European Congress IHPBA "Athens '95". Athens, Greece, 25-28 May 1995. Abstracts.
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Animals↗
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Action learning drives quality initiative at Athens Regional Medical Center, Athens, Georgia.
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Georgia↗
What is new and what is established in inflammatory bowel diseases. Proceedings of the Athens International Meeting on Inflammatory Bowel Diseases. Athens, 19-23 April, 1989.
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Animals↗
Exercise-induced QRS changes (Athens QRS score) in patients with coronary artery disease: a marker of myocardial ischemia.
Previous studies have shown a good correlation between exercise-induced changes of Q-, R-, and S-waves (Athens QRS score) and the number of the obstructed coronary arteries. The present study was undertaken to test the hypothesis that abnormal Athens QRS score is related to exercise-induced myocardial ischemia. Patients who had exercise radionuclide ventriculography (n = 150) or thallium-201 scintigraphy (n = 124) within 1 month of cardiac catheterization were studied. Athens QRS score was calculated based on the exercise-induced changes of the Q-, R-, and S-waves. Changes in Athens QRS score were compared to the number of obstructed coronary arteries, segmental contraction abnormalities, and exercise-induced myocardial perfusion defects. Athens QRS score and coronary artery disease: The Athens QRS score was decreased as the number of obstructed coronary arteries increased (normal coronary arteries 3.7 mm, confidence interval 1.0 to 3.9, one vessel disease 1.2 mm, two vessel disease -0.6 mm, three vessel disease -1.3 mm, p < 0.001). Athens QRS score and segmental contraction abnormalities: The Athens QRS score decreased as the number of segmental contraction abnormalities increased (no segmental contraction abnormalities 2.5 mm, confidence interval 1.0 to 3.9, one segmental contraction abnormality -0.4 mm, two segmental contraction abnormalities -1.5 mm, three segmental contraction abnormalities -2.6 mm, p < 0.001). Athens QRS score and reversible myocardial perfusion defects: The Athens QRS score was decreased as the number of exercise-induced myocardial perfusion defects increased (no perfusion defect 2.4 mm, confidence interval 0.9 to 3.9, one perfusion defect -0.7 mm, two perfusion defects -2.6 mm, three perfusion defects -3.3 mm, p < 0.001). Abnormal values of the Athens QRS score were better correlated with the number of exercise-induced segmental contraction abnormalities or the myocardial perfusion defects than the number of obstructed coronary arteries (p < 0.001). Exercise-induced changes in Athens QRS score were directly related to the number of obstructed coronary arteries, to exercise-induced segmental contraction abnormalities and to exercise-induced myocardial perfusion defects. However, Athens QRS score changes were more closely related to the number of exercise-induced segmental contraction abnormalities or to the exercise-induced myocardial perfusion defects than to the number of obstructed coronary arteries. The data suggest that exercise-induced QRS changes, Athens QRS score are related to exercise-induced myocardial ischemia.
Coronary Angiography↗
Time trends of tobacco smoking, air pollution, and lung cancer in Athens.
Athens is a city with a serious air pollution problem which has existed for more than 20 years. To evaluate whether air pollution has affected lung cancer incidence (and hence, mortality) in the population of Athens we have compared standardized lung mortality between Athens and the rest of Greece taking into account the tobacco consumption trends in the respective populations and varying the postulated latency between 0 and 20 years. There is no evidence for an independent or interactive (with tobacco smoking) effect of air pollution on lung cancer mortality; the tobacco-adjusted mortality appears, if anything, lower in Athens than in the rest of Greece and the slopes of lung cancer mortality on tobacco consumption are almost identical in Athens and in the rest of Greece. By contrast, the same data are compatible with a strong effect of tobacco smoking on lung cancer mortality, an effect which appears to involve not only the early carcinogenic stages but also some of the later ones. The results of the present analysis do not support the hypothesis that air pollution, at least in Athens until 1980, has increased the incidence of lung cancer to an extent large enough to be detectable in ecological correlation analyses. Nevertheless the inherent limitations of these methods indicate that their results should be interpreted with caution and only as a step toward the gradual understanding of a complex issue.
