Socio- Demographic, Clinical and Lifestyle Determinants of Low Response Rate on a Self- Reported Psychological Multi-Item Instrument Assessing the Adults’ Hostility and its Direction: ATTICA Epidemiological Study (2002-2012)

Background: Missing data constitutes a common phenomenon, especially, in questionnaire-based, population surveys or epidemiological studies, with the statistical power, the efficiency and the validity of the conducted analyses being significantly affected by the missing information. The aim of the present work was to investigate the socio-demographic, lifestyle and clinical determinants of low response rate in a self- rating multi-item scale, estimating the individuals’ hostility and direction of hostility.Methods: 3042 apparently healthy volunteers residing in the Athens metropolitan area participated in the ATTICA epidemiological study [1514 (49.8%) were men [46 years old (SD= 13 years)] and 1528 (50.2%) were women [45 years old (SD= 14 years)]]. Hostility and Direction of Hostility was assessed with the Hostility and Direction of Hostility (HDHQ) scale. Binary logistic regression with backward model selection was used in order to identify the key demographic, clinical and lifestyle determinants of higher non-response rate in the HDHQ scale.Results: The vast majority of the participants (87.0%) had missing information in the HDHQ scale. Older age, lower educational level, poorer health status and unhealthy dietary habits, were found to be significant determinants of high nonresponse rate, while female participants were found to be more likely to have missing data in the items of the HDHQ scale.Conclusions: The present work augments prior evidence that higher non-response to health surveys is significantly affected by responders’ background characteristics, while it gives rise to research towards unrevealed paths behind this claim

Olive oil intake is inversely related to cancer prevalence: a systematic review and a meta-analysis of 13800 patients and 23340 controls in 19 observational studies

Dietary fat, both in terms of quantity and quality, has been implicated to cancer development, either positively or negatively. The aim of this work was to evaluate whether olive oil or monounsaturated fat intake was associated with the development of cancer. A systematic search of relevant studies, published in English, between 1990 and March 1, 2011, was performed through a computer-assisted literature tool (i.e., Pubmed). In total 38 studies were initially allocated; of them 19 case-control studies were finally studied (13800 cancer patients and 23340 controls were included). Random effects meta-analysis was applied in order to evaluate the research hypothesis. It was found that compared with the lowest, the highest category of olive oil consumption was associated with lower odds of having any type of cancer (log odds ratio = -0.41, 95%CI -0.53, -0.29, Cohran's Q = 47.52, p = 0.0002, I-sq = 62%); the latter was irrespective of the country of origin (Mediterranean or non-Mediterranean). Moreover, olive oil consumption was associated with lower odds of developing breast cancer (logOR = -0,45 95%CI -0.78 to -0.12), and a cancer of the digestive system (logOR = -0,36 95%CI -0.50 to -0.21), compared with the lowest intake. The strength and consistency of the findings states a hypothesis about the protective role of olive oil intake on cancer risk. However, it is still unclear whether olive oil's monounsaturated fatty acid content or its antioxidant components are responsible for its beneficial effects

Circulating Tissue Inhibitor of Matrix Metalloproteinase-4 (TIMP-4) in Systemic Sclerosis Patients with Elevated Pulmonary Arterial Pressure

Decreased levels of matrix metalloproteinases (MMPs) or excess levels of their tissue inhibitors (TIMPs) may contribute to dysregulation of extracellular matrix turnover in systemic sclerosis (SSc). In a cross-sectional study of 106 SSc patients, we measured serum levels of TIMP-4 which is preferentially expressed in cardiovascular structures and searched for correlations with simultaneously performed echocardiography measurements of pulmonary artery systolic pressure (PASP), myocardial performance, and pulmonary function tests. TIMP-4, but not MMP-9, levels were significantly raised in patients with SSc than controls. However, in the subgroup of patients with PASP measurements lower to 40 mmHg (n = 69), TIMP-4 levels were comparable to controls irrespective of the presence of diffuse or limited skin involvement, or lung fibrosis. Individual PASP measurements suggestive of pulmonary hypertension were associated with increased TIMP-4 serum levels (P = .03), independently of age, extent of skin sclerosis, or lung fibrosis, suggesting a cardiopulmonary vasculature-specific role of TIMP-4 activation in SSc

Sexually Transmitted Infections in a Cohort of 15,921 Refugees (1926-1940) in the Region of Imathia, Northern Greece

