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PubMed2005

The epidemiology of epilepsy in Europe - a systematic review.

Population-based epidemiological studies on epilepsy are available mainly from the UK and the Nordic, Baltic and western Mediterranean countries. No studies were identified from large areas of Europe, especially from the former eastern Europe (except the Baltic countries) and the eastern Mediterranean countries. Based on the prevalence of epilepsy in different studies and accounting for incomplete case identification the estimated number of children and adolescents in Europe with active epilepsy is 0.9 million (prevalence 4.5-5.0 per 1000), 1.9 million in ages 20-64 years (prevalence six per 1000) and 0.6 million in ages 65 years and older (prevalence seven per 1000). Approximately 20-30% of the epilepsy population have more than one seizure per month. Based on the age-specific incidence rates in European studies, the estimated number of new cases per year amongst European children and adolescents is 130,000 (incidence rate 70 per 100,000), 96,000 in adults 20-64 years (incidence rate 30 per 100,000) and 85,000 in the elderly 65 years and older (incidence 100 per 100,000). The proportion of both new and established cases with epilepsy in the young, adults and elderly in individual countries may differ substantially from total European distribution because of differences in age structure.

Age Distribution↗
PubMed2005

Converging patterns of colorectal cancer mortality in Europe.

Trends in mortality rates from colorectal cancer during the second half of the 20th century were analysed for 21 European countries and grouped in three broad European regions. For each gender, age-standardised (world standard population) mortality rates were computed by the direct method, and joinpoint analysis was used to identify significant changes in rates. A favourable pattern in colorectal cancer mortality for both genders was observed in most European countries from the 1990s onwards. Colorectal cancer mortality rates were still in the upward direction in some Eastern European countries, as well as in some Mediterranean countries. Mortality rates tended to converge at around 20/100000 in men and around 11/100000 in women. This converging pattern is even clearer when colorectal mortality rates are examined in three broad European regions. Similar mortality rates over recent calendar years have been reached by countries where mortality has been decreasing in recent decades and in those countries (mainly Eastern European and Mediterranean countries) which have experienced a recent levelling-off and decrease. If recent trends are maintained, colorectal cancer mortality is likely to decline further in Europe in the current decade.

Adult↗
PubMed1990

[Sporadic kala-azar in the Black Sea region].

Visceral leishmaniasis is a disease, also called kala-azar, caused by species of Leishmania, which is known as intracellular parasite. Disease show a broad spectrum on the clinical symptoms. This infection is seen classically in Mediterranean countries, in same Asian countries between 30th-48th north parallels and in South America. In Mediterranean countries the parasite causing the visceral Leishmaniasis is Leishmania donovani. Turkey is also a Mediterranean country taking place between 36th-42nd north parallels.

Child, Preschool↗
PubMed1989

The Mediterranean diet: protective or simply non-toxic?

There is clear evidence that populations living in Mediterranean countries enjoy a longer life expectancy than Northern Europeans. Genetic or racial factors do not explain these societal differences as revealed by migrant studies. The major causes of death in affluent societies, cardiovascular disease, cancers and digestive disorders, show markedly different incidence rates in different European countries. These differences seem to depend on the varied dietary patterns in Europe but the classic lipid hypothesis alone fails to explain the differing rates of coronary heart disease. Limiting the free radical damage to cholesterol thereby reducing the induction of atherosclerosis is a plausible explanation for the finding that some countries, e.g. France as well as Mediterranean countries with their high fruit and vegetable consumption, are well protected against coronary heart disease. The Mediterranean diet is low in saturated fat content but contains either a high or low content of starch and total fat. A high fat diet reveals the genetically determined individual propensity to obesity, e.g. in Greece, but does not predispose to cardiovascular disease or mitigate against the cancer protective properties derived from the vegetable component of the Greek diet. Studies in the Mediterranean area highlight the considerable dietary diversity which is possible for achieving longevity.

Albania↗
PubMed2004

The benefit of the Mediterranean diet--considerations to modify German food patterns.

