Residential altitude and fish consumption : effect on systolic blood pressure in elderly : MEDIS study cross-sectional results

Background/Aims: Frequent consumption of fish is associated with decreased SBP levels. Both aging and living at high altitude are associated with significant increases in Systolic Blood Pressure (SBP) levels. The aim of this analysis was to examine the potential interaction between fish consumption and high altitude on SBP in elderly cohort. Methods: Mediterranean islands study (MEDIS) recruited 2749 older (aged 65+ years) individuals from 2005-2015. Participants were selected from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece. Dietary habits, energy intake, physical activity status, socio-demographic characteristics and clinical profile aspects (blood pressure) were measured. The altitude of the area was also recorded. [excerpt]peer-reviewe

Correlation of breast cancer risk factors with HER-2/neu protein overexpression according to menopausal and estrogen receptor status

BACKGROUND: Several researchers have claimed that classification of tumours on the basis of HER-2/neu overexpression or amplification may define a subset of breast cancer in which the net effect of a risk factor could be rather more obvious and its impact on breast cancer development more clear. We decided to investigate, in a group of patients from a geographical area with a low incidence of breast cancer, whether HER-2/neu positive tumours are correlated with established or suspected risk factors for breast cancer and thus to identify distinct subgroups of high risk women. METHODS: This study analysed data from patients who attended the Breast Unit at the University Hospital of Heraklion, Crete, Greece between 1996 and 2002. 384 women with primary invasive breast cancer were compared with 566 screened women who were referred to the Unit and had not developed breast neoplasm by the time the data were analysed. Risk factor data were obtained from each subject by personal interviews using a structured questionnaire. The detection and scoring of the HER-2/neu protein, estrogen and progesterone receptor expression were performed using immunochemistry. Odds ratios and 95% confidence intervals were determined by chi-square test and logistic regression analysis. Case-case odds ratios were calculated in order to measure the risk heterogeneity between HER-2/neu+ and HER-2/neu-tumours. Separate analyses were performed for premenopausal and postmenopausal women and according to estrogen receptor status. RESULTS: In multivariate analysis without HER-2/neu stratification, an increased breast cancer risk was associated with only four of the factors examined: use of oral contraceptives (OR = 4.40, 95%C.I: 1.46–13.28), use of HRT (OR = 7.34, 95%C.I: 2.03–26.53), an age at first full pregnancy more than 23 years (OR = 1.91, 95%C.I: 1.29–2.83) and body mass index more than 29 kg/m(2 )(OR = 3.13, 95%C.I: 2.02–4.84). Additionally, a history of abortion or miscarriage (OR = 0.56, 95%C.I: 0.38–0.82) was correlated with a decreased risk of breast cancer. In the case to case comparison only BMI >29 kg/m(2 )revealed a relative connection that was stronger with positive than with negative HER-2/neu tumours (ratio of OR's = 2.23, 95%C.I: 1.20–4.15, p = 0.011). This may indicate evidence of heterogeneity of a rather significant degree for this factor. In the ER negative group an age at first full pregnancy >23 years and a BMI >29 kg/m(2 )were associated with an increased risk in both HER-2/neu groups, but the association was significantly stronger for the latter factor in the positive HER-2/neu tumours (ratio of OR's = 2.46, 95%CI: 0.97–6.21). CONCLUSIONS: Our study did not confirm that the established or putative hormonal breast cancer risk factors differ regarding their relations with HER-2/neu+ versus HER-2/neu-breast tumours, with the exception of increased BMI. Further innovative studies with larger sample sizes are needed to examine how the status of these potentially modifiable breast cancer risk factors interacts with biological markers such as HER-2/neu oncoprotein

Association between siesta (daytime sleep), dietary patterns and the presence of metabolic syndrome in elderly living in Mediterranean area (MEDIS study):The moderating effect of gender

