Exploring primary healthcare professionals' experiences as educators on safe internet use: a school-based intervention from Greece.

AIM: The objective of this study was to explore the experiences and level of awareness among primary healthcare (PHC) professionals, who were trained and encouraged to participate as educators in a school-based intervention for safe internet use. METHODS: All directors of the PHC centers of the Third Health Authority of the prefecture of Macedonia, Greece were asked to invite their personnel to participate voluntarily in a project on safe internet use. Participants attended a 1-day train-the-trainers course on cyber-safety in order to serve as educators in a school-based intervention in their communities. An evaluation questionnaire was completed anonymously and voluntarily by the professionals 1 month after completion of the school intervention. The answers to the open-ended questions were analyzed using thematic content analysis. RESULTS: Forty-six PHC professionals from 13 PHC centers (response rate 72.2%) were trained. They served as educators to 30 middle schools and 21 high schools, reaching 8053 students, aged 12-18 years, from urban (22.5%), semi-urban (36.3%) and rural areas (41.2%). The experience was evaluated as positive by all 46 professionals, who recognized the following benefits: (i) acquisition of new knowledge on pathological internet use, (ii) ethical reward for raising awareness in students on the potential threats of internet use, (iii) revitalizing effect of the interaction with youth and (iv) reinforcement of cooperation and team spirit. CONCLUSIONS: The combined trainee's and trainer's experience could be rewarding and satisfying, contributing in raising PCH professionals' own awareness on new topics that should be included in their continuous educational agenda. Furthermore, involvement of trained PHC providers as educators in school-based interventions could reinforce their role in health promotion within their communities, both urban and rural.

Reporting guidelines on how to write a complete and transparent abstract for overviews of systematic reviews of health care interventions.

OBJECTIVE: An overview of systematic reviews (OoSRs) is a study designed to offer a broad view of evidence from existing systematic reviews (SRs). The abstract is an important part of an OoSRs as it can determine whether reading the full text is of interest. The aim of this article is to offer guidelines to promote transparent and sufficient reporting in abstracts of OoSRs of health care interventions. STUDY DESIGN AND SETTING: The items were developed by combining key features from abstracts of OoSRs, PRISMA for abstracts, and our published reporting guidelines for OoSRs. The initial version was distributed to experts to give feedback; pilot testing by a group of researchers followed. The refined checklist was applied by two reviewers independently in a sample of 40 abstracts. RESULTS: The developed instrument "Preferred Reporting Items for OoSRs abstracts" (PRIO for abstracts) consists of six sections with 15 topics including 20 items in total. The mean inter-rater reliability was 0.87 (95% confidence interval: 0.82, 0.92). An explanation and at least one published example of good reporting per item are provided. CONCLUSION: This instrument will assist authors in writing transparent and informative abstracts for OoSRs and can be adopted by journals that publish OoSRs.

Global avian influenza outbreaks 2010-2016: a systematic review of their distribution, avian species and virus subtype.

BACKGROUND: We conducted a systematic review to investigate avian influenza outbreaks and to explore their distribution, upon avian influenza subtype, country, avian species and other relating details as no comprehensive epidemiological analysis of global avian influenza outbreaks from 2010 to 2016 exists. METHODS: Data was collated from four databases (Scopus, Web of Science Core Correlation, PubMed and SpringerLink electronic journal) and a global electronic reporting system (ProMED mail), using PRISMA and ORION systematic approaches. One hundred seventy three avian influenza virus outbreaks were identified and included in this review, alongside 198 ProMED mail reports. RESULTS: Our research identified that the majority of the reported outbreaks occurred in 2016 (22.2%). These outbreaks were located in China (13.6%) and referred to commercial poultry farms (56.1%). The most common subtype reported in these outbreaks was H5N1 (38.2%), while almost 82.5% of the subtypes were highly pathogenic avian influenza viruses. There were differences noticed between ProMED mail and the scientific literature screened. CONCLUSIONS: Avian influenza virus has been proved to be able to contaminate all types of avian species, including commercial poultry farms, wild birds, backyard domestic animals, live poultry, game birds and mixed poultry. The study focused on wet markets, slaughterhouses, wild habitats, zoos and natural parks, in both developed and developing countries. The impact of avian influenza virus seems disproportionate and could potentially burden the already existing disparities in the public health domain. Therefore, a collaboration between all the involved health sectors is considered to be more than necessary.

