Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.502
Filtrar
1.
Medicina (Kaunas) ; 56(7)2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32708858

RESUMO

The evolving pandemic of Coronavirus Disease 2019 has posed a substantial health risk worldwide. However, there is a paucity of data regarding the clinical course and the therapeutic management of patients with chronic kidney disease and COVID-19 infection. To date, most evidence has come from renal transplantation, with about 45 patients reported thus far, and the current data from the ERA-EDTA (ERACODA) registry for transplanted patients and patients on Renal Replacement Therapy (RRT); as for those with glomerular diseases, data are lacking. Herein, we report the case of a 62-year-old patient with severe membranoproliferative glomerulonephritis who had been receiving a high burden of immunosuppression until four months before the COVID-19 infection. He developed severe disease with acute respiratory failure requiring mechanical ventilation. After treatment with hydroxychloroquine and azithromycin, despite his low chances, he gradually recovered and survived. To the best of our knowledge, this is one of the few reported patients with glomerulonephritis who had COVID-19 Besides our single case with glomerulonephritis early during the disease outbreak, the very low prevalence of COVID-19 infection in the country's transplant recipients (0.038%) and dialysis patients (0.24%) reflects the impact of the rapid implementation of social distancing rules as well as of preventive measures for disease control in the hospitals and dialysis units in our country.


Assuntos
Infecções por Coronavirus/complicações , Crioglobulinemia/complicações , Glomerulonefrite Membranoproliferativa/complicações , Pneumonia Viral/complicações , Insuficiência Respiratória/etiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus , Ceftriaxona/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Creatinina/metabolismo , Crioglobulinemia/imunologia , Ciclofosfamida , Inibidores Enzimáticos/uso terapêutico , Glomerulonefrite Membranoproliferativa/tratamento farmacológico , Glomerulonefrite Membranoproliferativa/imunologia , Glomerulonefrite Membranoproliferativa/metabolismo , Glucocorticoides/uso terapêutico , Grécia , Humanos , Hidroxicloroquina/uso terapêutico , Hospedeiro Imunocomprometido , Fatores Imunológicos/uso terapêutico , Falência Renal Crônica/terapia , Transplante de Rim , Leucemia Linfocítica Crônica de Células B/complicações , Leucemia Linfocítica Crônica de Células B/imunologia , Pulmão/diagnóstico por imagem , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Diálise Renal , Respiração Artificial , Insuficiência Respiratória/terapia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rituximab/uso terapêutico , Tomografia Computadorizada por Raios X
2.
Artigo em Inglês | MEDLINE | ID: mdl-32629791

RESUMO

Within the complex framework of anti-COVID-19 health management, where the criteria of diagnostic testing, the availability of public-health resources and services, and the applied anti-COVID-19 policies vary between countries, the reliability and accuracy in the modeling of temporal spread can prove to be effective in the worldwide fight against the disease. This paper applies an exploratory time-series analysis to the evolution of the disease in Greece, which currently suggests a success story of COVID-19 management. The proposed method builds on a recent conceptualization of detecting connective communities in a time-series and develops a novel spline regression model where the knot vector is determined by the community detection in the complex network. Overall, the study contributes to the COVID-19 research by proposing a free of disconnected past-data and reliable framework of forecasting, which can facilitate decision-making and management of the available health resources.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Previsões , Grécia/epidemiologia , Humanos , Pandemias , Saúde Pública , Análise Espaço-Temporal
3.
Stud Health Technol Inform ; 272: 21-23, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604590

RESUMO

During the last months the Coronavirus disease 2019 (COVID-2019) has been recognized as a global threat. Transmission of the infection has rapidly increased in Europe as well as in Greece, living behind a huge number of deaths. During this situation an analysis of the spread of the disease must be undertaken and characteristics of the virus must be recognized. For the analysis of the impact of the disease in the population during this time period, epidemiological indexes have been introduced.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Grécia/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-32605097

