Vaccination practices and influenza in professional football players in Greece.

BACKGROUND: There is limited data on vaccination practices for professional footballers globally. AIMS: To record vaccination practices employed by medical staff of individual football teams of the Super League Greece, and absenteeism of footballers related to influenza illness. METHODS: A brief questionnaire was distributed to chief medical officers (CMOs) of the sixteen teams of the Super League Greece. Participants were asked to report vaccines they recommended for footballers. In addition, the questionnaire included questions on new cases of influenza and absenteeism due to influenza. Descriptive statistics (absolute and relative frequencies) were used for the presentation of the results. RESULTS: Overall, 87% of the CMOs recommended seasonal influenza vaccine, 62% hepatitis B vaccine and 50% pneumococcal vaccine. Fourteen CMOs (87%) reported that the occurrence of seasonal influenza in the 2016-17 northern hemisphere season ranged from one to five cases, while two medical officers (12%) reported zero workdays lost due to influenza. CONCLUSIONS: Our survey shows considerable variation in vaccination practices of CMOs of the Super League Greece. The results of this survey should stimulate further evaluation of vaccination policy and influenza-related absenteeism in footballers.

Spatial and temporal distribution of p,p'-DDE (1­dichloro­2,2­bis (p­chlorophenyl) ethylene) blood levels across the globe. A systematic review and meta-analysis.

BACKGROUND: Although p,p'­DDT (1,1,1­trichloro-2,2­bis (p­chlorophenyl)­ethane) has been banned for decades in most countries, its major metabolite p,p'-DDE (1­dichloro­2,2­bis (p­chlorophenyl) ethylene) is still detected in the vast majority of human blood samples. OBJECTIVES: The purpose of this study was to quantitatively estimate the geographical distribution of DDE blood levels and record time-trends for specific countries and continents, exploiting available data from the scientific literature. METHODS: A literature search was performed in SCOPUS and PUBMED databases. Studies were screened at 2 levels applying different sets of inclusion/exclusion criteria. Blood levels of DDE along with other variables of interest were extracted, and a meta-analysis of random effects was conducted, by using the package metafor within the statistical programming language R. Results were expressed as pooled geometric means (GM [95% confidence intervals, CIs]). RESULTS: A total of 418 papers were included in the quantitative synthesis that contained data for 854 population subgroups, and analyzed a total of 195,595 samples. Overall global DDE concentrations dropped from 5207 (95% CI: 3616-7499) ng/g lipids during 1951-1969 to 207 (95% CI: 159-269) ng/g lipids for studies reporting sampling after 2000. Analyses for studies published from 2001 and onward revealed geographical differences regarding DDE burden. DISCUSSION: The significant decline in DDE blood levels after its restriction is demonstrated in our results. Differences in decrease trends were observed in different parts of the globe, which can be explained by deferred implementation of environmental policies. In some countries DDE concentrations remain high, and systematic biomonitoring is proposed.

Lymph node ratio as a prognostic factor in gastric cancer patients following D1 resection. Comparison with the current TNM staging system.

INTRODUCTION: Nodal ratio (NR) has been demonstrated to be an independent prognostic factor in patients with gastric cancer. We evaluated the prognostic role of NR comparing it with the current TNM (2010) classification in gastric cancer patients treated with curative (R0) D1 resection. MATERIALS AND METHODS: We retrospectively reviewed 110 patients who underwent R0 resection for gastric cancer at University Hospital of Larissa between 2002 and 2011. All patients had a D1 lymphadenectomy plus the nodes along the left gastric artery. Factors affecting survival as well as correlations between the N status, NR status and resected nodes were investigated. RESULTS: In univariate analysis the N and NR status but not the numbers of retrieved nodes were significant prognostic factors. Inside N1 and N2 categories, patients with different NR groups were present and survival of some of these subpopulations was statistically different at long-rank test. There was a correlation between the nodes retrieved and N status but not with the NR category. In multivariate analysis both N status (HR=1.45; 95% C.I. = 1.19-1.89) and NR (HR=4.53; 95% C.I. = 1.86-11.03) found to be independent prognostic factors of survival. CONCLUSION: Prognostic significance of N status and NR status was comparable. Unlike N status, NR is independent by the number of resected nodes, and therefore it is particularly useful in case of conventional lymphadenectomy.

Company closure and mortality in a Greek bus company.