Raising awareness on cyber safety: adolescents' experience of a primary healthcare professional-led, school-based, multi-center intervention.

Purpose Although safe Internet use is an emerging public health issue, there is a scarcity of published work describing relevant school-based interventions. The objective of this study was to explore the impact of a health professional-led, school-based intervention in raising awareness on cyber-safety in adolescents, Therefore, the aim of this study was to investigate adolescents' evaluation of this school-based intervention, 6 months after its implementation, as well as the impact of adolescents' school class and gender on their evaluation. Methods A student sample was selected using a multistage stratified random sampling technique, according to the location and school grade level (middle, high school). The students - aged from 12 to 18 years old experienced an interactive presentation in their classrooms on the amount of time spent online, the use of social networks and the available support services. An evaluation tool was completed anonymously and voluntarily 6 months after the intervention. Results Four hundred and sixty-two students (response rate 90.7%, 246 middle, 216 high school) completed the evaluation tool. Younger students, especially the ones in the first year of middle school, scored significantly higher in all six parameters used in the evaluation of this intervention compared with all the older participants: (a) they had kept the presented information on Safeline and Saferinternet websites and the helpline Ypostirizo (70.2% vs. 33.7%, p < 0.001) (b) they had already used it (32.5% vs. 12.3%, p < 0.001), (c) they had learned new information on cyber safety (66.4% vs. 34%, p < 0.001), (d) they rated the intervention as more interesting (median 8 vs. 7, p < 0.05), (e) they had reconsidered the way they use Internet (median 7 vs. 6, p < 0.05) and (f) they had changed their cyber behavior (median 7 vs. 5, p < 0.05). Conclusion The active involvement of students in a discussion on cyber-safety based on their experiences was highly evaluated. The impact of the intervention on the youngest students underlines the need for raising awareness on cyber-safety and support services, earlier in the students' life.

Pathological Internet use, cyberbullying and mobile phone use in adolescence: a school-based study in Greece.

Purpose This study investigated the prevalence of Internet addiction (IA) and cyberbullying and examined profiles of adolescents with increased risk to develop pathological behaviors. Methods In this cross-sectional, school-based study, 8053 students of 30 middle and 21 high schools (12-18 years old) were invited to participate, based on a multistage stratified random sampling technique. The Internet aiddiction test (IAT) was used along with information on socio-demographics, Internet activities and cyberbullying experience. Results Five thousand five hundred and ninety students participated (response rate 69.4%). Pathological Internet use (IAT ≥50) was found in 526 (10.1%), while 403 (7.3%) experienced cyberbullying as victims and 367 (6.6%) as perpetrators during the last year. In multivariable models, the odds of IA increased with online hours on mobile phones and Internet use during weekends, Internet café visits, chatrooms usage and engagement in cyberbullying. Cyberbullying victims were more likely to be older, female, Facebook and chatrooms users, while perpetrators were more likely to be male, older Internet users and fans of pornographic sites. A perpetrator was significantly more likely to have also been a victim [odds ratio (OR) = 5.51, confidence interval (CI): 3.92-7.74]. Hours of daily Internet use on a mobile phone was independently associated with IA and cyberbullying (OR) 1.41, 95% CI 1.30, 1.53 and OR 1.11, 95% CI 1.01, 1.21, respectively. Conclusions Cyberbullying is associated with IA and the hours spent online on a mobile phone affected both conditions. The increasing Internet access through mobile phones or other devices should be accompanied by the appropriate education of both parents and adolescents on safe Internet use.

Hepatitis B Virus Vaccination Coverage in Medical, Nursing, and Paramedical Students: A Cross-Sectional, Multi-Centered Study in Greece.

