Diphtheria and Tetanus Immunity Status among Greek Adults: Results from a Nationwide Seroprevalence Study

Diphtheria and tetanus could lead to serious morbidity. We aimed to evaluate immunity levels by measuring specific IgG antibodies for diphtheria and tetanus in serum samples from a nationally expanded sample of the Greek population. A geographically stratified sampling approach based on regional units (NUTS level 2) was applied by considering variables such as age group (30-80+) and sex. In total, 1201 persons (47.7% males and 52.3% females) participated in the survey. Bivariate analysis revealed a negative relationship between diphtheria and tetanus median antibody titers and age. The overall seropositivity rate for diphtheria IgG antibodies (≥0.10 IU/mL) was estimated at 31.5%. Regarding tetanus, the total seropositivity rate was estimated at 59.5% (tetanus IgG antibodies ≥0.10 IU/mL). Logistic regression analysis indicated that age groups <40 years and 40-59 years were independently associated with tetanus seropositivity. Logistic regression also revealed that male sex and being aged 60-69 years were independent risk factors for diphtheria-related seropositivity. Lastly, being resident of some regions was an independent risk factor for both diphtheria- and tetanus-related seropositivity. The present study shows that Greek adults are still not completely immune to diphtheria and tetanus. It is likely possible to achieve optimal immunization coverage by implementing serviceable public health initiatives after comprehending real community needs.

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

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.

Healthcare Workers' Attitudes towards Mandatory COVID-19 Vaccination: A Systematic Review and Meta-Analysis

BACKGROUND

COVID-19 vaccine mandates are considered a controversial public health policy both in public debate and among healthcare workers (HCWs). Thus, the objective of this systematic review is to give a deep insight into HCWs' views and attitudes towards COVID-19 vaccination mandates amid the ongoing COVID-19 pandemic.

METHODS

A systematic literature search of five databases (PubMed, Scopus, Embase, CINAHL, and Web of Science) was conducted between July 2022 and November 2022. Original quantitative studies that addressed the attitudes of HCWs regarding COVID-19 vaccine mandates were considered eligible for this systematic review. All the included studies (n = 57) were critically appraised and assessed for risk of systematic bias. Meta-analyses were performed, providing a pooled estimate of HCWs' acceptance towards COVID-19 vaccine mandates for: 1. HCWs and 2. the general population.

RESULTS

In total, 64% (95% CI: 55%, 72%) of HCWs favored COVID-19 vaccine mandates for HCWs, while 50% (95% CI: 38%, 61%) supported mandating COVID-19 vaccines for the general population.

CONCLUSIONS

Our findings indicate that mandatory vaccination against COVID-19 is a highly controversial issue among HCWs. The present study provides stakeholders and policy makers with useful evidence related to the compulsory or non-compulsory nature of COVID-19 vaccinations for HCWs and the general population. Other: The protocol used in this review is registered on PROSPERO with the ID number: CRD42022350275.

Assessment of Vaccination Status in Professional Football Players in Low Categories in Greece

BACKGROUND

There are limited data on the vaccination practices of footballers in low professional categories in Greece and Europe. The aim of this study was to investigate the vaccination practices followed by the medical staff of the low professional football categories in Central Greece.

METHODS

A questionnaire was developed and included questions on the vaccination practices of football players. The participants were chief medical officers of the fifteen low-category football teams in Central Greece. Overall, 10 out of 15 chief medical officers participated (response rate: 67%).

RESULTS

All participants recommended only the tetanus monovalent vaccine in cases with deep trauma of athletes. Influenza, pneumococcal vaccine, and Hepatitis A and B vaccines were not recommended by the medical officers. This was also the case for measles, mumps, rubella (MMR) vaccine and meningococcal vaccine with strains A, C, Y, W. Participants reported the lack of specific guidelines for vaccination in professional footballers.

CONCLUSIONS

The recent study showed poor vaccination practices in low categories of professional football teams in Central Greece. The qualitative view of the respondents revealed the importance of the absence of guidelines on vaccination of football players.