BACKGROUND: Previous studies strongly support an association between unemployment and an increased risk of morbidity and mortality. AIMS: To assess the impact of company closure on the mortality of redundant employees. METHODS: The mortality of a cohort of male ex-employees of the Athens Bus Transportation Company Epixirisi Astikon Siginonion (EAS) was followed from September 1992 to October 1993. Information on causes of death was obtained from death certificates and classified according to the ninth revision of the International Classification of Diseases. The expected number of deaths was calculated based on 5 year age groups. Cause-specific mortality rates for the Greek population were obtained from the Greek National Statistics Service, and standardized mortality rates (SMRs) were calculated using population census data for 1991. RESULTS: The cohort consisted of 4400 subjects. Thirty deaths were recorded. Crude mortality was significantly elevated (SMR = 1.75; 95% confidence interval (CI) 1.18-2.5; Table 1). A statistically significant excess in mortality from ischaemic heart disease was shown (18 deaths observed; SMR = 4.83; 95% CI 2.86-7.64). One year before the privatization and closure of EAS (1991), nine deaths were recorded among its 7400 employees (SMR = 0.34). CONCLUSIONS: Our study found a significant increase in all-cause mortality and death from ischaemic heart disease in male workers who were made redundant and suggested a significant negative impact of unemployment resulting from company closure on mortality. These results may signal future mortality patterns in Greece if the current climate of austerity and recession continues.

Exposure to occupational health hazards among Zambian workers.

BACKGROUND: Data on occupational safety and health in Southern Africa are scant. Hence the negative impact of poor working conditions is unknown and the scientific basis for interventions and policy formulation is lacking. AIMS: To determine the prevalence of, and factors associated with, exposure to occupational health hazards in Zambia. METHODS: We used data collected in the 2009 National Labour Force Survey. Unadjusted and adjusted odds ratios and their 95% confidence intervals were used to measure magnitudes of associations. RESULTS: Exposure to occupational hazards among the 64 119 respondents (response rate = 78%) included vibration from hand tools or machinery (3%), temperatures that make one perspire even when not working (4%), low temperatures whether indoors or outdoors (4%), smoke, fume, powder or dust inhalation (13%), pesticides (3%), noise so loud that voice had to be raised to talk to people (4%), chemical handling or skin contact (3%) and exposure to heavy object lifting, frequent bending of the back or rapid movement of limbs causing body pain (30%). In multivariate analysis, exposure to occupational health hazards was associated with older age, male sex, low educational level, being married/cohabiting and not being self-employed. CONCLUSIONS: Results from this study indicate that Zambian workers are exposed to a broad range of occupational health hazards. This could be useful for the formulation of a multi-sector approach aimed at the prevention and control of hazard exposure.

Features of registered occupational diseases in Greece: a veil of ignorance.

BACKGROUND: Under-registration of occupational diseases is a global problem. OBJECTIVES: The aim of this study was to describe the characteristics of the reported cases of occupational diseases, in the context of the largest insurance scheme in Greece. METHODS: Socio-demographic characteristics related to the identified cases of occupational diseases were collected from the archives of the special medical committee of the Social Insurance Institute (Idrima Koininikon Asfaliseon, IKA) for the year 1999. This year was chosen given that it largely represents the highest number of registered occupational diseases in comparison to the period 2000-2009. RESULTS: Sixty-seven (67) occupational diseases were recognized (3.4 cases/100,000 employees). There were 32 new cases (incidence rate: 1.64/100,000 employees). Occupational skin conditions and diseases of the respiratory system accounted for 85% of all diagnoses. Builders and unskilled blue collar workers were the most frequent occupational groups affected. CONCLUSIONS: These findings indicate a high rate of under-registration of occupational diseases in Greece, compared to data from the European Union. This under-registration could be attributed to a variety of limitations related to the current model of occupational health in Greece. The present pattern of registered occupational morbidity reflects the under-development of occupational health in Greece and stresses the need for further and intensified work in order to create modern occupational health services in this country.

Prevalence of self-reported symptoms compatible with carpal tunnel syndrome (CTS) among employees at a neonatal intensive care unit: a cross-sectional study.

BACKGROUND: Carpal Tunnel Syndrome is a significant work-related disease. OBJECTIVE: The aim of the study was to investigate the prevalence of symptoms possibly related to CTS in workers in a neonatal intensive care unit. METHODS: The self-administered INRS questionnaire for musculoskeletal symptoms was distributed to all 41 employees of a neonatal intensive care unit and to an appropriate sample of 82 employees of a paediatric emergency department and an adult intensive care unit. RESULTS: Employees of the neonatal intensive care unit recorded a significantly higher prevalence of symptoms potentially related to CTS in comparison with the reference group (58.5% vs 8.3%, respectively; p < 0.001). Logistic regression analysis indicated that work in the neonatal intensive care unit was independently associated with the risk of symptoms potentially related to CTS. CONCLUSIONS: The results provide some evidence for a higher prevalence of symptoms potentially related to CTS in nursing personnel of a neonatal intensive care unit. Further research work is needed to prove a causal association.

