Regional differences in mortality in Greece (1984–2004): The case of Thrace

<p>Abstract</p> <p>Background</p> <p>Mortality differences at national level can generate hypothesis on possible causal association that could be further investigated. The aim of the present study was to identify regions with high mortality rates in Greece.</p> <p>Methods</p> <p>Age adjusted specific mortality rates by gender were calculated in each of the 10 regions of Greece during the period 1984–2004. Moreover standardized mortality rates (SMR) were also calculated by using population census data of years 1981, 1991, 2001. The mortality rates were examined in relation to GDP per capita, the ratio of hospital beds, and doctors per population for each region.</p> <p>Results</p> <p>During the study period, the region of Thrace recorded the highest mortality rate at almost all age groups in both sexes among the ten Greek regions. Thrace had one of the lowest GDP per capita (11 123 Euro) and recorded low ratios of Physicians (284) per 100 000 inhabitants in comparison to the national ratios. Moreover the ratio of hospital beds per population was in Thrace very low (268/100 000) in comparison to the national ratio (470/100 000). Thrace is the Greek region with the highest percentage of Muslim population (33%). Multivariate analysis revealed that GDP and doctors/100000 inhabitants were associated with increased mortality in Thrace.</p> <p>Conclusion</p> <p>Thrace is the region with the highest mortality rate in Greece. Further research is needed to assess the contribution of each possible risk factor to the increased mortality rate of Thrace which could have important public health implications.</p

Diagnostic Clinical and Laboratory Findings in Response to Predetermining Bacterial Pathogen: Data from the Meningitis Registry

BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM) were collected from the Meningitis Registry (MR). Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta) and SPSS (version 15.0-Chicago) software. Statistically significant (p<0.05) variables were included in a conditional backward logistic regression model. A total of 838 (63.0%) attributed to Neisseria meningitidis, 252 (18.9%) to Haemophilus influenzae, 186 (14.0%) to Streptococcus pneumoniae and 55 (4.1%) due to other bacteria. For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash (OR 22.36), absence of seizures (OR 2.51), headache (OR 1.83) and negative gram stain result (OR 1.55) with a Positive Predictive Value (PPV) of 96.4% (95%CI 87.7-99.6). For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash (OR 13.62), positive gram stain (OR 2.10), coma (OR 3.11), seizures (OR 3.81) and peripheral WBC > or = 15000/microL (OR 2.19) with a PPV of 77.8% (95%CI 40.0-97.2). For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61), age > or = 1 year (OR 2.04), absence of headache (OR 3.01), CSF Glu < 40 mg/dL (OR 3.62) and peripheral WBC < 15,000/microL (OR 1.74) with a PPV of 58.5% (95%CI 42.1-73.7). CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied

Elevated Bathing-Associated Disease Risks Despite Certified Water Quality: A Cohort Study

Bacteriological water quality criteria have been recommended to ensure bathers’ health. However, this risk-assessment approach is based mainly on routine measurements of fecal pollution indicator bacteria in seawater, and may not be adequate to protect bathers effectively. The aim of this study was to assess the risks of symptoms related to infectious diseases among bathers after exposure to seawater which was of excellent quality according to EU guidelines. This study is a cohort study recruiting bathers and non-bathers. Water samples were collected for estimating bacterial indicators. Univariable and multivariable analysis was performed to compare the risks of developing symptoms/diseases between bathers and non-bathers. A total of 3805 bathers and 572 non-bathers were included in the study. Water analysis results demonstrated excellent quality of bathing water. Significantly increased risks of symptoms related to gastrointestinal infections (OR = 3.60, 95% CI 1.28–10.13), respiratory infections (OR = 1.92, 95% CI 1.00–3.67), eye infections (OR = 2.43, 95% CI 1.27–4.63) and ear infections (OR = 17.21, 95% CI 2.42–122.34) were observed among bathers compared with non-bathers. Increased rates of medical consultation and medication use were also observed among bathers. There was evidence that bathers experienced increased morbidity compared with non-bathers though the bathing waters met bacteriological water quality criteria. These results suggest that risk assessments of recreational seawaters should not only focus on bacteriological water quality criteria

