Prevalence of tobacco use, exposure to secondhand smoke and knowledge on smoking cessation among students of health professions in Central Greece: a cross-sectional study.

OBJECTIVES: The aim of this study was to assess the prevalence of tobacco use and exposure to secondhand smoke among students of health professions (SHPs) and determine possible risk factors for current smoking. In addition, we sought to investigate the level of students' knowledge regarding smoking cessation. DESIGN: Cross-sectional. SETTING: Central Greece. PARTICIPANTS: A convenient sample of 822 SHP volunteers were used, composed of 365 medical students, 123 students from a biochemistry department, 71 students from a nursing department, 176 from medical laboratory department and 84 students from a veterinary medicine department. PRIMARY AND SECONDARY OUTCOME MEASURES: We investigated the prevalence of current smoking and secondhand smoke, their determinants and SHP's knowledge and attitudes regarding smoking cessation. Univariate and logistic regression statistical analysis were used in order to identify risk factors associated with current smoking. RESULTS: The prevalence of current smoking was estimated at 23.5% (95% CI 20.7% to 26.5%), while 49% of current smokers reported they wanted to quit smoking. The prevalence of current e-cigarette use was 1.2%. In addition, 96.5% (95% CI 94.9% to 97.5%) of SHP have been exposed to secondhand smoke at least 1 day per week. Logistic regression analysis showed that increasing age (p<0.001), alcohol consumption (p<0.001) and exposure to secondhand smoke in the home (p<0.001) were independent risk factors for current smoking. Notably, only 11.6% of the participants had learnt about methods to be used for smoking cessation. CONCLUSIONS: Our results underline the need for integrated tobacco control initiatives that should discourage tobacco use among SHP, promote smoke free schools of health science, and implement programs that train SHP in effective cessation-counseling techniques.

Prevalence and determinants of current cigarette smoking and secondhand smoking among Greek adolescents: the Global Youth Tobacco Survey (GYTS) 2013 study.

OBJECTIVES: Smoking prevalence in Greece is considered high within the European Union and the collection of evidence on tobacco use among adolescents is of vital importance in order to develop effective smoking prevention and cessation programmes. DESIGN: Cross-sectional. SETTING: Greece. PRIMARY AND SECONDARY OUTCOME MEASURES: Global Youth Tobacco Survey (GYTS) is a national representative, paper-and-pencil, cross-sectional, school-based study of students at ages 13-15 years. The survey employed a multistage cluster sample design with schools selected proportional to enrolment size. Finally, 4618/5127 students aged 13-15 years participated in the survey. The school response rate was 98.1%, the student response rate was 90.1% and the overall response rate was 88.4%. RESULTS: The prevalence of current cigarette smoking was estimated at 10.1% (10.4% in GYTS 2005) and of exposure to secondhand smoking in public places at 67.4% (94.1% in GYTS 2005). The vast majority of the adolescents (82.1%) supported the banning of smoking inside enclosed public places. Most of the current smokers (90.8%) were not prevented/refused purchase because of their age according to existing law. Multivariate analysis showed that peer influence (OR=48.32; 95% CI 36.2 to 64.48), pocket money (OR=2.63; 95% CI 1.28 to 3.41), increasing age (OR=2.35; 95% CI 1.63 to 3.39) and low educational level of father (OR=2.82; 95% CI 1.7 to 4.68) were risk factors independently associated with current cigarette smoking. CONCLUSIONS: Despite the existence of strict laws related to tobacco control, exposure to secondhand smoking among Greek students remained high even when compared with GYTS in 2005. This is likely a result of weak enforcement, what is really missing is the enforcement of the related legislation.

Association of treatment for bacterial meningitis with the development of sequelae.