Air Pollution↗
Reasons for placement and replacement of restorations in student clinics in Manchester and Athens.
Data on reasons for the placement and replacement of restorations provide insight into patterns of clinical practice. This study investigated reasons for the provision of restorations in student clinics at the Universities of Manchester and Athens. Using the methods first described by Mjör, data were collected in relation to all initial and replacement restorations placed in adult patients in the main teaching clinics in the 2 schools over a 3-month period. The principal reason for intervention was recorded, according to approved treatment plans. Data were collected on 2620 restorations, 1431 (55%) of which were placed in Manchester. Primary caries was the main reason for the placement of initial restorations: 82% in Athens and 48% in Manchester (p<0.001). The principal reason for restoration replacement was secondary caries, accounting for 54% in Manchester and 33% in Athens (p<0.001). Other differences between the schools, included the ratio of initial placement to replacement restorations (Manchester 1:1.1; Athens 1:0.6: p<0.01) and significantly more 2-surface class II restorations having been placed in Manchester (p<0.001). Class III and IV restorations predominated in Athens. It is concluded, despite the acknowledged limitations of the methods employed, that the patterns of placement and replacement of restorations and the use of materials differ between the dental schools of Manchester and Athens. The differences are considered to relate more to local patterns of dental disease and patient selection for student clinics than to any differences in teaching philosophy. Subsequent studies of the type reported, despite acknowledged limitations would provide insight into the impact on patient care of the teaching of new materials, techniques and treatment philosophies.
Adolescent↗
Dental attendance patterns and oral hygiene habits of 5-year-old children in Athens and in south London.
This study compared the dental attendance patterns and oral hygiene habits of 5-year-old children in the London boroughs of Lambeth, Lewisham and Southwark with those in the municipality of Athens in the light of differing provision of oral health education. Questionnaires were sent to the parents of 384 children in London and 318 children in Athens who took part in a survey of dental health. Response rates of 51% and 53% respectively were obtained. More children visit the dentist in South London than in Athens, the difference being highly significant. In South London the majority of children visit every 6 months, whereas in Athens they only visit when they have toothache. More London children brush their teeth than Athens children, the difference being significant. Of those brushing in London, most brush twice daily. The above findings indicate marked differences in dental attendance patterns and oral hygiene habits, and this may be partly attributable to differences in the delivery of dental care and oral health education in the two countries.
Chi-Square Distribution↗
Daily mortality and "winter type" air pollution in Athens, Greece--a time series analysis within the APHEA project.
STUDY OBJECTIVE: There is evidence that air pollution in Athens between 1975 and 1987 had adverse short term health effects. The short term effects of "winter type" air pollution on the daily total number of deaths are investigated for the period 1987-91 as part of the European Community multi centre APHEA project. DESIGN: A temporal study using aggregated data is presented. The associations of the daily time series of three pollutants, sulphur dioxide (SO2), black smoke (BS), and carbon monoxide (CO) and the daily total number of deaths in the Athens area were assessed. DATA AND METHODS: The average measurement from three stations was used for each pollutant. The daily number of deaths was recorded from the Athens Town Registry and the registries of the 18 municipalities contiguous to Athens. Data on the mean daily temperature (degree C) and relative humidity (%) were also used. Poisson autoregressive models that also allowed for overdispersion were used. Seasonality, other long term patterns, temperature, humidity, day of the week, and holidays were adjusted for. Several a priori defined pollutant transformations and lags were investigated. One day measurements as well as cumulative exposure effects were assessed. Effect modification by season as well as among pollutants was tested. MAIN RESULTS: Linear terms were used for all pollutants. The magnitude of the effect was greater at lags 0 for CO and 1 for BS and SO2 gradually declining after lag 1. For an increase of 100 micrograms/m3 in SO2 and BS there were corresponding increases (95% CI) of 12% (7%, 16%) and 5% (3%, 8%) in the daily total numbers of deaths, while for an increase of 10 micrograms/m3 in CO the increase (95% CI) in the daily total number of deaths was 10% (5%, 15%). A significant interaction of the effects of SO2 with season were found. The strongest effect was observed during the winter, when higher levels of SO2 were observed. A stronger effect of SO2 on the daily total number of deaths was observed when the levels of BS were > 100 micrograms/m3. CONCLUSIONS: These results strengthen the evidence of a causal association between ambient particle, SO2, or CO levels in the air and the daily total number of deaths and points to an important public health issue for the Athens population.
