Asbestos ban policies and mesothelioma mortality in Greece.

BACKGROUND: Malignant mesothelioma is a rare form of cancer that mostly affects the pleura and has a strong link to asbestos exposure. Greece banned the use of asbestos in 2005, however, the public was already aware of this substance in the 1980s. This research aims to present an overview of Greece's mesothelioma age-standardized mortality rates (ASMR) from 1983 to 2019 by age, gender, and geographic region and to determine whether the actions to ban asbestos impacted these rates. METHODS: Data were retrieved by the Hellenic Statistical Authority (HSA) from death certificates that mentioned mesothelioma as the cause of death from 1983 to 2019 with details on the residence, gender, and age. Statistical analysis was performed using PRISM 6.0 software, a two-way ANOVA test, Trend analysis was conducted using Joinpoint Regression Program 5.0 software. The linear and non-linear model was used to calculate the age-standardized rates of annual percentage change (APC) and its 95% confidential interval (95% CI). RESULTS: From 1983 to 2019, 850 total mesothelioma deaths were recorded, the majority of whom were males (634). A rate of 74.6% accounts for males and 25.4% for females, and the ratio of Males: Females was 3:1. Males' ASMR and the whole population's ASMR reached their highest levels in 2011 (0.93/100000person-years and 0.53/100000person-years, respectively). To look for potential changes between the first two decades of the 21st century, we compared the mean ASMR of each geographic region in Greece between two different 10-year subperiods (2000-2009 and 2010-2019). Except for Epirus, all regions of Greece had elevated regional ASMRs, particularly in those with the highest asbestos deposits. Notably, the ASMR in Epirus decreased from 0.54/100000person-years (2000-2009) to 0.31/100000person-years (2010-2019). After 2011, the ASMR for men and the general population stabilized. This stability is important since mesothelioma in men is associated with occupational asbestos exposure. The intriguing discovery of a lower ASMR in Epirus emphasizes the need to raise awareness of the condition and implement effective public health measures. CONCLUSIONS: In Greece, the annual ASMR for males and the whole population reached its highest level in 2011, which is positive and encouraging and may be a sign that the rate will stabilize during the following years. Moreover, this study showed that the actions made in the 1980s regarding public awareness and surveillance directly impacted the decrease in Epirus rates. Future research, continual awareness, information, and recording are needed to monitor the mesothelioma epidemic. The possible benefit of a mesothelioma registry and the epidemiological surveillance of asbestos-related diseases, particularly mesothelioma mortality, need to be addressed. TRIAL REGISTRATION: Not applicable.

Are younger COPD patients adequately vaccinated for influenza and pneumococcus?

Influenza and pneumococcal pneumonia are major causes of increased morbidity and mortality among elderly and COPD patients. Vaccines against influenza and pneumococcus are recommended for COPD patients according to GOLD 2020 guidelines to prevent serious illnesses. Despite their high morbidity and mortality burden, the vaccination coverage rates remain far below the WHO's recommended targets. In Greece, there are insufficient data on influenza and pneumococcal immunization rates among younger COPD patients. This study investigated whether COPD patients under the age of 65 are adequately vaccinated against influenza and pneumococcus and the factors that influence vaccination rates. 1100 individuals at 22 Primary Health Centers in Central Greece participated in a two-year spirometry monitoring program. Face-to-face interviews were used to collect information regarding demographics, smoking status, comorbidities, respiratory illnesses in the previous two years, and influenza and pneumococcal vaccination coverage from all COPD patients. 117 patients aged 40-65 years old were diagnosed with COPD and 80.3% were males. Only 40.2% of them had received influenza and 32.5% pneumococcus vaccinations. Age, advanced stage of COPD, years on COPD diagnosis, respiratory infection within the previous two years, comorbidity, and smoking cessation are all positively connected with influenza and pneumococcus vaccine coverage in younger COPD patients. Gender, education level, and marital status did not affect influenza and pneumococcus vaccination rates. These vaccination rates among younger COPD patients demonstrate the need for increased awareness and knowledge about the advantages of immunizations in lowering morbidity and mortality.