Low acceptance of vaccination against the 2009 pandemic influenza A(H1N1) among healthcare workers in Greece.

A questionnaire survey on the attitude of healthcare workers towards pandemic influenza vaccination showed low acceptance (17%) of the pandemic vaccine. Factors associated with vaccine uptake were acceptance of seasonal influenza vaccination, medical profession and age. The main reason for refusal of vaccination was fear of side effects, which was stronger in those who received information on the safety of the vaccine mainly from mass media.

The decision making process on public health measures related to passenger ships: the example of influenza pandemic 2009.

BACKGROUND: Public health measures at sea ports have posed a challenge for public health competent authorities, especially in the context of the influenza pandemic of 2009. This paper discusses the response of authorities to notifications of infectious diseases on passenger ships and the importance of assessing the risks related to cases of influenza. It further provides options for health measures and considerations for decision making during a pandemic such as the influenza pandemic of 2009. DISCUSSION: Prevention and control of influenza have included action taken by both competent port authorities and ships' crews. Assessing the public health risk of each event reported from ships to competent authorities at ports is important before advice is given on implementation of control measures. Public health risk assessment involves appraisal of threats to passengers and crew on board the ship as well as to the population in the community. SUMMARY: Any public health measures taken should be necessary and proportional to the threat. Measures at ports cannot alone be effective in the prevention of the spread of a disease to the community since other means of transport play a major role. Measures taken on board ships can be effective in containing the disease. Consistent policy based on common protocols and carried out by competent authorities at local, national, European, or international levels are essential.

Quality of life and smoking among industrial workers in Greece.

BACKGROUND: Smoking is a predictor of quality of life, while socio-economic factors influence the prevalence of smoking habits. Occupational medical research has been fairly late in coming to study quality of life aspects in working populations. OBJECTIVES: The aim of the study is the assessment of smoking prevalence among blue- and white-collar workers industrial workers in Greece and its impact on health-related quality of life. METHODS: In a cross-sectional study the Euro-Qol 5D questionnaire was been used in a random sample of 472 blue and white-collar heavy industry workers. RESULTS: 57% of the study population were current smokers. The difference in prevalence of smoking across all the examined socio-demographic variables (sex, age, education and occupation) was not statistically significant. Smoking had a significant impact on the health-related quality of life. Smokers recorded significant lower scores (74.9) in the overall Visual Analogue Scale in comparison with non-smokers (79.1), (p = 0.007). Further analysis revealed that age, smoking and education were significant predictors of VAS score. A non-significant contribution was found for occupation and sex. Smokers reported significantly higher rates of problems regarding mobility, self-care and anxiety/depression than non-smokers. Logistic regression analysis showed an independent impact of smoking on mobility, self-care and anxiety/depression level. CONCLUSIONS: Smoking is a significant hazard and a strong predictor of poor quality of life among the blue- and white-collar workers under study. Anti-smoking policies integrated into a broader context of occupational health and safety at work could reduce smoking rates and thus improve worker's quality of life.

Prevalence of hepatitis A virus infection among municipal solid-waste workers.

A study was conducted among 151 municipal workers (72 solid-waste workers, and 79 workers not exposed to waste). Total antibodies against Hepatitis A virus (HAV) were measured, and socio-demographic information was collected using a self-administered questionnaire. Univariate analysis has shown that occupational exposure to waste, age, duration of employment and educational status were significantly associated with the prevalence of anti-HAV(+). Municipal Solid Waste Workers had a higher prevalence of anti-HAV(+) in comparison with municipal workers not exposed to waste. Duration of employment was significantly associated anti-HAV(+). Multivariate analysis revealed an independent association of anti-HAV(+) with occupational exposure to waste and ageing. Our results suggest a potential causal role of occupational exposure to waste, in the development of HAV infection.

Increased risk for coronary heart disease in blue-collar workers at a military industrial plant in Greece?