Objectives: Several lifestyle parameters including diet, physical activity and sleep were associated in isolation with the presence of Metabolic Syndrome (MetS) in adults, to date there is a paucity of studies which evaluated their combined role aging populations and especially with respect to gender. Therefore, the aim of the present study was to provide a global consideration of the lifestyle factors associated with MetS among elderly individuals. Design: Cross-sectional observational study. Setting: 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece. Participants: during 2005-2015, 2749 older (aged 65-100 years) from were voluntarily enrolled in the study. Measurements: Dietary habits, energy intake, physical activity status, sociodemographic characteristics, lifestyle parameters (sleeping and smoking habits) and clinical profile aspects were derived through standard procedures. The presence of MetS was defined using the definition provided by NCEP ATP III (revised) and cluster analysis was used to identify overall dietary habit patterns. Results: The overall prevalence of MetS in the study sample was 36.2%, but occurred more frequently in females (40.0% vs. 31.8%, respectively, p=0.03). Individuals with MetS were more likely to sleep during the day (89.4% vs. 76.8% respectively, p=0.039) and frequent ‘siesta’ was positively linked to the odds of MetS presence in females (Odds Ratio (OR) =3.43, 95% Confidence Intervals (CI): 1.08-10.9), but not for men (p=0.999). The lower carbohydrate (i.e., 45.2% of total daily energy, 120±16gr/day) dietary cluster was inversely associated with the odds for MetS presence, but only for men (OR=0.094, 95%CI: 0.010-0.883). Conclusions: Lifestyle parameters including sleep and diet quality are strongly associated with the presence of MetS in elderly cohort, but different their level of influence appears to be different, depending on gender. Further research is needed to better consider the role of lifestyle characteristics in the management of MetS in clinical practice

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

<p>Abstract</p> <p>Background</p> <p>Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece.</p> <p>Methods</p> <p>The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST).</p> <p>Results</p> <p>The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; <it>p </it>= 0.029).</p> <p>Conclusions</p> <p>The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.</p

Editor's Choice-2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS) Authors/Task Force Members (a), Victor Aboyans (*), Jean- Baptiste Ricco (*), Marie- Louise E. L. Bartelink, Martin Bjorck, Marianne Brodmann, Tina Cohnert, Jean-Philippe Collet, Martin Czerny, Marco De Carlo, Sebastian Debus, Christine Espinola-Klein, Thomas Kahan, Serge Kownator, Lucia Mazzolai, A. Ross Naylor, Marco Roffi, Joachim Rother, Muriel Sprynger, Michal Tendera, Gunnar Tepe, Maarit Venermo, Charalambos Vlachopoulos, Ileana Desormais Document Reviewers (b), Petr Widimsky, Philippe Kolh, Stefan Agewall, Hector Bueno, Antonio Coca, Gert J. De Borst, Victoria Delgado, Florian Dick, Cetin Erol, Marc Ferrini, Stavros Kakkos, Hugo A. Katus, Juhani Knuuti, Jes Lindholt, Heinrich Mattle, Piotr Pieniazek, Massimo Francesco Piepoli, Dierk Scheinert, Horst Sievert, Iain Simpson, Jakub Sulzenko, Juan Tamargo, Lale Tokgozoglu, Adam Torbicki, Nikolaos Tsakountakis, Jose Tunon, Melina Vega de Ceniga, Stephan Windecker, Jose Luis ZamoranoPeer reviewe

Design and implementation of interdomain architecture for deploying secure communications over heterogeneous wireless IP networks