Students of health professions are at high risk of hepatitis B Virus (HBV) infection during their clinical training. The aim of this cross-sectional, multi-centered study was to investigate the HBV vaccination coverage in Greek medical, nursing, and paramedical students, to look into their attitudes towards the importance of vaccines and to reveal reasons associated with not being vaccinated. A self-completed, anonymous questionnaire was distributed to 2119 students of health professions in Greece, during the academic year 2013-2014. The HBV vaccination coverage of students was high (83%), being higher among medical students (88.1%, vs. 81.4% among nursing and 80.1% among paramedical students; p < 0.001). The vast majority of them (95%) have been vaccinated during childhood. In addition, 30% of the unvaccinated students declared fear over HBV safety. Our results indicate that the healthcare students achieved higher reported immunization rates compared to the currently serving healthcare workers, but also to the students of the last decade. The fact that nursing and paramedical students have lower coverage figures underlines the importance of targeted interventions for the different subgroups of healthcare students in terms of educational programs and screening for HBV markers in order to increase HBV vaccination uptake.

Estimating the direct and indirect costs of lung cancer: a prospective analysis in a Greek University Pulmonary Department.

BACKGROUND: Lung cancer (LC) is a disease with high morbidity and mortality while the prevention and treatment constitutes a significant financial burden. This economic burden has an increasing trend, with hospitalization being the highest cost factor in most studies, while the patients' quality of life (QoL) and response to treatment is not proven to be positively affected. OBJECTIVE: To evaluate the direct and indirect cost of managing patients with LC in Greece according to stage and histological type of cancer, total chemotherapy cycles, age, gender, smoking habit, overall survival (OS), treatment outcome (TO) and QoL. METHODS: One hundred thirteen of 128 consecutive patients met the inclusion criteria and were included in this prospective study. Patient enrolment started in August 2011 and ended in November 2011. The duration of the patient follow up was 32 months after diagnosis until end of registry. Total direct cost included diagnosis and treatment cost. Indirect cost constituted of patient's and family caregivers lost days of productivity. QoL was assessed with EORTC-QLQ-30 and Lung Cancer Symptom Scale (LCSS) questionnaires before treatment and every three months. RESULTS: Total direct cost was €1,853,984 and chemotherapy drugs was the highest cost factor (€1,216,421). Total indirect cost was 28,774 days of which 27,293 were related to patients. Total direct cost was significantly related to the increased number of total chemotherapy cycles, longer OS, histological type of adenocarcinoma, female gender and younger patients. No relation was found between total indirect cost and the above factors. When the association between total direct/indirect cost and QoL was examined no significant results were drawn. CONCLUSIONS: The burden of LC on health care systems remains very high and was associated with the increased number of total chemotherapy cycles, longer OS, adenocarcinoma histological type of cancer, female gender and younger patients. Chemotherapy drugs constituted the higher factor of total direct cost. Indirect cost was considerably higher for patients than family caregivers and did not significantly differ in relation to the above factors. No significant conclusion was drawn regarding QoL and total direct/indirect cost.

Internet addiction in Greek medical students: an online survey.

OBJECTIVE: The authors investigated the prevalence of Internet addiction (IA) in undergraduate medical students to identify possible associations with sociodemographics and Internet habits. METHODS: All students at the Aristotle University of Thessaloniki School of Medicine, Greece, were invited to complete the online Internet Addiction Test (IAT) along with sociodemographics and preferences on Internet activities. RESULTS: The authors received 585 responses after three reminders (23.5 % response rate). Mild IA was found in 24.5 %, moderate in 5.4 %, and severe in 0.2 %. In multivariable analysis, the odds to develop IA were increased with visits in Internet cafes (Odds Ratio [OR] 3.49, 95 % Confidence Interval [CI]: 1.45, 8.46), the use of Facebook (OR 2.43, 95 % CI: 1.35, 4.38), Twitter (OR 2.45, 95 % CI: 1.37, 4.39), and online games (OR 1.95, 95 % CI: 1.29, 2.94). Using e-mails seemed to be protective against IA (OR 0.59, 95 % CI: 0.37, 0.94). CONCLUSION: This is the first IA prevalence study in a European medical school. Early-detection systems and other ways to help students with pathological behaviors should be developed.

