Mitochondrial Fraction of Circulating Cell-Free DNA as an Indicator of Human Pathology.

Circulating cell-free DNA (ccfDNA) of mitochondrial origin (ccf-mtDNA) consists of a minor fraction of total ccfDNA in blood or in other biological fluids. Aberrant levels of ccf-mtDNA have been observed in many pathologies. Here, we introduce a simple and effective standardized Taqman probe-based dual-qPCR assay for the simultaneous detection and relative quantification of nuclear and mitochondrial fragments of ccfDNA. Three pathologies of major burden, one malignancy (Breast Cancer, BrCa), one inflammatory (Osteoarthritis, OA) and one metabolic (Type 2 Diabetes, T2D), were studied. Higher levels of ccf-mtDNA were detected both in BrCa and T2D in relation to health, but not in OA. In BrCa, hormonal receptor status was associated with ccf-mtDNA levels. Machine learning analysis of ccf-mtDNA datasets was used to build biosignatures of clinical relevance. (A) a three-feature biosignature discriminating between health and BrCa (AUC: 0.887) and a five-feature biosignature for predicting the overall survival of BrCa patients (Concordance Index: 0.756). (B) a five-feature biosignature stratifying among T2D, prediabetes and health (AUC: 0.772); a five-feature biosignature discriminating between T2D and health (AUC: 0.797); and a four-feature biosignature identifying prediabetes from health (AUC: 0.795). (C) a biosignature including total plasma ccfDNA with very high performance in discriminating OA from health (AUC: 0.934). Aberrant ccf-mtDNA levels could have diagnostic/prognostic potential in BrCa and Diabetes, while the developed multiparameter biosignatures can add value to their clinical management.

Diabetic Foot and Work Outcomes: A Review.

The aim of this review article was to discuss impact of diabetic foot ulcers (DFUs) on employment status and work productivity. We performed a literature search from 2000 to 2023 in PubMed, Scopus, Google Scholar and in national repositories. The major work outcomes studied were presenteeism and absenteeism. Many DFUs patients had a poor social and educational background. Overall, DFUs patients experienced increased loss of productivity in their workplaces: either they had to be absent more working hours than average or they faced increased difficulty in meeting their daily requirements. The total loss in productivity is estimated to exceed almost one-third of anticipated working time, while 15 to 34.3% of DFUs patients expressed concerns about severe changes in their working environment, attributed directly to their condition. More than 1 out of 5 DFUs patients (ranging from 20 to 31.7%) were even confronted with overall job loss and unemployment. Amputations had an even more marked negative effect. In conclusion, DFUs negatively affect employment status and work productivity. Therefore, we need more studies with large participant numbers to increase our experience and to explore potential measures to mitigate these adverse effects.

Does the Simultaneous Introduction of Several Pharmaceuticals in the Post-Lenalidomide Era Translate to Better Outcomes in Relapse Refractory Multiple Myeloma? Findings from the Real-World Innovation in Multiple Myeloma (REAL IMM) Study.

Newer methodologies are needed to assess the real-world comparative effectiveness of a "generation" of pharmaceutical innovation versus the prior standard of care. This chart review study aimed to first evaluate the cumulative clinical benefits of pharmaceutical innovation in everyday relapse/refractory multiple myeloma before analyzing findings in the context of respective real-world outcomes from the bortezomib/lenalidomide era. Study endpoints included the 52-week PFS rate in second and third line of therapy (LOT), mPFS-2 across the first and second LOT, the ORR, reasons for discontinuation, and the treatment duration per therapeutic algorithm. Data from 107 patients were collected. The median follow-up was 2.0 years. Of the subjects who met the selection criteria for the second LOT, 72.2% maintained the PFS at 52 weeks. In the third-line setting, the PFS rate at 52 weeks was 63.5%. The mPFS across the first and second, the second, and the third LOTs were 26, 17, and 15 months, respectively. The ORR was 76.1% in the second and 69.7% in the third LOT. After non-response or progression, the main reason for drug discontinuation was treatment intolerability. The second-line ORR and the 52-week PFS rate were similar to previous real-world findings from the bortezomib/lenalidomide era. The cumulative mPFS across the second and third LOTs was higher than the respective mPFS across the first and second LOTs. Despite its limitations, the methodology and findings from this study may be used in future clinical and economic evaluations across all hematological malignancies.