This historical epidemiological study evaluates sexually transmitted infections (STIs) among Greek refugees during the Interwar period in the region of Imathia, Central Macedonia, Greece, as a part of the effort against sexually transmitted infections in Greece (1910-1940). We examined the archives of the Refugee Hospital of Veroia – the capital of the regional unit of Imathia (March 5, 1926 to October 27, 1940). This is a report of previously unpublished primary material comprising a cohort of 15,921 cases, among whom 41 patients were hospitalized on account of syphilis and 19 on account of gonococcal infection. Descriptive statistics were estimated. Primary (n=4), secondary (n=2), tertiary (n=13), congenital (n=7), and not further specified (n=15) cases of syphilis were identified, whereas a variety of differential diagnosis problems arose. Syphilis and gonococcal infection/gonorrhea seemed to affect various social groups, as evidenced by the variety of professions involved. Refugee patients originated from various areas such as Caucasus, Thrace, Constantinople, Bithynia, and Pontus. Lack of information and poor healthcare led to spreading of STIs in Greece. Law 3032/1922 was crucial for the Greek effort against sexually transmitted infection

Sexually Transmitted Infections in a Cohort of 15,921 Refugees (1926-1940) in the Region of Imathia, Northern Greece

This historical epidemiological study evaluates sexually transmitted infections (STIs) among Greek refugees during the Interwar period in the region of Imathia, Central Macedonia, Greece, as a part of the effort against sexually transmitted infections in Greece (1910-1940). We examined the archives of the Refugee Hospital of Veroia – the capital of the regional unit of Imathia (March 5, 1926 to October 27, 1940). This is a report of previously unpublished primary material comprising a cohort of 15,921 cases, among whom 41 patients were hospitalized on account of syphilis and 19 on account of gonococcal infection. Descriptive statistics were estimated. Primary (n=4), secondary (n=2), tertiary (n=13), congenital (n=7), and not further specified (n=15) cases of syphilis were identified, whereas a variety of differential diagnosis problems arose. Syphilis and gonococcal infection/gonorrhea seemed to affect various social groups, as evidenced by the variety of professions involved. Refugee patients originated from various areas such as Caucasus, Thrace, Constantinople, Bithynia, and Pontus. Lack of information and poor healthcare led to spreading of STIs in Greece. Law 3032/1922 was crucial for the Greek effort against sexually transmitted infection

Fish Consumption Moderates Depressive Symptomatology in Elderly Men and Women from the IKARIA Study

Background. The aim was to examine the association of depressive symptoms with fish eating habits, in elderly individuals. Methods. From June to October of 2009, we studied 330 men and 343 women, aged 65 to 100 years, permanent inhabitants of Ikaria Island. Among several characteristics, depression was assessed with the Geriatric Depression scale (GDS range 0–15), while dietary habits through a valid semiquantitative food frequency questionnaire. Results. Women had significantly higher values of the GDS compared to men (4.8 ± 3.5 versus 3.3 ± 3.1, P = .001). Participants in the upper tertile of depression scale ate less frequent fish and consumed higher quantities of alcohol, compared to those in the lowest tertile (all P < .05). Regarding fish consumption, 50% of the individuals reported consuming 1-2 times weekly, 32% 3 to 5 times weekly, 11% 2-3 times monthly, while the rest reported rare (4.5%) and everyday (1.2%) consumption. Logistic regression showed that increased fish consumption (>3 times/week versus never/rare) was inversely associated with the odds of having GDS greater the median value (i.e., 4) (odds  ratio = 0.34, 95% CI: 0.19, 0.61), after controlling for several cofounders. Conclusion. Frequent fish consumption in elderly seems to moderate depression mood

The effect of obesity and dietary habits on oxidative stress in Hashimoto’s thyroiditis

Objective: Increased oxidative stress has been described in patients with Hashimoto’s thyroiditis (HT). The aim of the present study was to investigate whether high oxidative stress is further influenced by obesity and dietary habits in euthyroid women with HT. Methods: Two hundred eighteen consecutive euthyroid women with HT were studied and separated in two groups; 102 with thyroxine replacement and 114 without. For the evaluation of oxidative stress, total lipid peroxide levels in serum (TOS) were measured and recoded as ‘high TOS’ vs ‘medium/low TOS’. The type of food and consumption frequency were recorded. Two binary variables were considered; normal vs low fruit consumption and daily vs sporadic vegetable consumption. Results: ‘High TOS’ was more frequent in women under thyroxine replacement (31.4% vs 14.7%, OR = 2.7, 95% CI: 1.4–5.2). The prevalence of ‘high TOS’ was higher among overweight/obese women compared to women with normal BMI (30.4% vs 12.5%, OR = 3.1, 95% CI: 1.5–6.4). Low fruit consumption was associated with increased ‘high TOS’ prevalence (30.6% vs 12.9%, OR = 3.0, 95% CI: 1.4–6.2). Sporadic vegetable consumption was associated with increased ‘high TOS’ prevalence compared to daily consumption (29.9% vs 13.5%, OR = 2.7, 95% CI: 1.3–5.7). The examined risk factors were independent and additive in their effect on TOS. At least three risk factors had to be concomitantly present for the likelihood of ‘high TOS’ to be significantly elevated. Conclusions: Oxidative stress is increased in women with HT under thyroxine replacement. Nevertheless, normal BMI, daily fruit and vegetable consumption, all contribute in maintaining oxidative stress at low levels