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.

Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis.

IMPORTANCE: Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk. OBJECTIVE: To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma. DATA SOURCES: We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings. STUDY SELECTION: We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded. DATA EXTRACTION AND SYNTHESIS: Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES: Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery. RESULTS: Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I(2) = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I(2) = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I(2) = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P = .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles. CONCLUSIONS AND RELEVANCE: Although confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.

Greek version of the Internet Addiction Test: a validation study.

The aim of this project was to translate, culturally adapt and validate the Internet Addiction Test (IAT) in Greek adults. Twenty-one post-graduate medical students participated in the cultural adaptation procedure and 151 both post- and under-graduate medical students in the validation process. The internal consistency shown by a Cronbach's alpha was 0.91. Two-week test-retest reliability was rtt = 0.84, p < 0.001. Face validity was affirmed by 83.6 % of the students. In terms of convergent validity, the hours of daily internet use were positively correlated with IAT score (rho = 0.48, p < 0.001). Moreover, IAT scores were higher in students that reported use of online gambling (40.5 vs 29.2, p = 0.004), pornographic sites (36.5 vs 28.0, p = 0.003) and online games (35.6 vs 28.2, p = 0.009). Exploratory factor analysis revealed three interpretable factors for the IAT, "Psychological/Emotional Conflict", "Time Management" and "Neglect Work", that showed good internal consistency and concurrent validity, explaining 55.3 % of the variance. The Greek version of IAT has shown good psychometric properties, comparable with the original IAT and the previously published translated versions, and can be a useful tool in future studies on internet addiction.

Effect of periodontal therapy on crevicular fluid interleukin-6 and interleukin-8 levels in chronic periodontitis.

Purpose. The aim of this study was to analyse the levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in gingival crevicular fluid (GCF) of patients with chronic periodontitis prior to and following surgical and/or nonsurgical periodontal therapy for a period of 32 weeks. Methods. GCF samples were obtained from 24 nondiseased and 72 diseased sites of 12 periodontal patients prior to as well as at 6, 16, and 32 weeks following non-surgical and surgical periodontal therapy. IL-6 and IL-8 levels were determined by enzyme-linked immunosorbent assay (ELISA). Results. Periodontal treatment improved all clinical parameters. Both treatment modalities resulted in similar IL-6 as well as IL-8 levels. Mean IL-6 and IL-8 concentrations were significantly higher in non-diseased compared to diseased sites and increased significantly following treatment in diseased sites. Mean total amounts of IL-6 and IL-8 (TAIL-6, TAIL-8) did not differ significantly between diseased and nondiseased sites, while following therapy TAIL-8 levels decreased significantly. Conclusions. The data suggest that periodontal therapy reduced the levels of IL-8 in GCF. However, a strong relationship between IL-6, IL-8 amounts in GCF and periodontal destruction and inflammation was not found.

Elevated circulating levels of the serum acute-phase protein YKL-40 (chitinase 3-like protein 1) are a marker of obesity and insulin resistance in prepubertal children.

YKL-40 (chitinase 3-like protein 1) is a newly recognized protein that is secreted by activated macrophages and neutrophils and expressed in a broad spectrum of inflammatory conditions and cancers. It has also been associated with endothelial dysfunction and diabetes in adults. Its role in childhood obesity has not been evaluated yet. Our aim was to evaluate the associations of serum YKL-40 levels with markers of obesity, inflammation, and insulin resistance in children. Forty-one obese prepubertal children and 41 age- and sex-matched lean controls were included, and serum YKL-40 levels were determined. Body mass index (BMI), blood pressure (BP), body fat percentage, fasting glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR) index, whole-body insulin sensitivity index, lipids, white blood cell (WBC) count, C-reactive protein, and fibrinogen levels were also assessed. Obese children had higher YKL-40 levels compared with controls (P = .003). Insulin-resistant individuals showed higher YKL-40 compared with non-insulin-resistant individuals after adjusting for age and BMI (adjusted P = .039). Serum YKL-40 levels were positively correlated with age, BMI, body fat percentage, fasting glucose and insulin, HOMA-IR index, whole-body insulin sensitivity index, systolic BP, mean BP, and WBC count (P < .05). After adjustment for age, sex, BMI, WBC count, and systolic BP, HOMA-IR index remained significantly associated with YKL-40 levels (P < .001). The study suggests that YKL-40 levels are elevated in obese youth and represent a marker of insulin resistance even in childhood. Prospective studies are needed to determine whether children with elevated YKL-40 levels are at higher risk for future cardiovascular disease.

