Role of Endothelial Progenitor Cells and Inflammatory Cytokines in Healing of Diabetic Foot Ulcers

Background: To evaluate changes in endothelial progenitor cells (EPCs) and cytokines in patients with diabetic foot ulceration (DFU) in association with wound healing. Methods: We studied healthy subjects, diabetic patients not at risk of DFU, at risk of DFU and with active DFU. We prospectively followed the DFU patients over a 12-week period. We also investigated similar changes in diabetic rabbit and mouse models of wound healing. Results: All EPC phenotypes except the kinase insert domain receptor (KDR)+CD133+ were reduced in the at risk and the DFU groups compared to the controls. There were no major EPC differences between the control and not at risk group, and between the at risk and DFU groups. Serum stromal-cell derived factor-1 (SDF-1) and stem cell factor (SCF) were increased in DFU patients. DFU patients who healed their ulcers had lower CD34+KDR+ count at visits 3 and 4, serum c-reactive protein (CRP) and granulocyte-macrophage colony-stimulating factor (GM-CSF) at visit 1, interleukin-1 (IL-1) at visits 1 and 4. EPCs tended to be higher in both diabetic animal models when compared to their non-diabetic counterparts both before and ten days after wounding. Conclusions: Uncomplicated diabetes does not affect EPCs. EPCs are reduced in patients at risk or with DFU while complete wound healing is associated with CD34+KDR+ reduction, suggesting possible increased homing. Low baseline CRP, IL-1α and GM-CSF serum levels were associated with complete wound healing and may potentially serve as prognostic markers of DFU healing. No animal model alone is representative of the human condition, indicating the need for multiple experimental models

Foot Muscle Energy Reserves in Diabetic Patients Without and With Clinical Peripheral Neuropathy

Objective: To investigate changes in the foot muscle energy reserves in diabetic non-neuropathic and neuropathic patients. Research Design and Methods: We measured the phosphocreatinine (PCr)/inorganic phosphate (Pi) ratio, total $^{31}$P concentration, and the lipid/water ratio in the muscles in the metatarsal head region using MRI spectroscopy in healthy control subjects and non-neuropathic and neuropathic diabetic patients. Results: The PCr/Pi ratio was higher in the control subjects (3.23 $\pm$ 0.43) followed by the non-neuropathic group (2.61 $\pm$ 0.36), whereas it was lowest in the neuropathic group (0.60 $\pm$ 1.02) (P < 0.0001). There were no differences in total $^{31}$P concentration and lipid/water ratio between the control and non-neuropathic groups, but both measurements were different in the neuropathic group (P < 0.0001). Conclusions: Resting foot muscle energy reserves are affected before the development of peripheral diabetic neuropathy and are associated with the endothelial dysfunction and inflammation

Determinants of Self-Rated Health in a Representative Sample of a Rural Population: A Cross-Sectional Study in Greece

Self-rated health (SRH) is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity) were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%), 790 (52%) and 237 (15.6%) rated their health as “very good”, “good” and “poor” respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed

Perceived Stress Scale: Reliability and Validity Study in Greece

Objective: To translate the Perceived Stress Scale (versions PSS-4, -10 and -14) and to assess its psychometric properties in a sample of general Greek population. Methods: 941 individuals completed anonymously questionnaires comprising of PSS, the Depression Anxiety and Stress scale (DASS-21 version), and a list of stress-related symptoms. Psychometric properties of PSS were investigated by confirmatory factor analysis (construct validity), Cronbach’s alpha (reliability), and by investigating relations with the DASS-21 scores and the number of symptoms, across individuals’ characteristics. The two-factor structure of PSS-10 and PSS-14 was confirmed in our analysis. We found satisfactory Cronbach’s alpha values (0.82 for the full scale) for PSS-14 and PSS-10 and marginal satisfactory values for PSS-4 (0.69). PSS score exhibited high correlation coefficients with DASS-21 subscales scores, meaning stress (r = 0.64), depression (r = 0.61), and anxiety (r = 0.54). Women reported significantly more stress compared to men and divorced or widows compared to married or singled only. A strong significant (p &lt; 0.001) positive correlation between the stress score and the number of self-reported symptoms was also noted. Conclusions: The Greek versions of the PSS-14 and PSS-10 exhibited satisfactory psychometric properties and their use for research and health care practice is warranted