Knowledge and Attitudes in First Aid Practices for Thermal Burns: a Cross-sectional Study Among Adults in Northern Greece.

Background: Burns are a major cause of morbidity, including prolonged hospitalization, disfigurement, disability, and emotional trauma. Long-term absence from work and high healthcare costs for burn treatment have a significant socio-economic impact. Objective: his study aims to evaluate the level of knowledge for burn management in the adult population of Thrace in Northern Greece and to determine factors associated with a better level of knowledge. Methods: A questionnaire-based cross-sectional study was conducted οn a random sample of the adult population of Thrace. Data were collected using a structured pre-coded questionnaire, which included subjects' socio-demographic characteristics and the first aid practices for burns. Multivariate logistic regression analysis was used to determine the effect of subjects' characteristics on their knowledge of burn first aid practices. Results: A total of 711 subjects (49.6% males; mean age, 41.89±16.48 years) were included in the study. The incidence of a previous burn was 55.4%. Only 10.5% of the subjects would apply the optimal practice, consisting of rinsing the burn wound with cool running water for at least 10 minutes, applying only non-adhesive dressing on it and leaving the blisters intact. The optimal practice was independently associated with female gender (aOR=1.86, p=0.016), high education level (aOR=2.00, p=0.023), the presence of >3 children (aOR=2.27, p=0.009) and previous training in first aid (aOR=2.36, p=0.001). A large number of participants reported the application of toothpaste (38%), moisturizer (35.4%), aloe (31.8%) or yogurt (27.7%) to the burn surface. Conclusion: Only a small proportion of the participants were aware of the optimal burn first aid practices, most of them female, of high socioeconomic status. We recommend a more targeted approach in the design of health campaigns in the future, in order to reach vulnerable parts of the population.

Label-Free Human Disease Characterization through Circulating Cell-Free DNA Analysis Using Raman Spectroscopy.

Circulating cell-free DNA (ccfDNA) is a liquid biopsy biomaterial attracting significant attention for the implementation of precision medicine diagnostics. Deeper knowledge related to its structure and biology would enable the development of such applications. In this study, we employed Raman spectroscopy to unravel the biomolecular profile of human ccfDNA in health and disease. We established reference Raman spectra of ccfDNA samples from healthy males and females with different conditions, including cancer and diabetes, extracting information about their chemical composition. Comparative observations showed a distinct spectral pattern in ccfDNA from breast cancer patients taking neoadjuvant therapy. Raman analysis of ccfDNA from healthy, prediabetic, and diabetic males uncovered some differences in their biomolecular fingerprints. We also studied ccfDNA released from human benign and cancer cell lines and compared it to their respective gDNA, confirming it mirrors its cellular origin. Overall, we explored for the first time Raman spectroscopy in the study of ccfDNA and provided spectra of samples from different sources. Our findings introduce Raman spectroscopy as a new approach to implementing liquid biopsy diagnostics worthy of further elaboration.

Assessing the impact of the COVID­19 pandemic health protocols on the hygiene status of swimming pools of hotel units.

