Oral Ingestion of Hexavalent Chromium through Drinking Water and Cancer Mortality in an Industrial Area of Greece - An Ecological Study

Background: Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem, making this a question of significant public health importance. Methods: We conducted an ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population. Results: A total of 474 deaths were observed. The SMR for all cause mortality was 98 (95% CI 89-107) and for all cancer mortality 114 (95% CI 94-136). The SMR for primary liver cancer was 1104 (95% CI 405-2403, p-value < 0.001). Furthermore, statistically significantly higher SMRs were identified for lung cancer (SMR = 145, 95% CI 100-203, p-value = 0.047) and cancer of the kidney and other genitourinary organs among women (SMR = 368, 95% CI 119-858, p-value = 0.025). Elevated SMRs for several other cancers were also noted (lip, oral cavity and pharynx 344, stomach 121, female breast 134, prostate 128, and leukaemias 168), but these did not reach statistical significance. Conclusions: Elevated cancer mortality in the Oinofita area of Greece supports the hypothesis of hexavalent chromium carcinogenicity via the oral ingestion pathway of exposure. Further studies are needed to determine whether this association is causal, and to establish preventive guidelines and public health recommendations

Ποσοτική έρευνα σχετικά με την κατάσταση και την εκπαίδευση στη δημοσιογραφία της υγείας στην Ευρώπη