OBJECTIVE: To test the hypothesis that blue-collar workers have a higher prevalence of risk factors for Coronary Heart Disease than white-collar workers. METHODS: A cross-sectional study of 262 employees (208 males, 54 females, mean age: 50,65 years) was made of a Greek military industrial plant. Blood samples were taken and analyzed for lipids, lipoprotein levels and glucose levels; arterial blood pressure and body mass index (BMI) were also recorded. Smoking habits were ascertained by the use of a self-administered questionnaire. RESULTS: White-collar workers had significantly higher mean levels of total and LDL cholesterol than blue-collar workers. No significant differences were found regarding arterial blood pressure, BMI, glucose, triglycerides and HDL cholesterol levels. Both groups reported similarly high rates of smoking. Multivariate analysis confirmed an independent association of abnormal levels of total and LDL cholesterol with white-collar occupation. CONCLUSION: These findings partly contradict the current pattern of CHD risk factors in Western workforces. Possible interpretations, as well as the limitations of the study, are discussed.

Vaccination against hepatitis B virus in workers of a general hospital in Athens.

BACKGROUND: Protection against hepatitis B virus infection by vaccination is considered to be an important preventive measure for health care workers. OBJECTIVES: Investigation of vaccination coverage against hepatitis B virus in health care workers of a regional general hospital in Athens and assessment of predictive factors possibly associated with the likelihood of vaccination. METHODS: In a cross-sectional study, a questionnaire survey was carried out on 175 health care workers of a regional general hospital in Athens. The questionnaire included questions concerning socio-demographic factors, HBV vaccination status and reasons for non-vaccination, as well as questions about knowledge of routes of transmission and the complications of HBV infection. Compliance with preventive practices against HBV infection was also assessed. RESULTS: Overall vaccination coverage was 57.1%. Logistic regression analysis revealed that occupation and use of gloves were independently associated with the likelihood of vaccination against HBV Doctors recorded an odds ratio (OR) for vaccination of 4.45 in comparison with nurses/paramedics. Health care workers who wore gloves always/most times demonstrated an odds ratio of 2.79 for vaccination against HBV in comparison with those who never/rarely used them. CONCLUSIONS: Our study illustrates the characteristics of health care workers with lower prevalence of vaccination against HBV in a representative sample of these workers in a regional general hospital in Athens: nurses/paramedics, those with low level of compliance with use of gloves, and those in non surgical departments. Educational interventions as part of a vaccination programme and continuing education on universal precautions could help increase HBV vaccination coverage among health care workers of the hospital under study.

Prevalence of hepatitis B virus markers in municipal solid waste workers in Keratsini (Greece).

AIM: To evaluate the prevalence of hepatitis B virus (HBV) markers among municipal solid waste workers (MSWWs) in Keratsini (Greece). METHODS: We assessed in a cross-sectional study the prevalence of biological markers of HBV infection (HbsAg, anti-Hbc, anti-Hbs) and their association with exposure to waste and other socio-demographic factors in 166 municipal employees in Keratsini (Greece). RESULTS: The prevalence of anti-Hbc (+) did differ significantly between exposed and non-exposed employees to waste. Older employees had a significantly higher prevalence of anti-Hbc (+). MSWWs who were anti-Hbc (+) were less educated than non-exposed employees. Logistic regression analysis has shown that the exposure to waste and age were independently associated with the anti-Hbc positivity. CONCLUSION: Occupational exposure to waste is possibly associated with the acquisition of HBV infection. Immunization of MSWWs should be considered to reduce the risk of HBV infection.

Occupational injuries in Greece (1938-1955): history of medicine and descriptive epidemiology.

AIM: To describe the longitudinal trends in the rates of total and fatal occupational accidents in Greece during 1938-1955. MATERIAL AND METHODS: Information on occupational injuries have been provided from the yearly reports of the Organization of Social Insurances (1938-1955) and on population data from the tables of National Statistic Agency. Bio-statistical analysis was performed by the use of SPSS software and Stat-Calc of Epi Info. RESULTS: The evolution of the longitudinal trend of occupational accidents has revealed a biphasic character, with a decreasing trend during 1938-1945 and an increasing trend during 1946-1955. The phenomenon was obvious in both sexes and in all age groups. On the contrary fatal occupational injuries increased across the period 1938-1945 and subsequently decreased. These temporal trends can be interpreted on the light of the important reduction in the level of economic activity during the second world war and the subsequent gradual recovery in the post war period. CONCLUSION: The biphasic characteristics of the occupational accidents longitudinal trend seems to be influenced by historical factors. Important lessons were learnt from the period of war. The decrease of the rate of total occupational accidents does not necessary reflect a satisfactory level of safety at work. The level of the economic activity, the efficiency of the registration and prevention agencies play a role. In addition, the rate of fatal injuries has a critical role in benchmarking national occupational health performance.