Recent penetration, but also the huge potential of wireless and mobile telecommunication systems has significantly changed our everyday life. Wireless networks have transformed from a luxury or scientific-only subject into a necessary means of communication, in less than 20 years. At the same time, the proliferation of new and innovative services has raised great interest and competition among service providers. The advent of multimedia applications has further increased the interest in wireless communications. Multimedia applications are now considered the driving force behind the transformation of the telecommunication system. In the past, a relatively small number of telecommunication network operators were responsible for the provision of services to the requesting users. In modern wireless environments, several smaller organizations take the role of the service provider (or content operator), building a complex business and collaboration model. Thus, modern third generation (3G) and fourth generation (4G) networks are expected to utilize several access technologies and at the same time extend in different administrative domains. This heterogeneous and multi-domain architecture of the modem telecommunication world requires a central point of control for the basic network functions (authentication, authorization and accounting). At the same time, a common means of inter-communication among several service providers needs to be established. In this context, an inter-domain architecture for deploying secure communications over heterogeneous IP networks is required. This thesis emphasizes on AAA mechanisms, in an effort to support seamless and smooth service delivery in modern heterogeneous and multi-domain environments. This thesis aims to identify the weaknesses and deficiencies in current AAA mechanisms and develop the required solutions. One of the main findings of this thesis is the observation that though the great majority of authentication and authorization issues are thoroughly investigated, accounting is not receiving the same level of attention. Current AAA solutions fail to support new requirements in the accounting field. This research focuses on the accounting functions and contributes towards building a novel accounting system to be incorporated inside the AAA framework, capable to provide the network administrators with all the tools to support the processes of authentication, authorization and accounting and at the same time enable secure communication between foreign administrative domains. Additionally, the generic accounting system is amended to support the SIP environment.Τα τελευταία χρόνια, η χρήση ασυρμάτων και κινητών συστημάτων επικοινωνίας έχει επεκταθεί και αγγίζει πολλές πτυχές της ζωής μας. Τα ασύρματα και κινητά δίκτυα, από αποκλειστικά ερευνητικό πεδίο πριν δύο δεκαετίες, αποτελούν σήμερα σημαντικό τμήμα της επικοινωνιακής υποδομής. Επιπλέον, σύγχρονες τάσεις καταδεικνύουν αύξηση του μεριδίου της συγκεκριμένης αγοράς στο κοντινό μέλλον. Παράλληλα, οι προσφερόμενες σχετικές υπηρεσίες και εφαρμογές πληθαίνουν με γοργό ρυθμό. Σημαντική συνεισφορά στην ολοένα και αυξανόμενη διείσδυση των ασύρματων τεχνολογιών στην αγορά έχει η δυνατότητα μετάδοσης πολυμέσων. Συγχρόνως με την εισαγωγή νέων υπηρεσιών, τα νεότερα ασύρματα δίκτυα τέταρτης γενιάς έχουν οδηγήσει στην αλλαγή του παραδοσιακού ρόλου των παροχών δικτύου (ή διαχειριστών δικτύου) και υπηρεσιών. Υπάρχει πλέον σαφής διαχωρισμός του ρόλου του παρόχου υπηρεσιών από αυτόν του παρόχου δικτύου με παράλληλη αύξηση του πλήθους και του μεγέθους των διαφορετικών παροχών. Ως αποτέλεσμα, τα μελλοντικά δίκτυα 3ης (3G) και 4ης γενιάς (4G) αναμένεται να αξιοποιούν πολλαπλές τεχνολογίες πρόσβασης στο μέσο και παράλληλα να εκτείνονται σε διαφορετικούς δικτυακούς τομείς διαχείρισης. Η ετερογενής και πολύ-διαχειριστική αυτή δικτυακή αρχιτεκτονική απαιτεί, εκτός των άλλων, ένα κεντρικό σημείο ελέγχου βασικών λειτουργιών του δικτύου (αυθεντικοποίηση, εξουσιοδότηση και λογιστική καταγραφή) και παράλληλα μηχανισμούς διασύνδεσης ανάμεσα σε διαφορετικούς δικτυακούς τομείς διαχείρισης. Στο πλαίσιο αυτό, απαιτείται η υλοποίηση μιας κατάλληλης διαδικτυακής αρχιτεκτονικής τομέων μεταξύ ετερογενών ασυρμάτων IP δικτύων. Η παρούσα διατριβή εστιάζει σε μηχανισμούς πρόσβασης ΑΑΑ παρέχοντας το πλαίσιο για την απρόσκοπτη επικοινωνία και πρόσβαση σε υπηρεσίες στα νεότερα ετερογενή και πολύ-διαχειριστικά περιβάλλοντα. Συγκεκριμένα, αντικείμενο της διατριβής είναι η αναγνώριση αδυναμιών και ελλείψεων στους μηχανισμούς ΑΑΑ και αντίστοιχα ο σχεδιασμός και αξιολόγηση πιθανών λύσεων και αντιμέτρων. Η μελέτη της σχετικής διεθνής βιβλιογραφίας καταδεικνύει την ύπαρξη πληθώρας εργαλείων αντιμετώπισης των προκλήσεων στους τομείς της αυθεντικοποίησης και της εξουσιοδότησης. Αντίθετα, διαφαίνεται η αδυναμία των υπαρχόντων μηχανισμών λογιστικής καταγραφής να αντιμετωπίσουν τις σύγχρονες και πολυεπίπεδες ανάγκες, όπως αυτές σκιαγραφήθηκαν στα παραπάνω. Στο πλαίσιο αυτό, η παρούσα διατριβή εστιάζει στο σχεδίασμά και την υλοποίηση ενός νέου ολοκληρωμένου συστήματος λογιστικής καταγραφής, το οποίο σε συνδυασμό με τις υπάρχουσες τεχνολογίες αυθεντικοποίησης και εξουσιοδότησης θα παρέχει στους διαχειριστές δικτύου ένα κεντρικό πλαίσιο ελέγχου, καθιστώντας παράλληλα δυνατή την ασφαλή επικοινωνία μεταξύ των διαφορετικών παροχών. Τέλος, αναγνωρίζοντας τη σημασία των υπηρεσιών μετάδοσης πολυμέσων, το γενικό σύστημα λογιστικής καταγραφής τροποποιείται κατάλληλα, ώστε να υποστηρίξει τις απαιτήσεις του SIP περιβάλλοντος