Increased Influenza Vaccination Coverage among Members of the Athens Medical Association Amidst COVID-19 Pandemic

Healthcare workers are at high risk of influenza virus infection as well as of transmitting the infection to vulnerable patients who may be at high risk of severe illness. The aim of this cross-sectional study was to investigate the prevalence and related factors of influenza vaccination coverage (2020-2021flu season), among members of the Athens Medical Association in Greece. This survey employed secondary analysis data from a questionnaire-based dataset on COVID-19 vaccination coverage and associated factors from surveyed doctors, registered within the largest medical association in Greece. All members were invited to participate in the anonymous online questionnaire-based survey over the period of 25 February to 13 March 2021. Finally, 1993 physicians (60% males; 40% females) participated in the study. Influenza vaccination coverage was estimated at 76%. Logistic regression analysis demonstrated that older age (OR = 1.02; 95% C.I. = 1.01-1.03), history of COVID-19 vaccination (OR = 2.71; 95% C.I. = 2.07-3.56) and perception that vaccines in general are safe (OR = 16.49; 95% C.I. = 4.51-60.25) were found to be independently associated factors with the likelihood of influenza vaccination coverage. Public health authorities should maximize efforts and undertake additional actions in order to increase the percentage of physicians/health care workers (HCWs) being immunized against influenza. The current COVID-19 pandemic offers an opportunity to focus on tailored initiatives and interventions aiming to improve the influenza vaccination coverage of HCWs in a spirit of synergy and cooperation.

Knowledge, Attitudes, and Practices of Primary Care Physicians towards COVID-19 in Greece: A Cross-Sectional Study

The aim of this study was to investigate the knowledge, attitudes, and practices of primary care physicians and residents towards the COVID-19 pandemic in Greece. A cross-sectional questionnaire-based study was conducted in Greece during March 2021. The population frame for the study was a list of currently practicing primary care physicians and residents who were registered within one of the main associations of general/family medicine in Greece. Hierarchical multiple logistic regression analysis was performed for practices at higher levels (vs. lower) in relation to knowledge, attitudes, and general characteristics of participants. Overall, 194 participants completed the survey (e-response rate: 38.4%). In total, 94% of participants were familiar with official recommendations regarding SARS-CoV-2, and 88.7% were vaccinated against SARS-CoV-2 or promptly intended to be. Physicians working in the private sector had a higher average practices score when compared to physicians working in the public sector (87.6 vs. 81.9, p < 0.05). Higher levels of attitudes predicted greater odds for higher levels of practices (odds ratio = 4.18, p < 0.05). Despite the relatively high COVID-19 vaccination rate of physicians, several participants were unvaccinated due to a then unscheduled first dose appointment. Attitudes were the only determinant for more proper practices towards the prevention of COVID-19.

Mortality and morbidity from infectious and non-communicable diseases in Greece during Axis/Nazi military occupation (1941-1944)

Greece has been severely damaged by the Second World War and the subsequent military occupation of the country by the Axis forces headed by Nazi Germany. The Greek society and economy were dislocated as a result of plundering of the country's vital resources, as well as enforced payments, instead paid to the occupying forces. The dramatic food shortages and famine appeared plaguing especially large cities. There is very limited information on the trends of mortality and morbidity (1941-1944) at a national level. The morbidity and mortality statistics of the General Statistical Service of Greece were assessed and the incidence morbidity and mortality rates have been calculated. As denominator population we used the population of Greece according to 1940 census. The morbidity due to exanthematic typhus, typhoid fever, dysentery and meningitis has been elevated over the period 1940-1944. An elevated specific mortality due to tuberculosis, malaria and typhoid fever was observed over the period 1940-1941. Regarding non-communicable diseases, the mortality due to hemorrhagic stroke was increased after 1940. In conclusion, we found that the Axis/Nazi military occupation of Greece had considerable health effects on infectious diseases and hemorrhagic stroke mortality. Deaths ostensibly due to infectious diseases (e.g. tuberculosis or malaria), were expedited by the hunger famine of the period under investigation. With regard to the elevated mortality due to hemorrhagic stroke, we believe that the stressful events of occupation and famine have triggered increased psychosocial stress which in turn may have increased the risk of hemorrhagic stroke mortality during the period of Axis/Nazi occupation of Greece.

Study Protocol: The Feeding Exercise Randomized Trial among Overweight and Obese Adolescents in Greece

Background: This paper describes the study protocol used in the Feeding Exercise Clinical Trial in Adolescents in the region of Larissa in Greece, a randomized controlled clinical trial, among overweight/obese adolescents.

