adolescents in Greece.

The mean suicide rate among 10-19-year-olds in Greece from 1980 to 1987 was 0.98/100,000 per year (male 1.07, female 0.89). Girls and boys demonstrated the greatest suicide rate at 16 and 19 years, respectively. The combined suicide rate was significantly higher in the rural areas (1.48) than in Athens (0.48) and the other urban areas (0.98). Boys committed suicide more frequently than girls in Athens and other urban areas, whereas girls did so in the rural areas. The suicide rate declined during the last three years of the study. Differences in the methods used and the reported reasons for suicide were observed among the adolescents in Athens, other urban areas, and the rural areas. Greek adolescents appear to be relatively protected from suicide, particularly those who live in the urban areas.

Adolescent↗
PubMed2006

Mediterranean spotted fever in crete, Greece: clinical and therapeutic data of 15 consecutive patients.

The clinical, epidemiological, and therapeutic aspects of 15 patients with Mediterranean spotted fever (MSF), admitted to the Internal Medicine Department of the General Hospital of Sitia (southeastern Crete, Greece) between December 2000 and July 2003, were studied. Diagnosis was made on the basis of clinical signs and symptoms and was confirmed by serology. Of the patients studied, 67% were men and 33% women, with a median age of 52 years (range of 23-76 years). Ten cases (67%) were diagnosed between May and July. Of all the patients, 93% had a history of contact with animals, mainly with sheep (11 patients, 73%), while 53% of them had a history of tick-bite (33%), or reported the presence of ticks in their environment (20%). The typical eschar lesion (tache noir) at the tick-bite site was present in 53% of the patients, while the rash was present in 87% of them. Laboratory findings included leukopenia (47%), thrombocytopenia (54%), elevation of transaminases (80%), hyponatremia (33%), and microscopic hematuria (80%). Four patients (27%) displayed pulmonary infiltrates on chest radiography. All patients were treated with doxycycline (200 mg daily) and recovered rapidly. Renal function deteriorated in one patient with chronic renal failure, but he recovered thereafter.

Adult↗
PubMed2000

Diet and hepatocellular carcinoma: a case-control study in Greece.

We conducted a case-control study in Athens, Greece, to investigate the role of diet in the etiology of hepatocellular carcinoma (HCC). Subjects were 97 incident cases of HCC and 128 controls with no history of cancer admitted for minor ailments in three major hospitals. Information on diet was collected using a validated food frequency questionnaire, and infection with hepatitis virus B (HBV) or C (HCV) was assessed using third-generation assays. Data were modeled through multiple logistic regression. We found no evidence that vegetable intake may reduce the risk of HCC, as reported in earlier investigations. In a multivariate model, only consumption of milk and dairy products appeared to be inversely related to HCC risk (odds ratio = 0.70, 95% confidence interval = 0.49-1.01), but the association was not statistically significant and is likely to have been generated by the multiple comparisons undertaken overall. Our data do not support an association of specific food groups or particular nutrients with the risk of HCC, whether positive or negative for HBV and/or HCV.

Aged↗
PubMed2002

Diet in relation to endometrial cancer risk: a case-control study in Greece.

The risk of endometrial cancer is positively associated with obesity, but the role of specific nutrients remains unclear. Given the distinct characteristics of the Greek diet and the low incidence of this form of cancer among Greek women, we undertook a case-control study to investigate the association of endometrial cancer with food groups and micronutrients. Cases were 84 women with histologically confirmed endometrial cancer and controls were 84 women with intact uterus admitted to the same teaching hospital in Athens, Greece. Consumption of pulses, nuts, and seeds was significantly inversely related to the risk for endometrial cancer. No other significant association with food groups was detected, although a protective effect of added lipids, which in the Greek diet are primarily represented by olive oil, was highly suggestive. Retinol, nicotinic acid, vitamin B- 6, and riboflavin were inversely associated with the disease. These findings need to be replicated, because this was a relatively small study with the statistical power to detect only strong associations between cases and controls; they appear, however, to support a role of diet in the etiology of endometrial cancer.

Aged↗
PubMed2004

Flavonoid intake in relation to lung cancer risk: case-control study among women in Greece.

