Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Abrupt and gradual drying-off procedure and intramammary dry treatment: Impact on udder health status of Chios breed dairy sheep

In order to evaluate the impact of drying-off procedure on udder health status and the effect of intramammary dry treatment on prevention of new intramammary infections and improving cure rate of mammary abnormalities, a randomized single blinded controlled trial was performed in which 80 Chios breed dairy ewes were randomly allocated into 2 groups. Ewes of Group A (n=40) dried off gradually during a 15-day period, whereas in ewes of Group B (n=40), udder drying-off took place abruptly. Half of the ewes of each group received intramammary infusion (1 syringe/teat) of benzathine cloxacilline (IDT subgroup, n=20). The rest of the ewes of each group received no treatment at all (control subgroup, n=20). Representative samples of teat duct material and milk were aseptically collected from each mammary half for cytological and microbiological examination. Samples were collected using both conventional and aseptic techniques at the time of enrollment until the final milking before dry off (7 to 14 days before the expected dry period), at dry period (approximately 65 days) and continued at lambing until the end of the ongoing milking period. 61.8% of bacterial isolates obtained from teat duct and milk were identified as coagulase-negative staphylococci (CNS). No significant differences were noticed between the two groups in the frequency of mammary gland infection peri-partum (p=0.466), in the risk of new mammary infections during dry period (p=0.750) and in the cure rate of any subsequent mammary infection (p=0.131). Drying-off procedure had no significant impact on somatic cell counts (p=0.760) or milk leucocyte subpopulations (p>0.05) but had a significant effect on milk production of the next lactation period (p<0.001). Ewes treated with antibiotic agent presented a significantly higher cure rate of subsequent mammary infections (p=0.036) and a significantly lower risk of new mammary infections (p=0.039) during dry period, compared to the control group. No statistically significant differences were noticed concerning the impact of treatment on cytological profiles (p>0.5), somatic cell counts (p=0.581) and milk production (p=0.705). The results strengthen the hypothesis that drying off procedure does not affect cure rate neither reduce the risk of new infections during dry period and has no effect on development of mastitis around dry period whereas the use of intramammary dry treatment provides a better bacteriological cure rate of the mammary gland and decreases the possibility of new intramammary infections during dry period.

P2802Second-generation drug-eluting stents versus coronary artery bypass surgery in patients with stable angina and an isolated lesion in the proximal left anterior descending artery

Background/Introduction

Both coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI), especially with the use of new-generation drug-eluting stents (DES), remain the most common therapeutic options of coronary artery disease, especially when the proximal segment of left anterior descending artery (pLAD) is involved. There are only a small number of studies comparing these approaches in patients with isolated lesions in LAD.

Purpose

We aim to compare the long-term outcomes of PCI with second-generation DES versus CABG surgery with left internal mammary artery, in patients with stable angina and an isolated single vessel pLAD disease.

Methods

The study population consisted of 1010 consecutive patients with stable angina and an isolated pLAD that were treated either with PCI with second generation (zotarolimus or everolimus) DES (631 patients) or with CABG surgery (379 patients). The primary endpoint was the occurrence of any major adverse cardiac event (MACE) namely cardiac death, non-fatal myocardial infarction and target lesion revascularization (using either percutaneous or surgical technique) as a composite index. Other evaluated main clinical outcomes were the components of MACE, patient-related outcome (PRO-a composite index of all-cause mortality, any myocardial infarction, any revascularization), recurrence of stable angina and arrhythmias occurrence.

Results

Lower rates of in-hospital complications (0.3% versus 12.1%, p<0.001) and shorter hospitalization [median, 1 (interquartile-range: 1–4) versus 8 (interquartile-range: 7–11), p<0.001] were recorded in the PCI group compared with the surgery arm. During the follow-up period (mean, 4.6±2.5 years), no statistical difference was observed in respect to MACE between the two study groups (10.1% versus 7.4%, p=0.14). Higher rates of repeat revascularization were detected in patients treated with PCI than those treated with CABG (5.5% versus 2.9%, p=0.05). Concerning other secondary endpoints, cardiac death (2.9% versus 3.2%, p=0.78), myocardial infarction (1.7% versus 1.3%, p=0.60), and PRO (18.9% versus 17.7%, p=0.64) did not differ in a statistically significant manner between the two techniques. Recurrence of stable angina was significantly increased in PCI (15.6% versus 8.4%, p=0.001), whereas arrhythmias occurrence was most common in the surgery group (6.3% versus 11.9%, p=0.002).

Conclusion

PCI with second-generation DES seem to have similar long-term clinical outcomes compared with CABG in patients with isolated LAD disease, highlighting the excellent long-term outcomes of both therapeutic approaches

Hemorrhagic pneumonia in neonatal minks in Greece concomitant with Leismania infantum detection

In the present study a severe outbreak of hemorrhagic pneumonia (HP) in neonatal minks concomitant with Leismania infantum (L. infantum) detection is reported. The outbreak took place on a Greek mink farm and affected 1,362 mink kits, with 524 dying. Macroscopic lesions of 14 necropsied affected kits were confined to the respiratory system with dark red, consolidated lung lobes and to the small intestine with severe, acute, hemorrhagic and necrotic enteritis. Microscopic examination of lung sections revealed severe hemorrhagic pyogranulomatous pneumonia. Bacteria were obtained in pure culture from the lungs of all necropsied animals and were confirmed as Pseudomonas aeruginosa (P. aeruginosa). Three out of 14 (21.4%) animals were positive for the presence of L. infantum DNA. The outbreak was attributed to the infection of minks with P. aeruginosa, possibly as a consequence of being immuno-suppressed by L. infantum. Further research is necessary, especially on the pathogenesis of P. aeruginosa/L. infantum co-infection and the implications of this interaction on HP disease outcome.

