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Papassotiriou I, Riza E, Benetou V, Orfanos P. Mediterranean diet and a health behavior index in relation to cardiovascular biomarkers: Data from the Health and Retirement Study. Nutr Metab Cardiovasc Dis 2024; 34:925-934. [PMID: 38355386 DOI: 10.1016/j.numecd.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/27/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIM Although lifestyle factors have been repeatedly examined for their role on cardiovascular diseases, their composite effect has not been frequently explored. We aimed to investigate the relation of dietary patterns (DPs) and a health behavior index (HBI) with cardiovascular biomarkers. METHODS AND RESULTS A cross-sectional analysis with data from 3461 US residents, participants in the Health and Retirement Study (HRS), was performed. Nutritional data were obtained with a food frequency questionnaire, while adherence to Mediterranean Diet (MD) was determined by the Mediterranean Diet Score. A posteriori DPs were estimated using principal component analysis and the HBI was constructed combining adherence to MD, smoking status, physical activity levels, alcohol consumption and body mass index. Multiple linear regression models were performed to examine the relation between DPs or HBI and levels of C-reactive protein (CRP), glycosylated hemoglobin (HbA1C), cystatin C (Cys C), total cholesterol (TC), high density lipoprotein (HDL) and TC:HDL in blood. Multiple linear regression showed that the "healthy" DP and the MD had a significant negative association with CRP and Cys C (p < 0.05), while the "Western-type" DP had a significant positive association with TC:HDL ratio, CRP and Cys C. Moreover, the HBI was positively associated with HDL (p < 0.05) and negatively associated with TC:HDL ratio, CRP and Cys C (p < 0.05). CONCLUSIONS Adherence to MD and to a healthy dietary pattern was negatively associated with biomarkers of inflammation, while the HBI was associated with a better cardiometabolic profile, assessed with blood biomarkers.
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Affiliation(s)
- Ionas Papassotiriou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Zoumpoulis G, Deligiorgi P, Lamprinos D, Georgakopoulos P, Oikonomou E, Siasos G, Rachiotis G, Damaskos C, Papagiannis D, Papavassiliou KA, Patoulis G, Patsourakos F, Benetou V, Riza E, Orfanos P, Lagiou P, Marinos G. Attitudes and Practices Related to COVID-19 Vaccination with the Second Booster Dose among Members of Athens Medical Association: Results from a Cross-Sectional Study. Vaccines (Basel) 2023; 11:1480. [PMID: 37766156 PMCID: PMC10534426 DOI: 10.3390/vaccines11091480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND There are limited data on the attitudes and acceptance of the second booster (fourth dose) of the COVID-19 vaccination among physicians. METHODS A cross-sectional, questionnaire-based, online study was conducted among members of the Athens Medical Association (A.M.A.) who were invited to participate anonymously over the period from January to March 2023. RESULTS From the 1224 members who participated in the survey, 53.9% did not receive the fourth dose of the COVID-19 vaccine. The main reasons for no vaccination were the lack of obligation to receive the fourth dose, the history of three doses of the COVID-19 vaccine and the lack of sufficient information about the effectiveness of the fourth dose. Over half of the three-dose-vaccinated participants were willing to receive the fourth dose in the near future. Interestingly, the vaccination coverage among participants who had been informed about the fourth dose through scientific sources was low. CONCLUSIONS The low vaccination coverage with the fourth dose reported in this study can lead to broad and serious consequences, such as increase in COVID-19 infections, reduction of available healthcare staff and increased caseloads of COVID-19 in hospitals. Furthermore, hesitant physicians will adversely influence the vaccination uptake among the general population due to their key role in informing and recommending the vaccine. The healthcare system administration should acknowledge and address physician's concerns through effective communication and better support.
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Affiliation(s)
| | | | | | | | - Evangelos Oikonomou
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Third Department of Cardiology, Thoracic Diseases General Hospital Sotiria, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Third Department of Cardiology, Thoracic Diseases General Hospital Sotiria, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Rachiotis
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Papagiannis
- Public Health & Vaccines Laboratory, Department of Nursing, School of Health Science, University of Thessaly, 38221 Volos, Greece
| | - Kostas A Papavassiliou
- First Department of Respiratory Medicine, "Sotiria" Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | - Vasiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Marinos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Al-Qadi M, Al-Hussami M, Riza E, Athamnah E, Shehadeh J, Kleisiaris C, Almegewly WH, Karavasileiadou S. Indicators of Healthcare Services Utilization among the Syrian Refugee Population in Jordan: An Observational Study. Healthcare (Basel) 2023; 11:healthcare11040478. [PMID: 36833012 PMCID: PMC9956226 DOI: 10.3390/healthcare11040478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Sufficient healthcare services utilization among the Syrian refugee population is one of the most important human rights. Vulnerable populations, such as refugees, are often deprived of sufficient access to healthcare services. Even when healthcare services are accessible, refugees vary in their level of utilization of these services and their health-seeking behavior. PURPOSE This study aims to examine the status and indicators of healthcare service access and utilization among adult Syrian refugees with non-communicable diseases residing in two refugee camps. METHODS The cross-sectional descriptive design was conducted by enrolling 455 adult Syrian refugees residing in the Al-Za'atari and Azraq camps in northern Jordan, using demographical data, perceived health, and the "Access to healthcare services" module, which is a part of the Canadian Community Health Survey (CCHS). A logistic regression model with binary outcomes was used to explore the accuracy of the variables influencing the utilization of healthcare services. The individual indicators were examined further out of 14 variables, according to the Anderson model. Specifically, the model consisted of healthcare indicators and demographic variables to find out if they have any effect on healthcare services utilization. RESULTS Descriptive data showed that the mean age of the study participants (n = 455) was 49.45 years (SD = 10.48), and 60.2% (n = 274) were females. In addition, 63.7% (n = 290), of them were married; 50.5% (n = 230) held elementary school-level degrees; and the majority 83.3% (n = 379) were unemployed. As expected, the vast majority have no health insurance. The mean overall food security score was 13 out of 24 (±3.5). Difficulty in accessing healthcare services among Syrian refugees in Jordan's camps was significantly predicted by gender. "Transportation problems, other than fee problems" (mean 4.25, SD = 1.11) and "Unable to afford transportation fees" (mean 4.27, SD = 1.12) were identified as the most important barriers to accessing healthcare services. CONCLUSION Healthcare services must imply all possible measures to make them more affordable to refugees, particularly older, unemployed refugees with large families. High-quality fresh food and clean drinking water are needed to improve health outcomes in camps.
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Affiliation(s)
| | - Mahmoud Al-Hussami
- Community Nursing Department, School of Nursing, The University of Jordan, Amman 11942, Jordan
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Esra’a Athamnah
- Health Center Medical Laboratory Technician, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Jumana Shehadeh
- Community Nursing Department, School of Nursing, The University of Jordan, Amman 11942, Jordan
| | - Christos Kleisiaris
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Wafa Hamad Almegewly
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
- Correspondence:
| | - Savvato Karavasileiadou
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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Riza E, Lazarou A, Karnaki P, Zota D, Nassi M, Kantzanou M, Linos A. Using an IT-Based Algorithm for Health Promotion in Temporary Settlements to Improve Migrant and Refugee Health. Healthcare (Basel) 2021; 9:1284. [PMID: 34682964 PMCID: PMC8535268 DOI: 10.3390/healthcare9101284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
The application of the electronic algorithm developed by the Mig-Healthcare project was pilot tested in a sample of migrants and refugees in 2 Reception and Identification Centres (RICs), temporary settlements, in Greece using portable devices. The questions relate to health literacy issues, to mental health, to vaccination history, to lifestyle habits such as smoking, alcohol intake, diet, to the presence of diseases such as heart disease or diabetes, to the use of prevention services and to dental care. A total of 82 adults, 50 women and 32 men, participated. Data analysis showed that 67.1% (55) of the respondents had difficulty in understanding medical information and 57.3% (47) did not know where to seek medical help for a specific health problem. Four main areas of health problems were identified and further action is required: (A) mental health concerns, (B) vaccinations, (C) obesity, and (D) dental hygiene. Direct linkage with the "Roadmap and Toolbox" section of the project's website gave the respondents access to many sources and tools, while through the use of the interactive map, specific referral points of healthcare delivery in their area were identified. IT-based intervention in migrant and refugee populations in Greece are effective in increasing health literacy levels and identifying areas for health promotion interventions in these groups. Through linkage with the project's database, access to healthcare provision points and action to seek appropriate healthcare when necessary are encouraged. Given the attenuated vulnerability profile of people living in temporary settlements, this algorithm can be easily used in primary care settings to improve migrant and refugee health.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Achilleas Lazarou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Pania Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 15121 Marousi, Greece; (P.K.); (D.Z.); (A.L.)
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 15121 Marousi, Greece; (P.K.); (D.Z.); (A.L.)
| | - Margarita Nassi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Athena Linos
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 15121 Marousi, Greece; (P.K.); (D.Z.); (A.L.)