With the onset of the coronavirus disease 2019 (COVID-19) pandemic, numerous countries imposed strict lockdown measures and travel bans, resulting in the closure of hotels. Over time, the opening of hotel units was gradually allowed, and new strict regulations and protocols were issued to ensure the hygiene and safety of swimming pools in the era of COVID-19. The present study aimed to evaluate the implementation of strict health COVID-19-related protocols in hotel units during the 2020 summer tourist season concerning microbiological hygiene and physicochemical parameters of water, and to compare the data with those from the 2019 tourist season. For this reason, 591 water samples from 62 swimming pools were analyzed, of which 381 samples were for the 2019 tourist season and 210 samples were for the 2020 tourist season. To examine the presence of Legionella spp, 132 additional samples were taken from 14 pools, of which 49 in 2019 and 83 in 2020. In 2019, 2.89% (11/381) of the samples were out of legislative limits (0/250 mg/l) regarding the presence of Escherichia coli (E. coli), 9.45% (36/381) were out of acceptable limits (0/250 mg/l) regarding the presence of Pseudomonas aeruginosa (P. aeruginosa) and 8.92% (34/381) had residual chlorine levels <0.4 mg/l. In 2020, 1.43% (3/210) of the samples were out of the legislative limits as regards the presence of E. coli, 7.14% (15/210) were out of acceptable limits regarding the presence of P. aeruginosa and 3.33% (7/210) of the samples measured residual chlorine levels <0.4 mg/l. The risk ratio (RR) in relation to the presence of E. coli due to incorrect compliance with the requirements for residual chlorine was calculated for 2019 at 8.50, while in 2020 it was calculated at 14.50 (P=0.008). The RR of the presence of P. aeruginosa due to inappropriate residual chlorine requirements was calculated in 2019 at 2.04 (P=0.0814), while in 2020 it was calculated at 2.07 (P=0.44). According to the microbiological hygiene and physicochemical parameters of the water samples studied, there was a significant improvement due to the strict protocols for the swimming pools in the summer season of 2020 compared to the tourist season of 2019, namely 72.72% (E. coli), 58.33% (P. aeruginosa), 79.41% (of residual chlorine <0.4 mg/l) in the three main parameters studied. Finally, an increased colonization by Legionella spp. detected in the internal networks of the hotels due to the non-operation of the hotels during the lockdown, the improper disinfection and stagnant water in the internal water supply networks. Specifically, in 2019, 95.92% (47/49) of the samples tested negative and 4.08% (2/49) tested positive (≥50 CFU/l) for Legionella spp., compared to 2020 where 91.57% (76/83) of the samples tested negative and 8.43% (7/83) tested positive.

Coastal Water Quality Modelling Using E. coli, Meteorological Parameters and Machine Learning Algorithms.

In this study, machine learning models were implemented to predict the classification of coastal waters in the region of Eastern Macedonia and Thrace (EMT) concerning Escherichia coli (E. coli) concentration and weather variables in the framework of the Directive 2006/7/EC. Six sampling stations of EMT, located on beaches of the regional units of Kavala, Xanthi, Rhodopi, Evros, Thasos and Samothraki, were selected. All 1039 samples were collected from May to September within a 14-year follow-up period (2009-2021). The weather parameters were acquired from nearby meteorological stations. The samples were analysed according to the ISO 9308-1 for the detection and the enumeration of E. coli. The vast majority of the samples fall into category 1 (Excellent), which is a mark of the high quality of the coastal waters of EMT. The experimental results disclose, additionally, that two-class classifiers, namely Decision Forest, Decision Jungle and Boosted Decision Tree, achieved high Accuracy scores over 99%. In addition, comparing our performance metrics with those of other researchers, diversity is observed in using algorithms for water quality prediction, with algorithms such as Decision Tree, Artificial Neural Networks and Bayesian Belief Networks demonstrating satisfactory results. Machine learning approaches can provide critical information about the dynamic of E. coli contamination and, concurrently, consider the meteorological parameters for coastal waters classification.

Honey's Antioxidant and Antimicrobial Properties: A Bibliometric Study.