BACKGROUND: In the early 1960s the occurrence of coronary heart diseases and cancer in Mediterranean countries was much lower than in other industrialised countries. The life expectancy of the Mediterranean population was higher, although medical care did not meet western standards. Studies showed that those findings were due to the Mediterranean diet and life style [1, 2]. AIM OF THE STUDY: is to investigate whether these findings are transferable to the present German diet and life style in order to take advantage of the positive effects of the Mediterranean diet and life style against the background of the still present high rate of coronary heart diseases and cancer in Germany. METHOD: Regarding the aim of the study we compared food consumption data from different years between 1961 and 1999 of four Mediterranean countries and Germany. The data for this comparison were taken from data of DAta Food NEtworking (DAFNE) based on Household Budget Surveys (HBS), and data of Food Balance Sheets (FBS). RESULTS: Compared to Mediterranean residents Germans eat less plant food, especially vegetables, cereals and pulses were consumed in lower amounts, whereas animal products were consumed in higher amounts at each meal. CONCLUSION: A transformation of components of the Mediterranean diet to the German diet is theoretically possible considering the availability of food. Nutrition has to be seen holistically and therefore the lifestyle, cultural and social aspects have to be taken into account. These aspects can help prevent the occurrence of coronary heart diseases and cancer. From a scientific point of view there is a further need of research focused on lifestyle in the context of food patterns in different European countries.

Coronary Disease↗
PubMed1990

Type 3 poliovirus/Finland/1984 is genetically related to common Mediterranean strains.

Strains of poliovirus type 3 isolated in Finland in 1984 and 1985 (P3/Fin/84) are known to differ considerably from the type 3 vaccine strains in both nucleotide sequence and antigenic properties. In the search for the origin of the outbreak we first tested 80 type 3 strains that had been isolated elsewhere in the world during the years 1953 to 1986. An oligonucleotide probe complementary to a highly variable 17 nucleotide interval in the 5' non-coding region of the genomic RNA of P3/Fin/84 reacted with five strains. Also it was revealed that two of the latter five strains were related to the P3/Fin/84 strains in two separate genomic regions compared after partial RNA sequencing. One of them was isolated in Switzerland in 1980 and the other in Turkey in 1981. The Swiss strain was from a patient who had recently returned from a journey to various Mediterranean countries. Consequently, 16 other strains isolated in the late 1970s and early 1980s in Europe or in the Mediterranean countries were studied in detail by partial genomic sequencing and with neutralizing monoclonal antibodies. Two separate regions of the genome were compared by sequencing and corresponding dendrograms were constructed. The Switzerland and Turkey strains were found to be the strains most closely related to the viruses of the 1984 Finland epidemic. These results indicate that type 3 poliovirus strains related to P3/Fin/84 had been circulating in Mediterranean countries since the late 1970s.

Amino Acid Sequence↗
PubMed1995

Characterization of the lung cancer epidemic in the European Union (1970-1990).

To characterize the situation of the lung cancer epidemic in the former European Community countries, we analyzed mortality time trends between 1970 and 1990, and by using Poisson log-linear models, we compared patterns of evolution between Mediterranean and non-Mediterranean countries. To ascertain the course traced by the cohort effect and the inflection points marking shifts in trend in the epidemic, we made use of invariant parameters from age-period-cohort models (net drift, curvature) and restricted slope range for cohort effect. Regarding men, whereas non-Mediterranean countries had already initiated the downward phase of the process, the Mediterranean countries, with the single exception of Italy, proved to be entirely in the development stage. Women evinced a different pattern of evolution in regard to both rate magnitudes and trend behavior. Apart from Spain and Greece, a sharp rise in adjusted and specific rates was observed for all countries.

Adult↗
PubMed1996

Migration and child health: the Dutch experience.

UNLABELLED: Nearly one million of the fifteen million inhabitants of the Netherlands are directly descending from migrant parents. Of these inhabitants, 75% come from former colonies (Surinam and the Netherlands Antilles) and Mediterranean countries like Turkey and Morocco. The mortality rate of Turkish and Moroccan children under 15 years of age is two to three times higher compared to Dutch children. Main causes are perinatal death (including congenital malformations), accidents and drowning, infectious diseases and death during holidays in the country of origin. Inequalities in health between the migrant and Dutch children are demonstrated in several surveys conducted at both national and local levels. Apart from socio-economic differences, this can be attributed to three main causes; different pathology due to imported infectious diseases or inherited disorders, different life style and socio-cultural factors. The cumulative factor explains the differences in health, comparable with several other countries in Europe where migrants from Mediterranean countries and former colonies live. CONCLUSION: Migration has an increasing impact on the daily practice of Dutch paediatricians as well as elsewhere in Europe. Inclusion of intercultural and international aspects of health in the curriculum of the medical paediatric education is paramount.