BACKGROUND: Bacterial meningitis continues to be a serious, often disabling infectious disease. The aim of this study was to assess the possibility that treatment influences the development of sequelae in childhood bacterial meningitis. METHODS: Two thousand four hundred and seventy-seven patients aged 1 month to 14 years with acute bacterial meningitis over a 32-year period were enrolled in the study. Data were collected prospectively from the Meningitis Registry of a tertiary university teaching hospital in Athens, Greece. Treatment was evaluated through univariate and multivariate analysis with regard to sequelae: seizure disorder, severe hearing loss, ventriculitis, and hydrocephalus. RESULTS: According to the multinomial logistic regression analysis, there was evidence that penicillin, an all-time classic antibiotic, had a protective effect on the occurrence of ventriculitis (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.05-0.60), while patients treated with chloramphenicol had an elevated risk of ventriculitis (OR 17.77 95% CI 4.36-72.41) and seizure disorder (OR 4.72, 95% CI 1.12-19.96). Cephalosporins were related to an increased risk of hydrocephalus (OR 5.24, 95% CI 1.05-26.29) and ventriculitis (OR 5.72, 95% CI 1.27-25.76). The use of trimethoprim/sulfamethoxazole increased the probability of seizure disorder (OR 3.26, 95% CI 1.08-9.84) and ventriculitis (OR 8.60, 95% CI 2.97-24.91). Hydrocortisone was associated with a rise in hydrocephalus (OR 5.44, 95% CI 1.23-23.45), while a protective effect of dexamethasone (OR 0.82, 95% CI 0.18-3.79) was not statistically significant. CONCLUSIONS: Current study findings suggest that the type of antimicrobial treatment for childhood bacterial meningitis may influence in either a positive or a negative way the development of neurological sequelae.

Risk factors of antibiotic misuse for upper respiratory tract infections in children: results from a cross-sectional knowledge-attitude-practice study in Greece.

Background. Upper respiratory tract infections (URTIs) are common in children. The cause of URTIs is usually viral, but parents' attitudes often contribute to inappropriate prescription of antibiotics, promoting antibiotic resistance. The objective of this study was to identify possible risk factors associated with antibiotic misuse in Greece, a country with high levels of antibiotic use and antibiotic resistance. Methods. A knowledge-attitude-practice (KAP) questionnaire was developed and distributed to Greek parents caring for children who were 5-6 years old, between January and July of the same school year. Results. The sample of the study contained 5312 parents from all geographic areas of Greece. The risk factors of being a father, having low education, having immigrant status, being a single parent, having low income, having <2 or >3 children, living in the islands, and being without experience in recurrent URTIs were significantly associated to inadequate knowledge, inappropriate attitudes, and wrong practices. Conclusions. This study has identified the main groups of parents that should be targeted in future intervention programs.

Prognostic factors related to sequelae in childhood bacterial meningitis: data from a Greek meningitis registry.

BACKGROUND: Bacterial meningitis (BM) is a life-threatening disease, often related with serious complications and sequelae. Infants and children who survive bacterial meningitis often suffer neurological and other sequelae. METHODS: A total of 2,477 patients aged 1 month to 14 years old hospitalized in a Children's Hospital in Greece diagnosed with acute bacterial meningitis were collected through a Meningitis Registry, from 1974 to 2005. Clinical, laboratory and other parameters (sex, age, pathogen, duration of symptoms before and after admission) were evaluated through univariate and multivariate analysis with regard to sequelae. Analysis of acute complications were also studied but not included in the final model. RESULTS: The rate of acute complications (arthritis and/or subdural effusion) was estimated at 6.8% (152 out of 2,251 patients, 95%CI 5.8-7.9) while the rate of sequelae (severe hearing loss, ventriculitis, hydrocephalus or seizure disorder) among survivors was estimated at 3.3% (73 out of 2,207 patients, 95%CI 2.6-4.2). Risk factors on admission associated with sequelae included seizures, absence of hemorrhagic rash, low CSF glucose, high CSF protein and the etiology of meningitis. A combination of significant prognostic factors including presence of seizures, low CSF glucose, high CSF protein, positive blood culture and absence of petechiae on admission presented an absolute risk of sequelae of 41.7% (95%CI 15.2-72.3). CONCLUSIONS: A combination of prognostic factors of sequelae in childhood BM may be of value in selecting patients for more intensive therapy and in identifying possible candidates for new treatment strategies.

Antibiotic use for upper respiratory tract infections in children: a cross-sectional survey of knowledge, attitudes, and practices (KAP) of parents in Greece.