Research attention has been drawn to honey's nutritional status and beneficial properties for human health. This study aimed to provide a bibliometric analysis of honey's antioxidant and antimicrobial properties. The research advancements within this field from 2001 to 2022 were addressed using the Scopus database, R, and VOSviewer. Of the 383 results, articles (273) and reviews (81) were the most common document types, while the annual growth rate of published manuscripts reached 17.5%. The most relevant topics about honey's antimicrobial and antioxidant properties were related to the agricultural and biological sciences, biochemistry, and pharmacology. According to a keyword analysis, the most frequent terms in titles, abstracts, and keywords were honey, antimicrobial, antioxidant, bee, propolis, phenolic compounds, wound, antibacterial, anti-inflammatory, and polyphenols. A trend topic analysis showed that the research agenda mainly encompassed antioxidants, pathogens, and anti-infection and chemical agents. In a co-occurrence analysis, antioxidants, anti-infection agents, and chemistry were connected to honey research. The initial research focus of this domain was primarily on honey's anti-inflammatory and antineoplastic activity, wound healing, and antibacterial agents. The research agenda was enriched in the subsequent years by pathogens, propolis, oxidative stress, and flavonoids. It was possible to pinpoint past trends and ongoing developments and provide a valuable insight into the field of honey research.

Anti-Inflammatory and Antibacterial Effects and Mode of Action of Greek Arbutus, Chestnut, and Fir Honey in Mouse Models of Inflammation and Sepsis.

Background: Honey has been shown to possess anti-inflammatory and bactericidal properties that may be useful for the prevention and treatment of infections as well as of acute and chronic inflammatory diseases. The antimicrobial potency of honey could be attributed to its physicochemical characteristics combined with the presence of certain compounds, such as hydrogen peroxide and polyphenols. Honey's bacteriostatic or bactericidal capacity varies depending on its composition and the bacterial type of each infection. Nevertheless, not all honey samples possess anti-inflammatory or antibacterial properties and their mechanism of action has not been clearly elucidated. Objectives: We therefore investigated the anti-inflammatory properties of three different honey samples that derived from different geographical areas of Greece and different botanical origins, namely, arbutus, chestnut, and fir; they were compared to manuka honey, previously known for its anti-inflammatory and antibacterial activity. Materials and Methods: To test the anti-inflammatory activity of the different samples, we utilized the in vivo model of LPS-driven inflammation, which induces septic shock without the presence of pathogens. To evaluate the antibacterial action of the same honey preparations, we utilized the cecal-slurry-induced peritonitis model in mice. Since acute inflammation and sepsis reduce the biotransformation capacity of the liver, the expression of key enzymes in the process was also measured. Results: The administration of all Greek honey samples to LPS-stimulated mice revealed a potent anti-inflammatory activity by suppressing the TNFα serum levels and the expression of TNFα and iNOS in the liver at levels comparable to those of the manuka honey, but they had no effect on IL-6 or IL-1ß. It was shown that the LPS-induced suppression of CYP1A1 in the liver was reversed by Epirus and Crete fir honey, while, correspondingly, the suppression of CYP2B10 in the liver was reversed by Evros chestnut and Epirus fir honey. The effect of the same honey samples in polymicrobial peritonitis in mice was also evaluated. Even though no effect was observed on the disease severity or peritoneal bacterial load, the bacterial load in the liver was reduced in mice treated with Evros chestnut, Epiros fir, and Crete fir, while the bacterial load in the lungs was reduced in Epirus arbutus, Crete fir, and manuka honey-treated mice. Conclusion: Our findings suggest that these specific Greek honey samples possess distinct anti-inflammatory and antibacterial properties, as evidenced by the reduced production of pro-inflammatory mediators and the impaired translocation of bacteria to tissues in septic mice. Their mode of action was comparable or more potent to those of manuka honey.

Joint Analysis of Phenotypic and Genomic Diversity Sheds Light on the Evolution of Xenobiotic Metabolism in Humans.