Tobacco use among students aged 13–15 years in Greece: the GYTS project

BACKGROUND: Data on the prevalence of tobacco use among teenagers in Greece are limited. We examined the prevalence of smoking among middle-school students in Greece using the Global Youth Tobacco Survey (GYTS). METHODS: The Global Youth Tobacco Survey was implemented in Greece during the academic year 2004 – 2005 by the University of Thessaly and the National School of Public Health. Data were collected using the GYTS self-administered anonymous questionnaire, which was distributed by specifically trained field workers to a nationally representative sample of middle-school students aged 13–15 years (through randomly selected schools and classes), randomly selected through a two-stage cluster sample design. Data processing and statistical analyses were performed at the Centers for Disease Control and Prevention (CDC). RESULTS: About one third of the students 32.1% (29.4 – 35.0) reported that they had tried tobacco in the past, while 16.2% (14.3 – 18.4) reported being current users of tobacco products. In addition, 1 in 4 of ever smokers reported that they began smoking before the age of 10 years old. Almost 1 in 5 never smokers reported being susceptible to initiate smoking in the next year and about 89.8% (88.3 – 91.1) of the respondents were exposed to environmental tobacco smoke in their homes and 94.1% (93.2 – 94.9) in public places. Finally, a strikingly high number of students 95% (89.5 – 97.7) reported that they were able to buy their own cigarettes without restrictions. CONCLUSION: The results of the GYTS show that the prevalence of smoking in middle-school children is alarmingly high in Greece. Smoking among young people constitutes a significant problem that is destined to worsen in the absence of any comprehensive efforts focused on strict anti-smoking legislation, policies and tobacco control interventions targeting children at a young age

Development and assessment of a questionnaire for a descriptive cross – sectional study concerning parents' knowledge, attitudes and practises in antibiotic use in Greece

<p>Abstract</p> <p>Background</p> <p>Upper Respiratory Infections (URIs) are common in children. The cause is usually viral, but parents' attitude often contributes to inappropriate antibiotic prescribing, promoting antibiotic resistance. The objective is to describe the process of developing a questionnaire to assess parents' Knowledge, Attitude and Practices (KAP) concerning the role of antibiotics when children suffer from URIs, as well as to evaluate the response rates, the completeness and the reliability (Cronbach) of the questionnaires. Finally, to note any limitations of the study.</p> <p>Methods</p> <p>Literature review, along with pre – testing yielded a questionnaire designed to assess the parents' KAP – level. A postal survey was set, in a national sample of 200 schools stratified by geographical region. The participants consist of a multistage geographical cluster sample of 8000 parents. The influence of demographic characteristics (i.e. sex, age, education) was analyzed. Cronbach index test and factor analysis were used to assess the reliability of the questionnaire.</p> <p>Results</p> <p>The response rate of the parents was 69%. Islands presented the lowest response rate while in Northern Greece the response rate was the highest. Sixty – eight point nine percent of the sample returned questionnaires fully completed, while 91.5% completed 95% of the questions. Three questions out of 70 were answered in a very low rate which was associated mostly with immigrant respondents. The section describing parents' attitude toward antibiotic use was not completed as much as the sections of knowledge or practices. The questions were factor analyzed and 10 out of the 21 extracted factors were finally evaluated, reducing the number of independent variables to 46. The reliability of the questionnaire was 0.55. However, only items that increased the Cronbach when added were eventually included in the final scales raising the internal consistency to 0.68. Limitations of the study, such as the vocabulary and form of the questionnaire and the idiocycrancy of the respondents, emerged during the analysis.</p> <p>Conclusion</p> <p>The response rate and the completeness of the questionnaires were higher than expected, probably attributed to the involvement of the teachers. The study findings were satisfactory regarding the development of a reliable instrument capable to measure parents' KAP characteristics.</p

Healthcare-associated transmission of Panton-Valentine leucocidin positive methicillin-resistant Staphylococcus aureus: the value of screening asymptomatic healthcare workers

Abstract Background Three patients hospitalised in the coronary care unit of a general district hospital (England, UK) were tested positive for Panton-Valentine leucocidin methicillin-resistant Staphylococcus aureus colonisation during their routine weekly screening for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were indistinguishable and all three patients have previously had negative screening tests. The outbreak investigation team considered exploring the possibility of PVL-MRSA transmission from members of staff to the patients and potentially between members of staff. Method As part of the investigations, healthcare workers on coronary care unit and intensive care unit were screened for MRSA carriage. Results Among 134 screened healthcare workers, five staff members (3.7%) were MRSA colonised. Among these isolates, four were Panton-Valentine leukocidin positive. However, only two healthcare workers had an indistinguishable isolate with the isolate identified among the colonised patients. Decolonisation treatment was offered to all colonised patients and healthcare workers. Conclusion In low MRSA prevalence settings, healthcare workers may be a reservoir of MRSA and an important potential source of transmission to patients. Screening and decolonisation of colonised healthcare workers may provide a valuable strategy in managing linked hospital acquisitions and reduce the risk of occupationally acquired complications. MRSA mass screen of healthcare workers should be considered in transmission with a strain that has a potentially increased virulence, such as Panton-Valentine leucocidin methicillin-resistant Staphylococcus aureus

Physical and environmental factors that influence humans health in recreational seacoast