Εισαγωγή: Τα ΜΜΕ διαδραματίζουν καίριο ρόλο στη διάχυση των πληροφοριών υγείας και τον καθορισμό της ημερήσιας θεματολογίας, επηρεάζοντας αντιλήψεις και συμπεριφορές ατόμων, ασθενών, ιατρών, καθώς και της πολιτικής ηγεσίας. Παράλληλα, εκφράζεται έντονη ανησυχία αναφορικά με ελλιπή, παραπλανητική ή ανακριβή κάλυψη των θεμάτων υγείας, που συνδέεται με προκλήσεις και περιορισμούς του ιατρικού ρεπορτάζ. Η έλλειψη εκπαίδευσης των δημοσιογράφων στην κάλυψη θεμάτων υγείας αποτελεί βασικό παράγοντα που επηρεάζει την ποιότητα της παρεχόμενης πληροφόρησης. Οι ίδιοι οι δημοσιογράφοι εκφράζουν ενδιαφέρον για σχετική εκπαίδευση, η οποία ωστόσο είναι περιορισμένη, ιδιαίτερα στην Ευρώπη. Σκοπός: Στόχος της παρούσης διατριβής είναι να διερευνήσει τις πεποιθήσεις των δημοσιογράφων διαφορετικών Ευρωπαϊκών χωρών αναφορικά με τη δημοσιογραφία της υγείας και τη σχετική εκπαίδευση. Η διατριβή αυτή επιδιώκει να προσδιορίσει το προφίλ των δημοσιογράφων που καλύπτουν θέματα υγείας, τις αντιλήψεις τους αναφορικά με την ποιότητα και τα εμπόδια του ιατρικού ρεπορτάζ, καθώς και την ανάγκη εξειδικευμένης εκπαίδευσης, παρέχοντας στοιχεία αναφορικά με τις θεματικές, τις δεξιότητες και τον τύπο εκπαίδευσης που επιθυμούν. Υλικό και Μέθοδοι: Στην έρευνα συμμετείχαν 176 δημοσιογράφοι από επτά Ευρωπαϊκές χώρες (Γερμανία, Ελλάδα, Εσθονία, Ηνωμένο Βασίλειο, Ισπανία, Ρουμανία και Φινλανδία). Χορηγήθηκε ερωτηματολόγιο μεταφρασμένο στη γλώσσα κάθε χώρας, το οποίο αποτελείται από 24 ομάδες ερωτήσεων και βασίστηκε σε εργαλείο σχετικής έρευνας στις ΗΠΑ (Kaiser Family Foundation &amp; Association of Health Care Journalists, 2009). Η στατιστική ανάλυση περιλάμβανε περιγραφικές αναλύσεις για το σύνολο των ερωτημάτων και πολυπαραγοντική ανάλυση. Διεξήχθη ανάλυση ως προς το συνολικό δείγμα και σε επίπεδο χώρας και διαφορετικών ομάδων δημοσιογράφων (βάσει χαρακτηριστικών). Αποτελέσματα: 61,4% των συμμετεχόντων είναι δημοσιογράφοι υγείας και 32,4% καλύπτουν θέματα υγείας περιστασιακά. Το 80,2% των συμμετεχόντων θεωρεί την κάλυψη των ιατρικών θεμάτων από τα ειδησεογραφικά μέσα μέτρια (43,0%) ή καλή (37,2%). Ως πηγές για την άντληση ιδεών ρεπορτάζ υγείας, οι συμμετέχοντες χρησιμοποιούν συχνότερα προσωπικές επαφές στον χώρο της υγείας και ειδικούς (52,4%), καθώς και επιστημονικά ιατρικά περιοδικά ή κλαδικά έντυπα (39,6%). Η πλειονότητα θεωρεί ότι ο ειδησεογραφικός οργανισμός στον οποίο ανήκει σπανίως (39,4%) ή μερικές φορές (27,1%) βασίζεται αποκλειστικά σε δελτία ή συνεντεύξεις τύπου χωρίς περαιτέρω διερεύνηση και αναφορές, με σημαντικές αποκλίσεις ανά χώρα. Ως σημαντικότερα εμπόδια στην κάλυψη των θεμάτων υγείας αναφέρουν την πρόσβαση και συνεργασία με πηγές, την ανεπαρκή εκπαίδευση σε θέματα υγείας, την έλλειψη χρόνου, τη γραφειοκρατία και τη διαχείριση αντικρουόμενων συμφερόντων. Περισσότεροι από έξι στους δέκα δημοσιογράφους (66,5%) δεν έχουν λάβει εξειδικευμένη εκπαίδευση στην κάλυψη θεμάτων υγείας, με τα υψηλότερα ποσοστά να εμφανίζονται σε Ελλάδα (87,0%), Γερμανία (84,0%) και Εσθονία (80,0%). Η πλειοψηφία των δημοσιογράφων θεωρεί, ωστόσο, την εξειδικευμένη εκπαίδευση απαραίτητη (51,7%) ή χρήσιμη (47,1%). Δημοσιογράφοι που έχουν λάβει εξειδικευμένη εκπαίδευση, όπως οι συμμετέχοντες σε Ρουμανία και Ισπανία όπου παρουσιάζονται τα υψηλότερα ποσοστά εκπαίδευσης (55,0% και 59,3% αντίστοιχα), τη θεωρούν πιο απαραίτητη. Δημοσιογράφοι των οποίων το κύριο δημοσιογραφικό ενδιαφέρον είναι η ιατρική έρευνα και επιστήμη είναι επίσης πιο πιθανό να τη θεωρούν απαραίτητη, σε σχέση με εκείνους οι οποίοι δεν ενδιαφέρονται για το συγκεκριμένο τομέα δημοσιογραφίας (ΣΛ=3,16; p=0,017). Υψηλό ποσοστό συμμετεχόντων επιθυμεί περισσότερη εκπαίδευση στην ιατρική έρευνα και επιστήμη (54,3%), σε πολιτικές υγείας (49,4%) και στα οικονομικά της υγείας (46,8%). Επίσης, μεγάλο είναι και το ποσοστό των δημοσιογράφων, οι οποίοι ενδιαφέρονται να ενισχύσουν δεξιότητες που αφορούν στην αξιολόγηση συγκρουόμενων συμφερόντων (48,6%), στην ερμηνεία ιατρικών ερευνητικών ανακοινώσεων (46,2%) και στην κατανόηση στατιστικών δεδομένων (45,9%). Τέλος, ο επιθυμητός τύπος εκπαίδευσης για το μεγαλύτερο μέρος των συμμετεχόντων, είναι οι ομάδες εργασίας/σεμινάρια (83,4%) ή τα εθνικά συνέδρια (82,6%), διάρκειας μίας (32,7%) έως δύο (36,4%) ημερών, το διαδικτυακό υλικό (79,8%) καθώς και τα έντυπα βιβλία/ οδηγοί (74,8%). Συμπεράσματα: Οι περισσότεροι δημοσιογράφοι που εξειδικεύονται ή καλύπτουν περιστασιακά το ιατρικό ρεπορτάζ σε Ευρωπαϊκές χώρες δεν έχουν λάβει σχετική εκπαίδευση, γεγονός που θεωρείται σημαντικό εμπόδιο στην κάλυψη των θεμάτων υγείας. Παράλληλα, η εξειδικευμένη εκπαίδευση θεωρείται απαραίτητη ή χρήσιμη από αυτούς που έχουν λάβει σχετική εκπαίδευση, και, βάσει της πολυπαραγοντικής λογιστικής παλινδρόμησης, προέρχονται από χώρες με υψηλά ποσοστά εκπαίδευσης (π.