Methods: The main aim of the study was to comparatively evaluate the effectiveness of 2 different clinical interventions among 12 to 18-year-old overweight and obese adolescents. The first group participated in an exercise program and the second group in a combined dietary and exercise program. The third group was the control group. The study was conducted between 2014 and 2015. All adolescents aged 12 to 18 years old from public schools of Larisa and also their parents asked to participate. The effects of the intervention program will be analyzed by repeated-measures analysis of variance or the Friedman test. Changes in lifestyle behaviors from the baseline to the end of the intervention will be assessed using a chi-square test for categorical variables. A Pearson or a Spearman correlation coefficient and a linear regression analysis will be performed to explore any associations between quantitative variables. The following parameters were measured among adolescents: height, weight, body mass index, waist circumference, systolic and diastolic pressure, pulse rate, dietary and exercise habits of the adolescents and their parents.

Conclusion: This is the first clinical trial in Greece investigating the impact of clinical interventions on obesity among adolescents. It is expected that the results will provide useful insights into the effectiveness of clinical interventions among overweight and obese adolescents in Greece.

Reported COVID-19 Vaccination Coverage and Associated Factors among Members of Athens Medical Association: Results from a Cross-Sectional Study

There are limited data on the prevalence and determinants of COVID-19 vaccination coverage among physicians. A cross-sectional, questionnaire-based, online study was conducted among the members of the Athens Medical Association (I.S.A.) over the period 25 February to 13 March 2021. All members of I.S.A. were invited to participate in the anonymous online survey. A structured, anonymous questionnaire was used. Overall, 1993 physicians participated in the survey. The reported vaccination coverage was 85.3%. The main reasons of no vaccination were pending vaccination appointment followed by safety concerns. Participants being informed about the COVID-19 vaccines by social media resulted in lower COVID-19 vaccination coverage than health workers being informed by other sources. Logistic regression analysis demonstrated that no fear over COVID-19 vaccination-related side effects, history of influenza vaccination for flu season 2020–2021, and the perception that the information on COVID-19 vaccination from the national public health authorities is reliable, were independent factors of reported COVID-19 vaccination coverage. Our results demonstrate a considerable improvement of the COVID-19 vaccination uptake among Greek physicians. The finding that participants reported high reliability of the information related to COVID-19 vaccination provided by the Greek public health authorities is an opportunity which should be broadly exploited by policymakers in order to combat vaccination hesitancy, and further improve COVID-19 vaccination uptake and coverage among physicians/HCWs, and the general population.

Living in Roma Settlements in Greece: Self-Perceived Health Status, Chronic Diseases and Associated Social Determinants of Health

We aimed to assess the self-perceived health status and the presence of chronic diseases of adult Roma living in settlements in Greece, and to explore associated social determinants of health. Data were derived from the Hprolipsis Health Survey. Multivariable regression models were applied. In total, 534 adults, 287 women, and 247 men were recruited from twelve Roma settlements in four prefectures. Although 62% of the participants perceived their health status as good/very good, about half of them had been diagnosed with at least one chronic disease. Several structural and intermediary social determinants of health were found to be significantly associated with the health outcomes; prefecture, settlement type, sex, age group, living with a partner, presence of depression symptoms, food insecurity, and alcohol consumption were associated with self-perceived health status; settlement type, sex, age group, presence of anxiety symptoms, food insecurity and number of persons living in the house with the presence of a chronic disease. This is one of the few studies assessing the self-perceived health status and presence of chronic diseases in Roma settlements in Greece and investigating the associated social determinants of health in the world. Community-based participatory action research and health literacy programs are needed to mitigate health inequalities in Roma settlements.

Perceived Importance of Public Health Risks in Greece: A Nationwide Survey of the Adult Population

The current study is the first to examine the perceptions of the Greek public towards selected health risks and prioritize perceived risk importance and the needs to be addressed for public health promotion. Participants were asked to consider the individual importance of selected risks and the top three most important risks. Data collection took place on February 2020 in a representative sample of the adult Greek population. Differences between groups were assessed with Chi-square tests. Logistic regression models were used to identify perceptions based on participants’ characteristics. Analysis was conducted in Stata 14, and 1976 adults participated in the survey: 48% male and 52% female. Road accidents, cancer and air pollution and environmental protection were considered the top three most important public health risks. Differences were observed between sexes; females were more concerned regarding the importance of the examined public health risks, and between age groups, younger ages considered STDs and contraception more important than older ages. Finally, non-smokers considered exercise and smoking to be more important than smokers. This is the first study to present and grade the public’s perceptions on the importance of public health risks in Greece. Our study’s prioritization of health risks could aid health authorities in improving and promoting the overall public health in Greece.