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Riza E, Kakalou E, Nitsa E, Hodges-Mameletzis I, Goggolidou P, Terzidis A, Cardoso E, Puchner KP, Solomos Z, Pikouli A, Stoupa EP, Kakalou C, Karamagioli E, Pikoulis E. Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations. Int J Environ Res Public Health 2021; 18:9257. [PMID: 34501844 PMCID: PMC8431650 DOI: 10.3390/ijerph18179257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contact tracing as an epidemiological strategy has repeatedly contributed to the containment of various past epidemics and succeeded in controlling the spread of disease in the community. Systematic training of contact tracers is crucial in ensuring the effectiveness of epidemic containment. METHODS An intensive training course was offered to 216 health and other professionals who work with vulnerable population groups, such as Roma, refugees, and migrants in Greece, by the scientific team of the postgraduate programme "Global Health-Disaster Medicine" of the Medical School, National and Kapodistrian University of Athens, with the support of the Swiss embassy in Greece. The course was delivered online due to the pandemic restriction measures and was comprised of 16 h over 2 days. The course curriculum was adapted in Greek using, upon agreement, a similar training course to what was developed by the Johns Hopkins University Bloomberg School of Public Health. Evaluation of the course was conducted in order to determine the short term satisfaction from participating in this training course. RESULTS A total of 70% of the course participants completed the evaluation questionnaires and all trainers gave feedback on the course. The training modules were ranked as extremely useful by the majority of the participants and over 50% of the participants specifically stated that the course content was directly related to their work with vulnerable groups. Content about the ethics of contact tracing and the effective communication skills presented were deemed most useful. CONCLUSION The course was well organised and provided the required skills for effective contact tracing. Many course participants intend to use some components in their work with vulnerable populations groups. Contact tracing efforts work best in a systematic and coordinated way and the provision of systematic and organised training can greatly increase its effectiveness.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Eleni Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evangelia Nitsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Ioannis Hodges-Mameletzis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Paraskevi Goggolidou
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK;
| | - Agis Terzidis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni Cardoso
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Karl Philipp Puchner
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | | | - Anastasia Pikouli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni-Panagiota Stoupa
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Christina Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evika Karamagioli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Emmanouil Pikoulis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
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Stavroulakis PJ, Tzora VA, Riza E, Papadimitriou S. Transportation, the pathogen vector to rule them all: Evidence from the recent coronavirus pandemic. J Transp Health 2021; 22:101087. [PMID: 36570714 PMCID: PMC9765011 DOI: 10.1016/j.jth.2021.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/25/2021] [Accepted: 05/13/2021] [Indexed: 05/03/2023]
Abstract
INTRODUCTION It is common knowledge that mobility refers to a distinct vector for pathogens, but the importance of prevention and the infusion of public health practices within transportation systems is not manifest. Replication studies of this effect are important because transportation remains veiled in modern societies, since its demand is not direct, but derived. METHODS Variables mirroring transportation and logistics' systems intensity (trade data, the logistics performance index, and investment in transportation) are cross-tabulated with epidemiological data from the recent coronavirus pandemic. As the samples of the data pertain to a dependent commonality, the statistical hypothesis test applicable is McNemar's test. In addition, the statistical power of the test(s) is calculated as a marker of methodological validity and reliability. To further strengthen the analytical methodology, a plethora of descriptive statistics have been calculated and multiple correspondence analysis (MCA) has been conducted. RESULTS This work confirms that the domain of transportation bears a strong association with not only mortality of a disease, but its recovery rates as well. All crosstabs provide statistically significant results and the statistical power calculated is very high, signifying the appropriateness of the methodology and the very low probability of Type II error. The MCA results are significant, as well. CONCLUSIONS The impact, or even the presence of transportation is veiled, as transportation comprises of derived demand dynamics. As such, its activities and even the prerequisites for its efficient operations many times go unnoticed. This work replicates a known effect, that mobility exacerbates the presence of a pathogen. The significance of this research lies on the fact that distinct indicators that reflect transportation and logistics are (though a robust calculatory methodology) statistically associated with epidemiological data.
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Affiliation(s)
- Peter J Stavroulakis
- Department of Management and International Business, School of Business and Economics, The American College of Greece, Ag. Paraskevi, Greece
- Department of Maritime Studies, School of Maritime and Industrial Studies, University of Piraeus, Piraeus, Greece
| | - Vasiliki A Tzora
- Department of Business Administration, School of Economics, Business, and International Studies, University of Piraeus, Piraeus, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology, and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Stratos Papadimitriou
- Department of Maritime Studies, School of Maritime and Industrial Studies, University of Piraeus, Piraeus, Greece
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Gil-Salmerón A, Katsas K, Riza E, Karnaki P, Linos A. Access to Healthcare for Migrant Patients in Europe: Healthcare Discrimination and Translation Services. Int J Environ Res Public Health 2021; 18:ijerph18157901. [PMID: 34360197 PMCID: PMC8345338 DOI: 10.3390/ijerph18157901] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. Methods: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. Results: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191; 95% CI [0.029, 0.352]) and Austria (0.167; 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994; 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384; 95% CI [1.189, 1.611]), as opposed to Austria (0.763; 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613; 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292; 95% CI [1.585, 6.837]). Conclusions: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population.
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Affiliation(s)
- Alejandro Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, 46010 Valencia, Spain
- International Foundation for Integrated Care, Oxford OX2 6UD, UK
- Correspondence:
| | - Konstantinos Katsas
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15125 Marousi, Greece; (K.K.); (P.K.); (A.L.)
| | - Elena Riza
- Department of Hygiene Epidemiology, Medical Statistics Medical School National, Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Pania Karnaki
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15125 Marousi, Greece; (K.K.); (P.K.); (A.L.)
| | - Athena Linos
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15125 Marousi, Greece; (K.K.); (P.K.); (A.L.)
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Kantzanou M, Karalexi MA, Zivinaki A, Riza E, Papachristou H, Vasilakis A, Kontogiorgis C, Linos A. Concordance of genotypic resistance interpretation algorithms in HIV-1 infected patients: An exploratory analysis in Greece. J Clin Virol 2021; 137:104779. [PMID: 33647801 DOI: 10.1016/j.jcv.2021.104779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Genotypic resistance-related mutations in HIV-1 disease are often difficult to interpret. Different algorithms have been developed to provide meaningful application into clinical context. We aimed to compare, for the first time in Greece, the results of genotypic resistance derived from three interpretation algorithms. METHODS The sequences of 120 HIV 1-infected patients were tested for genotypic resistance to 19 antiretroviral (ARV) drugs (n = 2280 sequences). The interpretation results of Rega, ANRS and ViroSeq algorithms were compared. RESULTS Complete concordance was found for 2/19 ARV drugs, namely lamivudine and emptricitabine. Concordance was high for nucleoside reverse transcriptase inhibitors (NRTIs) and low for protease inhibitors (PIs). In inter-algorithm pairs, agreement was high between Rega and ViroSeq (kappa = 0.701), especially by ARV class, namely NRTIs (k = 0.869) and NNRTIs (k = 0.562). The only exception was noted for rilpivirine, where agreement was higher between ANRS and Rega (k = 0.410) compared to other inter-algorithm pairs (k = 0.018-0.055). By contrast, for PIs all comparisons yielded concordance equivalent to chance (k = 0.000). CONCLUSIONS Our exploratory analysis provided evidence of significant inter-algorithm discordances, especially for PIs and NNRTIs highlighting the importance of matching the results of different algorithms to achieve optimized risk stratification. Ongoing research could assist clinical physicians in interpreting complex genotypic resistance patterns.
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Affiliation(s)
- Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Goudi, Athens, Greece
| | - Maria A Karalexi
- Department of Hygiene, Epidemiology & Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Goudi, Athens, Greece.
| | - Anduela Zivinaki
- Department of Hygiene, Epidemiology & Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Goudi, Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Goudi, Athens, Greece
| | - Helen Papachristou
- Department of Hygiene, Epidemiology & Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Goudi, Athens, Greece
| | - Alexis Vasilakis
- Department of Hygiene, Epidemiology & Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Goudi, Athens, Greece
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Campus (Dragana) Building 5, GR-68100, Alexandroupolis, Greece
| | - Athina Linos
- Department of Hygiene, Epidemiology & Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Goudi, Athens, Greece
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9
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Kolomvotsou AI, Riza E. Management of Diabetes Mellitus in Refugee and Migrant Patients in a Primary Healthcare Setting in Greece: A Pilot Intervention. Epidemiologia (Basel) 2021; 2:14-26. [PMID: 36417186 PMCID: PMC9620876 DOI: 10.3390/epidemiologia2010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
Over the past years there is a substantial wave of migrants and refugees all over the world. Europe accepts approximately one-third of the international migrant population with Greece, in particular, having received large numbers of refugees and migrants by land and sea since the beginning of the civil war in Syria. Diabetes, a non-communicable disease, is a global health problem, affecting people in developing countries, refugees and migrants, and its basic treatment tool includes self-management and education. In this pilot study, we organized educational, interactive group sessions for diabetic refugees, based on culture, health, and nutritional needs according to a questionnaire developed for the study. The sessions were weekly, for two months, in the context of primary healthcare, organized by a dietitian. Nine individuals completed the sessions, five of nine were diagnosed in Greece and seven of nine needed diabetes education. Their waist circumference was above normal and they were all cooking at home. Their nutritional habits improved by attending the sessions and the interaction helped their social integration. They all found the sessions useful, and felt more self-confident regarding diabetes control and healthier.