Socio-economic status, place of residence and dietary habits among the elderly: The Mediterranean islands study

Objective To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet.Design Cross-sectional.Setting Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0-55), whereas SES was estimated using education and financial status.Subjects During 2005-2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65-100 years), free of known chronic diseases, participated in the survey.Results Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P &lt; 001), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P = 0004), as well as financial status (P = 0001).Conclusions Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status. © 2010 The Authors

Successful ageing, dietary habits and health status of elderly individuals: a k dimensional approach within the multinational MEDIS study.

The definition and determinants of successful aging is still controversial. Although dietary habits have long been associated with aging, eating habits and behaviors have rarely been included in various proposed indices of successful aging. The aim of this work was to evaluate determinants of successful aging together with assessment of dietary habits in relation to healthcare facility use among elders living in the Mediterranean basin. During 2005-2011, 2663 elderly (aged 65-100years) individuals from 21 Mediterranean islands and rural Mani region (Peloponnesus) were voluntarily enrolled in the study. A successful aging index ranging from a score of 0 to a score of 10 was constructed using 10 attributes, i.e., education, financial status, physical activity, body mass index, depression, participation in social activities with friends and family, number of yearly excursions, number of cardiovascular disease risk factors and adherence to the Mediterranean diet. The applied factor analysis on the components of the index extracted three main components for successful aging: psychosocial-economic, bioclinical and lifestyle; confirming the multiple dimensions of aging. After adjusting for confounders, a 1/10-unit increase in the successful aging index was associated with 0.8 less annual visits to healthcare centers (95% CI -1.3 to-0.2). Stratified analysis by gender revealed heterogeneity of factors predicting successful aging. These findings suggest that successful aging is a multidimensional and complex concept that exhibits gender heterogeneity. Annual use of health care services by the elders was found to be related to level of successful aging