Nationwide Study on Practices Related to Screening Among Greek Paediatricians

Objective

The aim of this study was to investigate pediatricians' practices toward screening in Greece.

Materials and Methods

The survey was conducted within a six month period in a stratified random sample of 371 pediatricians. A questionnaire with three sections was created and pilot tested. Socio-demographic characteristics associated with inappropriate screening were identified using multivariable logistic regression models and latent class analysis.

Results

A total of 294 participants completed the telephone survey (response rate 78.6%). The median number of wrong answers to questions related to pediatricians' practice towards screening recommendations was 7±1.57 with minimum 2 and maximum 11 wrong answers. Pediatricians, with less than 15 years of experience, age >50 years old or view more than eighty patients per week, have had significantly higher odds of responding wrong to more than seven questions, hence be less compliant to USPSTF screening guidelines. Latent class analysis has shown that female gender, age <50 years old, and work in the private sector, were associated with a poor practice towards international screening guidelines.

Conclusion

Our survey found gaps in screening practices among a nationwide sample of Greek pediatricians. Moreover considerable variability in reported practices of screening was noted. There is a need for the development of a national childhood screening program in Greece.

Vaccination practices and influenza in professional football players in Greece

BACKGROUND

There is limited data on vaccination practices for professional footballers globally.

AIMS

To record vaccination practices employed by medical staff of individual football teams of the Super League Greece, and absenteeism of footballers related to influenza illness.

METHODS

A brief questionnaire was distributed to chief medical officers (CMOs) of the sixteen teams of the Super League Greece. Participants were asked to report vaccines they recommended for footballers. In addition, the questionnaire included questions on new cases of influenza and absenteeism due to influenza. Descriptive statistics (absolute and relative frequencies) were used for the presentation of the results.

RESULTS

Overall, 87% of the CMOs recommended seasonal influenza vaccine, 62% hepatitis B vaccine and 50% pneumococcal vaccine. Fourteen CMOs (87%) reported that the occurrence of seasonal influenza in the 2016-17 northern hemisphere season ranged from one to five cases, while two medical officers (12%) reported zero workdays lost due to influenza.

CONCLUSIONS

Our survey shows considerable variation in vaccination practices of CMOs of the Super League Greece. The results of this survey should stimulate further evaluation of vaccination policy and influenza-related absenteeism in footballers.

Thessaly and medicine from ancient Greek mythology to contemporary times: a perpetual relationship

The aim of this narrative review is to provide an overview of the connection between Thessaly and the development of medicine from ancient Greek mythology to contemporary times. From Chiron to Asclepius, from Asclepius to Hippocrates, and from Hippocrates to the true Hippocratic epidemiologist Dimitrios Trichopoulos, a plethora of myths and facts indicate the strong and perpetual alignment between Thessaly and the science of medicine.

Spatial and temporal distribution of p,p'-DDE (1‑dichloro‑2,2‑bis (p‑chlorophenyl) ethylene) blood levels across the globe. A systematic review and meta-analysis

BACKGROUND

Although p,p'‑DDT (1,1,1‑trichloro-2,2‑bis (p‑chlorophenyl)‑ethane) has been banned for decades in most countries, its major metabolite p,p'-DDE (1‑dichloro‑2,2‑bis (p‑chlorophenyl) ethylene) is still detected in the vast majority of human blood samples.

OBJECTIVES

The purpose of this study was to quantitatively estimate the geographical distribution of DDE blood levels and record time-trends for specific countries and continents, exploiting available data from the scientific literature.

METHODS

A literature search was performed in SCOPUS and PUBMED databases. Studies were screened at 2 levels applying different sets of inclusion/exclusion criteria. Blood levels of DDE along with other variables of interest were extracted, and a meta-analysis of random effects was conducted, by using the package metafor within the statistical programming language R. Results were expressed as pooled geometric means (GM [95% confidence intervals, CIs]).

RESULTS

A total of 418 papers were included in the quantitative synthesis that contained data for 854 population subgroups, and analyzed a total of 195,595 samples. Overall global DDE concentrations dropped from 5207 (95% CI: 3616-7499) ng/g lipids during 1951-1969 to 207 (95% CI: 159-269) ng/g lipids for studies reporting sampling after 2000. Analyses for studies published from 2001 and onward revealed geographical differences regarding DDE burden.

DISCUSSION

The significant decline in DDE blood levels after its restriction is demonstrated in our results. Differences in decrease trends were observed in different parts of the globe, which can be explained by deferred implementation of environmental policies. In some countries DDE concentrations remain high, and systematic biomonitoring is proposed.