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Affiliation(s)
- Anastasia I Kolomvotsou
- Dietetic Department, Polyclinic of Olympic Village, 13672 Αxarnai, Attiki, Greece
- Correspondence: ; Tel.: +30-6973-204749
| | - Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medical, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece;
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10
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Zota K, Karnaki P, Gil-Salmerón A, Riza E, Garcés-Ferrer J, Linos A. Pilot action within the framework of the Mig-HealthCare project - implementation of community-based pilot studies addressing health inequalities of migrants and refugees. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
In the framework of the Mig-HealthCare project, a roadmap to community-based health care was developed including a toolbox and an algorithm. The Mig-HealthCare partners piloted parts of the roadmap in 8 EU countries. Piloting included actions on health promotion issues for migrants/refugees, mental health issues, non-communicable diseases, screening for breast and cervical cancer and vaccination issues. Two recommended practices were also piloted among migrants/refugees namely the 'circle of health' and health mentors while the Greek partner tested the developed algorithm in various health settings. All pilots were evaluated using common and pilot specific indicators for (a) appropriateness: the extent to which the piloted interventions were suitable for the target groups (service providers and/or migrants/refugees) (b) effectiveness: the extent to which the pilots' objectives were achieved, or are expected to be achieved, taking into account their relative importance (c) satisfaction: the extent to which pilots meet or surpass target groups and stakeholders (refugee/migrants, service providers and local population) expectation and needs (d) sustainability: the continuation of benefits from the pilot. Sustainability in the pilot implementation context is the ability of key target groups to sustain pilot benefits. Moreover, the impact of the interventions and their results should be sustainable in time. The impact of the pilots on the study population as well as implications for community-level health services are discussed.
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Affiliation(s)
- K Zota
- Prolepsis Institute, Athens, Greece
| | | | - A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - A Linos
- Prolepsis Institute, Athens, Greece
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11
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Gil-Salmerón A, Karnaki P, Zota K, Riza E, Linos A. Discrimination accessing to health care services: Feelings of migrants and misunderstandings of professionals. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Discrimination against migrants in healthcare settings and also the negative impact of this discrimination on their health are well documented. These experiences of discrimination may present a barrier to accessing or seeking appropriate health care. For this reason, the Mig-HealthCare project aimed to study the perceived feeling of discrimination against migrants and explore the perception of community members regarding health-related issues about migrants. In order to answer both questions, based on a mix-methods design, the Mig-Healthcare consortium collected data from 1,286 questionnaires completed by migrants/refugees in 10 EU countries and carried out 6 focus groups and 5 individual interviews in 7 countries.
Quantitative results show increased levels of mental health-related symptoms among migrants/refugees as well as dental health problems. The majority of respondents in all countries of the interview, needed more information about their rights and the way to use the health care services, while in Greece migrants showed the biggest need for more information about several health topics.
Moreover, qualitative results pointed out the presence of deeply rooted misconceptions towards migrants and refugees that span across different thematic areas: migrants and refugees represent a vector for the transmission of new or eradicated diseases and a burden for the already overstretched welfare system since they often demand preferential pathways to health or social services at the expenses of the local population.
Implications for the quality of healthcare services available for migrants/refugees are discussed as well as health issues which are of particular importance to this population. Feelings of discrimination and the extent to which they influence the quality of care received are analysed in combination with health being a basic human right to which need to all people have equal rights.
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Affiliation(s)
- A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | - K Zota
- Prolepsis Institute, Athens, Greece
| | - E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | - A Linos
- Prolepsis Institute, Athens, Greece
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12
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Riza E, Karnaki P, Zota D, Linos A. Testing the Mig-HealthCare Algorithm in Greece. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The Mig-HealthCare Algorithm is a tool, comprising a set of questions developed with the aim to (a) guide the user on how to access all the categories and tools that are available through the Roadmap & Toolbox (b) help the user identify the health issues of importance when providing care to a specific migrant/refugee. At the end of a series of questions, a brief report summarizing the main outcomes is generated. The algorithm was tested in Greece in two mainland reception centres and a local hospital in an area serving migrants/refugees. Results discuss the usefulness of the algorithm for improving the delivery of appropriate health services to migrants/refugees and its importance in raising awareness about the health conditions which are crucial for migrants/refugees and are expected to pose a significant burden on the health care systems of host countries unless dealt with adequately at an early stage.
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Affiliation(s)
- E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - D Zota
- Prolepsis Institute, Athens, Greece
| | - A Linos
- Prolepsis Institute, Athens, Greece
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13
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Miltiadou K, Kalantzis I, Paraskeva M, Solomos Z, Tsifi A, Theodoridis D, Riza E, Triantafyllou K, Kosmas C. Advanced Lung Cancer Survival in Times of Economic Hardship: A Greek Paradigm. Asian Pac J Cancer Care 2020. [DOI: 10.31557/apjcc.2020.5.s1.19-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: Greece has been affected more than any other European country from the financial crisis that began in 2010. Just 20 months after Greece exited an eight-year long aid program, forecasts of a new recession within 2020 due to COVID-19 pandemic make concerns regarding the compromise of health care quality within the new crisis relevant once again. In this study we sought to evaluate clinical outcomes in patients with advanced lung cancer in the pre-crisis and crisis era in a dedicated oncology centre in Greece. Methods: A retrospective analysis of 522 consecutive medical records of lung cancer patients admitted in a Greek dedicated cancer hospital between the years 2008-2013 was performed. Progression Free Survival (PFS) and Overall Survival (OS) were calculated for advanced lung cancer compared over two consecutive time periods using 2010 as a cutoff point.Result: 71 and 78 patients comprised the study sample for the two periods. PFS and OS were similar over the two periods (7.73 [6.42-9.04] vs. 6.03 [5.02-7.04] and 13.70 [9.61-17.79] vs. 11.08 [7.74-15.92] months, respectively). Higher Performance Status (PS) was associated with worse survival measures over both periods, while no statistical significance was reached for OS in the latter period. Dissimilarities in PFS were observed between beneficiaries of different insurance trusts. Conclusion: Clinical outcomes for advanced lung cancer have not changed as a result of the financial crisis in our institution. The insurance provider seems to affect health outcomes. This old paradigm could serve as new guidance in the forthcoming recession due to COVID-19 pandemic.
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Lebano A, Hamed S, Bradby H, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Azzedine F, Riza E, Karnaki P, Zota D, Linos A. Migrants' and refugees' health status and healthcare in Europe: a scoping literature review. BMC Public Health 2020; 20:1039. [PMID: 32605605 PMCID: PMC7329528 DOI: 10.1186/s12889-020-08749-8] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. METHODS This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants' access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards. RESULTS The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described. CONCLUSIONS The European situation concerning migrants' and refugees' health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants' health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants' own views on their health and barriers to access to healthcare is key.
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Affiliation(s)
- Adele Lebano
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden. .,University of Edinburgh, School of Social and Political Science, Chrystal Macmillan Building15a, George Square, Edinburgh, EH8 9LD, UK.
| | - Sarah Hamed
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden
| | - Hannah Bradby
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden
| | - Alejandro Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | - Estrella Durá-Ferrandis
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | - Jorge Garcés-Ferrer
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | | | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, Goudi, 11527, Athens, Greece
| | - Pania Karnaki
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
| | - Dina Zota
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
| | - Athena Linos
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
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15
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Pikoulis E, Solomos Z, Riza E, Puthoopparambil SJ, Pikoulis A, Karamagioli E, Puchner KP. Gathering evidence on the decreased emergency room visits during the coronavirus disease 19 pandemic. Public Health 2020; 185:42-43. [PMID: 32535391 PMCID: PMC7247452 DOI: 10.1016/j.puhe.2020.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- E Pikoulis
- Global Health-Disaster Medicine Programme, Medical School National and Kapodistrian University of Athens, Greece
| | - Z Solomos
- Global Health-Disaster Medicine Programme, Medical School National and Kapodistrian University of Athens, Greece
| | - E Riza
- Global Health-Disaster Medicine Programme, Medical School National and Kapodistrian University of Athens, Greece
| | - S J Puthoopparambil
- International Maternal and Child Health (IMCH), Dept. of Women's and Children's Health, Uppsala University, Sweden.
| | - A Pikoulis
- Global Health-Disaster Medicine Programme, Medical School National and Kapodistrian University of Athens, Greece
| | - E Karamagioli
- Global Health-Disaster Medicine Programme, Medical School National and Kapodistrian University of Athens, Greece
| | - K P Puchner
- Global Health-Disaster Medicine Programme, Medical School National and Kapodistrian University of Athens, Greece
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16
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Riza E, Kalkman S, Coritsidis A, Koubardas S, Vassiliu S, Lazarou D, Karnaki P, Zota D, Kantzanou M, Psaltopoulou T, Linos A. Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices. Healthcare (Basel) 2020; 8:E115. [PMID: 32354069 PMCID: PMC7349376 DOI: 10.3390/healthcare8020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Alexandra Coritsidis
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8434, USA
| | - Sotirios Koubardas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofia Vassiliu
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Despoina Lazarou
- Institute of Human Sciences, Wadham College, University of Oxford, Oxford OX1 3PN, UK
| | - Panagiota Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
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17
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Bradby H, Lebano A, Hamed S, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Sherlaw W, Christova I, Karnaki P, Zota D, Riza E. Policy Makers', NGO, and Healthcare Workers' Accounts of Migrants' and Refugees' Healthcare Access Across Europe-Human Rights and Citizenship Based Claims. Front Sociol 2020; 5:16. [PMID: 33869425 PMCID: PMC8022609 DOI: 10.3389/fsoc.2020.00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/25/2020] [Indexed: 05/25/2023]
Abstract
Freely available healthcare, universally accessible to the population of citizens, is a key ideal for European welfare systems. As labor migration of the twentieth century gave way to the globalized streams of the twenty-first century, new challenges to fulfilling these ideals have emerged. The principle of freedom of movement, together with large-scale forced migration have led to large scale movements of people, making new demands on European healthcare systems which had previously been largely focused on meeting sedentary local populations' needs. Drawing on interviews with service providers working for NGOs and public healthcare systems and with policy makers across 10 European countries, this paper considers how forced migrants' healthcare needs are addressed by national health systems, with factors hindering access at organizational and individual level in particular focus. The ways in which refugees' and migrants' healthcare access is prevented are considered in terms of claims based on citizenship and on the human right to health and healthcare. Where claims based on citizenship are denied and there is no means of asserting the human right to health, migrants are caught in a new form of inequality.