RESUMO

The Coronavirus Disease 2019 (COVID-19) has spread on a global scale in an extremely short time, causing hundreds of thousands of deaths, and, at the same time, triggering extreme panic. Prevention in medicine is considered the best protection action for individuals in order to avoid infections. This study investigates whether Greek citizens (N = 3359) take the necessary precautions to prevent developing the COVID-19 disease, and it segments them based on homogenous behavior groups. Lastly, it provides communication techniques that should be implemented, targeting each citizen segment for a long-term COVID-19 free country. Data analysis revealed the extent of the applied precaution measures. The ones most applied by citizens were to avoid non-mandatory transportation, contact with individuals with respiratory symptoms, and individuals of high risk for severe illness (vulnerable groups). On the other hand, the least applied measures are daily checks of body temperature, monitoring for fever, cough, or dyspnea, use of a face mask when in public places, or when using public transportation. Additionally, cluster analysis revealed five groups of citizens based on self-reported behavior, namely, the Meticulous Proactive Citizens, the Self-isolated Citizens, the Cautious Citizens, the Occasionally Cautious Citizens, and the Unconcerned Citizens. Communication strategies targeting each segment are also discussed.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Comunicação em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Betacoronavirus , Temperatura Corporal , Análise por Conglomerados , Tosse , Dispneia , Feminino , Febre , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Adulto Jovem
5.
Stud Health Technol Inform ; 272: 217-220, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604640

RESUMO

Experiencing a devastating and intolerable economic crisis in Greece, the National Healthcare System (GR-NHS) needed a tool to manage expenditures and quality of healthcare services. The adoption of the Australian Disease Related Group (AU-DRG) system along with the International Statistical Classification of Diseases and Related Health Problems (ICD-10) constituted the major components of the needed tool. The tool provided the means to perform the transformation of the applying reimbursement system and at the same time to monitor and control expenditures and quality of GR-NHS. The prevailing fiscal conditions urged and obliged to design and implement a project regarding the introduction of a DRG system into GR-NHS in the limiting time period of 6 months or 27 weeks. The project utilized solely the available resources of the Ministry of Health with the direct support from the largest Health Insurance Fund (IKA). The aim of the project was to enable all hospitals demanding reimbursement from Social Security to use the developed KEN-DRG system. At the same time, the Social Security would be capable of controlling and budgeting the expenditures for beneficiaries and the Ministry of Health could control and assess the expenditures and the offered quality of services using the newly developed system.


Assuntos
Assistência à Saúde , Grupos Diagnósticos Relacionados , Austrália , Grécia , Gastos em Saúde
6.
Artigo em Inglês | MEDLINE | ID: mdl-32650614

RESUMO

INTRODUCTION: The ongoing severe acute respiratory syndrome (SARS)-CoV-2 pandemic has expanded globally. The aim of the current study is to investigate the knowledge, attitudes, and practices (KAP) of health care professionals in Greece towards SARS-CoV-2. METHODS: From 10-25 February 2020, 500 health care workers were approached. Knowledge, attitudes, and practices towards SARS-CoV-2 were assessed via a personal interview questionnaire. For knowledge, each correct answer was given 1 point; attitudes, or concerns aimed at prevention of SARS-CoV-2 infection, and practices, or behaviors towards performing preventive practices, were assigned 1 point each. Points were summed and a score for each category was calculated. RESULTS: A total of 461 health care workers returned the questionnaire and were included in the analysis (mean age ± SD: 44.2 ± 10.78 years, 74% females). The majority were nurses (47.5%), followed by physicians (30.5%) and paramedics (19%). The majority of subjects (88.28%) had a good level of knowledge (knowledge score equal to 4, or more). The majority of participants (71%) agreed with the temporary traveling restrictions ban. The uptake of a future vaccine against SARS-CoV-2 was estimated at 43%. Knowledge score was significantly associated with both attitudes score (p = 0.011) and practices score (p < 0.001), indicating that subjects with a high knowledge score demonstrated a more positive perception on preventive measures and would practice more preventive measures. Attitudes score was significantly associated with practices score (p = 0.009) indicating that subjects with a higher attitudes score are more likely to perform practices towards the prevention of SARS-CoV-2 transmission. CONCLUSION: There is a high level of knowledge concerning SARS-CoV-2 pandemic among Greek health care workers and this is significantly associated with positive attitudes and practices towards preventive health measures. The high level of knowledge of health professionals about SARS-CoV-2 may have contributed considerably to the successful management of the pandemic in Greece. Tailored educational campaigns aiming to increase the proportion of health care workers willing to accept a potential SARS-CoV-2 vaccine could be of paramount importance in future proactive vaccine educational campaigns.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus , Conhecimentos, Atitudes e Prática em Saúde , Corpo Clínico/estatística & dados numéricos , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Feminino , Grécia , Pessoal de Saúde , Humanos , Masculino , Corpo Clínico/psicologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Vacinas Virais
7.
JAMA Netw Open ; 3(6): e2013136, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32579195