Child↗
PubMed1997

Geographic distribution and regional origin of 272 cystic fibrosis mutations in European populations. The Biomed CF Mutation Analysis Consortium.

The geographic distribution of 272 cystic fibrosis (CF) mutations has been studied by assessing the origin of 27,177 CF chromosomes from 29 European countries and three countries from the North of Africa. The most common mutations are delta F308 (66.8%), G542X (2.6%), N1303K (1.6%), G551D (1.5%) and W1282X (1.0%). The delta F508 mutation has the highest frequency in Denmark (87.2%) and the lowest in Algeria (26.3%). Mutation G542X is common in the Mediterranean countries, with a mean frequency of 6.1%. N1303K is found in most of the western and Mediterranean countries and has the highest frequency in Tunisia (17.2%). The wide distribution of these mutations suggests an ancient origin. G551D is common in north-west and central Europe, but is uncommon in other parts of Europe. W1282X has the highest frequency in Israel (36.2%), being also common in most Mediterranean countries and north Africa. Seventeen mutation have frequencies between 0.1 and 0.9%, 1717-1G-->A (0.83%), R553X (0.75%), R1162X (0.51%), 621 + 1G-->T (0.54%) and 2183AA-->G (0.36%), being the most common ones. Some mutations reach relatively high frequencies in some extended geographic regions, such as mutation 394delTT in northern Europe (1.1-28.8%), R117H in northwestern Europe (1.3-3.0%), R553X in central Europe (1.1-24.4%), 1717-1G-->A in Belgium and France (1.1-5.3%), and 2183AA-->G in Italy and Greece (3.2%). Other mutations are only common in small regions: T338I (Sardinia), 711 + 1G-->T (Tunisia), R1162X (Algeria and north of Italy), 1609delCA (east of Spain), 1811 + 1.6kbA-->G (southeastern Spain), R1066C (Portugal), S549R (Algeria), R334W (Crete), 621 + 1G-->T (Central Greece), 3849 + 10kbC-->T (Israel), 2789 + 5G-->A (south of Greece), 451 + 1G--A (Israel), R347P (south of Bulgaria), 1677delTA (south of Bulgaria and Turkey), G85E (south of Greece), R347H (Turkey), 3905insT (Switzerland), 1078delT (Brittany), 1898 + 1G-->A (Wales), A455E (The Netherlands), delta I507 (Brittany), 3659delC (Sweden) and R560T (northern Ireland). Most of these mutations must have an origin and diffusion in the specific European population subgroup. Overall 55 mutations are common in one or several countries or regions of Europe and 217 mutations are rare with relative frequencies of lower than 1% in any of these regions and countries. This information might facilitate mutation analysis of CF in the different regions of Europe.

Africa, Northern↗
PubMed1998

[Dog tourism and import: an inquiry in Germany on the extent as well as on the spectrum and preference of countries of residence and origin respectively].

A survey was conducted among practicing veterinarians and at pet clinics in Germany in order to estimate the extent of tourism with dogs and import of dogs and to determine the range and preference of the foreign countries involved. The survey covered the years from 1985 to 1995 and included 5240 dogs, of which 4567 (87.2%) were born in Germany and 673 (12.8%) were born abroad. Among the latter, 263 (39.1%) originated from Mediterranean countries and Portugal, 344 (51.1%) were born in other European countries and 66 (9.8%) were from non-European countries. Of all 5240 dogs surveyed, 2894 (55.2%) had been taken abroad at least once between 1985 and 1995. Of these, 2424 (53.1%) were born in Germany, 470 (69.8%) were born abroad. Of the 2894 dogs taken abroad, 1929 (66.7%) travelled to Mediterranean countries or Portugal and 1152 of these had additional travels to other countries as well. The spectrum of all countries travelled to was very broad, but numerous dogs were taken regularly, repeatedly and exclusively to Austria, Switzerland, Italy, Spain or France. Other countries were visited only once for the majority of dogs. The analysis of the annual survey data revealed a steady increase of dogs along on trips from Germany to other countries, rising from 31.1% in 1990 to 40.8% in 1994. In any of these years, always more than 56% of these dogs were taken to Mediterranean countries.