Air Pollution↗
Evaluation of exercise-induced QRS amplitude changes (Athens score) and their clinical value.
The index of exercises-induced amplitude changes in a combination of Q, R and S waves, named Athens score, was tested in 213 patients, who underwent coronary angiography within 3 days of a maximal exercise test. Of the 155 cases with conclusive exercise test results, according to the coronary angiography document, 23 (14.8%) were diagnosed as having no significant coronary artery disease (CAD); 27 (17.4%) as 1-vessel disease; 28 (18.1%) as 2-vessel disease and 77 (49.7%) as 3-vessel disease. The Athens score for them was 4.87 +/- 2.89, 0.02 +/- 3.35, -1.70 +/- 3.68, -1.75 +/- 3.98 respectively, F = 19.65, P < 0.01. An Athens score of 2 mm predicted CAD with sensitivity of 84.9% and specificity of 78.3% both being higher than those of ST segment depression (75.0% and 60.9%). It was concluded that the Athens score was a promising index for improving the efficiency of exercise test to predict CAD.
Adult↗
Short-term effects of air pollution on mortality in Athens.
Short-term effects of air pollution on mortality in Athens during the years 1975-1982 were studied. Daily values of sulphur dioxide (SO2) and smoke, measured by a five-station network of the National Observatory of Athens, were used as air pollution indicators. Mortality data were abstracted from the Town Registries of Athens and 18 other contiguous towns within the Greater Athens area. It was found that the adjusted daily mortality (estimated by subtracting from the observed value of mortality an 'expected' value, calculated after fitting a sinusoid curve to the empirical mortality data) depends positively and significantly on the level of SO2 (b = +0.0058, p = 0.05). This relation is independent of temperature, relative humidity, secular, seasonal, monthly and weekly variations of mortality as well as of synergistic effects of the above variables with season. No relation was found between smoke and adjusted daily mortality. An analysis for the determination of a possible threshold in the levels of SO2 causing health effects was also undertaken, by studying changes in the SO2 regression coefficients after successive deletion from the regression model of the days with the highest SO2 values. Our study shows that if there is an SO2 threshold it must lie slightly below the level of 150 micrograms/m3 (mean daily value).
Air Pollutants↗
Short-term effects of air pollution on daily mortality in Athens: a time-series analysis.
BACKGROUND: Athens has a serious air pollution problem which became evident in the early 1970s. Studies for the years 1975-1982 have indicated a positive association of sulphur dioxide (SO2) with total daily mortality. Since 1983 the pollution profile in Athens has gradually changed but the levels of smoke, SO2 and carbon monoxide (CO) remain relatively high. METHODS: The association of air pollution with daily all-cause mortality in Athens for the years 1984-1988 was investigated using daily values of SO2, smoke and CO. Autoregressive models with log-transformed daily mortality as the dependent variable, were used to adjust for temperature and relative humidity (both lagged by 1 day), year, season and day of week, as well as for serial correlations in mortality. RESULTS: Graphic analysis revealed non-linear monotonically increasing relationships between total mortality and SO2, smoke and CO, with steeper exposure-response slopes at lower air pollution levels. Air pollution data lagged by 1 day had the strongest association with daily mortality. In three separate autoregression models for log(SO2), log(smoke) and log(CO) the regression coefficients for each were highly statistically significant (P < 0.001). Further multiple regression modelling showed that SO2 and smoke are both independent predictors of daily mortality, though to a lesser extent than temperature and relative humidity. The inclusion of CO in the model did not further improve the prediction of daily mortality. The magnitude of association is small, for instance, a 10% reduction in smoke is estimated to decrease daily mortality by 0.75% (95% confidence interval [CI]: 0.51-0.99). However, it cannot be accounted for by climatic and seasonal effects, so that a causal influence of air pollution on daily mortality seems plausible. CONCLUSIONS: These findings suggest that current air pollution levels in Athens (and many other industrialized cities) may be responsible for substantial numbers of premature deaths, and hence remain an important public health issue.