RESUMO

Importance: Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile. Objective: To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design, Setting, and Participants: In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece. Intervention: Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks. Main Outcomes and Measures: Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale, ranging from able to resume normal activities to death. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis. Results: A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group (P = .34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL (P = .73), respectively. The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = .02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P = .03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003). Conclusions and Relevance: In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration. There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels. These findings should be interpreted with caution. Trial Registration: ClinicalTrials.gov Identifier: NCT04326790.


Assuntos
Proteína C-Reativa/metabolismo , Colchicina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pneumonia Viral/tratamento farmacológico , Troponina/metabolismo , Moduladores de Tubulina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Causas de Morte , Infecções por Coronavirus/metabolismo , Diarreia/induzido quimicamente , Progressão da Doença , Feminino , Grécia , Hospitalização , Humanos , Inflamação/metabolismo , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Pandemias , Pneumonia Viral/metabolismo , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
8.
Soins ; 65(843-844): 34-36, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32563505

RESUMO

During the 2015 migration crisis in Europe, medical NGOs played a key role in caring for migrant people. Nursing practice during humanitarian crises is characterized by many challenges. Shared experience of a primary care nurse with migrants in Greece.


Assuntos
Cuidados de Enfermagem , Migrantes , Grécia , Humanos , Enfermagem de Atenção Primária
9.
Inflamm Bowel Dis ; 26(8): 1144-1148, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32476001

RESUMO

BACKGROUND: After the first case of infection with the novel coronavirus, SARS-CoV-2, in China, an outbreak rapidly spread, finally evolving into a global pandemic. The new disease was named coronavirus disease 2019 (COVID-19) and by May 10, 2020, it has affected more than 4 million people worldwide and caused more than 270,000 deaths. METHODS: We describe the Greek experience regarding the response to COVID-19, with particular focus on 2 COVID-19 reference hospitals in the metropolitan area of Athens, the capital of Greece. RESULTS: The first case of SARS-CoV-2 infection in Greece was reported on February 26, 2020, and prompted a decisive response from the Greek government. The primary focus was containment of virus spread, considering shortage of ICU beds. A general lockdown was implemented early on, and the national Health Care System underwent massive re-structuring. Our 2 gastrointestinal (GI) centers, which provide care for more than 1500 inflammatory bowel disease (IBD) patients, are located in hospitals that were transformed to COVID-19 reference centers. To maintain sufficient care for our patients, while also contributing to the fight against COVID-19, we undertook specific measures. These included provision of telemedicine services, electronic prescriptions and home delivery of medications, isolation of infusion units and IBD clinics in COVID-free zones of the hospitals, in addition to limiting endoscopies to emergencies only. Such practices allowed us to avoid interruption of appropriate therapies for IBD patients. In fact, within the SECURE-IBD database, there have been only 4 Greek IBD patients, to date, who have been reported as positive for SARS-CoV-2. CONCLUSION: Timely application of preventive measures and strict compliance to guidelines limited the spread of COVID-19 in Greece and minimally impacted our IBD community, without interfering with therapeutic management.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Adulto , Defesa Civil , Infecções por Coronavirus/prevenção & controle , Feminino , Grécia , Hospitais Especializados/organização & administração , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Medição de Risco , Síndrome Respiratória Aguda Grave/prevenção & controle , População Urbana
10.
Forensic Sci Int ; 313: 110365, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32563134