Africa↗
PubMed2005

Clinical and molecular characterization of chronic hepatitis B in Albania: a country that is still highly endemic for HBV infection.

Albania is a Mediterranean country, still with a high endemicity level of hepatitis B virus (HBV) infection. The chronic hepatitis B profile was characterized in this geographical area and used as a model to investigate the impact of endemicity level on the prevalence of the two major forms of chronic hepatitis B (HBeAg-positive and HBeAg-negative chronic hepatitis B). A cross-sectional study was conducted among 62 chronic hepatitis B patients consecutively admitted to the most important tertiary health care center for the diagnosis and treatment of liver disease in Albania. HBV-DNA was measured with an in-house PCR with a sensitivity of 10(4) copies/ml which uses primers encompassing the pre-core/core region. PCR products were subjected to sequencing and oligohybridization assay. Of the 62 patients, 75.8% had HBeAg-negative chronic hepatitis B. Genotype D was found in all 39 patients with detectable HBV viremia, for whom the heterogeneity of the region modulating HBeAg expression was assessed. Basic core promoter (BCP) mutations (1762/1764) were observed more often in anti-HBe-positive and older patients. In more than 90% of the HBeAg-negative chronic hepatitis B patients with detectable viremia, HBV that carries the G to A pre-core mutation at nucleotide 1896 was found. Patients with HBeAg-positive chronic hepatitis B were younger than HBeAg-negative chronic hepatitis B patients, and for symptomatic and asymptomatic liver-disease patients, the age of peak prevalence was at least 10 years lower for HBeAg-positive chronic hepatitis B patients. In conclusion, the virological and clinical pattern of chronic hepatitis B in Albania is similar to that observed in other Mediterranean countries; it seems to be independent of the HBV endemicity level.

Adult↗
PubMed2003

Two cases of glucose-6-phosphate dehydrogenase-deficient Nepalese belonging to the G6PD Mediterranean-type, not India-Pakistan sub-type but Mediterranean-Middle East sub-type.

In Nepal, we tested 300 males for glucose-6-phosphate dehydrogenase (G6PD) activity. Two subjects were G6PD deficient (0.67%). Compared with normal controls, G6PD activity was 12% and 26%, respectively. The hemoglobin concentration of these two subjects was normal. We extracted genomic DNA from whole blood and read all sequences of G6PD. Both subjects had the same replacement of 563C>T, which was classified as G6PD Mediterranean. The amino acid might change from Ser to Phe at codon 188. These subjects also had a replacement of 1311C>T, which caused no replacement of an amino acid. A similar replacement pattern of G6PD Mediterranean is described from persons living in Mediterranean countries and Middle East countries. However, G6PD Mediterranean found in India and Pakistan has no replacement at nucleotide 1311. Thus, these two subjects in Kathmandu, Nepal, would be closer to people in Middle East countries than people in India. This is the first study of molecular analysis for G6PD deficiency in Nepal.

Adolescent↗
PubMed2000

Cancer and Mediterranean dietary traditions.

The incidence of cancer overall in Mediterranean countries is lower than in Scandinavian countries, the United Kingdom, and the United States. This is mostly accounted for by the lower incidence among Mediterranean countries of cancer of the large bowel, breast, endometrium, and prostate. These forms of cancer have been linked to dietary factors, particularly low consumption of vegetables and fruit, and to a certain extent, high consumption of meat. The traditional Mediterranean diet is characterized by high consumption of foods of plant origin, relatively low consumption of red meat, and high consumption of olive oil, which in several studies has been reported to be more beneficial against cancer than other forms of added lipids. By taking into account the established or presumed nutritional causation of major forms of cancer and the composition of the traditional Mediterranean diet, estimates can be derived concerning the fraction of cancer occurrence in highly developed Western countries that could be attributed to their diets in comparison with the healthy traditional Mediterranean diet. Although estimates can only be crude, it can be calculated that up to 25% of the incidence of colorectal cancer, approximately 15% of the incidence of breast cancer, and approximately 10% of the incidence of prostate, pancreas, and endometrial cancer could be prevented if the populations of highly developed Western countries could shift to the traditional healthy Mediterranean diet.