Respiratory Symptoms and Lung Function among Greek Cotton Industry Workers: A Cross-Sectional Study

Background:

Workers in cotton industry are occupationally exposed to various dust-related hazards. The nature of these agents and the respective exposure levels depend on the cotton industry specific sector. These exposures could be associated with respiratory symptoms and changes in lung function parameters.

Objective:

To evaluate associations between occupational exposure and respiratory function as well as reported symptoms in several groups of workers at different stages of the cotton industry in a vertical approach that covers all the major sectors—from cotton ginning to weaving and fabric production.

Methods:

A questionnaire on respiratory symptoms and individual as well as workplace characteristics was completed by 256 workers at the cotton industry and 148 office workers (control group). Both groups underwent spirometry.

Results:

Workers in cotton industry reported a higher prevalence of severe dyspnea (p=0.002) and wheezing (p=0.004) compared to the control group. Also they were found to have a lower predicted FEV1% (p<0.029) and lower FEV1/FVC (p<0.001) values. In addition, a higher prevalence of FEV1% <80% (p<0.001) and FEV1/FVC <70% (p=0.041) were found among textile workers. Similar results were found for non-smoker textile workers compared to non-smoker control group workers. Those working in cotton ginning mills recorded the highest decrease of spirometric values. Duration of employment in cotton industry and smoking use were found to be predictors of lung function decline for cotton industry workers.

Conclusion:

Occupational exposure to cotton dust was associated with increased prevalence of respiratory symptoms and obstructive pattern in pulmonary function test.

Company closure and mortality in a Greek bus company

BACKGROUND

Previous studies strongly support an association between unemployment and an increased risk of morbidity and mortality.

AIMS

To assess the impact of company closure on the mortality of redundant employees.

METHODS

The mortality of a cohort of male ex-employees of the Athens Bus Transportation Company Epixirisi Astikon Siginonion (EAS) was followed from September 1992 to October 1993. Information on causes of death was obtained from death certificates and classified according to the ninth revision of the International Classification of Diseases. The expected number of deaths was calculated based on 5 year age groups. Cause-specific mortality rates for the Greek population were obtained from the Greek National Statistics Service, and standardized mortality rates (SMRs) were calculated using population census data for 1991.

RESULTS

The cohort consisted of 4400 subjects. Thirty deaths were recorded. Crude mortality was significantly elevated (SMR = 1.75; 95% confidence interval (CI) 1.18-2.5; Table 1). A statistically significant excess in mortality from ischaemic heart disease was shown (18 deaths observed; SMR = 4.83; 95% CI 2.86-7.64). One year before the privatization and closure of EAS (1991), nine deaths were recorded among its 7400 employees (SMR = 0.34).

CONCLUSIONS

Our study found a significant increase in all-cause mortality and death from ischaemic heart disease in male workers who were made redundant and suggested a significant negative impact of unemployment resulting from company closure on mortality. These results may signal future mortality patterns in Greece if the current climate of austerity and recession continues.

Exposure to occupational health hazards among Zambian workers

BACKGROUND

Data on occupational safety and health in Southern Africa are scant. Hence the negative impact of poor working conditions is unknown and the scientific basis for interventions and policy formulation is lacking.

AIMS

To determine the prevalence of, and factors associated with, exposure to occupational health hazards in Zambia.

METHODS

We used data collected in the 2009 National Labour Force Survey. Unadjusted and adjusted odds ratios and their 95% confidence intervals were used to measure magnitudes of associations.

RESULTS

Exposure to occupational hazards among the 64 119 respondents (response rate = 78%) included vibration from hand tools or machinery (3%), temperatures that make one perspire even when not working (4%), low temperatures whether indoors or outdoors (4%), smoke, fume, powder or dust inhalation (13%), pesticides (3%), noise so loud that voice had to be raised to talk to people (4%), chemical handling or skin contact (3%) and exposure to heavy object lifting, frequent bending of the back or rapid movement of limbs causing body pain (30%). In multivariate analysis, exposure to occupational health hazards was associated with older age, male sex, low educational level, being married/cohabiting and not being self-employed.

CONCLUSIONS

Results from this study indicate that Zambian workers are exposed to a broad range of occupational health hazards. This could be useful for the formulation of a multi-sector approach aimed at the prevention and control of hazard exposure.

Features of registered occupational diseases in Greece: a veil of ignorance

BACKGROUND

Under-registration of occupational diseases is a global problem.

