Differences in survival and cause-specific mortality in a culturally diverse Greek population, 1999-2008.

BACKGROUND: Modern urban populations exhibit considerable internal heterogeneity. Several social groups, such as ethnic minorities or immigrants, constitute individual clusters with different demographic and epidemiological characteristics. METHODS: Death records were collected from the Municipality Registry between 1999 and 2008. Kaplan-Meier survival analysis was conducted for (i) natively born Greeks, (ii) former USSR-repatriated Greeks and (iii) Roma. Further evaluation was conducted by log-rank (Mantel-Cox) test. Relative mortality rates were assessed by means of cross-tabulation (Pearson's χ(2)). RESULTS: Statistically significant differences in median survival were observed among the three social groups (P < 0.001). The relative mortality from infectious diseases was higher in the Roma population compared with natively born Greeks, odds ratio (OR) = 8.31 [confidence interval (CI) 95% 3.19-21.61]. More than 70% of these deaths were attributed to respiratory tract infections and were associated with children under the age of 5. Excess mortality due to external causes, injuries and substance abuse was observed in repatriated males compared with their natively born counterparts, OR = 2.27 (CI 95% 1.35-3.81). CONCLUSIONS: Specific public health interventions are required, to improve the survival of different cultural groups. For example, improvement of immunization status and increase in overall hygiene awareness can ameliorate high infant/childhood mortality in Roma population, while social integration can help reduce acculturation-related mortality among repatriated Greeks.

Monitoring of Frequency and Antimicrobial Susceptibility of Pathogens on the Hands of Healthcare Workers in a Tertiary Hospital.

OBJECTIVE: To monitor microbes, focusing on drug resistance, on the hands of the personnel of four departments of a tertiary hospital (ICU, neonatal unit, internal medicine ward and surgical ward) and explore differences between departments, professions and genders. MATERIALS AND METHODS: Hand sampling from 125 healthcare employees was conducted followed by isolation, identification and antibiotic resistance profiling of different microbial species. RESULTS: Staphylococcus spp was the most prevalent microbe (76/125, 60.8%), followed by different Gram-negative pathogens (45.6%). ICU employees had a significant probability to have Gram-negative contamination [OR 3.627 (95% CI 1.220-10.782)], independently of gender or profession. Staphylococcus spp presence was associated with working in the internal medicine ward [OR 6.976 (95% CI 1.767-25.540)] and the surgical ward [OR 5.795 (95% CI 1.586-21.178)]. Staphylococcus spp was more prevalent in males vs. females (81.3% vs. 54.9%, p=0.008) and in medical vs. nursing personnel (76.9% vs. 54.8, p=0.019). In the majority of Gram-negative isolates (56.1%), at least one multi-drug resistant (MDR) or extensively drug resistant (XDR) strain was isolated. A statistically significant higher prevalence of XDR Gram-negative microbes was found on the hands of nursing personnel (22.2% vs. 2.3% for medical doctors, p=0.014). Only 2 methicillin resistant Staphylococcus Aureus (MRSA) out of the 12 Staphylococcus aureus positive samples were identified. CONCLUSIONS: Employees in the ICU are more prone to Gram-negative and not to Gram-positive hand contamination. MDR and XDR pathogens are prevalent, and are associated with nursing profession.

Public health risk assessment associated with heavy metal and arsenic exposure near an abandoned mine (Kirki, Greece).

The 'Agios Philippos' lead-zinc mine in the Kirki region (NE Greece) is now closed, but its legacy of heavy metal contamination remains at the site. At present, management of the contaminated land is of major concern. The area is in a reclamation process and requires immediate remediation action, whereas human risks need to be carefully evaluated. In order to assess these risks, samples from around the mine were collected and analyzed and a scenario involving the oral, dermal, and inhaled doses of arsenic and heavy metals was formulated. A Monte Carlo approach was undertaken, in order to model the average daily dose and quantify the corresponding hazard index and cancer risk. A toxicological risk was associated with samples collected in the vicinity of the mine (floatation, mine tailings) and a pronounced carcinogenic risk for arsenic was evident at the broader occupational/environmental setting. These findings urge for immediate rehabilitation actions that will mitigate population exposures and promote long-term environmental safety in the area.

Validity of dietary patterns derived in nutrition surveys using a priori and a posteriori multivariate statistical methods.

AIM: To evaluate the validity of dietary patterns derived using both a priori and a posteriori methods. METHOD: Five hundred individuals (46 ± 16 years, 40% males) completed a valid 76-food item food frequency questionnaire and a 3-day dairy. The MedDietScore was used to a priori assess the adherence to the Mediterranean diet, while principal components and cluster analysis were used as the a posteriori methods. RESULTS: Both the a priori and a posteriori methods used led to relatively low-validity dietary patterns. However, the level of validity reached significance in many cases and, also, varied by the type of validation method used (i.e. Bland and Altman, non-parametric criteria, etc.). CONCLUSION: The aforementioned findings may suggest that the use of both a priori and a posteriori pattern analysis in nutrition surveys should be made with conscious thought and further research is needed in order to establish robust methodologies to assess the validity of patterns.

Heavy metal pollution associated with an abandoned lead-zinc mine in the Kirki region, NE Greece.