χ Ρουμανία &amp; Ισπανία) ή/και καλύπτουν πρωτίστως θέματα ιατρικής έρευνας και επιστήμης, ενώ δεν έχουν ως πρωταρχικό ενδιαφέρον τα οικονομικά της υγείας ανεξαρτήτου χώρας προέλευσης και στις δύο τελευταίες αναφορές.Introduction: Journalists play a key role in the dissemination of health-related information and agenda setting, influencing the perceptions and behaviors of individuals, patients, health professionals and policy makers. Τhere is concern about incomplete, unbalanced or inaccurate coverage of health issues associated with the challenges and limitations that health journalists face. The lack of specialized training for health journalists can influence the quality of health reporting. Journalists are interested in educational opportunities, which appear however to be limited, especially in Europe. Objective: The objective of this dissertation is to investigate the beliefs of journalists from different European countries about health journalism and related education. The thesis aims to describe the profile of journalists that report on health, their perceptions of the quality and the barriers to health reporting, and the need for specialized training. It also seeks to provide information on the health topics, skills and type of training preferred by journalists. Materials and Methods: A total of 176 journalists from seven European countries (Germany, Greece, Estonia, United Kingdom, Spain, Romania, and Finland) participated in the survey. A questionnaire, translated into the seven relevant languages, was administered to participants. The questionnaire consisted of 24 groups of questions and was based on the survey tool of related research conducted in the United States (Kaiser Family Foundation &amp; Association of Health Care Journalists, 2009). Statistical analysis included descriptives for all the questions of the survey and logistic regression. Analyses were conducted on the basis of the total sample, on a country-specific basis, as well as on different groups of journalists, based on their characteristics. Results: 61,4% of participants were health journalists and 32,4% were journalists occasionally reporting on health issues. 80,2% of participants consider the coverage of news media with regard to health issues as fair (43,0%) or good (37,2%). Participants’ most frequent sources of story ideas are personal contacts in the health sector and experts (52,4%), followed by medical journals and trade press publications (39,6%). The majority of journalists believe that their news/media organization rarely (39,4%) or sometimes (27,1%) reports stories based on news releases or news conferences without substantial additional reporting, including contacting independent sources. Significant differences emerged per country. The most common obstacles when reporting on health are related to accessing and working with sources, inadequate training on health and medical issues, lack of time, bureaucracy, and conflicts of interest. Over six out of ten journalists (66,5%) have not received specialized training on reporting health issues. Greece (87,0%), Germany (84,0%) and Estonia (80,0%) have the highest percentages of journalists that have not received specialized training. However, the majority of participants consider specialized training as necessary (51,7%) or good to have yet unnecessary (47,1%). Journalists who have received specialized training, particularly in countries where the majority of journalists have received specialized training, as the cases of Romania and Spain (55,0% and 59,3% respectively), consider it more necessary. Journalists who have a primary focus on medical research and science have higher odds of considering specialized training as necessary, in contrast to journalists whose primary focus is not medical research and science (OR=3.161; p=0,017). The health topics of most interest to participants in regards to training are medical research and science (54,3%), health policy (49,4%) and business/economics of health care (46,8%). Concerning specific skills, participants are mostly interested in improving their ability to evaluate conflicts of interest (48,6%), interpret medical research reports (46,2%) and understand statistics (45,9%). Preferable types of training include workshops (83,4%) or national conferences (82,6%), of one (32,7%) or two-day (36,4%) duration, online informational material (79,8%), and printed books and resource guides (74,8%). Conclusion: Most journalists specializing in health reporting or occasionally covering health issues in Europe have not received relevant training, which is considered a major obstacle in health reporting. At the same time, specialized education is considered to be necessary or useful by journalists who have received such training. Also, based on multivariate logistic regression, specialized education is considered to be necessary or useful by journalists who come from a European country where journalists are educated on health reporting (e.g Romania &amp; Spain), if their primary focus is medical research and science or if their primary focus is not business/economics of health care irrespective of the country of origin in both last cases