OBJECTIVES

The aim of this study was to describe the characteristics of the reported cases of occupational diseases, in the context of the largest insurance scheme in Greece.

METHODS

Socio-demographic characteristics related to the identified cases of occupational diseases were collected from the archives of the special medical committee of the Social Insurance Institute (Idrima Koininikon Asfaliseon, IKA) for the year 1999. This year was chosen given that it largely represents the highest number of registered occupational diseases in comparison to the period 2000-2009.

RESULTS

Sixty-seven (67) occupational diseases were recognized (3.4 cases/100,000 employees). There were 32 new cases (incidence rate: 1.64/100,000 employees). Occupational skin conditions and diseases of the respiratory system accounted for 85% of all diagnoses. Builders and unskilled blue collar workers were the most frequent occupational groups affected.

CONCLUSIONS

These findings indicate a high rate of under-registration of occupational diseases in Greece, compared to data from the European Union. This under-registration could be attributed to a variety of limitations related to the current model of occupational health in Greece. The present pattern of registered occupational morbidity reflects the under-development of occupational health in Greece and stresses the need for further and intensified work in order to create modern occupational health services in this country.

Prevalence of self-reported symptoms compatible with carpal tunnel syndrome (CTS) among employees at a neonatal intensive care unit: a cross-sectional study

BACKGROUND

Carpal Tunnel Syndrome is a significant work-related disease.

OBJECTIVE

The aim of the study was to investigate the prevalence of symptoms possibly related to CTS in workers in a neonatal intensive care unit.

METHODS

The self-administered INRS questionnaire for musculoskeletal symptoms was distributed to all 41 employees of a neonatal intensive care unit and to an appropriate sample of 82 employees of a paediatric emergency department and an adult intensive care unit.

RESULTS

Employees of the neonatal intensive care unit recorded a significantly higher prevalence of symptoms potentially related to CTS in comparison with the reference group (58.5% vs 8.3%, respectively; p < 0.001). Logistic regression analysis indicated that work in the neonatal intensive care unit was independently associated with the risk of symptoms potentially related to CTS.

CONCLUSIONS

The results provide some evidence for a higher prevalence of symptoms potentially related to CTS in nursing personnel of a neonatal intensive care unit. Further research work is needed to prove a causal association.

Low acceptance of vaccination against the 2009 pandemic influenza A(H1N1) among healthcare workers in Greece

A questionnaire survey on the attitude of healthcare workers towards pandemic influenza vaccination showed low acceptance (17%) of the pandemic vaccine. Factors associated with vaccine uptake were acceptance of seasonal influenza vaccination, medical profession and age. The main reason for refusal of vaccination was fear of side effects, which was stronger in those who received information on the safety of the vaccine mainly from mass media.

Low acceptance of vaccination against the 2009 pandemic influenza A(H1N1) among healthcare workers in Greece

A questionnaire survey on the attitude of healthcare workers towards pandemic influenza vaccination showed low acceptance (17%) of the pandemic vaccine. Factors associated with vaccine uptake were acceptance of seasonal influenza vaccination, medical profession and age. The main reason for refusal of vaccination was fear of side effects, which was stronger in those who received information on the safety of the vaccine mainly from mass media.

The decision making process on public health measures related to passenger ships: the example of influenza pandemic 2009

BACKGROUND

Public health measures at sea ports have posed a challenge for public health competent authorities, especially in the context of the influenza pandemic of 2009. This paper discusses the response of authorities to notifications of infectious diseases on passenger ships and the importance of assessing the risks related to cases of influenza. It further provides options for health measures and considerations for decision making during a pandemic such as the influenza pandemic of 2009.

DISCUSSION

Prevention and control of influenza have included action taken by both competent port authorities and ships' crews. Assessing the public health risk of each event reported from ships to competent authorities at ports is important before advice is given on implementation of control measures. Public health risk assessment involves appraisal of threats to passengers and crew on board the ship as well as to the population in the community.

SUMMARY

Any public health measures taken should be necessary and proportional to the threat. Measures at ports cannot alone be effective in the prevention of the spread of a disease to the community since other means of transport play a major role. Measures taken on board ships can be effective in containing the disease. Consistent policy based on common protocols and carried out by competent authorities at local, national, European, or international levels are essential.