BACKGROUND: Upper respiratory tract infections (URTIs) are common in children. The cause of URTIs is usually viral, but parents' attitudes often contribute to inappropriate prescription of antibiotics, promoting antibiotic resistance. The objective of this study was to document and analyse parental beliefs on antibiotic use for children with URTIs in Greece, a country with high levels of antibiotic use and antibiotic resistance. METHODS: A knowledge-attitude-practice questionnaire was developed and distributed to Greek parents caring for children who were 5-6 years old, between January and July of the same school year. The sample of the study contained parents from all geographic areas of Greece. RESULTS: The majority of Greek parents (80%) believed that UTRIs are mostly self-limited, although 74% of them expected to receive antibiotics when such a diagnosis was given. Earache was the most common reason for which parents expected antibiotics (45%). Greek parents rarely gave antibiotics to their children without medical advice (10%) and most (88%) believed that unnecessary antibiotic use drives antibiotic resistance and they were happy to receive symptomatic therapy if instructed by their physician. Almost 70% of parents confused antibiotics with other medicines used for symptomatic therapy for a child with URTI. CONCLUSION: Greek parents have a trusted relationship with their paediatrician and rarely give antibiotics without medical advice, indicating that parents contribute less than expected to antibiotic misuse. Parents also appreciate the benign course of most URTIs and the fact that unnecessary antibiotic use is harmful. More time needs to be invested in educating mostly physicians on the potential benefit from reducing antibiotic prescribing for children with URTI.

Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the Meningitis Registry.

BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM) were collected from the Meningitis Registry (MR). Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta) and SPSS (version 15.0-Chicago) software. Statistically significant (p<0.05) variables were included in a conditional backward logistic regression model. A total of 838 (63.0%) attributed to Neisseria meningitidis, 252 (18.9%) to Haemophilus influenzae, 186 (14.0%) to Streptococcus pneumoniae and 55 (4.1%) due to other bacteria. For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash (OR 22.36), absence of seizures (OR 2.51), headache (OR 1.83) and negative gram stain result (OR 1.55) with a Positive Predictive Value (PPV) of 96.4% (95%CI 87.7-99.6). For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash (OR 13.62), positive gram stain (OR 2.10), coma (OR 3.11), seizures (OR 3.81) and peripheral WBC > or = 15000/microL (OR 2.19) with a PPV of 77.8% (95%CI 40.0-97.2). For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61), age > or = 1 year (OR 2.04), absence of headache (OR 3.01), CSF Glu < 40 mg/dL (OR 3.62) and peripheral WBC < 15,000/microL (OR 1.74) with a PPV of 58.5% (95%CI 42.1-73.7). CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied.

Development and assessment of a questionnaire for a descriptive cross-sectional study concerning parents' knowledge, attitudes and practises in antibiotic use in Greece.

BACKGROUND: Upper Respiratory Infections (URIs) are common in children. The cause is usually viral, but parents' attitude often contributes to inappropriate antibiotic prescribing, promoting antibiotic resistance. The objective is to describe the process of developing a questionnaire to assess parents' Knowledge, Attitude and Practices (KAP) concerning the role of antibiotics when children suffer from URIs, as well as to evaluate the response rates, the completeness and the reliability (Cronbach) of the questionnaires. Finally, to note any limitations of the study. METHODS: Literature review, along with pre-testing yielded a questionnaire designed to assess the parents' KAP-level. A postal survey was set, in a national sample of 200 schools stratified by geographical region. The participants consist of a multistage geographical cluster sample of 8000 parents. The influence of demographic characteristics (i.e. sex, age, education) was analyzed. Cronbach index test and factor analysis were used to assess the reliability of the questionnaire. RESULTS: The response rate of the parents was 69%. Islands presented the lowest response rate while in Northern Greece the response rate was the highest. Sixty-eight point nine percent of the sample returned questionnaires fully completed, while 91.5% completed 95% of the questions. Three questions out of 70 were answered in a very low rate which was associated mostly with immigrant respondents. The section describing parents' attitude toward antibiotic use was not completed as much as the sections of knowledge or practices. The questions were factor analyzed and 10 out of the 21 extracted factors were finally evaluated, reducing the number of independent variables to 46. The reliability of the questionnaire was 0.55. However, only items that increased the Cronbach when added were eventually included in the final scales raising the internal consistency to 0.68. Limitations of the study, such as the vocabulary and form of the questionnaire and the idiocycrancy of the respondents, emerged during the analysis. CONCLUSION: The response rate and the completeness of the questionnaires were higher than expected, probably attributed to the involvement of the teachers. The study findings were satisfactory regarding the development of a reliable instrument capable to measure parents' KAP characteristics.