Vegetable and fruit intake: Associations with health and guidelines for adults in Greece

Katerina Belogianni - ORCID: 0000-0002-3634-7861 https://orcid.org/0000-0002-3634-7861Item not available in this repository.Introduction High vegetable and/or fruit intake has been associated with beneficial effects on health. Nevertheless, the level of scientific evidence supporting these associations needs to be investigated in order to formulate dietary guidelines for the general adult population. Material-Method The association between vegetable and fruit intake and incidence of coronary heart disease, stroke, type 2 diabetes and cancer was investigated and the level of evidence of these associations was graded. Quantitative and qualitative guidelines were subsequently developed taking into account several other factors. Results There is general agreement of evidence that the highest intake of vegetables and/or fruits compared to the lowest intake is associated with lower risk of coronary heart disease, stroke, type 2 diabetes, colorectal and oral cancer, while the majority of the evidence has shown that is also associated with lower risk of esophageal and stomach cancer. The final recommendations were set to 4 servings of vegetables and 3 servings of fruits daily. Conclusions The recommended daily consumption of 4 servings of vegetables and 3 servings of fruits for adults living in Greece is based on sound evidence, complies with their dietary habits and traditions, is practically feasible and should be encouraged by all health professionals.104pubpub

Promotion of Immunizations for Health Professionals in Europe: A Qualitative Study in Seven European Member States

Health Care Workers (HCWs) are a high-risk group for contracting Vaccine-Preventable Diseases who, despite legislation and guidance, remain undervaccinated. In order to understand their barriers and needs, focus groups were formed with 278 physicians, nurses, infection-control personnel, and policy-makers in 7 EU MS. Several implications for the development of promotional initiatives were identified including the need to overcome organizational barriers, to sensitize HCWs about the importance of immunization and to provide specific up-to-date information about vaccinations covering prevalence of diseases, protection years, side effects, administration times, antibody examinations, costs and immunization settings

Promotion of healthy nutrition among students participating in a school food aid program: a randomized trial

Belogianni, Katerina - ORCID 0000-0002-3634-7861 https://orcid.org/0000-0002-3634-7861Item not available in this repository.Objectives To evaluate the potential benefits on students’ eating habits, of incorporating healthy nutrition education as part of a school food aid program. Methods 146 schools participating in the DIATROFI Program in Greece during the 2013–2014 school year were randomly allocated to the environmental intervention (received a healthy daily meal) and the multicomponent intervention (MI) group (in addition to the meal, a healthy nutrition educational program was applied). The analysis, based on 3627 pre–post intervention questionnaire pairs, was stratified for children (ages 4–11 years) and adolescents (ages 12–18 years). Results Children participating in the MI group displayed 25 % higher odds of increasing the weekly consumption of milk/yoghurt and fruits, 61 % higher odds of improving BMI from overweight/obese to normal and 2.5 times higher odds of improving from underweight to normal. For adolescents in the MI group, the odds of increasing the consumption of vegetables were 40 % higher. In both intervention groups, approximately one in four overweight/obese adolescents reached normal weight. Conclusions Educational programs on healthy nutrition might be considered worth implementing in the framework of school food aid programs.The DIATROFI Program was funded by the Stavros Niarchos Foundation and has been approved and runs under the auspices of the Greek Ministry of Education and Religious Affairs.http://dx.doi.org/10.1007/s00038-016-0813-061pubpub

Essential Skills for Health Communication, Barriers, Facilitators and the Need for Training: Perceptions of Healthcare Professionals from Seven European Countries

Many healthcare professionals are unaware of the necessary skills and barriers hindering interpersonal health communication. This study aimed to evaluate the healthcare professional's perception regarding health communication training's necessity, barriers, facilitators and critical skills in health communication. Data from a cross-sectional online survey in the framework of the H-Com project were utilized. The study included 691 healthcare professionals (physicians, nurses, students and allied health professionals) from seven European countries. Only 57% of participants had participated in health communication training, while 88.1% of them indicated a willingness to be trained in health communication. Nurses were more likely (OR = 1.84; 95% CI 1.16, 2.91) to have received such training, compared to physicians. Most examined communication skills, barriers and facilitators of effective communication, and perceived outcomes of successful communication were considered crucial for most participants, although physicians overall seemed to be less concerned. Most agreed perceived outcomes were improved professional-patient relations, patient and professional satisfaction, physical and psychological health amelioration and patients' trust. Nurses evaluated the importance of these communication skills and communication barriers, facilitators and outcomes higher than physicians. Physicians may underestimate the importance of communication skills more than nurses. Health communication should become an integral part of training for all health professionals

Physician-patient communication: a qualitative study of perceptions, barriers, and needs in four European member states

Background: Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes, however, there is a lack of standard European Union (EU) communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU countries as part of the EU-funded project, Health Communication Training for Health Professionals–H-COM. Method: Focus groups were conducted with 31 patients and 38 physicians from Germany, Greece, Spain, and Cyprus. Two separate discussion guides were constructed for each target group around three themes: perceptions of, barriers to, and needs for health communication. Thematic analysis was used. Results: Commonalities and differences between countries and target groups were identified, with participants discussing attitudinal, emotional, educational, and systemic barriers to good communication. Participants indicated a significant gap in health communication knowledge, skills, and training for physicians, with regional differences. Conclusion: The results imply that there is a need for EU-wide communication training for physicians that would be best addressed by common themes and tailoring to specific regional differences. The results also imply that effective training should encompass a blend of theory and practical methods, and should be delivered via an e-learning platform for maximum accessibility. Training programs that adhere to these suggestions can begin to address the gaps in patient-centered care in the EU