Modifiable risk factors for spontaneous preterm birth in nulliparous women: a prospective study.

Background Spontaneous preterm birth (sPTB) has a detrimental impact on perinatal outcome, as well as on the resources of health systems in high-income countries. Thus, the objective of the current study was to determine the incidence of modifiable risk factors in pregnancy and their impact on the rate of sPTB. Methods All nulliparous pregnant women, in singleton pregnancies, with free medical and obstetric history, were eligible to participate in this study. The primary outcome of interest was the incidence of specific modifiable risk factors for sPTB. The correlations between these risk factors and sPTB were also investigated. Results Overall, 2027 women were eligible for the study and agreed to participate. The incidence of sPTB was 4.9%; 25.5% (n = 518) of the participants were in extreme maternal age (<20 or >35 years), 34.5% (n = 701) had an abnormal body mass index (BMI) (<18.5 or ≥25 kg/m2), 4.4% (n = 89) reported use of assisted reproductive technology (ART) and 10.9% (n = 220) reported themselves as smokers in pregnancy. In the multivariate analysis, sPTB was significantly correlated with ART conception [odds ratio (OR): 2.494, 95% confidence interval (CI): 1.196-5.199]. Conclusion Approximately one in 20 primiparous pregnant women in the study had a sPTB. The study population included a high percentage of women of advanced maternal age, with abnormal BMI and smokers, but these characteristics did not affect the incidence of sPTB. On the other hand, conception following ART increased two-fold the risk of sPTB.

How to keep up to date with medical information using web-based resources: a systematised review and narrative synthesis.

BACKGROUND: Keeping up to date with the latest medical information using Web-based resources has been sparsely described, and a comprehensive up-to-date review is needed. OBJECTIVES: To summarise the Web-based 'channels' that may assist the actors of the health care system (clinicians, medical researchers and students) to keep up to date with medical information. METHODS: We searched PubMed and Scopus for English language articles published between January 1990 and February 2019 that investigated ways for keeping up with medical information. We used the results from our search and relevant information from other sources to conduct a narrative synthesis. RESULTS: We found that resources that push information (e.g. web alerts, medical newsletters, listservs), resources that rely on the active information seeking (e.g. access to health librarians and electronic databases, podcasts, mobile apps), collaborative resources (e.g. web conferences, online journal clubs, web social media) and resources that synthesise information (e.g. bibliometrics, living systematic reviews) can contribute in keeping up with new findings and can enhance evidence-based medicine. Clinicians, medical researchers and students can benefit from the proper use of such Internet-based technological innovations. CONCLUSION: Internet provides many resources that can help the actors of the health care system stay up to date with the latest scientific findings.

Nutrition Interventions in Pediatric Pancreatitis: Guidelines We Can Trust.

OBJECTIVE: Despite the fact that pediatric pancreatitis is an uncommon disease, its prevalence has increased in recent years. Nevertheless, until 4 years ago, the lack of nutritional guidelines for pediatric pancreatitis was evident, with all recommendations being based on clinical practice guidelines (CPGs) for adults. The aim of the present study was to review and critically appraise guidelines for the medical nutrition therapy (MNT) of pediatric pancreatitis. METHODS: A comprehensive search was performed in electronic databases (PubMed, Scopus, National Institute for Health and Care Excellence), the International Guidelines Network, BMJ best practice, and the Scottish Intercollegiate Guidelines Network to identify CPGs on the MNT of pediatric pancreatitis. The validated AGREE II tool was used for guidelines appraisal by a team of 3 independent multidisciplinary reviewers. RESULTS: A total of 4 CPGs were retrieved with pediatric pancreatitis MNT information. Out of the 4 advising bodies in total, the joint society paper published by the ESPGHAN/NASPGHAN received the highest score in almost all domains, whereas the Belgian consensus obtained the lowest score in all domains but stakeholder involvement, and was not recommended by 2 out of 3 reviewers. CONCLUSIONS: Pediatric pancreatitis guidelines appear heterogenous in quality, rigour, and transparency. Our study points out existing gaps and biases in the CPGs, and delineates the need for improving the domains identified as being of low-quality.

Food addiction, orthorexia, and food-related stress among dietetics students.