Multivitamins and phospholipids complex protects the hepatic cells from androgenic-anabolic-steroids-induced toxicity.

INTRODUCTION: Androgenic-anabolic-steroids (AAS)-induced hepatotoxicity typically occurs with C-17 alkylated oral agents abused by exercising individuals at clinically recommended doses. Injectable compounds appear to have the same risk for hepatotoxicity, but are applied in doses three to six times higher than clinically recommended. AAS users occasionally try to avoid the well-known hepatotoxic effects associated with the abuse of a multitude of AAS agents, by using the pharmaceutical agent compound N a phospholipid/vitamin preparation. PRIMARY OBJECTIVE: The investigation of the actual hepatoprotective effect of compound N against AAS-induced toxicity. METHODOLOGY: This was an observational cohort study of 320 athletes; 160 were AAS users and the other 160 were not abusing any substances. Of the 160 users, 44 were using AAS and compound N (group A), and 116 were using solely AAS (group B). The 160 athletes abstaining from substances abuse acted as controls (group C). All athletes were tested for alterations in serum levels of hepatic enzymes. Enzyme levels before the study's onset and after the end of the 8-week AAS regimes were compared among the three groups, in order to delineate the hepatoprotective effect of compound N. RESULTS: Prior to our research all groups showed normal values in all enzymes except creatine kinase (CK). After the 8-week period, CK levels were slightly lower in group A, but without variation in Groups B and C; -Glutamyl Transferase (GT) levels remained normal. Groups A and C had no elevations in any of the enzymes, except CK, while in group B all enzymes' values were elevated above the normal range. The only factor differentiating AAS users in group A from those in group B was the use of compound N, thus the results being suggestive of the compound's detoxification effect. The severity of AAS abuse was positively associated with the degree of changes ( values) in all measured enzymes except GT and CK. CONCLUSIONS: Previous suggestions that serum hepatic enzyme elevations in exercising AAS abusers are connected to muscle fiber damage rather than the abuse itself, are contradicted by our results. Since all AAS abusing athletes were prone to exhibit elevations in enzymes' values, the mean values of group A were to be similar to those observed in group B, exceeding normal values. The group hepatic enzyme values of group B were significantly higher than the group C (control). Notably, group A did not have any statistically significant difference in the hepatic enzyme values compared to group C. The effect of exercise on these enzymes' elevations was ruled out by the comparability of training regimens and AAS toxicity was correlated to the severity of AAS abuse.

Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period.

BACKGROUND: Bacterial meningitis remains a source of substantial morbidity and mortality in childhood. During the last decades gradual changes have been observed in the epidemiology of bacterial meningitis, related to the introduction of new polysaccharide and conjugate vaccines. The study presents an overview of the epidemiological patterns of acute bacterial meningitis in a tertiary children 's hospital during a 32-year period, using information from a disease registry. Moreover, it discusses the contribution of communicable disease registries in the study of acute infectious diseases. METHODS: In the early 1970s a Meningitis Registry (MR) was created for patients admitted with meningitis in Aghia Sofia Children's Hospital in Athens. The MR includes demographic, clinical and laboratory data as well as treatment, complications and outcome of the patients. In 2000 a database was created and the collected data were entered, analyzed and presented in three chronological periods: A (1974-1984), B (1985-1994) and C (1995-2005). RESULTS: Of the 2,477 cases of bacterial meningitis registered in total, 1,146 cases (46.3%) were classified as "probable" and 1,331 (53.7%) as "confirmed" bacterial meningitis. The estimated mean annual Incidence Rate (IR) was 16.9/100,000 for bacterial meningitis, 8.9/100,000 for Neisseria meningitidis, 1.3/100,000 for Streptococcus pneumoniae, 2.5/100,000 for Haemophilus influenzae type b (Hib) before vaccination and 0.4/100,000 for Hib after vaccination. Neisseria meningitis constituted the leading cause of childhood bacterial meningitis for all periods and in all age groups. Hib was the second most common cause of bacterial meningitis before the introduction of Hib conjugate vaccine, in periods A and B. The incidence of bacterial meningitis due to Streptococcus pneumoniae was stable. The long-term epidemiological pattern of Neisseria meningitidis appears in cycles of approximately 10 years, confirmed by a significant rise of IR in period C. The Case Fatality Rate (CFR) from all causes was 3.8%, while higher CFR were estimated for Streptococcus pneumoniae (7.5%, RR=2.1, 95% CI 1.2-3.7) and Neisseria meningitidis (4.8%, RR=1.7, 95% CI 1.1-2.5) compared to other pathogens. Moreover, overall CFR varied significantly among the three time periods (p = 0.0015), and was estimated to be higher in period C. CONCLUSION: By using the MR we were able to delineate long-term changes in the epidemiology of bacterial meningitis. Thus the MR proved to be a useful tool in the study and the prevention of communicable diseases in correlation with prevention strategies, such as vaccinations.