Breast fat volume measurement using wide-bore 3 T MRI: comparison of traditional mammographic density evaluation with MRI density measurements using automatic segmentation

AIM

To compare magnetic resonance imaging (MRI)-derived breast density measurements using automatic segmentation algorithms with radiologist estimations using the Breast Imaging Reporting and Data Systems (BI-RADS) density classification.

MATERIALS AND METHODS

Forty women undergoing mammography and dynamic breast MRI as part of their clinical management were recruited. Fat-water separated MRI images derived from a two-point Dixon technique, phase-sensitive reconstruction, and atlas-based segmentation were obtained before and after intravenous contrast medium administration. Breast density was assessed using software from Advanced MR Analytics (AMRA), Linköping, Sweden, with results compared to the widely used four-quartile quantitative BI-RADS scale.

RESULTS

The proportion of glandular tissue in the breast on MRI was derived from the AMRA sequence. The mean unenhanced breast density was 0.31±0.22 (mean±SD; left) and 0.29±0.21 (right). Mean breast density on post-contrast images was 0.32±0.19 (left) and 0.32±0.2 (right). There was "almost perfect" correlation between pre- and post-contrast breast density quantification: Spearman's correlation rho=0.98 (95% confidence intervals [CI]: 0.97-0.99; left) and rho=0.99 (95% CI: 0.98-0.99; right). The 95% limits of agreement were -0.11-0.08 (left) and -0.08-0.03 (right). Interobserver reliability for BI-RADS was "substantial": weighted Kappa k=0.8 (95% CI: 0.74-0.87). The Spearman correlation coefficient between BI-RADS and MRI breast density was rho=0.73 (95% CI: 0.60-0.82; left) and rho=0.75 (95% CI: 0.63-0.83; right) which was also "substantial".

CONCLUSION

The AMRA sequence provides a fully automated, reproducible, objective assessment of fibroglandular breast tissue proportion that correlates well with mammographic assessment of breast density with the added advantage of avoidance of ionising radiation.

Comparative study of all Salmonella enterica serovar Enteritidis strains isolated from food and food animals in Greece from 2008 to 2010 with clinical isolates

The aim of the present work was to study the epidemiology of Salmonella enterica serovar Enteritidis (S. Enteritidis) in Greece, comparing all the food and food animal isolates during a 3-year period with clinical isolates. Submission of the generated data to the PulseNet Europe database was carried out in order to study the population structure of this particular serovar and indicate possible connections with European strains. One hundred and sixty-eight (168) S. Enteritidis strains of human, animal, and food origin, isolated during the period 2008-2010 in Greece, were studied. Strains were characterized by phenotypic (antibiotic resistance) and molecular [pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST)] methods. PFGE revealed 39 XbaI, 48 BlnI, and 80 XbaI-BlnI distinct pulsotypes, suggesting several clones circulating through the food chain and multiple sources of transmission. Submission to the PulseNet Europe database indicated that PFGE profile SENTXB.0001, the most common PFGE profile in Europe, was also predominant in Greece (33.3 %). MLST showed that all the strains studied shared the same sequence type (ST11), representing the most common ST in Europe. High rates of resistance to nalidixic acid were observed among human and poultry isolates (~25 %), indicating the potential fluoroquinolone treatment failure. Our data suggest that strains originating from multiple reservoirs circulated in Greece through the food chain during the study period. Predominant profiles in Greece were common to PulseNet Europe profiles, indicating similarities between the S. Enteritidis populations in Greece and Europe.

Reproductive performance of sows was improved by administration of a sporing bacillary probiotic (Bacillus subtilis C-3102)

This field study assessed the efficacy of a probiotic based on viable spores of Bacillus subtilis C-3102 (Calsporin; Calpis Co. Ltd., Japan) on the health status and productivity of sows and their litters through 2 full, sequential reproductive cycles from service of the first cycle to weaning of the second cycle. Fifty-six sows were allocated to 2 experimental groups, an untreated control (T1) group and a probiotic-treated (T2) group that received the same basal feed as the T1 group plus the probiotic at an approximate allowance of 30 g/t of feed (3 × 10(5) cfu/g). The offspring of T1 and T2 sows were offered basal and T2 creep feed (3 × 10(5) cfu/g), respectively. Health and zootechnical parameters of sows and piglets were recorded. Feeding the probiotic to sows and piglets resulted in significant benefits, observed in both cycles: 1) improved sow body condition during pregnancy (P < 0.05), 2) increased sow feed consumption, 3) reduced sow weight loss during lactation (P < 0.05), 4) reduced sow weaning-estrus interval (P < 0.05), and 5) higher BW of piglets at weaning (P < 0.05). Additionally, a significant (P < 0.05) improvement in piglet birth weight and in the number of piglets weaned was observed in the second cycle of T2 sows, while a significant improvement of mean daily gain of piglets from birth to weaning was observed in the first cycle of T2 sows. Microbiological examination of fecal samples showed that probiotic treatment significantly reduced both Escherichia coli and Clostridium spp. in piglet feces, particularly during the second cycle. The data suggested that continuous feed supplementation with the probiotic is beneficial for both sows and piglets, since zootechnical benefits were observed in both cycles.

Phenotypic and molecular characterization of multidrug-resistant Salmonella enterica serovar Hadar in Greece, from 2007 to 2010

All 120 strains of Salmonella enterica serovar Hadar isolated during 2007-2010 in Greece were characterized by phenotypic and molecular methods. High rates of resistance to nalidixic acid (92%) and low levels of ciprofloxacin resistance (88%) were observed. Pulsenet-pulsed field gel electrophoresis profile SHADXB.0001 was predominant in Greece (58%) as in Europe but PT1, a rare phage type in Europe, was frequent in Greece (56%). The SHADXB.0001 and PT1 clone (38%) were found in humans, animals and food of animal origin with R-type ApSpTNxpCp being predominant (25%). The data indicate that this clone (possibly endemic) was circulating through the food chain in Greece during the study period.