Detection of Helicobacter pylori in raw bovine milk by fluorescence in situ hybridization (FISH).

The transmission pathways of Helicobacter pylori in humans have not been fully elucidated. Research in the last decade has proposed that foodborne transmission, among others, may be a plausible route of human infection. Owing to the organism's fastidious growth characteristics and its ability to convert to viable, yet unculturable states upon exposure to stress conditions, the detection of H. pylori in foods via culture-dependent methods has been proven to be laborious, difficult and in most cases unsuccessful. Hence, nucleic acid-based methods have been proposed as alternative methods but, to date, only PCR-based methods have been reported in the literature. In the current study, fluorescence in situ hybridization (FISH) was used for the detection of H. pylori in raw, bulk-tank bovine milk. After repeated milk centrifugation and washing steps, the bacterial flora of raw milk was subjected to fixation and permeabilization and H. pylori detection was conducted by FISH after hybridization with an H. pylori-specific 16S rRNA-directed fluorescent oligonucleotide probe. Using this protocol, H. pylori was detected in four out of the twenty (20%) raw milk samples examined. The data presented in this manuscript indicate that FISH can serve as an alternative molecular method for screening raw bovine milk for the presence of H. pylori.

Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis.

BACKGROUND: Multidrug resistance among bacteria increases the need for new antimicrobial drugs with high potency and stability. Tigecycline is one candidate drug, and a previous meta-analysis of only published randomised controlled trials suggested that it might as effective as comparator treatments; we did a meta-analysis to include new and unpublished trials to assess its efficacy for the treatment of adult patients with serious bacterial infection. METHODS: We searched PubMed, Cochrane Central Register, and Embase up to March 30, 2011, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies, the results of which were obtained through the manufacturer. Eligible studies were randomised trials assessing the clinical efficacy, safety, and eradication efficiency of tigecycline versus other antimicrobial agents for any bacterial infection. The primary outcome was treatment success in patients who received at least one dose of the study drug, had clinical evidence of disease, and had complete follow-up (the clinically assessable population). Meta-analysis was done with random-effects models because of heterogeneity across the trials. FINDINGS: 14 randomised trials, comprising about 7400 patients, were included. Treatment success was lower with tigecycline than with control antibiotic agents, but the difference was not significant (odds ratio 0·87, 95% CI 0·74-1·02). Adverse events were more frequent in the tigecycline group than in the control groups (1·45, 1·11-1·88), with significantly more vomiting and nausea. All-cause mortality was higher in the tigecycline group than in the comparator groups, but the difference was not significant (1·28, 0·97-1·69). Eradication efficiency did not differ between tigecycline and control regimens, but the sample size for these comparisons was small. INTERPRETATION: Tigecycline is not better than standard antimicrobial agents for the treatment of serious infections. Our findings show that assessment with unpublished studies is needed to make appropriate decisions about new agents. FUNDING: None.

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.

Factors associated with the onset of sexual activity among Greek high school students.