Variation in genes involved in the absorption, distribution, metabolism, and excretion of drugs (ADME) can influence individual response to a therapeutic treatment. The study of ADME genetic diversity in human populations has led to evolutionary hypotheses of adaptation to distinct chemical environments. Population differentiation in measured drug metabolism phenotypes is, however, scarcely documented, often indirectly estimated via genotype-predicted phenotypes. We administered seven probe compounds devised to target six cytochrome P450 enzymes and the P-glycoprotein (P-gp) activity to assess phenotypic variation in four populations along a latitudinal transect spanning over Africa, the Middle East, and Europe (349 healthy Ethiopian, Omani, Greek, and Czech volunteers). We demonstrate significant population differentiation for all phenotypes except the one measuring CYP2D6 activity. Genome-wide association studies (GWAS) evidenced that the variability of phenotypes measuring CYP2B6, CYP2C9, CYP2C19, and CYP2D6 activity was associated with genetic variants linked to the corresponding encoding genes, and additional genes for the latter three. Instead, GWAS did not indicate any association between genetic diversity and the phenotypes measuring CYP1A2, CYP3A4, and P-gp activity. Genome scans of selection highlighted multiple candidate regions, a few of which included ADME genes, but none overlapped with the GWAS candidates. Our results suggest that different mechanisms have been shaping the evolution of these phenotypes, including phenotypic plasticity, and possibly some form of balancing selection. We discuss how these contrasting results highlight the diverse evolutionary trajectories of ADME genes and proteins, consistent with the wide spectrum of both endogenous and exogenous molecules that are their substrates.

Use of Edible, Medicinal, and Aromatic Plants in Various Health Disorders: A Cross-Sectional Evaluation among Inhabitants in the Area of Thrace, North-Eastern Greece.

BACKGROUND: Medicinal and aromatical plants (MAPs) have been historically used as traditional remedies in many cultures in Europe and globally. The aim of this study was to evaluate the use of MAPs in various health disorders in association to dietary habits and other lifestyle factors among residents in Thrace, NE Greece. METHODS: Data were collected through anonymous and voluntary responses to a structured online questionnaire, via convenience (snowball) sampling. RESULTS: The 561 responders (age: 39.7 ± 11.6 y) were mostly female (59.7%), with higher education (69.8%), working as state or private employees (55.4%), and having low/medium income (77.1%). Overall, more than 70% were using MAPs in various symptoms and common health disorders, such as chamomile against common cold and the flu. More than 20 different MAPs were being used in smaller frequencies against various conditions. Key contributing factors to the consumption of MAPs were sex (female over male), employment (employed vs. unemployed), education (higher education vs. lower) and higher Body Mass Index (overweight and obese vs. normal), while consumption of fruit, fish, and vegetables was mainly associated with the use of MAPs as common items of diet and in health disorders. CONCLUSIONS: The use of MAPs as part of the diet and as traditional remedy is present in the examined population, while particular choices seem to be affected by sociodemographic and lifestyle factors.

Physical Activity, Body Mass Index (BMI) and Abdominal Obesity of Pre-Adolescent Children in the Region of Thrace, NE Greece, in Relation to Socio-Demographic Characteristics.