We have examined the role of three classes of flavonoids that are relatively common in the Greek diet (flavanones, flavan-3-ols, and flavonols) in the etiology of lung cancer using data from a case-control study among women, which was undertaken in Athens, Greece, in the late 1980s. Study subjects were 154 women with lung cancer and 145 control women with orthopedic conditions. Women reported their life-long smoking histories and average frequency of consumption, before onset of present disease, of 47 food items or beverages that collectively covered >80% of the intake of each of the energy-providing nutrients. Intakes of flavonoids were calculated using the recently published U.S. Department of Agriculture database. The data were modeled through logistic regression, controlling for energy intake and smoking. There was no indication that intake of any of the studied flavonoid categories reduces the risk of lung cancer; indeed, for flavonols there was an unexpected positive association. Thus, our study does not indicate a protective effect of flavanones, flavan-3-ols, or flavonols on lung cancer risk and indicates that the factors responsible for the protective effect of vegetables and fruits against the risk of this cancer are unlikely to belong to these flavonoid categories.

Case-Control Studies↗
PubMedDate not supplied

Plus ça change: health sector reforms in Greece.

Changes in the health care sector in Greece since the pathbreaking introduction of the National Health System (NHS) in 1983 have been sluggish. Twenty years after its inception and a series of attempts to reform it, the NHS remains centralized, fragmented in terms of coverage, and quite far removed from its principles of equity and efficiency. Being part of an idiosyncratic welfare state, the health care system is bound to reflect the particularities of Greek society and economy, namely, clientelism, a weak formal-and a thriving informal-economy, the lack of a strong administrative class, a weak labor movement, and strong organized interests. As a result, several ambitious reform plans have failed repeatedly owing to an array of interrelated economic, political, and social factors that channel potential changes toward the trodden path. This constellation creates unfavorable conditions for the introduction and implementation of major reforms.

Greece↗
PubMed2006

The productive performance of public hospital clinics in Greece: a case study.

One of the most important and crucial issues for political and social reasons in Greece is the reorganization of the public sector health system--more precisely, the improvement of public hospital operations, both in terms of the resources they use and the quality and quantity of the services they provide. This study focuses on investigating the productivity performance of 10 clinics in a public hospital located in Thessaloniki. The methodology applied is the data envelopment analysis (DEA) to measure the Malmquist productivity index. The results indicated that the efficiency of the hospital clinics has improved. However, clinics' efficiency varies a lot from month to month. In a competitive environment, these differences need to be addressed, investigated and reduced in order to improve total efficiency.

Efficiency, Organizational↗
PubMed2003

Tele-ophthalmology and conventional ophthalmology using a mobile medical unit in remote Greece.

We evaluated the quality of medical services delivered to remote glaucoma patients from a mobile unit. A four-wheel-drive vehicle containing the necessary equipment visited five different remote locations in Greece. During a three-year prospective study, 1205 patients were examined, of whom 230 had glaucoma. The majority of the subjects were examined by the unit's medical staff using the available instrumentation (e.g. slit-lamp and tonometer), while 56 glaucoma subjects were telemedically examined by consultants at the Patissia General Hospital, in Athens. Control data were obtained from a random sample of 260 urban glaucoma patients. A significantly greater proportion of the remote patients had an inadequate awareness of glaucoma (77%) compared with the urban patients (20%). Significantly more remote patients had poorer compliance (68%) in comparison with urban patients (23%). A significantly larger proportion of the remote patients had high intra-ocular pressure (21%) compared with the urban patients (5%). Technical difficulties occurred in the 13 of the 56 telemedical examinations. Mobile medical units can enhance access to medical services and contribute to the health-care of under-served populations.

Adult↗
PubMed2001

Atmospheric circulation types and daily mortality in Athens, Greece.