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Affiliation(s)
- Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Adele Lebano
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | | | | | | | - William Sherlaw
- École des Hautes Etudes en Santé Publique (EHESP), Rennes, France
| | - Iva Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Pania Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Marousi, Greece
| | - Dina Zota
- Institute of Preventive Medicine, Environmental and Occupational Health, Marousi, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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18
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Gil-Salmerón A, Riza E, Karnaki P, Zota D, Linos A. Modelling healthcare access for migrants and refugees in Europe: identifying the major health issues. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The Mig-HealthCare systematically searched to identify the key health areas of refugee/migrant health in order to facilitate interventions that help access to care services for migrants and refugees. The literature review was carried out in March 2018 using 3 large scientific databases using a combination of search terms following the PRISMA methodology and a standard set of items used to report on systematic reviews. Based on the predefined inclusion and exclusion criteria, a total of 118 publications were used for data extraction. It is important to note, that in almost all of the sources identified, the following cross-cutting factors were described as influencing access to healthcare: Continuity of Information, how it relates to policy, how it differs between health services and across-borders. Furthermore, the organizational coordination among social and health care providers in the host country determinates the successful access to healthcare of migrants/refugees.Language & Communication takes into consideration both the healthcare service and its provision of translators and cultural mediators, and the host country language proficiency of the migrant/refugee.Organizational improvement of access and delivery of health care services for migrants and refugees in addition to Cultural Competence of the healthcare providers meaning the ability to maximize their sensitivity in the service of care to culturally diverse groups.Health literacy understood as the motivation and competences of the migrant population to access, understand, appraise, and apply health information.
Additionally, the health issues of particular importance for migrants/refugees as emerged from the systematic review, including mental health, maternal/child health, health promotion, NCDs and chronic diseases, Oral/|Dental health, and Vaccinations should be included in planning future needs and healthcare access.
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Affiliation(s)
- A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - D Zota
- Prolepsis Institute, Athens, Greece
| | - A Linos
- Prolepsis Institute, Athens, Greece
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19
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Karnaki P, Zota D, Riza E, Gil-Salmerón A, Durá-Ferrandis E, Tsiampalis T, Linos A. Survey on the physical and mental health among migrants and refugees in ten European countries. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
This study discusses the main findings of the quantitative research conducted within the Mig-HealthCare consortium countries to explore the physical and mental health of migrants and refugees. The study population is defined as migrants/refugees who have been residing in Europe, for at least 6 months and up to 5 years. In order to be able to capture the recent migration flow, the analysis was based on 1169 questionnaires collected in 10 EU-Member States, answered by adult migrants residing less than 5 years in the specific country.
A total of 29% of migrants stated that their health is poor or fair. Overall, 56.9% of migrants needed health care services during the last 6 months, however approximately one in four did not have access to them. The most frequent problems were long waiting times, not being able to organize an appointment, not knowing where to go, lack of communication and long distances. The most frequent chronic health problem migrants/refugees face is caries and headaches/migraines, followed by psychological disease and sleep disorders. Approximately one in three women have been pregnant since entering the current EU country, whereas one in four have had a miscarriage or abortion and 21.5% are currently pregnant.
Summing up, most of the migrants face common medical problems such as bad teeth, headaches and psychological problems. However long waiting times, not knowing where to go and lack of communication are barriers to accessing healthcare. The fact that the immunization status of migrants/refugees is unclear, a significant number suffer from serious chronic diseases and the limited breast and cervical cancer screening of female migrants/refugees pose serious threats to their health and important challenges for the health services of Europe.
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Affiliation(s)
| | - D Zota
- Prolepsis Institute, Athens, Greece
| | - E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | - A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - E Durá-Ferrandis
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | - A Linos
- Prolepsis Institute, Athens, Greece
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20
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Lebano A, Hamed S, Bradby H, Gil-Salmerón A, Garcés-Ferrer J, Karnaki P, Zota D, Riza E, Tsiampalis T, Linos A. Analysis of needs, expectations and capacities of health and social care professionals in order to provide culturally adapted care. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The Mig-HealthCare consortium conducted a qualitative study of the health care needs of vulnerable migrants/refugees in Europe. The research was conducted between Fall 2017 and Spring 2018. In total, 20 focus group discussions or, where necessary individual interviews (19), were organised with health care professionals and service providers; policymakers; and representatives from Non-Governmental Organisations - NGOs. Thematic qualitative analysis was employed. The main results of the analysis show that:
Health care provision for migrants is uneven throughout the EU and variations exist even within the same country. Health care providers and NGOs agree that health care for migrants is inadequate and biased in favour of particular conditions and cases (minors, pregnant women and acute conditions). Challenges faced by different countries vary; while in some countries the main issue is legal access, in other basic needs such as sanitation and basic infrastructure were emphasised. Austerity measures following the 2008 financial crisis have negatively affected the health care system in general, which in turn has negatively affected the provision of health care for migrants/refugees. Discrimination linked to socio-economic and ethnic conditions is reported as a barrier to equal health care access. Knowledge, language and communication on both the demand and the supply side of health care provision emerge as crucial to ensure equal access for migrants/refugees. Gender may act as a barrier with women tending to be more marginalised in the host country, in terms of language proficiency and health literacy, lowering health care access. One of the main challenges for providing equal health care access for migrants has to do with the ability to balance a universal right to health with the particular means of achieving it. The evidence collected here shows how this tension between end and means is at work in different moments of the provision of health care for migrants/refugees.
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Affiliation(s)
- A Lebano
- Uppsala University, Uppsala, Sweden
| | - S Hamed
- Uppsala University, Uppsala, Sweden
| | - H Bradby
- Uppsala University, Uppsala, Sweden
| | - A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - J Garcés-Ferrer
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | - D Zota
- Prolepsis Institute, Athens, Greece
| | - E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - A Linos
- Prolepsis Institute, Athens, Greece
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Riza E, Kalkman S, Karnaki P, Zota D, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Linos A. Best practices addressing healthcare care access of migrants and refugees in European countries. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Mig-healthCare has identified sources in the countries and languages of the consortium providing guidance for community-based healthcare for migrants and refugees. A total of 54 sources that refer to best practices in seven European countries were identified. Results were categorized along with the themes: organization, communication, training, education and facilities & services. Successful organizational measures were a close collaboration with different governmental authorities, NGOs, community organizations and various local service providers. Moreover, engagement with members from both the host community and the migrant/refugee community in the design and implementation phases is essential. The need to track all activities through data collection and periodic evaluations is important in order to evaluate the effectiveness of systems. Funding was mentioned as important to secure continuity of projects and systems. Bridging communication barriers is a major facilitator to reduce health disparities. Differences in the types of practices and challenges per country were noted. Translators and cultural mediators are a key element in successful implementation, but across EU there is a need for more specialized staff to face the cultural barriers of the large variation in refugee/migrant backgrounds. The empowerment of migrants/refugees in promoting well-being through the engagement of the host community to help reduce stigma and discrimination is a successful strategy facilitating the access to care due to the increase of their health literacy skills. Finally, tailored services to give an answer to the specific needs of migrants and refugees are important, for example at first reception centres, standard medical screening and psychosocial risk assessment was recommended. Through this analysis, we can distinguish community-based care models elements facilitating the access of migrants and refugees to healthcare.
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Affiliation(s)
- E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | - S Kalkman
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - D Zota
- Prolepsis Institute, Athens, Greece
| | - A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - E Durá-Ferrandis
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - J Garcés-Ferrer
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - A Linos
- Prolepsis Institute, Athens, Greece
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Zota D, Karnaki P, Gil-Salmerón A, Garcés-Ferrer J, Riza E, Linos A. Predictions concerning the use of health care services in Europe by migrants/refugees and the Mig-HealthCare Roadmap & Toolbox. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Based on the multiple levels of research conducted within the project the consortium developed a roadmap & toolbox which includes the following categories: Continuity of information, Language Culture & Communication, Mental Health, Vaccinations, Maternal/child health, Health promotion, Oral health/Dental Care and NCDs while the Toolbox contains tools on these categories in different languages. The roadmap & toolbox is accessible through the project website. In addition, different scenarios, giving a comprehensive picture of the foreseen situation and the evidence-based policies and actions needed to maximize the effective delivery and sensitivity in the service of care to culturally diverse population groups were developed focusing on mental health, chronic disease management and oral health. Refugees and migrants tend to have a higher prevalence of mental distress compared to non-refugees. For the challenge of lack of recording mental health of migrants/refugees, improving the collaboration between ‘migrant-specific’ organizations is needed. Health care systems in Europe will have to accommodate the high demand for health care services for chronic conditions among migrants/refugees in the coming years. Implications such as the impact of poverty, level of health literacy and/or the cultural adaption of the measures need to be considered when planning to address future trends related to non-communicable diseases including diabetes among migrants/refugees. The provision of oral care presents great variability across the European countries, but in most cases, it is characterized by high cost and restricted range of services if offered within the state health systems. Migrants /refugees will not be able to meet the high cost of private dental care. Local community interventions have been proven very effective.