OBJECTIVE: To record variables of the sexual behaviour of high school students in Northern Greece and to investigate factors associated with the onset of sexual activity. METHODS: A questionnaire (Centers of Disease Control /Prevention) adapted to national characteristics, was distributed to students from a representative sample of 11 high schools (7 public, 2 private, 2 vocational). A total of 523 students (1st, 2nd, 3rd grade) completed the questionnaire. Frequencies of certain sexual behaviours were estimated and multivariable logistic regression models were used to evaluate correlates of the onset of sexual activity. RESULTS: Onset of sexual activity was reported by 48% of adolescents, half of whom stated this had occurred by the age of 15. At last sexual intercourse 76% had used a condom and 21% no contraception at all. Initiation of sexual activity was influenced by gender, age, type of school and smoking. Boys, students attending vocational high schools and smokers were significantly more likely to have been sexually active. CONCLUSIONS: Sexually-related behaviours among Greek high school students are quite frequent; they should be regularly registered. Sexual education programmes specifically designed for youths must be implemented.

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.

Decreasing prevalence of alcohol consumption among greek adolescents.

AIM OF THIS STUDY: To obtain data on alcohol consumption among school children of secondary education and to investigate any correlation to their health behaviors and parental socioeconomic status. METHODS: A questionnaire was distributed to students from a representative sample of 15 schools from Thessaloniki, the second (after Athens) largest metropolitan city of Greece. A total of 1185 students (505 males, 680 females) participated. RESULTS: 286 males (56.6%) and 329 females (48.4%) reported consuming alcohol. The initiation of drinking was at the age of 13.2 years for boys and 13 years for girls. Alcohol drinking was positively associated with socio-demographic variables and negative health behaviors such as parental low level of education, lack of physical exercise, coffee consumption, and smoking. CONCLUSIONS: Although our results show a decrease in alcohol use, which is more pronounced in male students, the prevalence of frequent alcohol consumption is among the highest in Europe's countries.

Total serum homocysteine, folate and vitamin B12 in a Greek school age population.

BACKGROUND & AIMS: Moderate hyperhomocysteinemia is an independent risk factor for cardiovascular disease (CVD) even among children. The purpose of this study is to investigate for the first time the distribution and determinants of total serum homocysteine (tHcy) levels in healthy Greek children. METHODS: tHcy, folate, B12 were measured in 524 children (275 boys and 249 girls) aged 6-15 years old from different socioeconomic status in Northern Greece. RESULTS: The geometric mean tHcy level for boys and girls was 7.8 (3.4-24.2) and 7.5 (3.9-29.0) micromol/L, respectively. Eighty one (15.4%) children had homocysteine levels above the upper reference limits (>10 micromol/L). The geometric mean serum tHcy level was significantly (P<0.001) increasing with age; 6.4 (3.4-11.2) micromol/L was found in the age group of 6-9 yr (group1), 7.2(4.1-22.1) micromol/L in the one of 10-12 yr (group 2) and 8.5 (3.9-29.0) micromol/L in the one of 13-15 yr (group 3). Serum folate levels were found to be statistically significant (P<0.001) between age group 1 and age group 3 [11.8 (4.66-20.00) vs. 7.5 (0.99-20.00)ng/mL) and between age group 2 and 3 [10.0 (1.82-20.0) vs. 7.5 (0.99-20.00)ng/mL]. Vitamin B12 levels were significantly (P<0.001) different in the three age groups [1048 (117-2000), 805 (296-2000), 700 (214-2000)pg/mL] respectively. Age, BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively correlated with tHcy, whereas serum folate and vitamin B12 were negatively correlated. No association was found between tHcy levels and parental education status. In multiple linear regression analysis only age (Beta: 0.248, 95%, CI: (0.159-0.361), P<0.05) and folate (Beta: 0.347, 95%, CI: [(-0.206)-(-0.118)], P<0.05) were found significantly and independently associated with tHcy. CONCLUSIONS: tHcy levels were increasing with age and boys were found to have slightly higher levels than girls. Age and folate levels were the most significantly and independently determinants associated with tHcy. Children with tHcy levels above the upper reference limits (>10 micromol/L) were found to be correlated with BMI, WC, SBP, serum folate and vitamin B12 levels. These children should be encouraged to include high folate food items in their diet and where necessary folate supplements should be recommended. In addition, more prospective studies are necessary in order to evaluate the relationship of tHcy and CVD risk factors in children of our region.