Air Pollutants↗
Caries prevalence of 5-year-old children in Athens and in South London.
This study compared the dental health of 5-year-old children in the London boroughs of Lambeth, Lewisham and Southwark with that in the municipality of Athens, Greece. Three hundred and eighty-four children were examined in London, and 318 in Athens; both samples had a mean age of 5 years 6 months. The proportion of London children who were caries free was 56%, and of Athens children 57.5%, and the mean dmft was 1.63 and 1.48, respectively; these differences were not statistically significant. However, excluding caries-free children from the analysis, the London children had significantly fewer decayed teeth (mean 2.35 compared with 2.93 in Athens) and significantly more missing teeth (mean 0.63 compared with 0.02), indicating marked differences in treatment patterns.
Child, Preschool↗
Short-term effects of air pollution on hospital emergency outpatient visits and admissions in the greater Athens, Greece area.
The short-term effects of air pollution on morbidity in the Athens population were studied. Data were collected on the daily number of emergency outpatient visits and admissions for cardiac and respiratory causes (diagnoses at time of admission) to all major hospitals in the greater Athens area during 1988. Measurements of air pollution made by the Ministry of the Environment monitoring network included values for smoke, carbon monoxide, and nitrogen dioxide. Statistical analysis was done using multiple linear regression models controlling for potential confounding effects of meteorological and chronological variables, separately for winter (1/1-3/21 and 9/22-12/31) and summer (3/22-9/21). It was found that the daily number of emergency visits was related positively with the levels of air pollution, but this association did not reach the nominal level of statistical significance for most pollutants. The number of emergency admissions for cardiac and respiratory causes was related to a statistically significant degree with all indices of air pollution during the winter. Thus, the average adjusted increase in the daily number of cardiac admissions corresponding to an increase from the 5th to the 95th percentile of the season-specific distribution of each pollutant ranges from 15 to 17% or from 11 to 12.5 admissions per day, and for the daily number of respiratory admissions from 20 to 29% or from 8.3 to 12.1 admissions. The results of the present study indicate that air pollution in the Athens area has short-term effects on morbidity in the population.
Air Pollution↗
A cross-cultural comparison of mental health care delivery in Athens and Groningen.
Until recently mental health care in Greece was mainly delivered by old traditional mental hospitals and few outpatient services. In order to induce the process of change the University of Athens started to experiment with a community mental health service. In order to study what has been achieved in a relatively short time, data relating to the delivery of care cohorts of patients from a pilot area in Athens and from an area in the north of the Netherlands were compared. The overall new contact rate was much higher in the Groningen area, except for the category of psychoneuroses and personality disorders. Patients with a psychosis received more intensive treatment and left the services at a later stage in Athens. Differences of patterns of care in other diagnostic and age groups are discussed.
Adult↗
Blood oxygen binding properties for the burrowing owl, Athene cunicularia.
Isocapnic O2 equilibrium curves (O2ECs) were generated for whole blood of 4 adult burrowing owls (Athene cunicularia) using thin film techniques. At in vivo pHa (7.49 +/- 0.02; mean +/- 1 SEM) and 41 degrees C, the PO2 at half saturation (P50) was 42.3 +/- 0.8 Torr. CO2 and fixed acid (H+) Bohr slopes (delta log P50/delta pH) were -0.46 +/- 0.01 and -0.42 +/- 0.02, respectively, demonstrating a small specific CO2 effect. CO2 and H+ Bohr slopes were saturation-independent between 0.1 and 0.9 S. Hill plots for Athene blood were non-linear; the Hill coefficient (n) increased from 2.6 below 0.4 S to 3.4 above 0.6 S. Owl equilibrium data were accurately described by the equation: S = [(7.7 x 10(6]/(P4 + 44P3 - 108P2 + 3.5 x 10(4)P) + 1]-1. This complex O2EC shape may result from Hb heterogeneity; isoelectric focusing showed 4 isoHbs with a molar ratio of 9:1:1:1. This study revealed no apparent adaptations of Athene blood for hypoxic and hypercapnic conditions. We conclude that the observed blood O2 binding properties promote tissue O2 delivery during periods of surface activity. While occupying its burrow, the owl compensates for moderate alterations in inspired gas composition partly through increased ventilation.