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Affiliation(s)
- D Zota
- Prolepsis Institute, Athens, Greece
| | | | - A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - J Garcés-Ferrer
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | - A Linos
- Prolepsis Institute, Athens, Greece
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Kontos M, Riza E, Tsiampalis T, Kirkilesis G, Bokos I, Moris D, Darema M, Andriopoulos A, Varletzidou A, Vernadakis S, Nikolaidis C, Lionaki S, Sarantzi X, Anagnostopoulou C, Boletis I, Zavos G. Breast cancer incidence and survival in renal transplant patients: 35-year experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gargavanis AA, Kanistra KA, Diamantopoulos K, Liasis D, Photiou E, Giakoustidis DE, Riza E. Multi-trauma injuries and level of preparedness in transit refugee camps: a case in Idomeni, Greece. Med Confl Surviv 2019; 35:133-139. [PMID: 31264442 DOI: 10.1080/13623699.2019.1635279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Athanasios A Gargavanis
- Médecins Du Monde, Greek delegation , Thessaloniki , Greece.,Division of Transplant Surgery, Department of Surgery, Medical School, Aristotle University of Thessaloniki and Hippokration General Hospital , Thessaloniki , Greece
| | | | - Konstantinos Diamantopoulos
- Médecins Du Monde, Greek delegation , Thessaloniki , Greece.,Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute , London , UK
| | | | - Efstratios Photiou
- Pronto Soccorso e Medicina d'Urgenza, Ospedale Sant'Antonio , Padova , Italia
| | - Dimitrios E Giakoustidis
- Médecins Du Monde, Greek delegation , Thessaloniki , Greece.,Division of Transplant Surgery, Department of Surgery, Medical School, Aristotle University of Thessaloniki and Hippokration General Hospital , Thessaloniki , Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens , Athens , Greece
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Kakalou E, Riza E, Chalikias M, Voudouri N, Vetsika A, Tsiamis C, Choursoglou S, Terzidis A, Karamagioli E, Antypas T, Pikoulis E. Demographic and clinical characteristics of refugees seeking primary healthcare services in Greece in the period 2015-2016: a descriptive study. Int Health 2019; 10:421-429. [PMID: 29992276 DOI: 10.1093/inthealth/ihy042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background In 2015-2016, more than a million refugees entered Greece. Along with other organizations, PRAKSIS, a local non-governmental organization, deployed mobile medical units on three islands and in temporary settlements in Athens. Methods This is a descriptive cross-sectional study aimed at analysing the demographic and clinical characteristics of the population (n=6688) that received services from PRAKSIS between October 2015 and June 2016 in different locations (islands of Samos, Kos and Leros in the southeastern Aegean Sea and on the mainland at Athens-Piraeus Port Gate E) before and after the closure of European borders in March 2016. Results The majority (88%) of the population came from Syria, Afghanistan and Iraq. Among them, 53% were women and children. Infectious diseases decreased as the population moved from the islands to the Athens-Piraeus Port, while all other disease categories increased in relative frequency, the difference being statistically significant (p<0.05). Among all consultations, dental and oral cavity health complaints also increased in the Athens-Piraeus Port, but failed to reach statistical significance (p=0.11). Referrals from the mobile health units to specialist care rose from 4.2% of all patients clinically examined on the islands to 9.9% in the Athens-Piraeus Port, and the difference was statistically significant (p<0.05). Conclusions More research and systematic data collection are needed to inform appropriate policies for the humanitarian challenges posed by the recent refugee and migrant waves in Europe.
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Affiliation(s)
- E Kakalou
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - E Riza
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - M Chalikias
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece.,Piraeus University of Applied Science, Thebon & Petrou Ralli 250, Aigaleo, Greece
| | | | - A Vetsika
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - C Tsiamis
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece.,Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | | | - A Terzidis
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - E Karamagioli
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - T Antypas
- PRAKSIS, Stournari 57, Athens, Greece
| | - E Pikoulis
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
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Psaltopoulou T, Sergentanis TN, Ntanasis-Stathopoulos I, Tzanninis IG, Riza E, Dimopoulos MA. Anthropometric characteristics, physical activity and risk of hematological malignancies: A systematic review and meta-analysis of cohort studies. Int J Cancer 2019; 145:347-359. [PMID: 30614529 DOI: 10.1002/ijc.32109] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/02/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
Abstract
Overweight/obesity, adult attained height and physical activity are possible risk factors for hematological malignancies. This meta-analysis aims to evaluate the associations between these factors and hematological cancer risk in adults. Eligible cohort studies were sought in PubMed up to May 31, 2016; overall, 44 studies were included in the present analyses. Pooled relative risk estimates were calculated using random-effects models; separate analyses were conducted for non-Hodgkin lymphoma (NHL) and subtypes (diffuse large B-cell lymphoma, DLBCL; follicular cell lymphoma; small lymphocytic lymphoma/chronic lymphocytic leukemia, SLL/CLL), Hodgkin lymphoma (HL), multiple myeloma (MM), leukemia and subtypes (acute lymphoblastic leukemia, acute myeloid leukemia, AML). Obesity was associated with increased risk of NHL, HL, MM, leukemia overall and AML in both sexes, as well as with higher DLBCL risk in women; the dose-response meta-regression analysis confirmed these associations. Less pronounced effects were observed regarding overweight, as it was associated with increased MM risk in both sexes, NHL risk in males, DLBCL and overall leukemia risk in females. Taller men presented with significantly higher risk of NHL and taller women were affected by higher risk of NHL, DLBCL, FL, CLL/SLL, MM, leukemia and AML. On the other hand, physical activity and abdominal fatness were not associated with the risk of hematological malignancies. In conclusion, this meta-analysis highlights the pivotal role of anthropometric measures in shaping the risk of hematological malignancies in adults. Additional, well-designed studies stemming from all the continents are needed for the further substantiation and generalization of the results.
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Affiliation(s)
- Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis-Georgios Tzanninis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Karnaki P, Riza E, Nikolakopoulos S, Zota K, Linos A. Physical and mental health status of migrants/refugees in Europe – The Mig-HealthCare project. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
| | - E Riza
- Laboratory of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Nikolakopoulos
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
| | - K Zota
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
| | - A Linos
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
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Dalma A, Karnaki P, Riza E, Zota K, Veloudaki A, Linos A. Health services provision to migrants/refugees in Greece: A qualitative study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Dalma
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
| | - P Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
| | - E Riza
- Laboratory of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - K Zota
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
| | - A Veloudaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
| | - A Linos
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Marousi, Greece
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Riza E, Chrysi M, Vaidakis D, Angelou A, Kontos M, Pikoulis E. Does socio-economic status in Greece affect participation in cancer screening programmes during the period of financial crisis? J Public Health (Oxf) 2017. [DOI: 10.1007/s10389-017-0793-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Veloudaki A, Petralias A, Zota D, Karnaki P, Dalma A, Riza E, Linos A. Policy brief addressing food insecurity and obesity Case study: the DIATROFI program. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zota D, Dalma A, Petralias A, Lykou A, Kastorini CM, Yannakoulia M, Karnaki P, Belogianni K, Veloudaki A, Riza E, Malik R, Linos A. Promotion of healthy nutrition among students participating in a school food aid program: a randomized trial. Int J Public Health 2016; 61:583-92. [PMID: 27022997 DOI: 10.1007/s00038-016-0813-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the potential benefits on students' eating habits, of incorporating healthy nutrition education as part of a school food aid program. METHODS 146 schools participating in the DIATROFI Program in Greece during the 2013-2014 school year were randomly allocated to the environmental intervention (received a healthy daily meal) and the multicomponent intervention (MI) group (in addition to the meal, a healthy nutrition educational program was applied). The analysis, based on 3627 pre-post intervention questionnaire pairs, was stratified for children (ages 4-11 years) and adolescents (ages 12-18 years). RESULTS Children participating in the MI group displayed 25 % higher odds of increasing the weekly consumption of milk/yoghurt and fruits, 61 % higher odds of improving BMI from overweight/obese to normal and 2.5 times higher odds of improving from underweight to normal. For adolescents in the MI group, the odds of increasing the consumption of vegetables were 40 % higher. In both intervention groups, approximately one in four overweight/obese adolescents reached normal weight. CONCLUSIONS Educational programs on healthy nutrition might be considered worth implementing in the framework of school food aid programs.
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Affiliation(s)
- Dina Zota
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
| | - Archontoula Dalma
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanassios Petralias
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Anastasia Lykou
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina-Maria Kastorini
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Pania Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
| | - Katerina Belogianni
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
| | - Afroditi Veloudaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhea Malik
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Athena Linos
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis, Maroussi, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Petralias A, Papadimitriou E, Riza E, Karagas MR, Zagouras ABA, Linos A. The impact of a school food aid program on household food insecurity. Eur J Public Health 2016; 26:290-6. [PMID: 26873860 PMCID: PMC4804736 DOI: 10.1093/eurpub/ckv223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: We had a unique opportunity to establish the extent of food insecurity and the potential impact of a large-scale school-based nutritional program, in low-socioeconomic status districts of Greece, during the current economic crisis. Methods: Around 162 schools with 25 349 students participated during the 2012–2013 school year. Each student received a daily healthy meal designed by nutrition specialists. Food insecurity levels, measured using the Food Security Survey Module were assessed at baseline and after a 1–8-month intervention period. Pre–post intervention responses were matched at an individual level. Results: Around 64.2% of children’s households experienced food insecurity at baseline. This percentage decreased to 59.1% post-intervention, P < 0.001. On an individual level, food insecurity score diminished by 6.5%, P < 0.001. After adjustment for various socioeconomic factors, for each additional month of participation, the odds of reducing the food insecurity score increased by 6.3% (OR = 1.06, 95% CI: 1.02–1.11). Those experiencing food insecurity with hunger at baseline were more likely to improve food insecurity score than those who did not (OR = 3.51, 95%CI: 2.92–4.21). Conclusion: Children and families residing in low socioeconomic areas of Greece, experience high levels of food insecurity. Our findings suggest that participation in a school-based food aid program may reduce food insecurity for children and their families in a developed country in times of economic hardship.