PURPOSE: Health sciences, and in particular Nutrition and Dietetics students, have been shown to exhibit an increased prevalence of disordered eating. The aim of the present cross-sectional study was to evaluate other specified feeding and eating disorders (OSFEDs), including stress-related eating, food addiction, and orthorexia, in relation to the dietary intake, among nutrition/dietetics students. METHODS: A total of 176 undergraduate students from a Department of Nutrition and Dietetics, in Greece, participated in the study. Dietary intake was recorded, and the prevalence of Eating and Appraisal Due to Emotion and Stress (EADES), food addiction (with the modified Yale Food Addition scale mYFAS), and orthorexia were assessed. Chi-square and t tests were performed between sexes, orthorexic and non-orthorexic students, as well as between food-addicted and non-addicted participants. Multiple linear regression analysis assessed relationships between energy intake, BMI or waist circumference, and the food-related psychometric scales. RESULTS: Among participating students, 4.5% had food addiction and 68.2% demonstrated orthorexia. No differences were observed between men and women, concerning the prevalence of food addiction and orthorexia, the sum of mYFAS symptoms, or individual EADES factors. Orthorexic students exhibited increased BMI, reduced energy, and saturated fat intake. In addition, orthorexic men consumed more vegetables. Multiple linear regression analysis revealed that orthorexic behavior was associated with increased BMI, waist circumference and energy intake. Lower BMI was associated with increasing ability to cope with emotion-and-stress-related eating and increasing appraisal of ability and resources to cope with emotions and stress. Emotion-and-stress-related eating was negatively associated with BMI. Appraisal of ability and resources to cope with emotions and stress was associated with the energy intake. Finally, age was positively correlated with the appraisal of outside stressors/influences, indicating increased ability to cope with outside stressors among older students. CONCLUSIONS: The study shows that despite the suggested interventions, the problem of OSFEDs among nutrition and dietetics students is still valid. Regular screening, counseling, and education is needed to reduce its prevalence. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Molecular detection of Helicobacter pylori in a large Mediterranean river, by direct viable count fluorescent in situ hybridization (DVC-FISH).

Although the precise route and mode of transmission of Helicobacter pylori are still unclear, molecular methods have been applied for the detection of H. pylori in environmental samples. In this study, we used the direct viable count fluorescent in situ hybridization (DVC-FISH) method to detect viable cells of H. pylori in the River Aliakmon, Greece. This is the longest river in Greece, and provides potable water in metropolitan areas. H. pylori showed positive detection for 23 out of 48 water samples (47.9%), while no seasonal variation was found and no correlation was observed between the presence of H. pylori and indicators of fecal contamination. Our findings strengthen the evidence that H. pylori is waterborne while its presence adds to the potential health hazards of the River Aliakmon.

Reporting completeness in abstracts of systematic reviews of diagnostic test accuracy studies in cardiovascular diseases is suboptimal.

OBJECTIVE: Journal abstracts are crucial for the identification and initial assessment of content of studies. We evaluated whether authors in the field of cardiovascular diseases (CVDs) reported Diagnostic Test Accuracy Systematic Reviews (DTA SRs) abstracts adequately, as defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-DTA guidelines. METHODS: SRs of DTA studies in CVDs published in general and specialized medical journals were identified in a MEDLINE search between 2010-2020. Adherence to 12 PRISMA-DTA for abstracts items was assessed independently by two reviewers and compared by journal's type. Moreover, the association of reporting completeness with different characteristics was investigated. RESULTS: We included 72 abstracts. Studies published in general medical journals had higher mean reporting score than those in specialized journals (6.2 vs 5.3 out of 12 items; mean difference: 0.88; 95% confidence interval: 0.21, 1.55). PRISMA-DTA adherence was higher in journals that adopted this guideline and in articles with structured abstracts. However, number of participants analysed, funding and registration were the least-reported items in the identified abstracts. CONCLUSION: The reporting of abstracts of DTA reports in CVDs is suboptimal according to PRISMA-DTA guidelines. Abstract reporting could be improved with the use of higher word count limits and the adoption of PRISMA-DTA guidelines especially in specialized journals.

Moderators of Food Insecurity and Diet Quality in Pairs of Mothers and Their Children.