Prevalence of hepatitis A virus infection among municipal solid-waste workers

A study was conducted among 151 municipal workers (72 solid-waste workers, and 79 workers not exposed to waste). Total antibodies against Hepatitis A virus (HAV) were measured, and socio-demographic information was collected using a self-administered questionnaire. Univariate analysis has shown that occupational exposure to waste, age, duration of employment and educational status were significantly associated with the prevalence of anti-HAV(+). Municipal Solid Waste Workers had a higher prevalence of anti-HAV(+) in comparison with municipal workers not exposed to waste. Duration of employment was significantly associated anti-HAV(+). Multivariate analysis revealed an independent association of anti-HAV(+) with occupational exposure to waste and ageing. Our results suggest a potential causal role of occupational exposure to waste, in the development of HAV infection.

Epidemiologic profile of otorhinolaryngological, head and neck disorders in a tertiary hospital unit in Greece: a challenge for general practitioners?

BACKGROUND

In Greece, primary care is still developing. The aim of this study was to define the epidemiologic profile of common otorhinolaryngological, head and neck disorders in order to help general practitioners to deal with them in a primary care future.

METHODS

A total of 6771 patients attended the Otorhinolaryngology emergency department of the University General Hospital of Heraklion (Crete), between January and December 2004. All cases were included in this retrospective study. The registry of the Otorhinolaryngology emergency department was analysed and age, sex, seasonality and clinical diagnosis were tabulated. All patients were evaluated by Otorhinolaryngologists. The classification of the cases was based on the main symptom or clinical sign that conditioned the reason for seeking care. Diagnoses were also coded according to the International Classification of Diseases (ICD-10).

RESULTS

The male to female ratio was 1:1. The mean age for females was 36.3 years standard deviation (SD): 21.1 and for males was 36.8 years (SD = 22.0). Eight hundred eighty six patients (13.1%) formed the paediatric sub-group. Over 60% of the cases were classified in ten major groups of diagnosis. Acute tonsillitis (12.3%) and acute pharyngitis (9.0%) were the most common causes of all medical visits, followed by otitis media (7.6%) and external ear canal obstruction by ear wax (6.2%). Oedema of the larynx was detected in 0.4%. A negative diagnosis of otorhinolaryngological, head and neck disorder was formulated in 553 patients (8.2%). Hospitalization rate was 5.2%. The highest rate of visits was registered in March.

CONCLUSION

Most patients used the facility as a primary care service. Real emergencies were a minority. Recovering data about which areas of Otorhinolaryngology deserve more emphasis might help primary health care providers to diagnose and manage the common otorhinolaryngological, head and neck disorders properly.

Quality of life and smoking among industrial workers in Greece

BACKGROUND

Smoking is a predictor of quality of life, while socio-economic factors influence the prevalence of smoking habits. Occupational medical research has been fairly late in coming to study quality of life aspects in working populations.

OBJECTIVES

The aim of the study is the assessment of smoking prevalence among blue- and white-collar workers industrial workers in Greece and its impact on health-related quality of life.

METHODS

In a cross-sectional study the Euro-Qol 5D questionnaire was been used in a random sample of 472 blue and white-collar heavy industry workers.

RESULTS

57% of the study population were current smokers. The difference in prevalence of smoking across all the examined socio-demographic variables (sex, age, education and occupation) was not statistically significant. Smoking had a significant impact on the health-related quality of life. Smokers recorded significant lower scores (74.9) in the overall Visual Analogue Scale in comparison with non-smokers (79.1), (p = 0.007). Further analysis revealed that age, smoking and education were significant predictors of VAS score. A non-significant contribution was found for occupation and sex. Smokers reported significantly higher rates of problems regarding mobility, self-care and anxiety/depression than non-smokers. Logistic regression analysis showed an independent impact of smoking on mobility, self-care and anxiety/depression level.

CONCLUSIONS

Smoking is a significant hazard and a strong predictor of poor quality of life among the blue- and white-collar workers under study. Anti-smoking policies integrated into a broader context of occupational health and safety at work could reduce smoking rates and thus improve worker's quality of life.

Increased risk for coronary heart disease in blue-collar workers at a military industrial plant in Greece?

OBJECTIVE

To test the hypothesis that blue-collar workers have a higher prevalence of risk factors for Coronary Heart Disease than white-collar workers.

METHODS

A cross-sectional study of 262 employees (208 males, 54 females, mean age: 50,65 years) was made of a Greek military industrial plant. Blood samples were taken and analyzed for lipids, lipoprotein levels and glucose levels; arterial blood pressure and body mass index (BMI) were also recorded. Smoking habits were ascertained by the use of a self-administered questionnaire.