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Affiliation(s)
- Athanassios Petralias
- Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Eleni Papadimitriou
- Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Margaret R Karagas
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alexia B A Zagouras
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Athena Linos
- Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kastorini CM, Lykou A, Yannakoulia M, Petralias A, Riza E, Linos A. The influence of a school-based intervention programme regarding adherence to a healthy diet in children and adolescents from disadvantaged areas in Greece: the DIATROFI study. J Epidemiol Community Health 2016; 70:671-7. [DOI: 10.1136/jech-2015-205680] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 12/17/2015] [Indexed: 11/04/2022]
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Karagiannis D, Deliveliotis C, Papadimitriou E, Riza E, Lykou A, Petralias A, Papatsoris A, Linos A. Oral exposure to hexavalent chromium through drinking water and urologic morbidity in an industrial area of Greece. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0681-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Moustafa GA, Xanthopoulou E, Riza E, Linos A. Skin disease after occupational dermal exposure to coal tar: a review of the scientific literature. Int J Dermatol 2015; 54:868-79. [DOI: 10.1111/ijd.12903] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 11/13/2014] [Accepted: 11/23/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Eleni Xanthopoulou
- Faculty of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics; Medical School; University of Athens; Athens Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics; Medical School; University of Athens; Athens Greece
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Riza E, Linos A, Petralias A, de Martinis L, Duntas L, Linos D. The effect of Greek herbal tea consumption on thyroid cancer: a case-control study. Eur J Public Health 2015; 25:1001-5. [PMID: 25842380 DOI: 10.1093/eurpub/ckv063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although in the last decade several studies have addressed the protective role of black and green tea on several diseases, including cancer, there are only few and controversial studies on the effect of tea on benign and malignant thyroid diseases. METHODS An age and gender group matched case-control study conducted in Athens, Greece, was designed. 113 Greek patients with histologically confirmed thyroid cancer and 286 patients with benign thyroid diseases along with 138 healthy controls were interviewed with a pre-structured questionnaire in person by trained interviewers. RESULTS An inverse association between chamomile tea consumption and benign/malignant thyroid diseases was found (P < 0.001). The odds of chamomile tea consumption, two to six times a week, after controlling for age, gender and BMI, were 0.30 (95% CI: 0.10-0.89) and 0.26 (95% CI: 0.12-0.5) for developing thyroid cancer and benign thyroid diseases, respectively when compared with not consumption. The duration of consumption was also inversely associated with the diseases. Thirty years of consumption significantly reduced the risk of thyroid cancer and benign thyroid diseases development by almost 80%. Similar, although weaker protective association, was found for sage and mountain tea. Adjustment for smoking, alcohol and coffee consumption did not alter the results. CONCLUSIONS Our findings suggest for the first time that drinking herbal teas, especially chamomile, protects from thyroid cancer as well as other benign thyroid diseases.
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Affiliation(s)
- Elena Riza
- 1 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens, 11527, Greece
| | - Athena Linos
- 1 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens, 11527, Greece 1 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens, 11527, Greece
| | - Athanassios Petralias
- 1 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens, 11527, Greece 1 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens, 11527, Greece
| | - Luca de Martinis
- 2 Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, 7 Fragoklisias Street, Maroussi, 15125, Greece
| | - Leonidas Duntas
- 3 Department of Statistics, Athens University of Economics and Business, 76 Patission Street, Athens, 10434, Greece
| | - Dimitrios Linos
- 4 Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Fondazione Salvatore Maugeri I.R.C.C.S., Via S. Maugeri 10, I-27100, Pavia, Italy 5 Endocrine Unit, Evgenidion Hospital, University of Athens, 20 Papadiamantopoulou Street, 11528 Athens, Greece
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Christoforidou EP, Riza E, Kales SN, Hadjistavrou K, Stoltidi M, Kastania AN, Linos A. Bladder cancer and arsenic through drinking water: a systematic review of epidemiologic evidence. J Environ Sci Health A Tox Hazard Subst Environ Eng 2013; 48:1764-75. [PMID: 24007431 DOI: 10.1080/10934529.2013.823329] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Exposure to inorganic arsenic (As) through drinking water is a major international public health issue. We carried out a systematic review of the existing literature examining the association between the risk of bladder cancer in humans and exposure to arsenic through drinking water. We searched electronic databases for studies published from January 2000 up to April 2013. Eight ecological studies, six case-control studies, four cohort studies and two meta-analyses were identified. The vast majority of the studies were carried out in areas with high arsenic concentrations in drinking water such as southwestern and northeastern Taiwan, Pakistan, Bangladesh, Argentina (Cordoba Province), USA (southeastern Michigan, Florida, Idaho) and Chile. Most of the studies reported higher risks of bladder cancer incidence or mortality in areas with high arsenic concentrations in drinking water compared to the general population or a low arsenic exposed control group. The quality assessment showed that among the studies identified, arsenic exposure was assessed at the individual level only in half of them and only three assessed exposure using a biomarker. Further, five out of eight ecological studies presented results with adjustment for potential confounders except for age; all cohort and case-control studies presented results with adjustment for cigarette smoking status in the analysis. The majority of the studies with varying study designs carried out in different areas provided evidence of statistically siginificant increases in bladder cancer risk at high concentrations of arsenic (>50 μg L(-1)). Assessing bladder cancer risk at lower exposure concentrations requires further investigation.
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Affiliation(s)
- Eleni P Christoforidou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of Athens, Athens, Greece.
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Zoidaki A, Riza E, Kastania A, Papadimitriou E, Linos A. Musculoskeletal disorders among dentists in the Greater Athens area, Greece: risk factors and correlations. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-012-0534-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Frantzeskou E, Kastania AN, Riza E, Jensen OC, Linos A. Risk factors for fishermen's health and safety in Greece. Int Marit Health 2012; 63:155-161. [PMID: 23129097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND This is, to the best of our knowledge, the first occupational health study in Greek fishing. AIM The aim of the study is to determine the risks for health and safety in Greek fisheries workers by exploring their health status and the health risk factors present in their occupational environment, thus providing a current baseline for further research in the future and for documentation of the needs for prevention. MATERIALS AND METHODS A questionnaire pilot study was carried out in a random sample of 100 Greek fishermen. RESULTS Twenty-eight per cent (28%) had experienced at least one injury, of which half caused more than one day absence, while 14% had a near drowning experience. The health risks factors studied include excessive weight, cardiovascular incidents and dermatological, musculoskeletal, respiratory, hearing, stress, and anxiety problems. The occupational health risk factors include alcohol, fatty food consumption, smoking, and lack of physical exercise. CONCLUSIONS The health effects observed are causally related to diet, smoking, and exercise, which in turn relate to the specific working conditions and culture in small-scale fishing that need to be taken into consideration in prevention programmes. The results are comparable with international fisheries experience, mainly from Poland, Denmark, and Turkey.
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Affiliation(s)
- Elpida Frantzeskou
- Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
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Riza E, Remoundos DD, Bakali E, Linos D, Linos A. POSTMENOPAUSAL OBESITY AND MAMMOGRAPHIC DENSITY IN A COHORT OF GREEK WOMEN. Maturitas 2009. [DOI: 10.1016/s0378-5122(09)70272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Riza E, dos Santos Silva I, De Stavola B, Perry N, Karadedou-Zafiriadou E, Linos D, Remoundos DD, Linos A. Correlates of high-density mammographic parenchymal patterns by menopausal status in a rural population in Northern Greece. Eur J Cancer 2005; 41:590-600. [PMID: 15737565 DOI: 10.1016/j.ejca.2004.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Revised: 11/09/2004] [Accepted: 12/14/2004] [Indexed: 11/17/2022]
Abstract
Reproductive factors affect breast cancer risk, but less is known of their associations with mammographic density and whether these differ by menopausal status. We report on a cross-sectional study of 1946 pre- and 3047 post-menopausal women who joined a breast screening programme in Northern Greece during 1993-1997. The odds of having a high-density Wolfe pattern (P2/DY) was inversely associated with age (P for linear trend <0.001) in both pre- and post-menopausal women and, for post-menopausal women, with years since menopause (P < 0.001). The odds of a P2/DY pattern declined with higher parity (P < 0.001) and younger age at first pregnancy (P = 0.05) in both pre- and post-menopausal women. They also decreased with the duration of breast-feeding in pre-menopausal women (P = 0.03 in pre- and P = 0.69 in post-menopausal women; test for interaction with menopausal status: P = 0.07). Age at menarche, age at menopause and the number of miscarriages/abortions were not associated with mammographic density. Age at first pregnancy and parity were strong correlates of mammographic density in pre- and post-menopausal women while duration of breast-feeding appeared to be particularly important in pre-menopausal women.
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Affiliation(s)
- Elena Riza
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Abstract
BACKGROUND Occupational risk factors contribute significantly to the development of lung cancer; however, little is known about the extent to which employees are informed of occupational exposure to carcinogenic substances. METHODS Through a case-control study, we estimated the level of awareness among Greek employees potentially exposed to known carcinogenic substances within various occupational settings. RESULTS Only 6.6% of men (n = 482) employed in occupations with potential exposure to carcinogenic substances were aware of such occupational exposures. Age, education, and residence were significantly associated with awareness. Employees having at least a secondary level of education were 3.5 times more aware than those having at most 6 years of educational training. CONCLUSIONS Assessing awareness among workers potentially exposed to occupational risk factors and promoting occupational health education are important steps for increasing health and safety at the workplace.