We investigated the short-term effects of synoptic and mesoscale atmospheric circulation types on mortality in Athens, Greece. The synoptic patterns in the lower troposphere were classified in 8 a priori defined categories. The mesoscale weather types were classified into 11 categories, using meteorologic parameters from the Athens area surface monitoring network; the daily number of deaths was available for 1987-1991. We applied generalized additive models (GAM), extending Poisson regression, using a LOESS smoother to control for the confounding effects of seasonal patterns. We adjusted for long-term trends, day of the week, ambient particle concentrations, and additional temperature effects. Both classifications, synoptic and mesoscale, explain the daily variation of mortality to a statistically significant degree. The highest daily mortality was observed on days characterized by southeasterly flow [increase 10%; 95% confidence interval (CI), 6.1-13.9% compared to the high-low pressure system), followed by zonal flow (5.8%; 95% CI, 1.8-10%). The high-low pressure system and the northwesterly flow are associated with the lowest mortality. The seasonal patterns are consistent with the annual pattern. For mesoscale categories, in the cold period the highest mortality is observed during days characterized by the easterly flow category (increase 9.4%; 95% CI, 1.0-18.5% compared to flow without the main component). In the warm period, the highest mortality occurs during the strong southerly flow category (8.5% increase; 95% CI, 2.0-15.4% compared again to flow without the main component). Adjusting for ambient particle levels leaves the estimated associations unchanged for the synoptic categories and slightly increases the effects of mesoscale categories. In conclusion, synoptic and mesoscale weather classification is a useful tool for studying the weather-health associations in a warm Mediterranean climate situation.

Adolescent↗
PubMed2000

Urinary incontinence, the hidden health problem of Cretan women: report from a primary care survey in Greece.

OBJECTIVE: The prevalence of urine leakage and care-seeking rates of women 35-75 years of age who visited GPs in two rural areas of Crete were investigated. PARTICIPANTS: All the women who visited their family physician in two primary care units during the period of August to November 1997 (N = 251) were asked if they had experienced symptoms of involuntary urine leakage. A set of questions was addressed to the women who replied positively. RESULTS: Sixty-nine of the 251 women (27.5%) reported symptoms of involuntary urine leakage, and among the incontinent women 11 (15.9%) had previously contacted the health services about their problem. Only six out of thirty (20%) of the incontinent women who report effects on household activities, social and sexual life had contacted a physician about urinary incontinence (UI). The most common reason reported for not consulting the physicians was that the symptoms were not considered serious (35 women out of 58, 60.3%). CONCLUSION: This study points out the need for further awareness programs for both women and healthcare professionals to be set up in countries like Greece, in which a low care-seeking rate of incontinent women has been reported.

Adult↗
PubMed1978

Pederasty, heroism, and the family in classical Greece.

Male homosexuality in Classical Greece found its expression in relationships that conformed to a pederastic model. This socially endorsed hierarchical relationship between older lover and younger beloved can be understood as an integral part of the culture by examining the concept of heroism and of the ideal warrior/hero presented in the poems of Homer and discussed in classical literature. Pederasty functioned to support the family and the continued primacy of masculine values and ethics. There is evidence that by the Classical period, traditional views, formed on the model of the warrior/hero, were undergoing a weakening and confusion. Social critics of the time rediculed these weaknesses and urged a return to values that stressed the dominance and strength of the hero.

Education↗
PubMed1997

Magnus Hirschfeld in Greece.

In 1932 Magnus Hirschfeld, the eminent German sexologist, visited Greece. It was after a long journey that took him round the world, lecturing about the new science he had created. In the Greek capital his unconventional theories concerning an intermediate "third sex" and his ideas about sexual reform became the object of an attack in the local press. Close examination of the debate which followed reveals some interesting points regarding Hirschfeld's approach to publicity and his attempts to foster an emancipation movement for homosexual issues.

Civil Rights↗
PubMed2005

Allergic rhinitis, asthma, and atopy among grape farmers in a rural population in Crete, Greece.