RESUMO

In order to reduce transmission of COVID-19, social distancing measures were proposed, including spatial distancing (2m distance), or even generalized lockdown. Main concern was to prevent overwhelming of the healthcare systems, mainly of the intensive care units (ICUs) by decreasing the spreading of the disease. In Greece, the Government, after consulting with experts in the fields of infectious disease and epidemiology, implemented a rather aggressive stance with an early lockdown. Aim of our study, is to identify and compare the characteristics of cases referred for autopsy during the first month of the lockdown period for the COVID-19 outbreak, versus the cases referred during the same period in 2019. 231 autopsy cases were included in our study, 125 in 2019 and 106 in 2020. Regarding gender, age and nationality, no significant differences were detected between the two time periods. Age subgroup analysis demonstrated increased number of cases within the age group 70-79 years, in 2020. As to the place of death, the increase in the percentage of out-of-hospital deaths was not confirmed as statistically significant. Regarding type of death (violent, sudden/unexpected), the drop of violent deaths in the 2020 examined period, was not confirmed as statistically significant; however, further subgroup analysis showed a significant drop of fatal injuries resulting from road traffic accidents in the 2020 period. The slight increase of sudden/unexpected deaths, especially myocardial infarction cases, did not reach statistical significance. One month after lockdown, we cannot detect significant differences in the two time periods examined. Further study should be conducted soon when more data will become available. Frequency of fatal myocardial infarction seems to remain unaffected by the COVID-19 pandemic while deaths resulting from road traffic accidents exhibit a significant decrease. Homicides and suicides remain at low levels, in our jurisdiction area, seemingly unaffected by the COVID-19 outbreak and the subsequent lockdown. It appears that since sudden/unexpected deaths, statistically remain unaffected, the preventive measures taken by the Greek authorities prevented overwhelming of the healthcare system, which could function properly.


Assuntos
Autopsia/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Mortalidade/tendências , Pandemias/estatística & dados numéricos , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Adulto , Fatores Etários , Idoso , Causas de Morte , Medicina Legal , Grécia/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
11.
In Vivo ; 34(3 Suppl): 1695-1699, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503831

RESUMO

BACKGROUND/AIM: Coronavirus is an ongoing pandemic challenging health systems worldwide. The aim of this report was to evaluate the effectiveness of lockdown in different countries, highlighting the performance of Greek society and authorities. METHODS: We analyzed publicly available data from the "Worldometer". We evaluated the efficacy of lockdown at one month after implementation. Delta Days (DD) referred to the difference in the days of reaching 1 case/million people to the adoption of lockdown. RESULTS: Higher healthcare expenditure as % of the national GDP was not correlated with better 30-day mortality outcomes. DD index was significantly correlated to the incidence of COVID-19 per million people at 30 days (p-value=0.001). The correlation between DD and 30-day mortality was not statistically significant (p-value=0.087). CONCLUSION: Early lockdown was proven to be the appropriate policy to limit the spread of COVID-19. Greece was a success story in preventing spread despite limited resources.


Assuntos
Infecções por Coronavirus/prevenção & controle , Política de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/economia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Saúde Global , Grécia/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Humanos , Incidência , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/mortalidade , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Quarentena/estatística & dados numéricos , Alocação de Recursos
12.
Infez Med ; 28(suppl 1): 89-95, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532944

RESUMO

INTRODUCTION: Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome - Coronavirus 2 (SARS-CoV-2) emerged in China and has become a global threat. Comparison of hematological parameters between mild and severe cases of SARS-CoV 2 is so far limited, but significant differences in parameters such as interleukin-6, d-dimers, glucose, fibrinogen and C-reactive protein have been already reported. PURPOSE: In this study we analyzed the changes observed in easily measured blood biomarkers in the patients and provided evidence of how these markers can be used as prognostic factors of the disease. METHODS: Demographic characteristics, detailed medical history, and laboratory findings of all enrolled SARS-CoV 2 infection positive patients who were referred to Patras University Hospital from the period of March 4th 2020 (when first confirmed case in Greece appeared in our hospital) until April 4th 2020 were extracted from electronic medical records and analyzed. RESULTS: We provided evidence that some very common laboratory values can be used as independent predictive factors in SARS-CoV 2 infection. Despite the retrospective nature of this study and the small number of subjects analyzed, we showed that NLR, LDH, d-dimers, CRP, fibrinogen and ferritin can be used early at the patient's first visit for SARS-CoV 2 infection symptoms and can predict the severity of infection. CONCLUSION: More studies are warranted to further objectively confirm the clinical value of prognostic factors related to SARS-CoV 2 and establish an easy-to-get panel of laboratory findings for evaluating the disease severity.