Psychiatric and hostility factors related to use of anabolic steroids in monozygotic twins.

INTRODUCTION: Anabolic androgenic steroids (AAS) are derived by chemical manipulation of the testosterone molecule. The specified category of drugs produces anabolic, androgenic and psycho-active effects including elevated aggressive, hostile, violent and anti social behavior. OBJECTIVE: The objective of this case report observational study was to evaluate the possible psychological consequences of AS use in the twin user of each pair, compared with the non-user twin. METHODOLOGY: We studied two pairs of male monozygotic twins: one pair 24 years old and the other 31 years old, with absolute genome and phenotype similarity. One of the twins of each pair used AAS while the other did not. Both pairs lived in Hellenic provincial towns and followed a common training and nutrition regime. The psychometric instruments used were the Symptoms Check List-90 (SCL-90) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The psychometric evaluations took place within a time interval of 6 months. RESULTS: The study found high levels of aggressiveness, hostility, anxiety and paranoid ideation in the twins who used AS. The non-user twins showed no deviation from their initial status. CONCLUSION: The use of AAS induced several important psychiatric changes in monozygotic twins which were not present in the twin who did not use AAS.

Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse.

OBJECTIVE: The objective of our study was to evaluate the psychological consequences of real-world AAS use in athletes abusing such agents, in comparison with a placebo and control group of comparable athletes, while correlating the severity of abuse with the side effects observed. The hypothesis tested by the study was that the use of AAS induces a wide range of psychological side effects whose impact and emergence is dependent upon the severity of the abuse. DESIGN: The study includes a substantial group of AAS abusing athletes and two more groups demographically similar to the first, one composed of athletes not using any substance and a placebo group. All athletes were stratified according to the severity of AAS abuse. Psychometric instruments were applied to all athletes in specific time intervals, dependent to the AAS abusers' regimens, providing us with a final psychological profile that was to be compared to the pre-study profile. All results were comparable (within and between groups) for statistically significant differences and correlated to the severity of the abuse. Homogeneity of all groups was safeguarded by random doping controls, monitoring of drug levels and analysis of all self obtained drugs by method of liquid chromatography/mass spectrometry. All athletes were provided with a common exercise and dietary regime, so common training and nutritional conditions were achieved. METHODS: We studied a cohort of 320 body-building, amateur and recreational athletes, of whom 160 were active users of AAS (group C), 80 users administering placebo drugs (group B) and 80 not abusing any substance (Group A). Group C athletes were stratified according to AAS abuse parameters, thus providing us with three subgroups of "light, medium and heavy abuse". Athletes of groups A and B were included in a "no abuse" subgroup. The psychometric instruments used were the Symptoms Check List-90 (SCL-90) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The psychometric evaluations took place within a time interval of 13 months. Statistical analysis was performed by using the Mann-Whitney/Wilcoxon two-sample non-parametric test (Kruskal-Wallis test for two groups) for data that were not normally distributed and Linear regression analysis was used to ascertain the correlation between severity of use and escalation of side effects. RESULTS: The study showed a statistically significant increase in all psychometric subscales recorded in group C, and no statistically significant difference in group C and A. There was a significant increase in the scorings of group C for all subscales of SCL-90 and HDHQ. Correlation of abuse severity and side effects showed that there was a statistical significant increase in Delta values of all SCL-90 and HDHQ subscales that escalated from light abuse to medium and heavy abuse/consumption patterns. CONCLUSIONS: The results of the study suggest that the wide range of psychiatric side effects induced by the use of AAS is correlated to the severity of abuse and the force of these side effects intensifies as the abuse escalates.