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Affiliation(s)
- Christos Chatzis
- Department of Hygiene and Epidemiology, University of Athens Medical School, Goudi, Greece
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Shickle D, Carlisle J, Fryers P, Wallace S, Suckling R, Cork M, Bowns I, Beyleveld D, McDonagh A, Sandvik L, Mowinckel P, Abdelnoor M, Erikssen G, Erikssen J, White R, Altmann DR, Nanchahal K, Oliver S, Donovan JL, Peters TJ, Frankel S, Hamdy FC, Neal DE, Whincup PH, Gilg J, Papacosta O, Miller GJ, Alberti KGMM, Cook D, Lawlor DA, Ebrahim S, Smith GD, Lampe F, Morris R, Whincup P, Walker M, Ebrahim S, Shaper A, Brunner E, Shipley M, Hemingway H, Juneja M, Page M, Stansfeld S, Kumari M, Walker B, Andrew R, Seckl J, Papadopoulos A, Checkley S, Marmot M, Wood D, Sheehan J, Reilly M, Twomey H, Collins M, Daly A, Loningsigh S, Dolan E, Smith GD, Ben-Shlomo Y, Perry I, Moher M, Yudkkin P, Wright L, Turner R, Fuller A, Schofield T, Mant D, Feder G, Lilford RJ, Dobbie F, Warren R, Braunholtz D, Boaden R, Nolte E, Scholz R, Shkolnikov V, McKee M, Neilson S, Gilthorpe MS, Wilson RC, Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T, Cromwell DA, Griffiths DA, Campbell MJ, Mollison J, McIntosh E, Grimshaw J, Thomas R, Rovers MM, Straatman H, Zielhuis GA, Hemminki E, Hove SL, Veerus P, Hakama M, Tuimala R, Rahu M, Ukoumunne OC, Gulliford MC, Shepstone L, Spencer N, Araya R, Rojas G, Fritsch RE, Acuna J, Lewis G, Ajdacic-Gross V, Bopp M, Eich D, Rossler W, Gutzwiller F, Corcoran P, Brennan A, Reilly M, Perry IJ, Middleton N, Whitley E, Frankel S, Dorling D, Gunnell D, Stanistreet D, Paine K, Scherf C, Morison L, Walraven G, O'Cathain A, Sampson F, Nicholl J, Munro J, Chapple A, Ziebland S, McPherson A, Herxheimer A, Shepperd S, Miller R, Brindle L, Donovan JL, Peters TJ, Quine S, O'Reilly M, Cahill M, Perry IJ, Maconochie N, Doyle P, Prior S, Ego A, Subtil D, Cosson M, Legoueff F, Houfflin-Debarge V, Querleu D, Rasmussen F, Smith GD, Sterne JAC, Tynelius P, Leon DA, Doyle P, Roman E, Maconochie N, Smith P, Beral V, Macfarlane A, Shoham-Vardi I, Winer N, Weitzman D, Levcovich A, Lahelma E, Kivela K, Roos E, Tuominen T, Dahl E, Diderichsen F, Elstad J, Lissau I, Lundberg O, Rahkonen O, Rasmussen NK, Yngwe MA, Gilmore AB, McKee M, Rose R, Salmond C, Crampton P, Tobias M, Li L, Manor O, Power C, Bruster S, Coulter A, Jenkinson C, Osler M, Prescott E, Gronbak M, Andersen AN, Due P, Engholm G, Drury N, Bruce J, Poobalan AS, Smith WCS, Jeffrey RR, Chambers WA, Mueller JE, Doring A, Stieber J, Thorand B, Lowel H, Chen R, Tunstall-Pedoe H, Redpath A, Macintyre K, Stewart S, Chalmers JWT, Boyd AJ, Finlayson A, Pell JP, McMurray JJV, Capewell S, Chalmers JWT, Macintyre K, Stewart S, Boyd AJ, Finlayson A, Pell JP, Redpath, McMurray JJV, Capewell S, Critchley J, Capewell S, Stefoski-Mikeljevic J, Johnston C, Cartman M, Sainsbury R, Forman D, Haward R, Morris E, Haward R, Forman D, Cartman M, Johnston C, Moebus S, Lehmann N, Goodacre S, Calvert N, Montgomery AA, Fahey T, Ben-Shlomo Y, Harding J, Anderson W, Florin D, Gillam S, Ely M, Nath U, Ben-Shlomo Y, Thomson RG, Morris HR, Wood NW, Lees AJ, Burn DJ, West RR, Fielder HM, Palmer SR, Dunstan F, Fone D, Higgs G, Senior M, Moss N, Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, Donovan J, Rottingen JA, Garnett GP, Jagger C, Robine JM, Clarke M, Tobiasz-Adamczyk B, Szafraniec K, Lall R, Campbell MJ, Walter SJ, McGrother C, Donaldson M, Dallosso H, Dineen BP, Bourne RR, Ali SM, Huq DMN, Johnson GJ, Stang A, Jockel KH, Karvonen S, Vikat A, Rimpela M, Borras JM, Schiaffino A, Fernandez E, Borrell C, Garcia M, Salto E, Jefferis B, Power C, Graham H, Manor O, Yudkin P, Hey K, Roberts S, Welch S, Johnstone E, Murphy M, Griffiths S, Jones L, Walton R, Rasul F, Stansfeld SA, Hart CL, Gillis C, Smith GD, Marks D, Lambert H, Thorogood M, Neil H, Humphries S, Wonderling D, Surman G, Newdick H, Johnson A, Pharoah P, Glinianaia SV, Wright C, Rankin J, Basso O, Christensen K, Olsen J, Love A, Cheung WY, Williams J, Jackson S, Maddocks A, Hutchings H, Gissler M, Pakkanen M, Olausson PO, Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG, Aveyard P, Markham WA, Sherratt E, Bullock A, Macarthur C, Cheng KK, Daniels H, Murphy S, Egger M, Grimsley M, Green G, Read C, Redgrave P, Suokas A, McCulloch A, Zagozdzon P, Zaborski L, Cardano M, Costa G, Demaria M, Gnavi R, Spadea T, Vannoni F, Batty D, Leon DA, Rahi J, Morton S, Leon D, Stavola BDE, Gunnell D, Fouskakis D, Rasmussen F, Tynelius P, Harrison G, Spadea T, Faggiano F, Armaroli P, Maina L, Costa G, Ellison GTH, Travis R, Phillips M, Dedman D, Upton M, McCarthy A, Elwood P, Davies D, Shlomo YB, Smith GD, Berrington A, Cramer DW, Kuper H, Harlow BL, Titus-Ernstoff L, McLeod A, Stockton D, Brown H, Leyland AH, Liratsopulos G, West CR, Williams EMI, Abrams K, Sharp L, Little J, Brockton N, Cotton SC, Haites NE, Cassidy J, Kamali A, Kinsman J, Kintu P, Quigley M, Carpenter L, Kengeya-Kayondo J, Whitworth. JAG, Porter K, Noah N, Rawson H, Crampin A, Smith WCS, Group CMSOBOTMS, Jahn A, Kudzala A, Kitundu H, Lyamuya E, Razum O, Thomas SL, Wheeler JG, Hall AJ, Moore L, Dennehy A, Shemilt I, Belderson P, Brandon M, Harvey I, Moffatt P, Mugford M, Norris N, O'Brien M, Reading R, Robinson J, Schofield G, Shepstone L, Thoburn J, Cliffe S, Leiva A, Tookey P, Hamers F, Nicoll A, Critchley J, Capewell S, Ness AR, Hughes J, Elwood PC, Whitley E, Smith GD, Burr ML, Chase D, Roderick P, Cooper K, Davies R, Raftery J, Martikainen P, Kauppinen TM, Valkonen T, Somerville M, Barton A, Foy C, Basham M, Thomson H, Petticrew M, Morrison D, Chandola T, Biddulph J, McCarthy M, Gallivan S, Utley M, Kinra S, Black ME, Murphy M, Hey K, Jones L, Brzezinski ZJ, Mazur J, Mierzejewska E, Evans JG, Clarke R, Sherliker P, Birks J, Wrieden WL, Connaghan JP, Tunstall-Pedoe H, Silva IDS, Mangtani P, McCormack V, Bhakta D, Sevak L, McMichael AJ, Sauvaget C, Nagano J, Ogilvie D, Raffle AE, Alden B, Brett M, Babb PJ, Quinn M, Banks E, Beral V, Bull D, Reeves G, Leung GM, Lam TH, Thach TQ, Hedley AJ, Roderick P, Davies R, Crabbe D, Patel P, Raftery J, Bhandari P, Pearce R, Thomas MC, Walker M, Lennon LT, Thomson AG, Lampe FC, Shaper AG, Whincup PH, Fallon UB, Ben-Shlomo Y, Laurence KM, Lancashire RJ, Pharoah POD, Nevin NC, Smith GD, Fear NT, Roman E, Ansell P, Bull D, Nilsen TIL, Vatten LJ, Lane JA, Harvey RF, Murray LJ, Harvey IM, Donovan JL, Egger M, Wright CM, Parker L, Lamont D, Craft AW, Hallqvist J, Lundberg M, Diderichsen F, Boniface DR, McNeilly E, Bromen K, Pohlabeln H, Ahrens W, Jahn I, Jockel KH, Darby S, Doll R, Whitley E, Key T, Silcocks P, Linos D, Markaki I, Ntalles K, Riza E, Linos A, Memon A, Darif M, AL-Saleh K, Suresh A, de Vries CS, Bromley SE, Williams TJ, Farmer RDT, Ruiz M, Nieto A, Boshuizen HC, Nagelkerke NJD, Schellekens JFP, Peeters MF, Den Boer JW, Van Vliet JA, Neppelenbroek SE, Spaendonck MAECV, Mazloomzadeh S, Woodman CBJ, Collins S, Winter H, Bailey A, Young LS, Rosenbauer J, Herzig P, Giani G, Olowokure B, Spencer NJ, Hawker JI, Blair I, Smith R, Olowokure B, White J, Rush M, Hawker JI, Ramsay M, Watkins J, Mayor S, Matthews I, Crilly M, Bundred P, Prosser H, Walley T, Walker ZAK, Oakley L, Townsend JL, Donovan C, Smith H, Bell J, Hurst Z, Marshall S, Wild S, Whyman C, Barter M, Wishart K, Macleod C, Marinko K, Malmstrom M, Johansson SE, Sundquist J, Crampton P, Salmond C, Tobias M, Lumley J, Small R, Brown S, Watson L, Gunn J, Hawe P, Shiell A, Langer M, Steiner G, Tiefenthaler M, Adamek S, Ronsmans C, Khlat M, Waterstone M, Bewley S, Wolfe C, Hooper R, Moore L, Campbell R, Whelan A, Winter H, Macarthur C, Bick D, Lancashire R, Knowles H, Henderson C, Belfield C, Gee H, Biggerstaff D, Lilford R, Olsen J, the EuroMap Group, Spencer EA, Davey GK, Appleby PN, Key TJ., Breeze E, Leon D, Clarke R, Fletcher A, Boniface DR, McNeilly E, Lam TH, Ho