The "Agios Philippos" mine in the Kirki region (NE Greece) has been abandoned in 1998 after half a century of ore exploration without a reclamation or remediation plan. This article aims at elucidating the potential environmental risks associated with this site by quantifying pollution in tailing basins, stream waters, stream sediments and agricultural fields. Concentrations of heavy metals in the abandoned mine tailings reached 12,567 mg/kg for Pb, 22,292 mg/kg for Zn, 174 mg/kg for Cd and 241 mg/kg for As. The geoaccumulation index and enrichment factor for these metals were indicative of extremely high contamination (I(geo) > 5) and extremely high enrichment (EF > 40), respectively. Stream waters in the proximity of the mine had an acidic pH equal to 5.96 and a high sulfate content (SO(4)(-2) = 545.5 mg/L), whereas concentrations of Mn, Zn and Cd reached 2,399 microg/L, 7,681 microg/L and 11.2 microg/L. High I(geo) and EF values for Cd, Zn and As in stream sediments indicates that surface water pollution has a historic background, which is typically associated with acid mine drainage. Agricultural fields in the proximity of the mine exhibited high I(geo) and EF values, which were in decreasing order Cd > Pb > Zn > As. These findings urge for an immediate remediation action of the afflicted area.

Seasonal variations of allergenic pollen in a Mediterranean region - Alexandroupolis, north-east Greece.

OBJECTIVES: The aim of this study was to describe the aerobiological characteristics of NE Greece, identify the most prevalent taxa, define the duration of the main pollen season and correlate allergen records with meteorological parameters. MATERIALS AND METHOD: A 7-day volumetric trap, running continuously throughout the year, was used to collect circulating pollen. Pollen taxa were characterized by standard protocols and counted as grains/m(3) . The main pollen season was deduced from these data and running means (10-day averages) were plotted against time. Correlations with climatic factors (temperature, rain, humidity, wind velocity) were assessed by single linear regression analysis. RESULTS: In total, 11 pollen families were identified, including 6 arboreal and 5 non-arboreal taxa. The 5 most prevalent taxa were Oleaceae, Fagaceae, Poaceae, Cupressaceae and Pinaceae. Peak pollen concentrations were detected in April and May, with daily averages exceeding 410 grains/m(3) . Compositeae had the longest pollen season of 135 days and Oleaceae the shortest, extending to only 27 days. Correlations with meteorological parameters showed variable associations among different taxa, with mean temperature (p<0.001), relative humidity (p=0.015), and wind speed (p=0.042) emerging as the most significant determinants as regards total pollen counts. CONCLUSIONS: Describing the aerobiological characteristics of NE Greece enabled the identification of allergenic risks that are specific for this region. Records generated in this study can be used to alert sensitized individuals of prevailing seasonal patterns, in order to take necessary precautions against imminent exposures. The monitoring system established here can serve as a reference guide for future epidemiological research focusing on allergic asthma and rhinitis.

Short-term stability of dietary patterns defined a priori or a posterior.

OBJECTIVES: The aim of this work was to evaluate whether the short-term stability (repeatability) of dietary patterns derived using a priori and a posterior approaches is affected by food items or food groups selected for the analysis. A priori methods seek to determine a person's adherence to a pre-specified (usually 'healthy') diet, whereas a posterior methods are used to record a person's (or more generally a population's) actual diet. DESIGN AND MAIN OUTCOME MEASURES: To test the a priori approach, the MedDietScore was selected as an index of adherence to the Mediterranean diet. A sample of 500 participants (aged 18-82 years, 38% male) completed a 76-item food frequency questionnaire (FFQ), while another 250 participants (aged 17-76 years, 34% male) completed a 36-item FFQ and the MedDietScore, twice within a 15-day interval. The MedDietScore was additionally indirectly calculated from participants' 76-item FFQ and 36-item FFQ answers. To test the a posterior approach, principal-components analysis (PCA) was used to derive dietary patterns. PCA was applied to data derived from the 76-item FFQ, using as independent variables first the 50 food items recorded on the FFQ and second 12 food groups (i.e., aggregated data) derived from the FFQ items. RESULTS: Both the indirectly calculated (i.e., through the two FFQs) and the directly recorded MedDietScore mean values were similar between the two administrations (p-values>0.05). In addition, PCA using the 50 food items revealed three major dietary patterns that were similar in both administrations, explaining 23% and 25% of the dietary intake variability, respectively, while PCA using 12 food groups also revealed three similar patterns between the two administrations (explaining 43% and 46% of the dietary intake variability, respectively). CONCLUSIONS: The results indicate the short-term stability of dietary patterns derived using either a priori or a posterior methods. For the a posterior approach the use of food groups, instead of food items, seems to explain more variation in dietary intake.

Diferenças na mortalidade por câncer rural/urbana: um estudo de caso do nordeste da Grécia / Rural/urban disparities in cancer mortality: a case-study from northeast Greece

Uma abordagem epidemiológica descritiva foi realizada a fim de abordar a questão das disparidades rural/urbana da mortalidade por câncer no nordeste da Grécia. O método de normalização direta foi usado para controlar as diferenças na distribuição da faixa etária entre as duas regiões. A região A era altamente urbanizada (>90%) e a região B, predominantemente, agrícola. O registro dos casos foi realizado de acordo com o protocolo da CID10 da Organização Mundial de Saúde. Foram observados resultados estatisticamente significativos para mortalidade por câncer de próstata, que foi 86% maior na área rural em oposição aos indivíduos de áreas urbanas (RR=1,86, IC95% 1,10?3,14). Em outros tipos de câncer (por exemplo, câncer de estômago) um efeito coorte pode estar presente, necessitando assim mais investigações sobre a hipótese. Desigualdades socioeconômicas, tais como acesso a cuidados de saúde e educação, são fatores fundamentais para a erradicação das disparidades rural/urbana na mortalidade por câncer. As intervenções devem centrar-se na promoção da saúde e conscientização, especialmente abordando a importância do rastreamento precoce e diagnóstico de câncer.