Vitamins A, C and E and the risk of breast cancer: results from a case-control study in Greece

Although several dietary compounds are hypothesized to have anticarcinogenic properties, the role ofpecific micronutrients in the development of breast cancer remains unclear. To address this issue, we assessed intake of retinol, β-carotene, vitamin C and vitamin E in relation to breast cancer risk in a case–control study in Greece. Eight hundrednd twenty women with histologically confirmed breast cancer were compared with 1548 control women. Dietary data were collectedhrough a 115-item semiquantitative food frequency questionnaire. Data were modelled by logistic regression, with adjustment forotal energy intake and established breast cancer risk factors, as well as mutual adjustment among the micronutrients. Amongost-menopausal women, there was no association between any of the micronutrients evaluated and risk of breast cancer. Amongremenopausal women, β-carotene, vitamin C and vitamin E were each inversely associated with breast cancer risk, but afterutual adjustment among the three nutrients only β-carotene remained significant; the odds ratio (OR) for a one-quintilencrease in β-carotene intake was 0.84 (95% confidence interval 0.73–0.97). The inverse association observed with β-carotene intake, however, is slightly weaker than the association previously observed with vegetable intake in these data,aising the possibility that the observed β-carotene effect is accounted for by another component of vegetables. ©1999 Cancer Research Campaig

Gender differences in blood lipids in a Greek island population the EPIC Study

Female and male volunteers of the Aegean island of Lesvos participated in an epidemiological, cross-sectional study to examine total serum cholesterol (TC) and high density (HDL-C) levels, to study gender differences and explore changes in blood lipids with menopause. Five hundred sixty three females and three hundred thirty two males, ages 30 to 78, were recruited as part of the Creek component of the European Perspective study on Nutrition, Cancer and Health (EPIC Study). Assessments included dietary and anthropometric measurements, demographic information and blood lipid assays. Mean, TC, HDL-C and TC/HDL-C ratio for women were 216 mg/dl, 51.5 mg/dl and 4.3 respectively and for men TC, HDL-C and TC/HDL-C ratio were 217 mg/dl, 41.4 mg/dl and 5.5 respectively. With menopause, TC levels and the TC/HDL-C ratio significantly increased while HDL-C tended to decrease after controlling for age, BMI, smoking, dietary lipid and alcohol consumption. According to the TC/HDL ratio in the younger ages (30-39), approximately 85% of women were placed in the low to moderate risk category but with advancing age (above 60) that percentage decreased to 64%. In men, approximately 50% were placed at high risk for TC/HDL-C ratio at a young age (30-39). This percentage increased with advancing age, but decreased to 47% in men above 60 years of age. Gender differences and menopausal blood lipid alterations generally observed in Western populations with high incidence:of CVD are also observed in our Creek island population. Our study points to the adverse blood lipid profiles especially in men as one of the factors contributing to the increasing CVD mortality in Greece. (C) 1999 Elsevier Science Inc

Injecting drug use amongst inmates in Greek prisons

We present a national cross-sectional comparative study of injecting drug use amongst male inmates in Greek prisons in relation to demographic and penal variables. A representative sample of 1.000 inmates were randomly selected from ten correctional institutions. 861 questionnaires were included in the analysis. 290 inmates (33.6%) reported injecting drugs, of whom 174 (60%) had injected while in prison, and 146 (50.3%) had shared sometime while in prison. Inmate injectors were predominately aged 25 to 34 years; they were incarcerated mostly due to drug offences (54.7%) and offences against property (30.5%); they were characterised by a multiplicity of previous sentences and a long duration of total time in prison. Most of the injectors had been convicted for drug offences in the past. Injectors, compared to non-injectors, were more likely to have had an HIV blood test. Regarding their sexual behaviour during the twelve months prior to imprisonment, injectors were more likely to have multiple female sexual partners - other than their wives or regular partners. Results are discussed, in the European context in particular in relation to the apparent relatively low level of injecting drug use among the Greek population in general yet similar rates of injecting drug use among inmates as in other European countries