Human’s health while bathing in recreational water will is affected by a combination of physical, chemical and biological hazards. The main objective of this study was to examine the health risks of bathers with respect to recreational seawater and to examine the physical, chemical and biological hazards that are responsible for this outcome. Furthermore our objective was to estimate the general quality of the sea-water bathing areas in Greece during the ten year period (1997-2006) and to formulate a risk factor assessment by associating the different pollution markers (tar, garbage, phenols, oils, floating materials) and other parameters (jellyfish, sea condition, rain, seaweed, wind direction), with microbiological bacterial indicators concentrations of seawater sampling test results. Finally we applied a new risk assessment approach in recreational sea waters. Τhe examination of quality of sea-water bathing areas in Greece over a 10-year period helped to identify risk factors for high bacteria indicator organism concentrations. Qualitative descriptive analysis was applied and the microbiological test results of 231,205 water samples were associated with pollution markers and other parameters. Measurements of E.coli (99.6%) and Enterococci (100%) were found to be in accordance with the mandatory value guidelines set by the new European Directive. An increasing trend for the yearly mean value of faecal Streptococci was noted. Using logistic regression analysis, phenolic smell (OR=2.10, CI=2.04-2.16), rainfall the day before sampling (OR=1.67, CI=1.64-1.74), high seas (OR=1.42, CI=1.39-1.46) and rainfall on the day of sampling (OR=1.27, CI=1.20-1.33) were positively independently associated with high levels of bacterial indicators (total coliforms, faecal coliforms, faecal Streptococci and Escherichia coli). The highest risk, absolute risk value 42.8%, (RR=3.17, CI=2.97-3.38) was measured when previous day-rainfall, phenolic smell and high seas were simultaneously recorded. Such parameters should be further investigated as predetermining factors for the assessment of beach bathing water quality, providing a timely indication of water risk assessment. During the summer of 2008 a cohort study was conducted including bathers from three different bathing sites in central Greece. Initial questioner and a 10 days later follow up were used. The questioner included information on demographics, bathing behavior, aesthetic issue of the beach, clinical signs and symptoms of diseases related to bathing. Moreover, a control group of non bathers with the same residence of the bathers was included in the study. In total, 4,293 bathers were approached. Only 34 bathers in the beach (0.79%) refused to take part in the survey from the beginning and 270 bathers (6.34%) did not respond or refused to take part during the telephone contact in the follow up 10 days later (total response rate=92.45%). In total 149 water samples and 152 sand samples were collected from the bathing sites on a regular daily basis for the quantitative analysis of bacterial indicators (total coliforms, faecal coliforms, Enterococci, Escherichia coli and Staphylococcus aureus). Univariate and backward logistic regressions analysis to asses the risk among the bathers compare to non bathers was used. We identify a statistical significant increased risk among swimmers in recreational sea water in comparison to non bathers for injuries, respiratory diseases, gastroenteritis, ear, eye and dermatological diseases. These results were observed despite the excellent bathing water quality. The significant increased risk among bathers in comparison to non bathers for professional medical help such visiting a doctor or a pharmacist or use of a medication is a indirect proof for higher morbidity among bathers. Furthermore as we found no relation for hospitalization or home care to the above described diseases we can certainly say that the diseases or symptoms related to swimming in recreational seawater are in the most cases of mild or medium severity and certainly no fatally. Other than the water quality factors may play a protagonist factor in health effects among bathers mainly in clean waters. Bathing itself is a reason for increased reported illness