Research has suggested that maternal diet and characteristics may influence the diet of offspring during childhood. The present cross-sectional study aimed to assess the influence of distinct maternal characteristics and the diet quality of mothers on the prevalence of household food insecurity (FI) and the diet quality of children. A total of 179 mother-child pairs were recruited from two primary schools in the metropolitan area of Thessaloniki. The children were aged between 10 and 12 years old. Diet quality was assessed as the level of adherence to the Mediterranean diet (MD), with the use of the KIDMED for the children and the MedDietScore for the mothers. The household FI and the social and demographic characteristics of the mothers were also recorded, and anthropometric measures of both the mothers and their children were collected. Approximately » (26.3%) of the pairs reported some degree of FI, with a greater prevalence (64.7%) within single-mother families. Moreover, FI affected the level of maternal MD adherence (p = 0.011). On the other hand, FI was decreased in households with a greater maternal educational level (OR: 0.25; 95% CI: 0.10-0.63) and conjugal family status (OR: 0.15; 95% CI: 0.87-0.52). Maternal adherence to the MD was inversely related to the respective adherence of their offspring (OR: 0.93; 95% CI: 0.86-0.997), suggesting that during periods of financial constraints, maternal diet quality is compromised at the expense of affording a better diet for the minors in the family.

AGREEing on Guidelines for Nutrition Management of Adult Severe Burn Patients.

BACKGROUND: Severe burns are associated with a plethora of profound metabolic, immunologic, and physiologic responses, demanding prompt and adequate management. The objective of the present study was to review, compare, and critically appraise medical nutrition therapy guidelines for adult patients with severe burns, and produce salient points for the future update of relevant guidelines. METHODS: A total of 8 clinical practice guidelines developed by the American Burn Association (ABA), the European Burn Association (EBA), the European Society for Parenteral and Enteral Nutrition (ESPEN), the Midlands National Health Service, the Society for Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the Spanish Society of Intensive Care Medicine and Coronary Units and Spanish Society of Parenteral and Enteral Nutrition, the Indian Association for Parenteral and Enteral Nutrition (IAPEN), and the International Society for Burn Injury regarding medical nutrition therapy in burn patients was independently reviewed by a team of 4 multidisciplinary researchers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. RESULTS: From the appraised guidelines, the SCCM/ASPEN guidelines received the greatest scoring in the majority of AGREE domains compared with ABA, EBA, and IAPEN, which obtained the lowest scores. On the other hand, the ESPEN guidelines provided the majority of information concerning nutrition support and medical nutrition therapy. CONCLUSION: Our study identified gaps in most nutrition guidelines and emphasized methodologic issues that could improve the quality of future guidelines concerning nutrition support among adult severe burn patients.

Malnutrition surveillance among refugee children living in reception centres in Greece: a pilot study.

Background: The health of asylum seekers is of cardinal importance for the future health of Europe. The aim of the present cross-sectional study was to assess malnutrition prevalence among refugee children living in reception areas in northern Greece. Methods: A total of 192 refugee children (1-18 y old), inhabitants of the refugee reception centres in Drama and Kavala, were evaluated for acute and chronic malnutrition according to the WHO growth standards and charts. Results: In the total sample, 13.0% of the participants had at least one form of malnutrition, the prevalence of underweight was 7.8% and stunting affected 7.3% of the children. Moreover, a greater proportion of adolescent girls from the Drama centre (38.5%) demonstrated at least one form of malnutrition compared with the children in Kavala (p=0.046). Girls demonstrated an increased prevalence of malnutrition compared with boys, while children <5 y of age appeared more vulnerable. Conclusions: The present data underscore the necessity for malnutrition screening among refugees in order to have an early assessment of their nutritional status and address the direct and root causes of this substantial problem.

Growth, the Mediterranean diet and the buying power of adolescents in Greece.