Breast Neoplasms↗
PubMed1994

[Mortality from breast cancer in the European Community (1970-1985)].

BACKGROUND: A comparative study of mortality by breast cancer in the different countries of the European Community was carried out. METHODS: Deaths by breast cancer in women over the age of 14 from 1970-1985 were considered. The data were collected from the Statistical Yearbook of the World Health Organization. Poisson log-lineal models were used to calculate the relative risk and evaluate the temporary tendency of each country. Lastly a different model was established for each age group (15-44, 45-64, > 65) to know their evolution over time in the different countries. RESULTS: A north-south pattern was observed in the mortality by this tumor. Considered altogether, the Mediterranean countries present a mortality defect of 45% with respect to the remaining countries. The global tendency is slightly upwards in all the countries. This increase is significantly greater in the Mediterranean countries (7% every 5 years). Analysis by age showed that this increase is produced in the group of women over the age of 44 years. CONCLUSIONS: The increase in death by breast cancer in the European countries continues to rise despite the existing detection programs and improvements in survival. The differences among the countries tend to decrease making the incidence of breast cancer in the north and south of Europe ever more similar.

Actuarial Analysis↗
PubMed1991

[A descriptive epidemiological study of ulcerative colitis in a community hospital (1985-1989)].

BACKGROUND: The incidence of ulcerative colitis (UC) shows a marked geographical variation. It is high in Anglo-Saxon and Scandinavian countries, while in Mediterranean countries the available data on its epidemiological features are few. Spain is not an exception. METHODS: The new cases of UC diagnosed during the period 1985-1989 in the Hospital de Sabadell (a reference center of an area with a markedly industrial population of 343924) were retrospectively evaluated. The definitive diagnosis of UC required a negative fecal microbiological study and findings in colonoscopy and biopsy consistent with UC. RESULTS: During the study period 68 new cases of UC were diagnosed, representing a mean yearly incidence of 3.95/10(5) population, and 5.26/10(5) considering only the adult population (age greater than 14 years). No significant differences were found (p greater than 0.05) in the sex and age distributions, although the male/female ratio was 1.06. In 84% of cases UC was limited to the rectum and/or distal colon, with a low frequency of pancolonic forms (5%). In 70% of patients UC was classified as a low severity disease. CONCLUSIONS: Although the estimation of incidence only from hospital cases underestimates the true incidence, and also considering the limitation of comparing results of studies from several time periods, the incidence of UC in our area is the highest one reported to the present time in Spain and Southern Europe. Nevertheless, it is lower than that in most Northern European countries.

Adolescent↗
PubMed1986

[Creutzfeldt-Jakob disease in the Paris area: ethnic origin of the patients].

Twenty six (27 p. 100) of 96 patients dying from Creutzfeldt-Jakob disease in the Paris metropolitan area between 1968 and 1982 were born in foreign countries although the proportion of foreign-born residents account for only 15 p. 100 of the population. The annual mortality rate of Creutzfeldt-Jakob's disease in this group of foreign-born cases (1.33 per million) was twice that of French-born residents (0.64 per million). Twenty of the 26 foreign-born cases originated from countries surrounding the Mediterranean sea, and 5 of 7 familial cases belonged to 2 Tunisian families. There was no spatial clustering of foreign-born cases and no relationship between their Paris residence and the percent of foreign-born people living in the same area. The disproportionate frequency of Creutzfeldt-Jakob's disease among foreign-born residents thus seems to be a contributing factor to the higher prevalence of Creutzfeldt-Jakob's disease in Paris when compared to the rest of France. It further suggests that the prevalence of Creutzfeldt-Jakob's disease in Mediterranean countries may be greater than expected.

Creutzfeldt-Jakob Syndrome↗