This study aimed to explore the prevalence of overweight, obesity, and abdominal obesity, and define predictive factors of their occurrence among pre-adolescents in the region of Thrace, NE Greece. A secondary aim was to record physical activity at different times (schooldays, weekends, holidays) and explore associations with characteristics such as gender, overweight and obesity, and socio-demographic conditions. A cross-sectional study was conducted involving children aged 11-12 years. Participating children were measured for height, weight, and waist circumference, and their parents answered a questionnaire. In total, 1929 children were included. Prevalence of overweight was 31.5%, prevalence of obesity 17%, and only 1% of children were underweight. Abdominal obesity was detected in 20.3% of the sample. Overweight and obesity were more frequent in males, who also had higher mean values of Body Mass Index-for-age z-scores (BMIaz) and Waist-to-Height ratio (WtHR). Obesity rates were higher among those not participating in physical activities; however, no significant difference was observed between normal-weight, overweight and obese children in the time spent for organized athletic activities or free play. Logistic regression analysis showed that the probability for overweight/obesity was higher in boys (OR = 1.39, 95% CI = 1.16-1.66) and lower in children whose fathers had a higher educational level (OR = 0.75, 95% CI = 0.60-0.93). The probability for abdominal obesity was also higher in boys (OR = 1.37, 95% CI = 1.10-1.72) and lower in children participating at least one hour/day in an organized physical activity (compared to those with no physical activity (OR = 0.66, 95% CI = 0.51-0.85), and whose father was exercising at least 1-2 times/week (OR = 0.76, 95% CI = 0.591-0.98). In conclusion, the prevalence of overweight and obesity among pre-adolescents in NE Greece was estimated at 48.5%. This is associated with the male gender and not participating in physical activities. The educational level and exercise habits of the father (but not of the mother) affect the probability of obesity and abdominal obesity, respectively.

Indoor air quality and sick building syndrome in a university setting: a case study in Greece.

The perceived Indoor Air Quality (IAQ), the prevalence of Sick Building Syndrome (SBS) symptoms and its contributing risk factors were assessed in a university during the period of the economic crisis in Greece. Data was collected from 613 employees via questionnaires. Hierarchical linear regression analysis was performed. The most prevalent perceived IAQ complaints were 'Dust and dirt' (63.2%), 'Room temperature too low' (24.9%) and 'Varying room temperature' (24.4%). The most frequently reported SBS symptom was 'Fatigue' (34.1%). The prevalence of General, Mucosal and Dermal symptoms was 40.8%, 19.8% and 8.1%, respectively. Several contributing risk factors were identified, such as IAQ Discomfort Scale, atopy, sleep problems, female, exposure to biological and chemical agents, PC-use, Psychosocial Work Scale and job satisfaction. Poor perceived IAQ and high prevalence of SBS symptoms were reported from the university staff in a temperate climate country. SBS seemed to be multifactorial.

Undergraduate Medical Education During the Pandemic: How do Academic Staff Members in Greece and Cyprus Feel About it?

This study used a questionnaire to examine how academic staff members in Greece and Cyprus feel about the changes in undergraduate medical education during the COVID-19 pandemic. In general, e-learning was not considered an adequate way of teaching and was less enjoyable. Participants aged 31-40 years experienced more (P = .001), while staff in higher academic ranks less difficulty (P < .001) in adjustment. There was a small increase in workload, which was higher among respondents researching into COVID-19 (P = .001). During the pandemic, daily screen use >6 h was increased from 28.8% to 57.5%. The majority (74.2%) stated that scientific and educational training opportunities were not affected by the pandemic. In conclusion, the pandemic has induced important changes in undergraduate medical education. This new condition was considered adequate but not pleasant, with younger faculty members being more burdened.

Association of the Modified Mediterranean Diet Score (mMDS) with Anthropometric and Biochemical Indices in US Career Firefighters.

The Mediterranean diet is associated with multiple health benefits, and the modified Mediterranean Diet Score (mMDS) has been previously validated as a measure of Mediterranean diet adherence. The aim of this study was to examine associations between the mMDS and anthropometric indices, blood pressure, and biochemical parameters in a sample of career firefighters. The participants were from Indiana Fire Departments, taking part in the "Feeding America's Bravest" study, a cluster-randomized controlled trial that aimed to assess the efficacy of a Mediterranean diet intervention. We measured Mediterranean diet adherence using the mMDS. Anthropometric, blood pressure, and biochemical measurements were also collected. Univariate and multivariate linear regression models were used. In unadjusted analyses, many expected favorable associations between the mMDS and cardiovascular disease risk factors were found among the 460 firefighters. After adjustment for age, gender, ethnicity, physical activity, and smoking, a unitary increase in the mMDS remained associated with a decrease of the total cholesterol/HDL ratio (ß-coefficient -0.028, p = 0.002) and an increase of HDL-cholesterol (ß-coefficient 0.254, p = 0.004). In conclusion, greater adherence to the Mediterranean diet was associated with markers of decreased cardiometabolic risk. The mMDS score is a valid instrument for measuring adherence to the Mediterranean diet and may have additional utility in research and clinical practice.