Assuntos
Infecções por Coronavirus/sangue , Pneumonia Viral/sangue , Adulto , Idoso , Biomarcadores , Proteína C-Reativa/análise , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Grécia/epidemiologia , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Talassemia beta/epidemiologia
13.
Waste Manag ; 113: 351-358, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32580103

RESUMO

There is much debate around promoting waste to energy incineration facilities in many communities globally, mainly because of social opposition against potential negative health effects of the operation of these installations close to urban areas. In this paper, a novel decision support approach is developed and its applicability is demonstrated for the greater Thessaloniki area, Greece. In this area, the incineration facilities are hotly debated, mainly due to the "Not In My Back Yard" syndrome related with health considerations. The exclusive method of treatment is landfilling. Health impacts and corresponding externalities attributed to the operation of an incineration facility are reliably estimated. Three potential alternative sites and three scenarios of emission rates are considered, depending on the abatement technology used. The estimated externalities are compared to the corresponding ones attributed to other pressures in the area. The "Years of Life Lost (YOLL)" indicator attributed to the operation of the facility is 2.8 YOLL in the worst-case scenario. This corresponds to a minimal added implication in comparison with the 11,044 YOLL estimated for the area due to the other environmental pressures (road traffic, space heating, industrial activity). The externalities ratio (externalities due to incineration facility/total externalities) for the region is approximately 0.03%. Thus, the impact of this operation on human health is negligible -and preferable to landfilling- even in the case that maximum emission rates are considered. Efforts should be targeted towards enhancing public awareness and militating the widely acknowledged "Not In My Back Yard" syndrome by local communities.


Assuntos
Incineração , Eliminação de Resíduos , Grécia , Humanos , Resíduos Sólidos/análise
14.
Hastings Cent Rep ; 50(3): 50-53, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596885

RESUMO

When confronted by the novel ethical challenges posed by a pandemic, it is helpful to turn to history for guidance and direction. In this essay, the author revisits Thucydides's description of the Plague of Athens from The Peloponnesian War as he considers the New York State Task Force on Life and the Law's 2015 guidelines on ventilator allocation. Confronted by the exigencies of the Covid-19 surge that struck New York, he questions the task force's decision not to give any degree of preference to health care workers who might become ill. He posits that they are due a compensatory ethic and some deference given the risks they have assumed, often with inadequate protective gear. Reflecting on his ambivalence, he asks if his change of heart reflects the impact of experiential learning or the erosion of nomos-or governing norms-described by Thucydides when the plague struck Athens.


Assuntos
Temas Bioéticos , Protocolos Clínicos/normas , Infecções por Coronavirus/epidemiologia , Pessoal de Saúde , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Betacoronavirus , Grécia/epidemiologia , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias , Peste/epidemiologia
16.
PLoS One ; 15(5): e0232906, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32459797

RESUMO

Mediterranean Early Iron Age chronology was mainly constructed by means of Greek Protogeometric and Geometric ceramic wares, which are widely used for chronological correlations with the Aegean. However, Greek Early Iron Age chronology that is exclusively based on historical evidence in the eastern Mediterranean as well as in the contexts of Greek colonisation in Sicily has not yet been tested by extended series of radiocarbon dates from well-dated stratified contexts in the Aegean. Due to the high chronological resolution that is only achievable by (metric-scale) stratigraphic 14C-age-depth modelling, the analysis of 21 14C-AMS dates on stratified animal bones from Sindos (northern Greece) shows results that immediately challenge the conventional Greek chronology. Based on pottery-style comparisons with other sites, the new dates for Sindos not only indicate a generally higher Aegean Early Iron Age chronology, but also imply the need for a revised understanding of the Greek periodisation system that will foreseeably have a major impact on our understanding of Greek and Mediterranean history.