The effects of psychopathology and shame on social representations of health and lifestyle behaviours via free association: a graph analysis approach.

BACKGROUND: There is a knowledge gap in whether psychopathology aspects can shape and mark the social representations about health and lifestyle. In this work, we investigated the association of psychopathology and shame with the centrality of the words describing eight common social representations of health and lifestyle. METHODS: A convenience sample of 288 adults participated with an average age of 44.7, and 62.6% were women. The participants were asked to express three consecutive words associated with eight different health and lifestyle experiences by utilizing the free association method. The participants also were completed the Symptom Checklist-90-Revised (SCL-90-R), the Experiences of Shame Scale (ESS), and the Other as Shamer Scale (OAS). Canonical correlation analysis was applied to investigate the relationship between the set of the eight-word centralities and the psycho-demographic variables consisting of the subject's age and gender, the SCL 90 subscales, the OAS, and the ESS. Based on these findings, a structural equation explorative model was formed to test the unidimensionality of the five centralities construct. RESULTS: Τhe psychological characteristics of interpersonal sensitivity, depression, external shame, and hostility were found to affect the word selection process on the social representations concerning nightlife, health, diet, lifestyle, and alcohol consumption. Participants with increased levels of depression tend to choose more centrally positioned words when the stimulus word was diet and more decentralized responses when the stimulus word was health. At the same time, higher external shame corresponded to more decentralized words for the categories of health and lifestyle. CONCLUSIONS: Our results indicate that there is a potential interaction between the psychological state and how a social representation of health and lifestyle is constructed through selected words. Graph theory emerged as an additional tool to use to study these relations.

Effects of smoking cessation on serum leptin and adiponectin levels.

BACKGROUND: Evidence on the association of leptin and adiponectin and smoking is limited and discordant. Leptin and adiponectin represent the most abundant adipokines in human plasma that play crucial roles in the pathophysiology of metabolic syndrome, atherosclerosis and insulin resistance. Leptin up-regulates the expression of several pro-inflammatory cytokines and is increased upon weight gain. Adiponectin has been shown to possess insulin sensitizing, anti -inflammatory and anti-atherogenic properties and is increased upon weight reduction. Our aim was to assess the effects of smoking cessation on serum leptin and adiponectin levels. METHODS: We assessed the changes in serum leptin and adiponectin levels, serum CRP levels and BMI in apparently healthy smokers after 3 and 6 months of abstinence from smoking. Successful cessation was confirmed by an exhaled carbon monoxide measurement. 26 healthy non-smokers were recruited as controls. RESULTS: Among the sample group, 32 subjects had quitted smoking at 3 months and 29 subjects at 6 months. Samples' leptin increased significantly from baseline to three months (mean change 3.76 ng/ml [95 % CI 0.89, 6.64], p =0.012) and then decreased significantly from three to six months of smoking cessation (mean change -4,29 ng/ml [95 % CI -7.34, -6.64], p = 0.008). Samples' adiponectin increased significantly from baseline to three months of abstinence from smoking (mean change 2.34 [95 % CI -0.05, 4.73], p -0.05). BMI was significantly increased (mean change 2.03 kg/m(2) [95 % CI 1.60, 2.46], p <0.05), while CRP decreased significantly from baseline to 6 months of smoking cessation (mean change -0.68 mg/dl [95 % CI -1.06, -0.30], p = 0.001). CONCLUSIONS: Smoking quitters' leptin levels appear to increase 3 months after smoking cessation and then decrease from 3 to 6 months of abstinence from smoking. Adiponectin levels increase during the first trimester of smoking cessation. The decrease in CRP levels indicates that the low grade inflammation observed in smokers is gradually restored. The alterations of serum leptin and adiponectin after 6 months of smoking cessation suggest the same but do not reach statistically significant levels. Weight gain and changes in fat distribution may attenuate the beneficial effects of smoking cessation.