among bathers (with mechanism as example such the loss of protective cerumen as a result of heat, humidity in the ear). Bathers who were swimming in a high bather density beach had significant increased risk for developing respiratory disease, gastroenteritis and ear infections in relation to bathers who were swimming in beach with lower bather density. Overcrowding of bathers in the beaches is a parameter that explains many of the diseases we observed and certainly plays a protagonist role. Bather density is as a predominant factor for illness in excellent bathing water quality. An update of the risk assessment approach in recreational sea waters is needed.Οι λουόμενοι στις θαλάσσιες ακτές κολύμβησης διατρέχουν κινδύνους, που προέρχονται από αίτια που σχετίζονται με τον κολυμβητή, την συμπεριφορά του (πνιγμός, ατυχήματα, κακώσεις κ.ά.), τους φυσικούς και περιβαλλοντικούς παράγοντες (θερμότητα, κρύο, διαμόρφωση ακτής, κυματισμός, μικρόβια, ρύποι, κ.ά.). Οι επιδημιολογικές μελέτες σειράς ανέδειξαν στο παρελθόν ότι οι κολυμβητές κινδυνεύουν από μια σειρά νοσημάτων όπως γαστρεντερίτιδες και οξείες εμπύρετες λοιμώξεις του αναπνευστικού (AFRI= Acute Febrile Respiratory Illness). Ελάχιστες μελέτες ανέδειξαν συσχέτιση με ωτίτιδες, οφθαλμοπάθειες και λοιμώξεις του δέρματος. Παράλληλα, στη βιβλιογραφία περιγράφονται επιπρόσθετοι κίνδυνοι που διατρέχουν οι λουόμενοι όπως τα ατυχήματα, οι κακώσεις, οι πτώσεις, ο πνιγμός, η μικροβιακή μόλυνση των υδάτων, τα κυανοβακτήρια, η ηλιακή ακτινοβολία, το κρύο, η ζέστη, οι αλλεργίες, τα έντομα, τα ζώα, οι διάφοροι αισθητικοί παράγοντες, η χημική μόλυνση των υδάτων, οι έμμεσοι παράγοντες που διαμορφώνουν το περιβάλλον και το κλίμα μιας περιοχής, ο συγχρωτισμός των κολυμβητών και οι παράγοντες που σχετίζονται με την ανοσιακή κατάσταση του λουομένου. Βασικός στόχος της μελέτης αυτής ήταν να διασαφηνίσει αρχικά ποιες είναι οι παράμετροι της ανθρώπινης υγείας που επηρεάζονται στις ακτές κολύμβησης και στη συνέχεια να εκτιμήσει τους φυσικούς και περιβαλλοντικούς παράγοντες που την επηρεάζουν. Επιπρόσθετα στόχος ήταν να εκτιμηθεί στην Ελλάδα ο σχετικός κίνδυνος για την υγεία των κολυμβητών των θαλάσσιων ακτών. Για τους σκοπούς αυτούς, πέραν της βιβλιογραφικής αναζήτησης, διενεργήθηκε το καλοκαίρι του 2008 μεγάλης κλίμακας επιδημιολογική μελέτη σειράς σε 4.293 λουόμενους-κολυμβητές και σε 572 μη εκτεθειμένους (μη κολυμβητές). Παράλληλα με την διενέργεια της επιδημιολογικής μελέτης σειράς διενεργήθηκαν 149 δειγματοληψίες νερού αλλά και 152 δειγματοληψίες άμμου καθώς επιπρόσθετος στόχος ήταν να διερευνηθεί ο ρόλος της άμμου στις παραλίες κολύμβησης. Για τη μικροβιακή ανάλυση του νερού και της άμμου απαιτήθηκαν συνολικά 2.867 καλλιέργειες και ανακαλλιέργειες σε διάφορα στερεά θρεπτικά υλικά (τρυβλία) και 803 επιβεβαιωτικές καλλιέργειες σε θρεπτικούς ζωμούς. Συμπληρωματικός στόχος της μελέτης ήταν να εκτιμηθεί η ποιότητα των Ελληνικών υδάτων κολύμβησης τα τελευταία έτη, να αναζητηθούν οι επισκοπικοί παράμετροι που επηρεάζουν την ποιότητα των υδάτων κολύμβησης και να δημιουργηθεί ένας χάρτης GIS καθαρών και μολυσμένων ακτών κολύμβησης. Αυτά τελικά επιτεύχθηκαν μέσω της επεξεργασίας και της στατιστικής ανάλυσης των καταγραφών, των μετρήσεων ποιότητας των υδάτων των Ελληνικών ακτών, του ΥΠΕΧΩΔΕ κατά τα έτη 1997-2006, που περιελάμβαναν συνολικά 231.205 αποτελέσματα των μετρήσεων ποιότητας των υδάτων αναψυχής. Τέλος, καταβλήθηκε προσπάθεια να δημιουργηθεί ολοκληρωμένο μοντέλο ταξινόμησης των θαλάσσιων ακτών κολύμβησης με βάση τον κίνδυνο για την ανθρώπινη υγεία. Αυτό βασίστηκε στα αποτελέσματα της επεξεργασίας και της στατιστικής ανάλυσης των μετρήσεων ποιότητας των υδάτων αλλά και το σχετικό κίνδυνο για την ανθρώπινη υγεία που προέκυψε από την επιδημιολογική μελέτη σειράς. Προκειμένου να εκτιμηθεί η ποιότητα των υδάτων των Ελληνικών ακτών κολύμβησης χρησιμοποιήθηκαν τα αποτελέσματα των μικροβιολογικών μετρήσεων των υδάτων των ετών 1997-2006 (δεδομένα ΥΠΕΧΩΔΕ). Οι Ελληνικές ακτές σύμφωνα με τα αποτελέσματα της ανάλυσης παραμένουν στο μεγαλύτερο ποσοστό καθαρές με τις τιμές των μικροβιολογικών παραμέτρων να βρίσκονται πολύ κάτω από τα προβλεπόμενα όρια της Εθνικής και της Κοινοτικής νομοθεσίας. ...........................................................................................