Assuntos
Arqueologia/métodos , Cerâmica/história , Datação Radiométrica/métodos , Animais , Cerâmica/análise , Cronologia como Assunto , Fósseis/história , Grécia , História Antiga , Humanos , Sicília
18.
Sci Total Environ ; 734: 139504, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32464381

RESUMO

The effects of large-scale environmental gradients on the spatial patterns of macrobenthic communities used in marine health assessment were evaluated using beta diversity methods. In this work, beta diversity partitioning and relevant ecological modelling methods revealed clear patterns between the northern and the southern parts of the Aegean Sea (Greece). A community turnover point was observed in the Evoikos Gulf marking the transition between the northern and the southern communities. The increased beta diversity in this work was due to species replacement driven mainly by the latitudinal gradients of bottom temperature and salinity whereas species richness did not present substantial differences between the Aegean macrobenthic communities. These findings are attributed to the ability of beta diversity methods to detect the environmental filtering that occurs in these marine provinces through the assessment of biotic interactions in respect to geographic distance. We propose a new standpoint of using beta diversity measures for benthic environmental assessment on a large spatial scale and in marine areas characterised by environmental gradients.


Assuntos
Biodiversidade , Ecossistema , Grécia , Modelos Teóricos , Salinidade
19.
Lancet Haematol ; 7(6): e469-e478, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32470438

RESUMO

BACKGROUND: Transfusion-dependent haemoglobinopathies require lifelong iron chelation therapy with one of the three iron chelators (deferiprone, deferasirox, or deferoxamine). Deferasirox and deferiprone are the only two oral chelators used in adult patients with transfusion-dependent haemoglobinopathies. To our knowledge, there are no randomised clinical trials comparing deferiprone, a less expensive iron chelator, with deferasirox in paediatric patients. We aimed to show the non-inferiority of deferiprone versus deferasirox. METHODS: DEEP-2 was a phase 3, multicentre, randomised trial in paediatric patients (aged 1 month to 18 years) with transfusion-dependent haemoglobinopathies. The study was done in 21 research hospitals and universities in Italy, Egypt, Greece, Albania, Cyprus, Tunisia, and the UK. Participants were receiving at least 150 mL/kg per year of red blood cells for the past 2 years at the time of enrolment, and were receiving deferoxamine (<100 mg/kg per day) or deferasirox (<40 mg/kg per day; deferasirox is not registered for use in children aged <2 years so only deferoxamine was being used in these patients). Any previous chelation treatment was permitted with a 7-day washout period. Patients were randomly assigned 1:1 to receive orally administered daily deferiprone (75-100 mg/kg per day) or daily deferasirox (20-40 mg/kg per day) administered as dispersible tablets, both with dose adjustment for 12 months, stratified by age (<10 years and ≥10 years) and balanced by country. The primary efficacy endpoint was based on predefined success criteria for changes in serum ferritin concentration (all patients) and cardiac MRI T2-star (T2*; patients aged >10 years) to show non-inferiority of deferiprone versus deferasirox in the per-protocol population, defined as all randomly assigned patients who received the study drugs and had available data for both variables at baseline and after 1 year of treatment, without major protocol violations. Non-inferiority was based on the two-sided 95% CI of the difference in the proportion of patients with treatment success between the two groups and was shown if the lower limit of the two-sided 95% CI was greater than -12·5%. Safety was assessed in all patients who received at least one dose of study drug. This study is registered with EudraCT, 2012-000353-31, and ClinicalTrials.gov, NCT01825512. FINDINGS: 435 patients were enrolled between March 17, 2014, and June 16, 2016, 393 of whom were randomly assigned to a treatment group (194 to the deferiprone group; 199 to the deferasirox group). 352 (90%) of 390 patients had ß-thalassaemia major, 27 (7%) had sickle cell disease, five (1%) had thalassodrepanocytosis, and six (2%) had other haemoglobinopathies. Median follow-up was 379 days (IQR 294-392) for deferiprone and 381 days (350-392) for deferasirox. Non-inferiority of deferiprone versus deferasirox was established (treatment success in 69 [55·2%] of 125 patients assigned deferiprone with primary composite efficacy endpoint data available at baseline and 1 year vs 80 [54·8%] of 146 assigned deferasirox, difference 0·4%; 95% CI -11·9 to 12·6). No significant difference between the groups was shown in the occurrence of serious and drug-related adverse events. Three (2%) cases of reversible agranulocytosis occurred in the 193 patients in the safety analysis in the deferiprone group and two (1%) cases of reversible renal and urinary disorders (one case of each) occurred in the 197 patients in the deferasirox group. Compliance was similar between treatment groups: 183 (95%) of 193 patients in the deferiprone group versus 192 (97%) of 197 patients in the deferisirox group. INTERPRETATION: In paediatric patients with transfusion-dependent haemoglobinopathies, deferiprone was effective and safe in inducing control of iron overload during 12 months of treatment. Considering the need for availability of more chelation treatments in paediatric populations, deferiprone offers a valuable treatment option for this age group. FUNDING: EU Seventh Framework Programme.