Juvenile (age 13-18) smoking incidence determinants in Greece.

Smoking is a form of medical addiction, usually adopted during adolescence. The aim was to determine the prevalence of smoking in adolescents, aged 13-18 years old, to investigate their attitudes towards smoking and determine the contribution of social influences to onset and continuation of smoking. An anonymous self-report questionnaire was filled in by 873 high school students of Central Greece. Smoking incidence was 19.2%, with a 13.7% of regular smokers. The presence of a smoker in the family and a smoker friend were correlated with increased smoking rates. School grades were correlated negatively with smoking attitude and positively with allowance. Age was correlated negatively with social influence. Social influence appears stronger on younger ages and is a main determinant of smoking behavior. A more susceptible attitude towards smoking is formed during late adolescence. Certain social predictive factors for attitude towards smoking are proposed.

Telemetric detection of chronic obstructive pulmonary disease and investigation of quality of life for people working in shipbuilding industry.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) has a significant impact on quality of life-related health. AIM: It was the detection of Chronic Obstructive Pulmonary Disease by using telemetric methods and the investigation of the quality of life for people working in Shipbuilding Industry compared with a control group. METHODS: A group of one hundred men working in the shipbuilding industry aged 51.8 ± 8.2 years old and a control group of one hundred men of the general population aged 51.1 ± 6.4 years were studied. All participants completed the General Health Questionnaire - 28, the Fagerstrom test and a form with demographic characteristics. Pulmonary function test results were electronically sent to a specialist for evaluation. RESULTS: People working in the shipbuilding zone had significantly lower values (p<0.001) in FVC, FEV1 and FEV1/FVC compared with the general population participants. Worse social functionality was exhibited by workers in the shipbuilding zone, people with elementary education, unemployed and by those suffering from comorbidities (p <0.001). CONCLUSIONS: Health level and its individual dimensions are both associated with health self-assessment and occupational and economic status. The coexistence of chronic diseases and smoking dependence affects emotion and social functioning of individuals.

Assessment of health level and socio-economic characteristics of people working in the shipbuilding industry: a control group study.

INTRODUCTION: The health level of the population and the way people perceive it has been associated with their physical and mental health, as well as with their social and occupational characteristics. PURPOSE: The comparative assessment of mental and health level in shipbuilding industry workers and general population and its relationship to social and economic parameters. METHODS: A group of one hundred men working in the shipbuilding industry aged 51.8±8.2 years old and a control group of one hundred men of the general population aged 51.1±6.4 were studied. All participants completed the General Health Questionnaire - 28 and Fagerstrom test and a form with demographic, occupational and economic status characteristics. The statistical software SPSS 17.0 was used for data analysis. RESULTS: Twenty-six percent of the general population and 47% of men working in the shipbuilding industry assessed their health as moderate/poor. Higher median values of anxiety and depressive symptomatology were observed in individuals characterizing their health as moderate/poor (p<0.001), their work as physically too demanding and in individuals with high dependency on smoking (p<0.05). With regard to the parameter of physical complaints, people working in the shipbuilding industry, non-active employees and those with comorbidities were found more burdened in relation to the general population (p<0.05). Depressive disorders were more common in those stating that their economic situation had been significantly deteriorated and in individuals with chronic diseases, which also showed reduced social functioning (p<0.05). CONCLUSIONS: Health level and its individual dimensions are both associated with health self-assessment and occupational and economic status. The coexistence of chronic diseases and smoking dependence affects emotion and social functioning of individuals.

mu-Opioid stimulation of isolated parietal sheep peritoneum decreases peritoneal permeability in vitro.