RESULTS

White-collar workers had significantly higher mean levels of total and LDL cholesterol than blue-collar workers. No significant differences were found regarding arterial blood pressure, BMI, glucose, triglycerides and HDL cholesterol levels. Both groups reported similarly high rates of smoking. Multivariate analysis confirmed an independent association of abnormal levels of total and LDL cholesterol with white-collar occupation.

CONCLUSION

These findings partly contradict the current pattern of CHD risk factors in Western workforces. Possible interpretations, as well as the limitations of the study, are discussed.

Prevalence of hepatitis B virus markers in municipal solid waste workers in Keratsini (Greece)

AIM

To evaluate the prevalence of hepatitis B virus (HBV) markers among municipal solid waste workers (MSWWs) in Keratsini (Greece).

METHODS

We assessed in a cross-sectional study the prevalence of biological markers of HBV infection (HbsAg, anti-Hbc, anti-Hbs) and their association with exposure to waste and other socio-demographic factors in 166 municipal employees in Keratsini (Greece).

RESULTS

The prevalence of anti-Hbc (+) did differ significantly between exposed and non-exposed employees to waste. Older employees had a significantly higher prevalence of anti-Hbc (+). MSWWs who were anti-Hbc (+) were less educated than non-exposed employees. Logistic regression analysis has shown that the exposure to waste and age were independently associated with the anti-Hbc positivity.

CONCLUSION

Occupational exposure to waste is possibly associated with the acquisition of HBV infection. Immunization of MSWWs should be considered to reduce the risk of HBV infection.

Vaccination against hepatitis B virus in workers of a general hospital in Athens

BACKGROUND

Protection against hepatitis B virus infection by vaccination is considered to be an important preventive measure for health care workers.

OBJECTIVES

Investigation of vaccination coverage against hepatitis B virus in health care workers of a regional general hospital in Athens and assessment of predictive factors possibly associated with the likelihood of vaccination.

METHODS

In a cross-sectional study, a questionnaire survey was carried out on 175 health care workers of a regional general hospital in Athens. The questionnaire included questions concerning socio-demographic factors, HBV vaccination status and reasons for non-vaccination, as well as questions about knowledge of routes of transmission and the complications of HBV infection. Compliance with preventive practices against HBV infection was also assessed.

RESULTS

Overall vaccination coverage was 57.1%. Logistic regression analysis revealed that occupation and use of gloves were independently associated with the likelihood of vaccination against HBV Doctors recorded an odds ratio (OR) for vaccination of 4.45 in comparison with nurses/paramedics. Health care workers who wore gloves always/most times demonstrated an odds ratio of 2.79 for vaccination against HBV in comparison with those who never/rarely used them.

CONCLUSIONS

Our study illustrates the characteristics of health care workers with lower prevalence of vaccination against HBV in a representative sample of these workers in a regional general hospital in Athens: nurses/paramedics, those with low level of compliance with use of gloves, and those in non surgical departments. Educational interventions as part of a vaccination programme and continuing education on universal precautions could help increase HBV vaccination coverage among health care workers of the hospital under study.

Occupational injuries in Greece (1938-1955): history of medicine and descriptive epidemiology

AIM

To describe the longitudinal trends in the rates of total and fatal occupational accidents in Greece during 1938-1955.

MATERIAL AND METHODS

Information on occupational injuries have been provided from the yearly reports of the Organization of Social Insurances (1938-1955) and on population data from the tables of National Statistic Agency. Bio-statistical analysis was performed by the use of SPSS software and Stat-Calc of Epi Info.

RESULTS

The evolution of the longitudinal trend of occupational accidents has revealed a biphasic character, with a decreasing trend during 1938-1945 and an increasing trend during 1946-1955. The phenomenon was obvious in both sexes and in all age groups. On the contrary fatal occupational injuries increased across the period 1938-1945 and subsequently decreased. These temporal trends can be interpreted on the light of the important reduction in the level of economic activity during the second world war and the subsequent gradual recovery in the post war period.

CONCLUSION

The biphasic characteristics of the occupational accidents longitudinal trend seems to be influenced by historical factors. Important lessons were learnt from the period of war. The decrease of the rate of total occupational accidents does not necessary reflect a satisfactory level of safety at work. The level of the economic activity, the efficiency of the registration and prevention agencies play a role. In addition, the rate of fatal injuries has a critical role in benchmarking national occupational health performance.