STUDY OBJECTIVE: To measure the prevalence of allergic rhinitis, atopy, and asthma among grape farmers, and to compare the respiratory and atopic status in grape farmers with those of nonexposed control subjects. DESIGN: Cross-sectional study. SETTING: Malevisi region in northern Crete, Greece. SUBJECTS AND METHODS: One hundred twenty grape farmers and 100 control subjects living in the Malevisi region were examined. The protocol comprised a questionnaire, skin prick tests for 16 common allergens, measurement of specific IgE antibodies against 8 allergens, and spirometry before and after bronchodilation. RESULTS: Grape farmers were found to have an excess of respiratory symptoms. The comparison with the control group, after adjusting for age, sex, and smoking status, showed that the differences were statistically significant for rhinorrhea (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.5 to 5.1; p < 0.001), sneezing (OR, 2.2; 95% CI, 1.2 to 4.0; p < 0.01), and nasal itching (OR, 1.9; 95% CI, 1.0 to 3.6; p < 0.05), but were nonsignificant for asthma-related symptoms. In the multiple logistic regression model, grape farmers were found to have increased work-related symptoms, such as sneezing (OR, 2.9; 95% CI, 1.3 to 6.6; p < 01), rhinorrhea (OR, 2.9; 95% CI, 1.3 to 6.6; p < 0.01), cough (OR, 3.7; 95% CI, 1.2 to 11.4; p < 0.05), and dyspnea (OR, 3.8; 95% CI, 1.1 to 1.3; p < 0.05). The prevalence of allergic rhinitis was 40.8% in grape farmers and 26% in control subjects (OR, 2.0; 95% CI, 1.1 to 3.5; p < 0.02). Increased but statistically nonsignificant values of asthma prevalence were found in grape farmers (6.7%) compared with the control group (2.0%). The prevalence of atopy was 64.2% in grape farmers and 38.0% in the control group (OR, 2.2; 95% CI, 1.2 to 3.5; p < 0.01). Mean FEV1 was significantly lower in grape farmers than in control subjects (p < 0.05), after adjusting for age, sex, and smoking status. Bronchial obstruction was reversible in 23 grape farmers (19.2%) and in 6 control subjects (6%; p < 0.01). CONCLUSIONS: The study mainly demonstrated the high prevalence of allergic rhinitis and work-related respiratory symptoms in grape farmers compared to control subjects. It also suggested that grape farming is possibly associated with increased allergic sensitization to specific pollens, low baseline FEV1, and increased bronchial hyper-responsiveness. Further studies are needed to determine the potential risk factors for these disorders among the farming population.

Adult↗
PubMedDate not supplied

A chemometric interpopulation study of the essential oils of Cistus creticus L. growing in Crete (Greece).

The chemical composition of the essential oils of twenty-five populations of Cistus creticus subsp. creticus L. from the island of Crete (Greece) and their interpopulation variability were analysed in detail by GC-MS. 142 compounds were identified representing an average of 56.8-89.8% of the oil composition. The components are represented here by homologous series of monoterpenes, oxygenated monoterpenes, sesquiterpenes, oxygenated sesquiterpenes, diterpenes, labdane diterpenes, aldehydes, alkanes, esters, fatty acids, ketones, and others. Labdane diterpenes were detected and identified in the essential oils and have been found in high percentage composition. The results from the chemical analysis of the essential oils were submitted to chemometric cluster analysis in order to detect some pattern distribution and to identify which constituents can differentiate the groups of individuals. Two main chemotypes (clusters) were well differentiated; the first deals with eight populations of West Crete and the second with the rest of the populations. Cluster analysis based on labdane type diterpenes patterns, proved to be the best chemotype for the examined populations among the other chemical groups.

Aldehydes↗
PubMed2001

Early detection and population monitoring of Ceratitis capitata (Diptera: Tephritidae) in a mixed-fruit orchard in northern Greece.

Population monitoring of the Mediterranean fruit fly,Ceratitis capitata (Wiedemann), was studied in 1998 in a mixed-fruit orchard in northern Greece, using International Pheromone McPhail traps (IPMT) baited with the female targeted attractants ammonium acetate, putrescine, and trimethylamine, and Jackson traps baited with the male specific parapheromone trimedlure. Special emphasis was placed on detecting the low initial adult population resulting from surviving overwintering larvae as early as possible in the spring and early summer. Traps were suspended on various host trees, using trap grid densities of either 15 or 1.5 traps per hectare. The first adults detected were females captured on 24 June in IPMT traps suspended on apricot trees, which are among the earliest maturing hosts in the area. From the end of July, the most effective trap was the IPMT trap placed on peaches, which followed apricots in the fruit ripening sequence. IPMT traps captured predominately females (approximately 80% of the total captures) and by far outperformed Jackson traps in early detection (the first males in Jackson traps were captured in August) as well as in total captures until mid-October. After mid-October, however, more flies were captured in Jackson traps. Comparing the performance of two trap grid densities on apple trees (the common host in the two grids), we found that in the high-density trap grid the first adults were detected 1 wk earlier than in the low-density trap grid. Our findings for this locality suggest that trap type and plant species on which traps are suspended are of key importance in early detection and population monitoring of C. capitata.

Animals↗