The association between sleep pathology and depression: A cross-sectional study among adults in Greece.

A cross-sectional population based study was conducted in order to evaluate the potential association of sleep characteristics with depression using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants aged between 19 and 86 years old were enrolled in our study. Depression symptoms were assessed using the Beck Depression Inventory. Participants self-reported their daily sleep habits and filled in the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of depression was 28.4%. Depression symptoms were more prominent among minority groups. Subjects with depression reported shorter sleep duration and had reduced sleep efficiency. In patients with depression mean sleep duration was reduced by 23 min and mean sleep efficiency by 4%. Patients with depression were at higher risk of insomnia, poor sleep quality and obstructive sleep apnea, but not of excessive daytime sleepiness. Concerning insomnia subtypes, depression was associated with difficulties maintaining sleep and early morning awakening, but not problems initiating sleep. Sleep disturbances are highly prevalent in depression and our findings support early pharmacological or cognitive behavioral interventions in order to address this key depression-associated symptom. Only addressing problems initiating sleep might not be sufficient in depression.

Investigation of the health effects on workers exposed to respirable crystalline silica during outdoor and underground construction projects.

Chronic exposure of workers to powder containing crystalline silica (Silicon dioxide; SiO2) can lead to chronic lung diseases (lung cancer, silicosis, etc.). Aim of this study was to evaluate the exposure of Greek construction workers to SiO2 and describe their pulmonary function. The study involved 86 outdoor and underground workers. Medical and professional history was obtained, and breath samples were collected at morning hours through a mask for the determination of SiO2 levels. Pulmonary function tests, radiological examination and evaluation of radiographs were also performed. Pulmonary function examination showed that the majority of the workers were within normal range (61.4%) while the rest were diagnosed with mild (26.5%) and more severe impairment (7.24%). Working conditions (underground-outdoor) were statistically significantly related to the categorization of pulmonary function (P=0.038). During radiological examination, the type of working activity/ conditions (underground-outdoor) were statistically significantly related to the categorization of these findings (P=0.044). Of the 69 employees, 52 did not present findings (75.4%) and 5 were diagnosed with findings specific to occupational diseases (7.23%). Environmental exposure to respirable crystalline silica (RCS) was detected at 0.0125 mg/m3 in the workplace, which is not beyond the legal limits. Underground workers with more than 15 years of exposure to SiO2 are more likely to present chronic silicosis compared to the workers of outdoor activities.

Association of Family Income with Health Indices and Healthcare Utilization in a Large Sample of Residents in Northern Greece.