Acid-Base Equilibrium↗
C3 to C9 hydrocarbon measurements in the two largest cities of Greece, Athens and Thessaloniki. Calculation of hydrocarbon emissions by species. Derivation of hydroxyl radical concentrations.
Non-methane hydrocarbon concentrations (NMHC) were determined in samples collected in electropolished canisters aboard a Falcon aircraft in Athens and Thessaloniki. Some canisters were also collected on the ground in Athens. Chemical analysis by cryoconcentration permitted the speciation of NMHC. The aircraft samples allowed the determination of the background concentrations in the periphery of each city. Concentration ratios were compared with other European cities. The aromatic hydrocarbon fraction dominates the measured species. Using the simple box model modified to account for the chemical destruction of each hydrocarbon, the emissions for each species were determined in Athens and Thessaloniki. The hydroxyl radical concentrations were calculated using hydrocarbon concentration ratios in the urban areas and at a downwind distance.
Air Pollution↗
Prevalence of asthma and asthma-like symptoms in Athens, Greece.
Asthma is a common chronic condition and there is evidence that its prevalence may be rising. The European Respiratory Health Survey (ECRHS) was planned to produce comparable data on asthma epidemiology in Europe. In Greece, in particular, a similar study has not been conducted previously and no epidemiological data are available on adult asthma prevalence. Furthermore, the role of air pollution in the pathogenesis of asthma is currently an issue of debate. Athens is a city with high air pollution, and a study of asthma epidemiology in this city may confirm or refute a possible link with the expression of asthma. A questionnaire developed by the ECRHS was sent to a random sample of 3533 households in Peristeri, an industrialized borough of Athens. Responses were received from 2774 households (response rate 78%). Of all the data on individual subjects, only those from 3325 adults aged 20-44 years were considered, according to the study protocol. The self-reported current prevalence of asthmatic attacks and asthma-like symptoms were as follows: asthma attack 2.4%, use of asthma medication 2.1%, awakening by shortness of breath 5.6%, awakening by cough 17.8%, wheezing 15.8% and nasal allergies 18.4%. It is concluded that the prevalence of asthma and related symptoms in this region of Athens is rather low, despite the high air-pollution levels in the city.
Adult↗
Urban living, tobacco smoking, and chronic obstructive pulmonary disease: a study in Athens.
We studied the relation of urban living and tobacco smoking to the development of chronic obstructive pulmonary disease. The study was based on 110 incident cases of chronic obstructive pulmonary disease between 50 and 60 years of age who were permanent residents of Athens and 400 control patients hospitalized for traumatic and orthopedic conditions in the same hospitals at the same time. All subjects were interviewed about their smoking habits, place of birth, history of past residence, and years of schooling. We found that subjects with more education have a reduced risk of developing chronic obstructive pulmonary disease, with 4 additional years of schooling corresponding to a 30% reduction of risk. We also found that those who have lived all their lives in urban areas (mostly in Athens) have a twofold greater risk of chronic obstructive pulmonary disease compared with people who have lived exclusively or partly in rural areas before settling in Athens. Finally, we found that smokers have a 10-fold relative risk of developing chronic obstructive pulmonary disease, and this risk is strongly dependent on the number of cigarettes consumed per day. The findings of the present study suggest that air pollution, or another aspect of the urban environment, can be an important contributor to the development of chronic obstructive pulmonary disease.
Air Pollution↗