The peritoneal mesothelium is one of the main barriers to ion transport in peritoneal dialysis. In a previous study, we showed the existence of a micro-opioid influence on the in vitro ionic permeability of serosal membranes (specifically, pleura and pericardium), which become less permeable to ionic currents after the action of morphine. In the present study, we used Ussing chamber experiments to investigate the effect of morphine on the transmesothelial electrical resistance (RTM) of isolated parietal sheep peritoneum. Peritoneal samples from the diaphragm of adult sheep were isolated directly after the death of the animals and were transferred to the laboratory within 30 minutes in a cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O2/5% CO2. A planar sheet of parietal peritoneum was mounted in an Ussing-type chamber and morphine (10(-9) mol/L) was added apically and basolaterally. The RTM was measured before and serially for 30 minutes after the addition of morphine. Because active ion transport is temperature dependent, the Ussing chamber was held at 37 degrees C. Results presented are the mean +/- standard error of 6 experiments. The control RTM (before the addition of morphine) was 20.26 +/- 0.57 Omega x cm2. Addition of morphine basolaterally induced, within 1 minute, an increase in RTM of 24% +/- 4.8%, which declined thereafter (p < 0.01). When morphine was added apically, the results were not similar, because no significant change occurred in the RTM. The RTM is an established surrogate of peritoneal permeability. The results of the present study indicate rapid action of basolaterally added morphine on the permeability of the parietal peritoneum. The observed increase in the RTM indicates the existence in the parietal peritoneum of micro-opioid receptors that seem to prevail basolaterally. The clinical implications of these results should be further investigated.

Effect of endothelin-1 on the transmesothelial resistance of isolated visceral sheep peritoneum.

The mesothelium is part of the peritoneal barrier that manages the water and ion transport essential for peritoneal dialysis (PD) treatment. In addition, it has a central role in the pathogenesis of peritoneal fibrosis and the resulting ultrafiltration failure observed in many PD patients. Endothelin-1 (ET-1) is a potent vasoactive peptide originally described as an endothelial cell-derived factor In addition, ET-1 has been shown to stimulate fibrogenic activity in various organs by regulating the production and turnover of matrix components. The aim of the present study was to investigate, by means of Ussing chamber experiments, the effect of ET-1 on the transmesothelial electrical resistance (RTM) of isolated visceral sheep peritoneum. Intact sheets of visceral sheep peritoneum were obtained from 12 adult sheep. The samples were collected from the slaughterhouse immediately after the deaths of the animals and, within 30 minutes, were transferred in oxygenated Krebs-Ringer bicarbonate (KRB) solution at 4 degrees C to the laboratory to be mounted in an Ussing-type chamber. Endothelin-1 (10(-7) mol/L) was then added to the KRB solution apically or basolaterally, and the RTM was measured before and serially for 10 minutes after the addition of the ET-1. The control RTM (before addition of ET-1) was 22.8 +/- 0.56 Omega x cm2. Addition of ET-1 apically significantly increased the RTM by 63.82% +/- 16.93% (p < 0.05) within 1 minute. After addition of ET-1 basolaterally, the RTM also increased significantly by 90.91% +/- 57.31% within 1 minute (p < 0.05). In both cases, these values persisted throughout the experiment. These results clearly indicate an inhibitory effect of ET-1 on the ionic permeability of visceral sheep peritoneum. The rapid increase in RTM observed after the addition of ET-1 suggests the existence of endothelin receptors (ET-A or ET-B, or both) on visceral sheep peritoneum. Previous studies demonstrated that ET-1, acting on ET-B receptors, potently inhibits epithelial sodium channels in mammalian cell cultures. Nevertheless, the exact pathways that underlie these findings remain unclear; their elucidation requires further investigation.

Effect of sodium-potassium pump inhibition by ouabain on the permeability of isolated visceral sheep peritoneum.