Endovascular equipoise shift in a phase III randomized clinical trial of sonothrombolysis for acute ischemic stroke

Background: Results of our recently published phase III randomized clinical trial of ultrasound-enhanced thrombolysis (sonothrombolysis) using an operator-independent, high frequency ultrasound device revealed heterogeneity of patient recruitment among centers. Methods: We performed a post hoc analysis after excluding subjects that were recruited at centers reporting a decline in the balance of randomization between sonothrombolysis and concurrent endovascular trials. Results: From a total of 676 participants randomized in the CLOTBUST-ER trial we identified 52 patients from 7 centers with perceived equipoise shift in favor of endovascular treatment. Post hoc sensitivity analysis in the intention-to-treat population adjusted for age, National Institutes of Health Scale score at baseline, time from stroke onset to tPA bolus and baseline serum glucose showed a significant (p &lt; 0.01) interaction of perceived endovascular equipoise shift on the association between sonothrombolysis and 3 month functional outcome [adjusted common odds ratio (cOR) in centers with perceived endovascular equipoise shift: 0.22, 95% CI 0.06–0.75; p = 0.02; adjusted cOR for centers without endovascular equipoise shift: 1.20, 95% CI 0.89–1.62; p = 0.24)]. After excluding centers with perceived endovascular equipoise shift, patients randomized to sonothrombolysis had higher odds of 3 month functional independence (mRS scores 0–2) compared with patients treated with tPA only (adjusted OR: 1.53; 95% CI 1.01–2.31; p = 0.04). Conclusion: Our experience in CLOTBUST-ER indicates that increasing implementation of endovascular therapies across major academic stroke centers raises significant challenges for clinical trials aiming to test noninterventional or adjuvant reperfusion strategies

Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial

Background: Pulsed-wave ultrasound increases the exposure of an intracranial thrombus to alteplase (recombinant tissue plasminogen activator), potentially facilitating early reperfusion. We aimed to ascertain if a novel operator-independent transcranial ultrasound device delivering low-power high-frequency ultrasound could improve functional outcome in patients treated with alteplase after acute ischaemic stroke. Methods: We did a multicentre, double-blind, phase 3, randomised controlled trial (CLOTBUST-ER) at 76 medical centres in 14 countries. We included patients with acute ischaemic stroke (National Institutes of Health Stroke Scale score ≥10) who received intravenous thrombolysis (alteplase bolus) within 3 h of symptom onset in North America and within 4·5 h of symptom onset in all other countries. Participants were randomly allocated (1:1) via an interactive web response system to either active ultrasound (2 MHz pulsed-wave ultrasound for 120 min [sonothrombolysis]; intervention group) or sham ultrasound (control group). Ultrasound was delivered using an operator-independent device, which had to be activated within 30 min of the alteplase bolus. Participants, investigators, and those assessing outcomes were unaware of group assignments. The primary outcome was improvement in the modified Rankin Scale score at 90 days in patients enrolled within 3 h of symptom onset, assessed in the intention-to-treat population as a common odds ratio (cOR) using ordinal logistic regression shift analysis. This trial is registered with ClinicalTrials.gov, number NCT01098981. The trial was stopped early by the funder after the second interim analysis because of futility. Findings: Between August, 2013, and April, 2015, 335 patients were randomly allocated to the intervention group and 341 patients to the control group. Compared with the control group, the adjusted cOR for an improvement in modified Rankin Scale score at 90 days in the intervention group was 1·05 (95% CI 0·77–1·45; p=0·74). 51 (16%) of 317 patients in the intervention group and 44 (13%) of 329 patients in the control group died (unadjusted OR 1·24, 95% CI 0·80–1·92; p=0·37) and 83 (26%) and 79 (24%), respectively, had serious adverse events (1·12, 0·79–1·60; p=0·53). Interpretation: Sonothrombolysis delivered by an operator-independent device to patients treated with alteplase after acute ischaemic stroke was feasible and most likely safe, but no clinical benefit was seen at 90 days. Sonothrombolysis could be further investigated either in randomised trials undertaken in stroke centres that are dependent on patient transfer for endovascular reperfusion therapies or in countries where these treatments cannot yet be offered as the standard of care