HIV/AIDS related knowledge of inmates in Greek prisons

Within the context of a national study on the prevalence of male inmates’ HIV-risk behaviour, we present data regarding the HIV-related knowledge of a sub sample of inmates in terms of modes of HIV transmission, methods of HIV prevention and risks of HIV transmission within prison. The sample comprised a randomly selected group of 242 inmates from the Greek prison with the largest inmate population. Inmates appeared highly knowledgeable regarding transmission via sexual behaviour and the basic modes of reducing risk during sexual intercourse. Nevertheless, high levels of misconception regarding certain sexual practices and drug related issues were also apparent. Significant knowledge gaps regarding risk of HIV transmission in prison also appeared. There were no significant differences between injecting drug users (IDUs) and non-IDUs regarding their knowledge, except on items related to procedural aspects of drug using, with non-IDUs being less knowledgeable. Inmates perceived themselves as knowing ‘a medium’ amount of information about AIDS. The pattern of knowledge that emerged was that although inmates knew the basic facts about AIDS, they were still ignorant or had misconceptions in significant areas. Results are discussed in relation to similar patterns of HIV-related knowledge that have appeared in other European studies in prison populations and in Greek studies of the general population

Simple sleep questions can predict 12-year mortality in a rural population

There is apt evidence in favor of a significant association between sleep and mortality. So far, most studies examine sleep problems using comprehensive, time-consuming tools and questions. In this study, we investigated the ability of four simple “yes” or “no” answered questions (i.e. easiness to fall asleep, restful upon awakening, sleep satisfaction and presence of insomnia) to predict 12-year all-cause and cardiovascular mortality in a rural population of 1519 citizens. The sample consisted of 652 males and 867 females, with a mean age of 56.9 years old (range 15–102 years old). Age, gender, education, smoking, body mass index and health status were used as confounders in the Cox proportional hazard models. 293 (19.3%) deaths were recorded. After adjusting for confounders, difficulty to fall asleep was significantly related to an increased risk of cardiovascular death in smokers (aHR 3.71, 95% CI 1.01–13.62). Male individuals, not feeling restful upon awakening were at a significantly increased risk of all-cause (aHR 2.08, 95% CI 1.33–3.24) and cardiovascular mortality (aHR 6.24, 95% CI 1.90–20.49), in the latter case only if they were non-smokers. Smokers, not satisfied with their sleep, were at a significantly increased risk of cardiovascular death (aHR 5.44, 95% CI 1.73–17.09). The presence of insomnia significantly increased the risk of all-cause mortality (aHR 8.10, 95% CI 1.66–39.57) in smokers of basic education and cardiovascular mortality (aHR 26.68 95% CI 4.78–148.49) in smokers. In conclusion, simple sleep questions can predict mortality, at least in rural populations. Future studies should expand these results to other populations. © 2018, Japanese Society of Sleep Research

Religiosity as a predictor of mortality: A retrospective cohort study in 1519 rural citizens in Greece

Objective: Investigating the role of religiosity in mortality. Design: A retrospective cohort study (mean follow-up period 131.2 ± 30.8 months) in 1519 rural citizens in Greece (57.1% women, mean age 56.9 ± 20.4 years). Main outcome measures: Measurements included education, disease status, body mass index, lifestyle, sleep-quality and self-rated health (SRH). Religiosity was assessed as composite score of praying and church attendance. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHR) for all-cause and cardiovascular mortality. Results: A total of 293 deaths were recorded, 59.2% of which had occurred due to cardiovascular diseases, followed by cancer diseases (17%). All-cause mortality was found increased for older people (aHR: 1.10, 95%CI: 1.08–1.11, p &lt; .0001), for males (aHR: 1.44, 95%CI: 1.14–1.83, p = .002), for people reporting good SRH (aHR:.66, 95%CI:.51–.87, p = .003). Moreover, with increasing age the practice of regular exercise decreases all-causes mortality by approximately 3.5% by each year. Participants in the moderate category of religiosity were found to have decreased risk for all-cause mortality (aHR:.61, 95%CI:.46–.83, p = .001) compared to those in the low religiosity category. Cardiovascular mortality was also significantly associated with SRH and religiosity. Conclusion: Religiosity predicts mortality, in a rural population in Greece. Deciphering the mediators of religiosity and mortality relationship could facilitate future health policies. © 2016 Informa UK Limited, trading as Taylor &amp; Francis Group