The permeability for small solutes and the ultrafiltration capacity of the peritoneum are essential for effective peritoneal dialysis (PD) treatment. Elucidation of the factors that regulate these two properties is therefore of great importance. Ouabain, a potent inhibitor of the Na+-K+ pump has been shown to reduce fluid absorption in animal models of PD. In the present study, we used Ussing chamber experiments to investigate the effect of ouabain on the transmesothelial electrical resistance (RTM) of isolated visceral sheep peritoneum. Peritoneal samples from the omentum of adult sheep were isolated immediately after the deaths of the animals and were transferred to the laboratory in cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O2/5% CO2. A planar sheet of visceral peritoneum was mounted in an Ussing-type chamber, and ouabain (10(-3) mol/L) was added apically and basolaterally. The RTM was measured before and serially for 30 minutes after the addition of ouabain. Because active ion transport is temperature-dependent, all measurements were taken at 37 degrees C. The results presented are the mean +/- standard error of 6 experiments. Before the addition of ouabain, the control RTM was measured as 21.26 +/- 0.57 Omega x cm2. Addition of ouabain basolaterally induced an increase in the RTM to 27.62 +/- 0.72 Omega x cm2 within 1 minute (p < 0.05), and this level persisted throughout the experiment. The effect of ouabain, when added apically, was similar, characterized by a rapid rise in the RTM to 24.66 +/- 0. 76 Omega x cm2 at 1 minute (p < 0. 05), with subsequent persistence at that level. A clear association between RTM and active ion transport has been shown in previous studies. The results of the present study, showing a rapid effect of ouabain on the RTM of visceral peritoneum, therefore clearly suggest that cell membrane Na+K+-ATPase is important for peritoneal ionic transport. In addition, ouabain was previously shown to reduce vasodilation and intraperitoneal sodium or to increase intraperitoneal volume, especially in the presence of conventional acidic solutions. Those findings, combined with the results of the present study, clearly indicate that intraperitoneal administration of digitalis glycosides may have some beneficial effect in PD patients; however the specific clinical implications need further investigation.

The contribution of ascorbic acid and dehydroascorbic acid to the protective role of pleura during inflammatory reactions.

It is well-known that parapneumonic effusions lead to the formation of inflammatory exudates which contain an increasing amount of inflammatory cells, especially polymorphonuclear. At these pathological conditions characterized by oxidative stress, ascorbic acid (AA) plays an important role in quenching free radicals, so that it could protect neutrophils and mesothelial cells from oxidative damage. Besides that ascorbic acid and its metabolite dehydroascorbic acid (DHA) alters the sheep visceral and parietal pleura permeability. More specific ascorbic acid as well as dehydroascorbic acid decreases the permeability of pleura after addition on apical and basolateral side in both visceral and parietal pleurae. It seems that, AA and DHA have an opposite action upon pleura from that of the inflammatory mediators, like VEGF, which increases the permeability of pleura and causes mesothelial barrier dysfunction. The decrease of pleura permeability induced by AA and DHA suggest the hypothesis that AA and/or its metabolite DHA during inflammatory reactions not only protects mesothelial cells from oxidative damage, but also contributes to maintaining the mesothelial barrier function. Consequently, the inflammatory pleural fluid may be trapped in pleural space and the inflammation may be restricted, and have extension avoided.

Functional similarities between pleura and the renal proximal tubule--membrane and cellular considerations.

The small amount of liquid that, under physiological conditions, is presented in the pleural cavity has been the focus of extensive research for more than a century. However, there are still unanswered questions and considerable controversies about the nature of the forces governing its movement into and out of the pleural cavity. Early in the 20th century has been proposed that pleural fluid turnover is simple based on the balance between hydraulic and colloid osmotic pressures existing across the pleural membranes. This original hypothesis has not been validated by data accumulating over the last 20 years. Pleural tissues and renal proximal tubules present high water permeability, small transepithelial electrical resistance (22.02 Omega cm2) and the same cation transportation such as Na+ channels, Na+-K+ ATPase channels, and Na+-H+ exchanger. In contrast to previous conflicting theories concerning pleura fluid movement, the same functional characteristics suggest the hypothesis that physiology of pleura is similar to proximal tubules.