Objective:To describe the impact of subjects' family income, which was used as a proxy for socioeconomic status, with health characteristics and healthcare utilization of a large representative sample of population in Northern Greece, taking into account several socio-demographic characteristics and health behaviors of the participants. Material and method:Eight hundred and twelve participants (43.7% males) with a mean age of 49.±14.8 years (range 19-83 years), from the area of Thrace, Greece, were enrolled in this cross-sectional populational study. A two-stage stratified sampling scheme was used and subjects were classified, according to the net mean monthly household income, into three financial levels: low .1000 Euro; medium 1001-2000 Euro; and high >2000 Euro. Self-reported questionnaires for socio-demographic, lifestyle and health related characteristics were collected. Sleep characteristics, utilizing Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire, and mental health, using Zung Self-rating Anxiety Scale and Beck Depression Inventory have been also assessed. Results:The majority of participants belonged to the lower income level (476 subjects, 58.6%). Lower income level was associated with a higher prevalence of high alcohol consumption (p=0.030), low adherence to Mediterranean diet (p=0.016), low physical activity (p<0.001) and either short or long nocturnal sleep duration (p<0.001). After adjusting for all socio-demographic and lifestyle characteristics, subjects with low income had a higher risk for anxiety (aOR=1.97, p=0.017), depression (aOR=4.88, p<0.001), dyslipidemia (aOR=2.50, p=0.007), diabetes (aOR=3.58, p<0.001), obesity (aOR=1.97, p=0.038), cardiovascular disease (aOR=3.04, p=0.015) and sleep disorders, as well as for primary (aOR=3.56, p=0.017) and secondary (aOR=2.49, p=0.010) healthcare utilization compared to subjects with high income. Conclusion:Low income is an important factor, which adversely affects the health of individuals via different pathways such as adaptation of harmful everyday habits. Large-scale prospective cohort studies are necessary to verify these associations in a methodologically more robust way.

Adherence to the Mediterranean Diet and Healthy Aging: A Narrative Review over the Last Decade.

Objective: Even though modern medicine has significantly contributed to the extension of human lifespan, it has failed to delay the upsurge of chronic diseases. Health benefits of the Mediterranean diet are well established. Thus, adherence to this diet pattern may be the key to healthy aging. Ôhe aim of this review is to investigate the potential benefits of the Mediterranean diet on healthy aging. Methods: A literature search of three databases (ScienceDirect, MEDLINE and The Cochrane Library) was conducted in order to trace all relevant studies published between January 1st 2010 and June 6th 2020 that focused on the impact of adherence to the Mediterranean diet on the physical and mental well-being of individuals aged 60 or older. Results:Twenty-two studies fulfilled the selection criteria and were classified into six groups, according to the main outcome of each study: mental health (eight studies), frailty (6), cardiovascular risk factors (3), plasma levels of uric acid (1), length of hospital stay (1), and aging mechanisms (3). Based on these studies, the protective role of Mediterranean diet on depression, cardiovascular and frailty risk was established. Moreover, adherence to the Mediterranean diet resulted in reduced plasma uric acid levels as well as decreased length of hospital stay and mortality risk among patients who were urgently admitted for any cause in a tertiary hospital. In contrast, results on the effect of Mediterranean diet on cognition were controversial, as studies presented positive or neutral correlations. Conclusions: This review provides evidence on the association between adherence to the Mediterranean diet and healthy aging and highlights the importance of conducting more studies among seniors in order to provide further insight into this matter.

Unraveling innovation potential in the real-world setting: eighteen novel agents with twenty-six approved European indications, in the management of leukemias, lymphomas, and multiple myeloma.

Introduction: Real-world effectiveness of hemato-oncology pharmaceuticals may not necessarily mimic clinical trial efficacy results, mainly due to demographic and clinical practice variability. The aim of this review was to systematically assess the availability of real-world evidence (RWE) and the transferability of clinical trial (CT) efficacy results to real life, for novel agents recently approved to manage lymphomas, leukemias, and multiple myeloma. This is the largest cross-indication review comparing RWE to CT results, aspiring to inform clinical practice and decision-making when funding hemato-oncology pharmaceuticals.Areas covered: The review methodology focused on identifying all novel agents that entered EU landscape between 2012 and 2016 by using European Medicines Agency (EMA) database, while conducting a systematic PubMed literature review of RWE in the specific hematological malignancies, in order to compare RWE versus CT efficacy endpoints.Expert opinion: In total, 18 international nonproprietary names (INNs) that received EMA approval for any indication were included and the registrational efficacy results are presented. Eight (44%) INNs proved to have relevant RWE generated in at least one approved indication. The analysis of findings revealed high variability in terms of RWE availability and transferability of CT results to relevant real-life experience among the disease areas investigated.