The role of an attenuated anticoccidial vaccine on the intestinal ecosystem and on the pathogenesis of experimental necrotic enteritis in broiler chickens

The objective of the present study was to investigate the effect of an attenuated anticoccidial vaccination on the intestinal ecosystem and on the pathogenesis of experimental necrotic enteritis (NE) in broiler chickens. Two hundred and forty 1-day-old Cobb 500 broiler chickens were randomly allocated to four treatment groups according to the following experimental design: control Group N; Group PN, where birds were vaccinated with anticoccidial vaccine; Group M, where birds were challenged with Clostridium perfringens and with Eimeria maxima; and Group PM, where birds were both vaccinated and challenged. From each bird, the intestine, gizzard and liver were scored for gross NE lesions. Intestinal digesta were collected for pH and viscosity determination. Samples from the gastrointestinal tract and liver were taken for microbiological analysis. Evaluation of the experimental data revealed that Group M had significantly higher overall mean NE intestinal lesions compared with Group PM. Viscosity values of jejunum digesta as well as pH values of the duodenum, jejunum and ileum digesta in Group M were significantly lower compared with Group PM. C. perfringens counts in the caeca of Group PM were significantly lower compared with Group M. The milder decrease of pH and viscosity values of intestinal content and the reduction of C. perfringens counts in the caeca in challenged and vaccinated birds may explain the lower score of NE gross intestinal lesions and may suggest a positive effect on intestinal ecosystem and a significant protective effect of attenuated anticoccidial vaccination against NE in a subclinical experimental model.

Culture phenotypes and molecular characterization of Mycobacterium avium subsp. paratuberculosis isolates from small ruminants

In this study the suitability of different solid media was investigated for the isolation of Mycobacterium avium subsp. paratuberculosis (Map) in order to identify the optimum single or combination of media to permit the isolation of all strain types from small ruminants. A subset of these Map strains was then further characterized by molecular typing methods to assess the genetic diversity of Map strains in the study area (Northern Greece). Map strains were isolated from tissues and faeces of infected goats (n=52) and sheep (n=8) and were analysed for polymorphisms in IS1311 to classify the strain type as Type C or S. The study found that M7H11 supplemented with mycobactin j, OADC and new born calf serum (M7H11+Mj) is the best single choice of medium for the primary isolation of Map of both Type C and S from small ruminants. The combination of M7H11+Mj and Herrolds egg yolk medium supplemented with mycobactin j and sodium pyruvate allowed the detection of all Map isolates in this study. Nineteen Map isolates were characterised by pulsed-field gel electrophoresis and the isolates demonstrated significant genetic diversity. Twelve different SnaBI and 16 distinct SpeI profiles were detected of which 25 have not been described previously and are new profiles. The combination of both enzyme profiles gave 13 different multiplex profiles. Ten different multiplex profiles were detected in goats and three in sheep. One ovine isolate gave the same multiplex profile as a caprine isolate and two different profiles were found within a single goat herd.

Sequence diversity of the leukotoxin (lktA) gene in caprine and ovine strains of Mannheimia haemolytica

Mannheimia haemolytica is the aetiological agent of pneumonic pasteurellosis in small ruminants. The primary virulence factor of the bacterium is a leukotoxin (LktA), which induces apoptosis in susceptible cells via mitochondrial targeting. It has been previously shown that certain lktA alleles are associated either with cattle or sheep. The objective of the present study was to investigate lktA sequence variation among ovine and caprine M haemolytica strains isolated from pneumonic lungs, revealing any potential adaptation for the caprine host, for which there is no available data. Furthermore, we investigated amino acid variation in the N-terminal part of the sequences and its effect on targeting mitochondria. Data analysis showed that the prevalent caprine genotype differed at a single non-synonymous site from a previously described uncommon bovine allele, whereas the ovine sequences represented new, distinct alleles. N-terminal sequence differences did not affect the mitochondrial targeting ability of the isolates; interestingly enough in one case, mitochondrial matrix targeting was indicated rather than membrane association, suggesting an alternative LktA trafficking pattern.

Epidemic waves during Justinian's plague in the Byzantine Empire (6th-8th c. AD)

The aim of the present study is to collect the epidemic outbreaks and the epidemic waves of the bubonic plague of the Byzantine Empire during the first pandemic (541-751 AD). Human activities, such as trade and military movements have been speculated as underlying factors for the causation of the pandemic. Historical data combined with geographical spreading of the plague, allows an alternative speculation of suspicious enzootic areas in the Middle East. We conclude that the possible existence of enzootic areas in that region might have been responsible for the causation of the numerous outbreaks of the bubonic plague in the Eastern provinces of the Byzantine Empire during the 6th-8th century period.

A pathogenic myxoma virus in vaccinated and non-vaccinated commercial rabbits

A case of a myxoma virus strain in vaccinated and non-vaccinated rabbits is described, and genetic identification of that strain was performed in this study. In two commercial farms being 150km apart, myxomatosis has been occurred after the import of animals from a common supplier. The disease was manifested firstly in the existing non-immune population of does and fatteners, and later in all vaccinated animals, being 2-3 months immune at the time of first symptoms. Morbidity was almost 100% with nasal discharge, listlessness, fever, eyelid swelling, eye and nasal purulent discharge, papules in the ears, facial oedema, and swelling of the anagenital region, with result always the death of the animals. Examination by PCR had shown the presence of a 492-bp specific product in all the symptomatic animals tested from both farms, having 100% nucleotide sequence identity with the homologous region of the myxoma virus Lausanne strain. The simultaneous occurrence of myxomatosis in the vaccinated and non-vaccinated rabbits of both farms, suggests that the supplier was possibly the source of a viral isolate with increased virulence.

Validation of a fluorescence polarization assay (FPA) performed in microplates and comparison with other tests used for diagnosing B. melitensis infection in sheep and goats

Fluorescence polarization assay (FPA) is a relatively new test for the serological diagnosis of Brucella spp. infection in animals. FPA, carried out in 96-well microplate format, was validated here for diagnosing B. melitensis infection in sheep and goats. This study included sera from 1933 sheep and goats, from animals reared in naturally infected flocks (verified by culture) and showing a positive reaction to two different tests conducted in parallel. In addition, 2154 sera originating from healthy sheep and goats, reared in areas where B. melitensis had never been isolated, were assayed. The optimum cut-off value offering the highest diagnostic sensitivity (DSn) and diagnostic specificity (DSp) was determined at 15 mP over the mean value of the buffer control used in each microplate as determined by receiver operating characteristic analysis. The DSn and DSp of the FPA for small ruminants carried out in microplates at this cut-off value were calculated to be 95.9% and 97.9% with 95% confidence intervals (95% CI) of 94.9-97.7% and 97.2-98.4%, respectively. The accuracy of the FPA, as expressed by determination of the area under the curve, was 0.991. Indirect ELISA and FPA tests offered the highest DSn when compared with the Rose Bengal test, the complement fixation test, the modified Rose Bengal test and competitive ELISA. The parallel or serial combination of FPA with indirect ELISA offers the highest DSn and DSp. As temperature can affect the results of the FPA, all reagents must be at the same temperature and the standard for comparison must always be read under the same conditions as the sera under test. FPA performed in microplates is a promising assay; the DSn and accuracy are better than those of the tests currently approved for diagnosing B. melitensis in small ruminants. Because of its simplicity, speed, and accuracy, this test can improve capacity for laboratory testing and the efficacy of an eradication program based on a test-and-slaughter policy.

Assessment of serological response of young and adult sheep to conjunctival vaccination with Rev-1 vaccine by fluorescence polarization assay (FPA) and other serological tests for B. melitensis

The serological response of young and adult sheep vaccinated conjunctivally with Rev-1 vaccine was assessed by fluorescence polarization assay (FPA), Rose Bengal test (RBT), complement fixation test (CFT), modified Rose Bengal test (m-RBT), indirect ELISA (i-ELISA) and competitive ELISA (c-ELISA), at different post vaccination intervals. One hundred and thirty six adult sheep and 64 lambs were used in the study. The vaccinated animals were bled prior to vaccination (0 day) and thereafter at 21st, 42nd, 35th, 63rd, 91st, 125th, 159th, and 223rd and 330th day post vaccination. The majority of animals (young and adult) showed positive reaction by FPA, RBT, CFT, m-RBT and c-ELISA 21 days post vaccination, whereas by i-ELISA at 42 days. All tests perform equal when animals vaccinated as young are tested 125 days (4 months) post vaccination. In case of animals vaccinated at adulthood, FPA, RBT, CFT and c-ELISA perform equal if the animals are tested 223 days (approximately 8 months) post vaccination. I-ELISA and m-RBT show low specificity if ewes vaccinated at adulthood are tested 330 days (11 months) post vaccination. If control of brucellosis in sheep is based on conjunctivally vaccination of lambs with Rev-1, the vaccinated animals can be tested by any test used for diagnosis of B.melitensis infection accurately at least 4 months post vaccination. If brucellosis control is based on mass vaccination the use of m-RBT and i-ELISA is not recommended for testing adult animals at least for 330 days (11 months) post vaccination due to tests low specificity. Further research is needed so the appropriate cut-offs to be established for FPA, c-ELISA or i-ELISA to become valuable tools for the eradication of Brucella spp. infection in small ruminants in areas where vaccination is practiced.

Flavonoid classes and risk of peripheral arterial occlusive disease: a case-control study in Greece

OBJECTIVE

To assess the relation between specific flavonoid classes and peripheral arterial occlusive disease (PAOD), an important manifestation of atherosclerosis.

DESIGN

Using data from a case-control study conducted in Greece in 1980 on the nutritional epidemiology of PAOD, we have exploited recently published databases on the content of foods in specific flavonoid classes to assess the relation between intake of these compounds and PAOD.

SETTING

A major teaching hospital in Athens, Greece.

SUBJECTS

Cases were 100 patients with PAOD and controls 100 patients with minor surgical conditions admitted to the same hospital.

INTERVENTIONS

No interventions. All cases and controls were interviewed in the hospital wards, and a 110-food item semiquantitative food frequency questionnaire was administered by the same interviewer.

RESULTS

Flavonols, flavones and perhaps flavan-3-ols were inversely associated with PAOD risk, the odds ratios (and 95% confidence intervals) for increments equal to the corresponding standard deviations being 0.41 (0.20-0.86), 0.56 (0.32-0.96) and 0.53 (0.26-1.05), respectively. Total flavonoids were also significantly inversely associated with PAOD.

CONCLUSIONS

On the basis of these results, the biological properties of flavonoids and evidence concerning their relation to other manifestations of atherosclerosis, we conclude that dietary intake of specific classes of flavonoids, as well as total flavonoids, may have a protective effect against PAOD.

SPONSORSHIP

This study was partially supported by a grant to Harvard University by the Samourkas Foundation.

Incidence and Characteristics of Childhood Hodgkin’s Lymphoma in Greece: A Nationwide Study (Greece)

OBJECTIVES

To estimate the incidence and epidemiological profile of childhood (0-14 years) Hodgkin's lymphoma in Greece derived by the network of childhood Hematology-Oncology departments on the basis of all 95 newly diagnosed cases during a seven-year period.

METHODS

Seventy-one of these cases were individually age and gender matched to an equal number of controls.

RESULTS

The incidence of childhood Hodgkin Lymphoma reached a relatively high figure of 7.8 per million children-years, with an age distribution (2.2 for children 0-4; 6.3 for those 5-9 and 13.9 for those 10-14-years-old) and male to female ratio (1.7:1) similar to that reported from other cancer registries. Childhood Hodgkin's lymphoma was more common among children living in less crowded quarters (odds ratio (OR): 6.5 and 95% confidence intervals (95% CI): 1.4-30.7), among those who have changed residence 60 to 18 months before the onset of the index disease (OR: 4.4, and 95% CI = 1.4-14.0), among those whose families owned a cat (OR: 5.5, 95% CI = 1.2-25.6) but not among those whose families owned a dog and marginally more common, among those with a history of infectious mononucleosis (OR: 5.0, 95% CI = 0.6-42.8).

CONCLUSIONS

Our results point to infectious agent(s) as playing an etiological role but do not allow discrimination among the delayed establishment of the herd immunity hypothesis, the population mixing hypothesis or that invoking transmission of the agent(s) from the non-human reservoir.

Adiponectin in relation to childhood myeloblastic leukaemia

Adiponectin, an adipocyte-specific secretory protein known to induce apoptosis, has been reported to be inversely related to breast and endometrial cancers and recently found to inhibit proliferation of myeloid but not lymphoid cell lines. We hypothesised that adiponectin may be inversely associated with acute myeloblastic leukaemia (AML), but not with acute lymphoblastic leukaemia of B (ALL-B) or T (ALL-T) cell origin in children. Blood samples and clinical information were collected over the period 1996–2000 from 201 children (0–14 years old) with leukaemia (22 AML, 161 ALL-B and 18 ALL-T cases) through a national network of childhood Hematology-Oncology units in Greece and from 201 controls hospitalised for minor pediatric ailments. Serum adiponectin levels were measured under code, at the Beth Israel Deaconess Medical Center, Boston, MA, USA using a radioimmunoassay procedure. Each of the three leukaemia groups was compared with the control group through multiple logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) for an increase of adiponectin equal to 1 s.d. among controls were estimated controlling for gender, age, as well as for height and weight, expressed in age–gender-specific centiles of Greek growth curves. Adiponectin was inversely associated with AML (OR=0.56; 95% CI, 0.34–0.94), whereas it was not significantly associated with either ALL-B (OR=0.88; 95% CI, 0.71–1.10) or ALL-T (OR=1.08; 95% CI, 0.67–1.72). Biological plausibility and empirical evidence point to the importance of this hormone in the pathogenesis of childhood AML.

Home and leisure activities and childhood knee injuries

AIM

To assess the relative occurrence of non motor-vehicle knee injuries and identify important clusters that can be targeted for preventive interventions.

METHODS

The study subjects covered 2167 children (0-14 years) who suffered non motor-vehicle knee injuries out of 66870 registered during a three-year period in an established Emergency Department Injury Surveillance System (EDISS). A more serious joint injury was identified in 263 (12%) children, whereas the remaining 1904 children had only soft tissue knee injuries.

RESULTS

The incidence of non motor-vehicle knee injuries was estimated at 6.5 per 1000 children-years. Both the incidence of knee injuries and the male-to-female ratio increase with increasing age, reflecting the gender and age pattern of physical activity. Three clusters were identified: The first consisted of more serious knee injuries among older children, frequently resulting after a fall from stairs or a collision in school during winter months; the second cluster consisted of rather minor knee injuries occurring mostly among younger girls at home or in playgrounds, following a fall after stumbling or hit by an object while playing, especially during the summer; the third cluster comprised injuries among older boys, sustained mainly subsequent to overexertion in a sports area.

CONCLUSION

Knee injuries tend to be more common among boys but more serious among girls. More and less serious knee injuries tend to fall into distinct clusters that could facilitate prioritization of preventive measures.

Prevalence and correlates of depression in late life: a population based study from a rural Greek town

BACKGROUND

Depression in late life is common and has serious consequences on function, medical co-morbidity, quality of life, and use of medical services.

OBJECTIVE

To estimate the age- and gender-specific prevalence of depression among people over 60 years of age, and to examine correlates of depression, in particular the relationship between depression and cognitive impairment.

METHOD

From a total of 965 inhabitants, aged over 60 years, in Velestino, a rural town in central Greece, 608 were accessible and constituted the target population. During a five-month period in 2000, a trained health visitor interviewed all study participants. The interview covered socio-demographic characteristics, medical history, and administration of the 15-question Geriatric Depression Scale (GDS-15) and the Mini Mental Scale Examination instrument (MMSE).

RESULTS

The prevalence of mild or more severe depression (GDS> or =7) was 27%, while the prevalence of moderate to severe depression (GDS> or =11) was 12%. Increasing age, female gender, lower education, and being currently unmarried were associated with higher risk of depression in univariate regression models, but these associations disappeared after controlling for cognitive function, except for the association with marital status. Cognitive impairment was strongly associated with increased risk for depression. The co-morbid presence of digestive, neurological and heart conditions was also associated with increased risk for depression, while cancer was not.

CONCLUSION

In a rural Greek area, the prevalence of depression in late life is high. Depression was more common among unmarried individuals, those with significant cognitive impairment, and in association with specific medical conditions.

Lipid peroxides in type 2 diabetic patients with neuropathy

Diabetes and its metabolic changes in peripheral nerves contribute to cause a decrease of nitric oxide production and diminished nerve blood flow. Since lipid peroxides are thought to be formed by free radicals and may play an important role in the development of vascular disease, we have investigated the possible relationship between lipid peroxides (measured as thiobarbitouric acid reacting substances (TBARS) in diabetic patients with peripheral neuropathy. Seventy-seven patients with Type 2 diabetes (39 neuropathic and 38 non-neuropathic) and 38 control subjects were studied. The neuropathy study group had significantly lower levels of TBARS, 3.5micromol/l (2.2-5.6, 95% confidence limits) compared to controls 4.5microm/l (3.08-6.8), p < 0.001 and to diabetics without neuropathy 4.9micromol/l (3.09-8.05), p < 0.001. No differences were found in metabolic control between the two diabetic groups. In the neuropathy group there was a negative correlation between the score for nerve dysfunction with the TBARS levels (r = - 0.42, p < 0.01). In conclusion, in diabetic patients with neuropathy there are abnormalities of TBARS levels.

An integrated evaluation of socioeconomic and clinical factors in the survival from childhood acute lymphoblastic leukaemia: a study in Greece

An evaluation of the role of socioeconomic factors in the survival of children with leukaemia, controlling for major clinical prognostic indicators, has been attempted in very few studies and the role of these factors may be different in various cultural settings. Our investigation aims to study the independent role of socioeconomic factors on the prognosis of childhood acute lymphoblastic leukaemia (ALL) in Greece. During a 7-year period (1996-2002) 293 cases of incident ALL were diagnosed and followed up in four Childhood Haematology-Oncology Units, which covered over half of all childhood ALL cases nationwide. At the time of diagnosis, information concerning age, gender, maternal schooling, maternal marital status, sibship size, distance of residence from the treating centre, attendance of day care centre and clinical information was recorded. The influence of these factors on survival was studied by modelling the data through Cox's proportional-hazards regression. After adjustment for clinical prognostic factors, children of mothers who were not currently married, were of low educational level or were living far from the treating centre tended to have lower survival (P-values 0.02, 0.14 and 0.08, respectively). There was also evidence that two factors that are predictive of disease occurrence, that is sibship size and attendance of day care centre, may also predict survival (P-values 0.04 and 0.26, respectively). In conclusion, socioeconomic factors are likely to influence survival from ALL at least in some sociocultural contexts. Moreover, there is evidence that factors that could affect incidence of ALL through modulation of herd immunity may also have prognostic implications for this disease.

Frequency and nature of recorded childhood immunization-related errors in Greece

BACKGROUND

While routine immunizations are very safe, their administration to healthy children requires minimization of immunization programmatic errors. In order to estimate the incidence and ascertain the nature of reported immunization errors in the Greek childhood population, we have undertaken a study using data from the National Poison Information Center in Greece, which also has the responsibility to address medication-induced errors.

METHODS

All immunization errors concerning children and reported to the National Poison Information Center during the 2-yr period 1999-2000 were retrieved and the conditions of their occurrence were examined. The incidence of reported errors was calculated under the assumption that during each year 100,000 children are born in Greece, and during their childhood they receive a total of about 20 immunization doses of all childhood immunizations.

RESULTS

There were 40 immunization errors reported, corresponding to a reported incidence of about 11 per million immunization doses. Of these errors, 20 concerned OPV, 13 DTP, 5 MMR, 1 Haemophilus influenza and 1 Hepatitis B immunizations. In 12 instances an erroneous route was used (out of which 11 concerned OPV), whereas overdose was documented in 13 instances (out of which 8 concerned OPV). The third most common error was administration of DTP instead of the recommended Td vaccine. No adverse patient outcomes were reported.

CONCLUSIONS

In Greece, reported errors in immunization practice are relatively rare. Packaging modifications (about one in three errors in this study) of the OPV and DTP could further reduce their incidence.

A quantification of preventable unintentional childhood injury mortality in the United States

OBJECTIVE

To calculate the preventable fraction of unintentional childhood injury deaths in the United States.

DESIGN

Ecological study of cause specific unintentional childhood injury mortality rates across the 50 states (and the District of Columbia) of the United States (US) over the 10 year period 1989-98.

METHODS

The internet accessible database from the National Center for Injury Prevention and Control was used in order to estimate unintentional childhood (0-14 years) injury mortality rates by external cause and time trends over the study period for each of the US states and for the four major geographical regions of the country. In the principal analysis, a calculation was made of the fraction and absolute number of unintentional childhood injury deaths that could have been prevented annually if the mortality rate in the region with the lowest rate also existed in the remaining three. In another scenario, the lowest external cause specific unintentional childhood injury mortality rates from the 50 US states and the District of Columbia were summed to provide the "ideal" lowest conceivable unintentional childhood injury mortality rate from all causes. Ecological correlations between unintentional childhood injury mortality rates from specified external causes, median income, and percent of the population with a college degree were made.

MAIN OUTCOME MEASURES

Unintentional childhood injury mortality rates by cause.

RESULTS

Unintentional childhood injury mortality rate declined by 3.5% per year in the country as a whole. If every region of the US had experienced the same injury rate as the Northeast, then one third of all unintentional childhood injuries would not have occurred. More optimistic scenarios indicate that up to two thirds of all unintentional childhood injury deaths could be prevented. Across states, unintentional childhood injury mortality is strongly inversely related to median income.

CONCLUSIONS

About one third of all unintentional childhood injury deaths in the US are preventable with the means and resources available in the Northeastern states. Among the relevant characteristics in the Northeast region, in comparison with other US regions, are the higher education level of parents, the lower gun ownership, the higher population density that implies shorter distances traveled by cars, a better developed emergency medical system, and the existence of several injury prevention programs.

Carriage of Neisseria meningitidis by Greek children: risk factors and strain characteristics

Oropharyngeal swabs were cultured from 554 children aged 2-19 years attending nurseries, primary schools and secondary schools in the central Athens area. A questionnaire was completed to identify risk factors for carriage. Susceptibility to antimicrobial agents was determined by Etest. The genetic relatedness of the strains was examined by pulsed-field gel electrophoresis (PFGE), and isolate serogrouping was performed by slide agglutination. Twenty-two (4%) children were carriers of Neisseria meningitidis; seven isolates belonged to serogroup C, and five to serogroup B. One isolate was resistant to co-trimoxazole, and five showed intermediate resistance to penicillin. DNA analysis of 16 isolates revealed six distinct PFGE patterns. Clusters with indistinguishable PFGE patterns were noted in the same school. More than one serogroup was included in the same clonal group. On multivariate logistic regression analysis, only age > 12 years remained independently associated with the carrier state (odds ratio, 7.96; 95% CI, 2.24-28.33; p < 0.001). Overall, the N. meningitidis carriage rate among Greek schoolchildren increased with age, and the predominant serogroups in the Athens region were groups C and B. These findings may have important implications for future immunisation strategies with conjugate vaccines.

Injuries among disabled children: a study from Greece

OBJECTIVE

To compare the differential implications of sociodemographic and situational factors on the risk of injury among disabled and non-disabled children.

DESIGN

Data from the Emergency Department Injury Surveillance System (EDISS) were used to compare, in a quasi case-control approach, injured children with or without disability with respect to sociodemographic, event and injury variables, and to estimate adjusted odds ratios for the injury in a disabled rather than a non-disabled child.

SETTING

Two teaching hospitals in Athens and two district hospitals in the countryside that participate in the EDISS.

PATIENTS

In the five year period 1996-2000, 110 066 children were recorded with injuries; 251 among them were identified as having a motor/psychomotor or sensory disability before the injury event.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Mechanism of injury, type of injury, risk-predisposing socioeconomic and environmental variables, odds ratio for injury occurrence.

RESULTS

Falls and brain concussion are proportionally more common among disabled children, whereas upper limb and overexertion injuries are less common among them. Urban environment, migrant status, and cold months are also associated with increased odds for injuries to occur among disabled rather than non-disabled children. The odds ratio for the occurrence of an injury among disabled children increases with increasing age.

CONCLUSIONS

The results of the study provide the information for the targeting of trials of preventive measure in disabled children at increased risk of severe injuries.

Characteristics of farm injuries in Greece

OBJECTIVES

To assess the characteristics of occupational and leisure farm injuries in Greece.

METHODOLOGY

During a five-year period (1996-2000), 4,326 unintentional farm injuries have been recorded by the Emergency Department Injury Surveillance System in Greece. Data concerning demographic variables, accident conditions, and injury characteristics were collected by in person interviews. The data were analyzed by simple cross-tabulation and hierarchical cluster analysis.

RESULTS

Injuries from falls on the same level are mainly lower-limb fractures and occur during the winter among older women. Falls from higher level concern migrant workers, who also tend to suffer severe multiple injuries, including concussions, particularly during autumn. Injuries resulting from cutting and piercing instruments, as well as from machinery, are generally open wounds in the upper-limbs, suffered by young migrant workers. Head injuries resulting from striking against an object are more generally spread across socio-demographic variables. Overexertion is the dominant mechanism for dislocations and sprains in the lower limbs. Snake and insect bites are common among younger migrant workers during summer, and they affect the upper limbs during manual work close to the ground. Non-traffic injuries from vehicles are frequently severe, involving head concussion of generally young individuals.

CONCLUSIONS

In Greece, farm injuries are frequently serious and require hospitalization. These injuries show distinct patterns among older women (lower-limb fractures), young individuals (non-traffic vehicle-related injuries) and migrant workers (injuries from cutting and piercing instruments, falls from high level, and bites). Prevention strategies should give priority to these population groups. These prevention strategies should include guidance for poorly educated workers, including migrants, enforcement of safety regulations concerning farming machinery, and discouragement of risky farming activities among elderly individuals, particularly women.

A cluster analysis of road traffic-related childhood knee injuries

BACKGROUND

Knee injuries represent an important category of road traffic injuries among children, and they are heterogeneous in their aetiology. The aims of this study were to estimate the incidence of road traffic childhood knee injuries in Greece by age and gender, point out their time, place and person co-ordinates and identify clusters with distinct characteristics with a view to potential preventive interventions.

METHODS

During a 3-year period, 305 children with knee injuries resulting from a road traffic accident were identified among the 66,870 children with injuries recorded in the Emergency Department Injury Surveillance System (EDISS) of Greece. Using previously derived sampling ratios and national data on childhood population, incidence data by age and gender were estimated. Hierarchical analysis was undertaken for cluster identification.

RESULTS

The incidence of road traffic knee injuries was 97.5 per 100,000 children-years. The incidence increased with age and was higher among boys than among girls. Most childhood knee injuries (50.2%) occur among pedestrians, and the majority (90.9%) of the children or their guardians admitted responsibility in crossing the road. Of the 31 children injured as car passengers, the vast majority (87.1%) were unrestrained, and a large fraction (38.7%) were front seat passengers. Two clusters were identified: the first consisted of younger children who resided mostly in the Athens area and suffered less serious knee injuries as pedestrians or car passengers during the colder months; the second consisted of older children, frequently tourists, who suffered more serious injuries as cyclists while vacationing.

CONCLUSIONS

Many of the children who suffered road traffic knee injuries as pedestrians admitted responsibility in road crossing, whereas a large proportion of children who were injured as car passengers were injured while improperly seated in the front and without seatbelt protection. Older children, frequently tourists, were at high risk of knee injuries while using motorcycles and bicycles.