SY, Hedley AJ, Mak KH, Canoy D, Khaw KT, Thorogood M, Appleby PN, Mann JI, Key TJ, Bobak M, Pikhart H, Martikainen P, Rose R, Marmot M, Rooney CIF, Cook L, Uren Z, Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Poobalan AS, Bruce J, King PM, Krukowksi ZH, Smith WCS, Chambers WA, Seagroatt V, Goldacre M, Purcell B, Majeed A, Mayor S, Watkins J, Matthews I, Morris RW, Whincup PH, Emberson J, Lampe FC, Walker M, Wannamethee G, Shaper AG, Ebrahim S, May M, McCarron P, Frankel S, Smith GD, Yarnell J, Ebrahim S, May M, McCarron P, Shlomo YB, Stansfeld S, Gallacher J, Smith GD, Taylor FC, Rees K, Ebrahim S, Angelini GD, Ascione R, Muller-Nordhorn J, Binting S, Kulig M, Voller H, Willich SN, Group FTPS, Whincup PH, Emberson J, Papacosta O, Walker M, Lennon L, Thomson A, Sturdy PM, Anderson HR, Butland BK, Bland JM, Victor CR, Wilman C, Gupta R, Anderson HR, Mindell J, Joffe M, Nikiforov B, Pattenden S, Armstrong B, Hedley AJ, Wong CM, Thach TQ, Chau P, Lam TH, Anderson HR, Whitley E, Darby S, Deo H, Doll R, Raleigh VS, Logie J, Macrae K, Lawrenson R, Villegas R, Nielson S, O'Halloran DJ, Perry IJ, Gallacher JEJ, Elwood PC, Yarnell JWG, Shlomo YB, Pickering J, Evans JMM, Morris AD, Sedgwick JEC, Pearce AJ, Gulliford MC, Walker M, Thomson A, Whincup P, Lyons RA, Jones S, Richmond P, McCarthy J, Fone D, Lester N, Johansen A, Saunders J, Palmer SR, Barnes I, Banks E, Beral V, Jones GT, Watson KD, Taylor S, Papageorgiou AC, Silman AJ, Symmons DPM, Macfarlane GJ, Pope D, Hunt I, Birrell F, Silman A, Macfarlane G, Thorpe L, Thomas K, Fitter M, Brazier J, Macpherson H, Campbell M, Nicholl J, Morgan A, Roman M, Allison T, Symmons D, Urwin M, Brammah T, Roxby M, Williams G, Primatesta P, Falaschetti E, Poulter NR, Knibb R, Armstrong SJ, Chilvers CED, Logan RFA, Woods KL, Bhavnani V, Clarke A, Dowie J, Kennedy A, Pell I, Goldacre MJ, Kurina L, Seagroatt V, Yeates D, Watson E, Clements A, Yudkin P, Rose P, Bukach C, Mackay J, Lucassen A, Austoker J, Guillemin M, Brown W, Tell GS, Nurk E, Vollset SE, Nygard O, Refsum H, Ueland PM, Villegas R, Nielson S, Creagh D, Hinchion R, Perry IJ, Allen NE, Key TJ, Vatten LJ, Odegard RA, Nilsen ST, Austgulen R, Harding AH, Khaw KT, Wareham NJ, Riza E, Silva IDS, De Stavola B, Bradlow HL, Sepkovic DW, Linos D, Linos A. Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations. Br J Soc Med 2001. [DOI: 10.1136/jech.55.suppl_1.a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Riza E, dos Santos Silva I, De Stavola B, Bradlow HL, Sepkovic DW, Linos D, Linos A. Urinary estrogen metabolites and mammographic parenchymal patterns in postmenopausal women. Cancer Epidemiol Biomarkers Prev 2001; 10:627-34. [PMID: 11401912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
It has been hypothesized that women who metabolize their endogenous estrogens predominantly via 16(alpha)-hydroxylation rather than via 2-hydroxylation and, as a result, have a low ratio of 2-hydroxyestrone (2-OHE1):16(alpha)-hydroxyestrone (16(alpha)-OHE1) are at an increased risk of breast cancer. Epidemiological evidence in support of this hypothesis is scarce and mostly based on measurements made after the onset of the disease. To gain insight into the role of these metabolites in the etiology of breast cancer, we assessed their relationship with high-density Wolfe mammographic parenchymal patterns (P2/DY), a recognized indicator of risk of this tumor. The study was nested within a large cross-sectional survey on determinants of mammographic patterns carried out in a population-based breast screening program in Northern Greece. Urinary levels of 2-OHE1 and 16(alpha)-OHE1 were measured in a random sample of 70 postmenopausal women with P2/DY mammographic patterns and in a random sample of 70 women with N1 mammographic patterns, individually matched to the P2/DY women on year of birth, years since menopause and date of urine collection. Women with a P2/DY pattern had, on average, 58% higher levels of 2-OHE1 (P = 0.002) and 15% higher levels of 16(alpha)-OHE1 (P = 0.37) than those with an N1 pattern. The ratio of 2-OHE1:16(alpha)-OHE1 was 35% higher (P = 0.005) in women with a P2/DY pattern. Women in the highest one-third of this ratio were six times more likely to have a P2/DY pattern than those in the lowest one-third after adjusting for potential confounders (prevalence odds ratio, 6.2; 95% CI, 1.7-22.9; test for linear trend, P = 0.002). These findings seem to suggest that a high, rather than a low, 2-OHE1:16(alpha)-OHE1 ratio may be associated with an increase in breast cancer risk at postmenopausal ages, unless the pathway through which estrogen metabolites may affect breast cancer risk is unrelated to mammographic parenchymal patterns.
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Affiliation(s)
- E Riza
- Cancer and Public Health Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, England.
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Abstract
This paper summarises the similarities and differences between the cervical cancer screening programmes operating in the 15 Member States of the European Union as presented in the separate papers prepared by each country. The screening programmes are compared in terms of their duration of operation, type and sources of funding, invitation methodology, target population, organisation and quality assurance methodology with the aim of shedding some light upon the current situation of cervical cancer screening within the European Union.
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Affiliation(s)
- A Linos
- Department of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias St, GR 115 27 Goudi, Athens, Greece
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Affiliation(s)
- A Linos
- Department of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias St, GR 115 27 Goudi, Athens, Greece
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Abstract
The aim of this study was to describe the state of the art in cervical cancer screening in Greece by presenting the two regionally organised screening programmes that currently operate in the country. Both programmes were initiated in 1991 and are partly funded by the European Union. The Ormylia screening programme covers the population of Halkidiki (Northern Greece), a predominantly rural area. The second programme covers the regions of Messinia and Ilia (Southern Greece). Both programmes are targeted at women aged 25-64 years of age and a Papanicolaou (Pap) smear test is recommended every 2-3 years. Electoral and municipal registries are used to identify the target population and personal invitations are sent to the eligible women in the screening programme. The Ormylia programme is based at the Centre 'Our Lady Who Loves Mankind', whereas mobile units are used by the Messinia and Ilia programme. Slide reading for the Ormylia programme is performed in the cytology laboratory of Alexandra Hospital in Athens and epidemiological support is provided by the Department of Hygiene and Epidemiology (Medical School, University of Athens). A specifically designed database is used for data recording. Over 80% of the target population in the region have already been screened. Communication of results is by means of a personal letter upon a negative result and in person upon a suspicious result. Quality assurance in both programmes is based on the European protocol. These two programmes are the sole organised cervical cancer screening activities in Greece in the absence of a national programme. They employ well-trained personnel, they use modern equipment and have strict quality assurance procedures.
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Affiliation(s)
- E Riza
- Department of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias St, GR 115 27 Goudi, Athens, Greece.
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