Background The aim of the present cross-sectional study was to evaluate associations between pocket money, Mediterranean diet (MD) adherence and growth among Greek adolescents. Methods A total of 319 (157 boys and 162 girls) Greek adolescents, aged 10-18 years participated in the study. Pocket money was recorded, MD adherence was assessed with the KIDMED score and growth was evaluated using the World Health Organization (WHO) growth charts. Results Participants receiving pocket money exceeding 6.0€ daily demonstrated increased fast-food consumption and breakfast skipping. Overall, a negative relationship was revealed between pocket money and obesity. However, lower allowance receivers were less likely to be obese, consume fruit per day and more likely to consume breakfast and sweets, compared to average pocket money receivers. Increased MD adherence was associated with a lower risk of overweight and as expected, unhealthy eating habits were observed among obese adolescents. Conclusions Interrelationships tend to exist between MD adherence, pocket money and growth among adolescents.

Knowledge, attitudes and proposals of medical students concerning transplantations in Greece.

OBJECTIVES: In Greece, there is limited research on issues related to organ donation. We aimed to study the attitudes, knowledge, and actions of local medical students regard to organ donation and transplantations of tissues and organs in Greece. METHODS: This cross-sectional questionnaire based survey was done in Laboratory of Hygiene and Social Medicine, School of Medicine, Aristotle University of Thessaloniki, Greece on medical students in years 1 to 6. In a sample of 600 medical students, a special anonymous questionnaire, which included data as sex, age, and semester of studies, as well as questions regarding certain aspects of transplantation, was distributed. 558 valid questionnaires were completed (men 52.3% and women 47.7%). RESULTS: The vast majority of the sample (93.6%) were in favor of transplantations whereas 32 (5.7%) of the students claimed to be organ donors. 78.9% claimed ignorance of the existing legislation concerning transplantations and organ donation in our country. 81.2% believed that the voting of law, which would consider all Greek organ donors after death will cause strong reactions. As the main causes, responsible for the shortage of transplants in our country were stated to be the inadequate public information, Greek mentality, and the lack of organized transplant centers. Public information through Media, a lifelong free health check-up for organ donors and activation of voluntary organizations that promote organ donation were proposed as the most important actions that could increase organ donation and transplantations in Greece. CONCLUSIONS: The need for further informative actions stressing the importance of organ donations appears to be the only way to increase transplantations in our country and towards this direction medical students could also be activated. A new medical curriculum should increase medical students' awareness of the organ shortage problem. Public education is recommended to correct misconceptions.

The quality of safety reporting in trials is still suboptimal: survey of major general medical journals.

OBJECTIVE: To evaluate whether the quality of reporting harms improved after the publication of the Extension of the Consolidated Standards of Reporting Trials (CONSORT) statement and predictors that influence the safety reporting in randomized controlled trials (RCTs) STUDY DESIGN AND SETTING: Systematic survey of published RCTs assessing drugs. In MEDLINE, we identified 228 RCTs published in Annals of Internal Medicine, British Medical Journal, Journal of American Medical Association, The Lancet, and The New England Journal of Medicine in 2003 and 2006. RESULTS: The reporting of harms have improved over time both in quality and extent of space. However, the mean score as an overall measure of adequacy in reporting harms was 0.58 in 2003 and increased to 0.67 in 2006, indicating a moderate safety reporting. Safety was more adequate in trials with statistically significant results for efficacy, private funding, primary harms outcome, and anti-infective, antineoplasmatic, or immunosuppressive agents. CONCLUSION: The use of the Extension of the CONSORT statement may be associated with improving the quality of safety reporting in RCTs, but there are still deficiencies that need to be corrected to use quantitative objective evidence for harms in performing meta-analyses and making therapeutic decisions.

Cigarette smoking among adolescents in Thessaloniki, Greece.

OBJECTIVES: Epidemiological characteristics in tobacco smoking among adolescents were investigated in Thessaloniki, Greece. METHODS: The target sample was 1,221 students coming from 15 high schools. RESULTS: Cigarette smoking was higher among girls than boys (40.9% vs. 34.3%). However, the percentage of boys who were smoking more than 20 cigarettes per day was found larger than the relevant percentage of girls (81.2% vs. 75% of total smokers). The boys also reported an earlier initiation of tobacco use (12.7 years vs. 12.9 years in girls). Physical activity was negatively correlated with smoking, whereas drinking alcohol and low parental education were positively correlated with smoking. CONCLUSIONS: Health promotion programs should be instituted not only during adolescence, but rather before the age of 14.