Growth velocity during the first postnatal week of life is linked to a spurt of IGF-I effect

There is adequate evidence that growth during the perinatal period is linked to the risk of several adult onset diseases, and recent findings indicate that the insulin-like growth factor (IGF) system is involved in prenatal growth, as reflected in birthweight. However, whether major components of the IGF system are involved in the immediate post-natal growth has not been studied. Maternal questionnaires were completed, and laboratory measurements of several variables, including IGF-I, IGF-II and IGF-binding protein-3 (IGFBP-3), were made for a total of 331 apparently healthy full-term newborns, from whom routine blood samples were taken during the first 5 days of their life. Birthweight and weight at the time of bleeding were among the recorded variables, and the difference divided by the age in days of the newborn was considered as reflecting immediate postnatal growth velocity. Immediate postnatal growth velocity was strongly positively associated with IGF-I. The squared adjusted correlation coefficient was 0.29 when IGF-I was incorporated in the model predicting postnatal growth velocity but was only 0.08 when IGF-I was excluded. In contrast, IGF-II and IGFBP-3 had no effect on postnatal growth velocity. It thus appears that IGF-I underlies growth during the immediate postnatal period. To the extent that perinatal growth may affect adult onset diseases, the findings of this study suggest that the action of IGF-I during the immediate postnatal period may represent a process of major importance.

Countrywide estimation of the burden of injuries in Greece: a limited resources approach

BACKGROUND

We have assessed the ability of the Emergency Department Injury Surveillance System (EDISS), a registration network operating with limited resources, to predict the burden and pattern of injuries in the whole Greece.

METHODS

We have compared hospitalizations calculated on the basis of EDISS with those routinely recorded by the National Statistical Service countrywide. EDISS relies on data collected in the Emergency Departments of four hospitals, two located in the Greater Athens area, and two district hospitals in the remaining Greece. EDISS data concern hospitalized and non-hospitalized patients of all ages, with all types of injuries irrespectively of their etiology or intent.

RESULTS

Over a three-year period 148 835 subjects with injuries were interviewed. Using sampling ratios of 2.2% for all injuries outside Greater Athens and for adults in Greater Athens but 28.9% for childhood injuries, the total annual number of injuries in Greece was estimated at 1.53 million (95% confidence interval: 1.48-1.57 million). Of those, about 18% concern children less than 15 years old. The difference between the EDISS estimated and the actually recorded hospitalized injuries was, in preliminary terms, acceptable.

DISCUSSION

Of the ten major categories of injuries, seven among children and five among adults have shown deviations of less than 20%. For the remaining categories deviations were larger but in only one instance did the difference exceed 50%. It is concluded, that for a small and relatively homogeneous country, like Greece, injury data provided by four large hospitals can generate reasonably reliable estimates for large categories of injuries.

Sports injuries among children in six European union countries

Since sports participation entails the risk of injuries that account for substantial morbidity and disability, the existence of adequate epidemiological information is essential for the development of sound preventive strategies. In this study, we present data on the occurrence of sports injuries among children in six European countries, namely Austria, Denmark, France, Greece, The Netherlands, and the United Kingdom. An operational definition for sports injuries was developed, and comparable data from the European Home and Leisure Accident Surveillance System, an established injury surveillance system operating in 12 European union countries, were collected from the participating member states, during a 1-year period (1998). Sports injuries were examined in schools, in organised and unorganised settings, and in specific types of sports by demographics and injury descriptive variables. Sports injuries represent a quantitatively important and sufficiently serious problem in European union countries, accounting for an estimated annual number of about a quarter of a million outpatient visits in two of the participating countries, which provide national estimates. It is evident, that sport injuries are not only common but also injuries of considerable severity, since a large fraction represents fractures, while approximately 4% of the total require hospitalisation. Football and basketball among male children are, in declining order, the two sports responsible for the most frequent injuries in the European union countries, whereas gymnastics and volleyball prevail among females. The study indicates the importance of injury surveillance in describing the epidemiology of sports injuries and provides an estimate of the magnitude and the profile of sport injuries that take place annually in European union countries.

Injuries in public and private playgrounds: the relative contribution of structural, equipment and human factors

The aim of this case-control study was to identify and quantify risk factors of injuries in playgrounds, where children spend an increasing amount of time in developed countries. The study took place in Greater Athens during 1999. A continuous Emergency Departments Injury Surveillance System (EDISS) of hospitals that cover about 30% of the children's time at risk in Greater Athens identified 777 injuries in public and private playgrounds out of a total of 17 497 injuries. Public playgrounds differ from private ones, because the former generally have more equipment, usually of greater height, with less resilient surfaces, and supervision relies mainly on parents or guardians. Patterns of type of playground use were assessed in a sample of 294 children from the same study base who served as a control group in a hierarchical case-control design. The annual incidence of playground injuries in Greater Athens was about 7 in 1000 among boys and 4 in 1000 among girls, with a 2.2 times higher risk for an injury in public than in private playgrounds (95% confidence interval 1.61-3.07). Children in public vs private playgrounds had a statistically significant eight times higher odds for concussion and six times higher for open wounds, whereas the odds for long bone fractures were four and for other fractures two; swings, slides and seesaws were the types of equipment most frequently associated with injuries. It was further shown that supervision of children was suboptimal (< 60%) in both public and private playgrounds, and children in private playgrounds sustained an unduly high frequency of sprain/ dislocation injuries (odds ratio 1.75) because they were encouraged to play bare-footed.

CONCLUSION

Close to 50% of playground injuries could be prevented by structural and equipment changes, while further reduction could be accomplished through simple measures including closer supervision and encouraging children to wear proper shoes and use protective equipment whenever necessary.