Assuntos
Deferasirox/uso terapêutico , Deferiprona/uso terapêutico , Transfusão de Eritrócitos/métodos , Hemoglobinopatias/tratamento farmacológico , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Administração Oral , Adolescente , Agranulocitose/induzido quimicamente , Agranulocitose/epidemiologia , Albânia/epidemiologia , Anemia Falciforme/terapia , Técnicas de Imagem Cardíaca/métodos , Criança , Pré-Escolar , Chipre/epidemiologia , Deferasirox/administração & dosagem , Deferasirox/economia , Deferiprona/administração & dosagem , Deferiprona/economia , Egito/epidemiologia , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Ferritinas/sangue , Ferritinas/efeitos dos fármacos , Grécia/epidemiologia , Hemoglobinopatias/terapia , Humanos , Lactente , Quelantes de Ferro/administração & dosagem , Quelantes de Ferro/economia , Sobrecarga de Ferro/sangue , Itália/epidemiologia , Imagem por Ressonância Magnética , Masculino , Cooperação do Paciente , Resultado do Tratamento , Tunísia/epidemiologia , Reino Unido/epidemiologia , Doenças Urológicas/induzido quimicamente , Doenças Urológicas/epidemiologia , Talassemia beta/terapia
20.
Environ Pollut ; 264: 114766, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32417583

RESUMO

Cryptosporidium and Giardia are important parasites due to their zoonotic potential and impact on human health, often causing waterborne outbreaks of disease. Detection of (oo)cysts in water matrices is challenging and few countries have legislated water monitoring for their presence. The aim of this study was to investigate the presence and origin of these parasites in different water sources in Northern Greece and identify interactions between biotic/abiotic factors in order to develop risk-assessment models. During a 2-year period, using a longitudinal, repeated sampling approach, 12 locations in 4 rivers, irrigation canals, and a water production company, were monitored for Cryptosporidium and Giardia, using standard methods. Furthermore, 254 faecal samples from animals were collected from 15 cattle and 12 sheep farms located near the water sampling points and screened for both parasites, in order to estimate their potential contribution to water contamination. River water samples were frequently contaminated with Cryptosporidium (47.1%) and Giardia (66.2%), with higher contamination rates during winter and spring. During a 5-month period, (oo)cysts were detected in drinking-water (<1/litre). Animals on all farms were infected by both parasites, with 16.7% of calves and 17.2% of lambs excreting Cryptosporidium oocysts and 41.3% of calves and 43.1% of lambs excreting Giardia cysts. The most prevalent species identified in both water and animal samples were C. parvum and G. duodenalis assemblage AII. The presence of G. duodenalis assemblage AII in drinking water and C. parvum IIaA15G2R1 in surface water highlights the potential risk of waterborne infection. No correlation was found between (oo)cyst counts and faecal-indicator bacteria. Machine-learning models that can predict contamination intensity with Cryptosporidium (75% accuracy) and Giardia (69% accuracy), combining biological, physicochemical and meteorological factors, were developed. Although these prediction accuracies may be insufficient for public health purposes, they could be useful for augmenting and informing risk-based sampling plans.


Assuntos
Criptosporidiose , Cryptosporidium , Água Potável , Animais , Bovinos , Giardia , Grécia , Humanos , Aprendizado de Máquina , Oocistos , Ovinos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA