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Papakonstantinou E, Zacharodimos N, Georgiopoulos G, Athanasaki C, Bothou DL, Tsitsou S, Lympaki F, Vitsou-Anastasiou S, Papadopoulou OS, Delialis D, Alexopoulos EC, Petsiou E, Keramida K, Doulgeraki AI, Patsopoulou IM, Nychas GJE, Tassou CC. Two-Month Consumption of Orange Juice Enriched with Vitamin D3 and Probiotics Decreases Body Weight, Insulin Resistance, Blood Lipids, and Arterial Blood Pressure in High-Cardiometabolic-Risk Patients on a Westernized Type Diet: Results from a Randomized Clinical Trial. Nutrients 2024; 16:1331. [PMID: 38732578 PMCID: PMC11085203 DOI: 10.3390/nu16091331] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
This study examined the effects of orange juice (OJ) supplemented with vitamin D3 (2000 IU) and probiotics (Lacticaseibacillus casei Shirota and Lacticaseibacillus rhamnosus GG, 108 cfu/mL) on cardiometabolic risk factors in overweight and obese adults following a Westernized-type diet. Fifty-three high-risk individuals were randomly assigned to one of two groups. Over 8 weeks, one group consumed a vitamin D3 and probiotic-enriched OJ and the other regular OJ (control). Diets remained unchanged and were documented through food diaries. Measures of metabolic and inflammatory markers and blood pressure were measured at the start and end of the study. Post-intervention, the enriched OJ group showed the following significant metabolic improvements (without changes in triglycerides, inflammation, or central blood pressure): reduced fasting insulin, peripheral blood pressure, body weight (-1.4 kg 95% CI: -2.4, -0.4), energy (-270 kcal 95% CI: -553.2, -13.7), macronutrient (dietary fat -238 kcal 95% CI: -11.9, -1.0; carbohydrates -155 kcal 95% CI: -282.4, -27.3; sugars -16.1 g 95% CI: -11.9, -1.0) intake, and better lipid profiles (total cholesterol -10.3 mg/dL 95% CI: -21.4, 0.9; LDL-C -7 mg/dL 95% CI: -13.5, -0.5). The enriched OJ led to weight loss, less energy/macronutrient consumption, improved lipid profiles, and increased insulin sensitivity after 8 weeks in those following a Westernized diet, thus indicating potential benefits for cardiometabolic risk. This study was a part of FunJuice-T2EDK-01922, which was funded by the EU Regional Development Fund and Greek National Resources.
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Affiliation(s)
- Emilia Papakonstantinou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Nikolaos Zacharodimos
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sophias Ave, 11528 Athens, Greece; (G.G.)
| | - Christina Athanasaki
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Dionysia-Lydia Bothou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Sofia Tsitsou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Foteini Lympaki
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Stamatia Vitsou-Anastasiou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
- Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 75 Iera Odos, 11855 Athens, Greece;
| | - Olga S. Papadopoulou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sophias Ave, 11528 Athens, Greece; (G.G.)
| | | | - Eleni Petsiou
- Henry Dunant Hospital, 107 Mesogeion Ave, 11526 Athens, Greece;
| | - Kalliopi Keramida
- Cardiology Department, General Anticancer Oncological Hospital Agios Savvas, 171 Alexandras Ave, 11522 Athens, Greece;
| | - Agapi I. Doulgeraki
- Laboratory of Food Microbiology and Hygiene, Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Ismini-Maria Patsopoulou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
| | - George-John E. Nychas
- Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 75 Iera Odos, 11855 Athens, Greece;
- Shandong Agricultural University, Tai’an 271002, China
| | - Chrysoula C. Tassou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
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Sioula EK, Tigani X, Artemiadis AK, Vlachakis D, Chrousos GP, Darviri C, Alexopoulos EC. An 8-week Stress Management Program in Information Technology Professionals and the Role of a New Cognitive Behavioral Method: a Pilot Randomized Controlled Trial. J Mol Biochem 2020; 9:22-31. [PMID: 33520743 PMCID: PMC7842355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The aim of this study is to compare and evaluate the sort-term benefits of the effects of an 8-week stress management techniques in information technology professionals. METHODS In this parallel randomized controlled trial, participants were randomly assigned to either the stress management group (n=40; relaxation breathing, progressive muscle relaxation, guided imagery) or in the Pythagorean Self awareness group (n=41). Self-reported validated measures were used to evaluate perceived stress, health locus of control, anxiety and depression. RESULTS All groups were found with significantly better cognitive speed and verbal memory at the end of the follow-up. Taking into account the group by time interaction coefficients, PSAT was found significantly superior to standard SM with regards to depression, emotional intelligence, lifestyle and personal control and verbal memory suggesting that verbal memory improvement through time should be mostly attributed to PSAT. On the other hand, the cognitive speed improvement during follow-up should be attributed to both interventions. CONCLUSIONS These findings provide important insight into the role of stress management. Future studies should focus on randomized, controlled trials with larger samples and longer follow-up times.
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Affiliation(s)
- Evangelia K Sioula
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Str., 11527, Athens, Greece
| | - Xanthi Tigani
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Str., 11527, Athens, Greece
| | - Artemios K Artemiadis
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Str., 11527, Athens, Greece
- Medical School, University of Cyprus, Nicosia, 2029, Cyprus
| | - Dimitrios Vlachakis
- Division of Endocrinology and Metabolism, Biomedical Research Foundation of the Academy of Athens, Athens 11527, Greece
- Laboratory of Genetics, Department of Biotechnology, School of Food, Biotechnology and Development, Agricultural University of Athens, 75 Iera Odos, 11855, Athens, Greece
| | - George P. Chrousos
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Str., 11527, Athens, Greece
- First Department of Pediatrics, Children’s Hospital Aghia Sofia, School of Medicine, University of Athens, 1 Thivon Str., 11527, Athens, Greece
| | - Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Str., 11527, Athens, Greece
| | - Evangelos C. Alexopoulos
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Str., 11527, Athens, Greece
- Occupational Health Department, Metropolitan General Hospital, 15562 Athens, Greece
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Cheiloudaki E, Alexopoulos EC. Adherence to Treatment in Stroke Patients. Int J Environ Res Public Health 2019; 16:ijerph16020196. [PMID: 30641978 PMCID: PMC6351941 DOI: 10.3390/ijerph16020196] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/30/2018] [Revised: 12/30/2018] [Accepted: 01/10/2019] [Indexed: 11/16/2022]
Abstract
Background: Compliance with medication in patients who have suffered stroke is usually not-optimal. This study aims to measure the level of compliance with the treatment and to identify socio-demographic, clinical, and subjective factors related to the long-term compliance of stroke patients with their treatment. Methods: 140 patients (66.4% males) suffered an ischemic stroke at least six months old, participated in the survey. Compliance was measured using the Medication Adherence Report Scale and the quality of life by the Stroke Specific Quality of Life questionnaire. Furthermore, the Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire on perceptions about the disease were assessed. The doctor–patient relationship was assessed by the Common-Sense Model of Self-Regulation questionnaire and the family support was assessed by the FSS scale. Univariate and multivariate analysis was employed to identify the significant factors affecting compliance in these stroke patients. Results: In 68.6% of patients the compliance was classified as optimal, in 25.7% as partial and as poor in 5.7%; the last two categories were treated as sub-optimal compliance in multivariate analysis. The high compliance was related to patient’s mental state (OR:3.94 95% CI: 1.84–4.46), the perception medication necessity (OR:1.26 95% CI: 1.01–1.56), and the doctor–patient communication (OR:1.76 95% CI: 1.15–2.70). Men showed a lower compliance than women, as well as increased concerns about taking medication (OR: 0.83, 95% CI: 0.69–0.99). Paradoxically, the work /productivity related quality of life was inversely associated with compliance (OR (95% CI): 0.44 (0.23 to 0.82)). Conclusions: The perception of medication necessity and the doctor–patient communication are manageable factors associated with compliance in treating patients who have suffered stroke. In addition, rehabilitation and return to work programs should consider these factors when providing support to those persons.
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Affiliation(s)
| | - Evangelos C Alexopoulos
- School of Social Sciences, Hellenic Open University, 26335 Patra, Greece.
- Occupational Health Department, Metropolitan General Hospital, 15562 Athens, Greece.
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Niedhammer I, Milner A, Witt K, Klingelschmidt J, Khireddine-Medouni I, Alexopoulos EC, Toivanen S, Chastang JF, LaMontagne AD. Response to letter to the editor from Dr Rahman Shiri: The challenging topic of suicide across occupational groups. Scand J Work Environ Health 2018. [PMID: 29218357 DOI: 10.1002/9780470743386] [Citation(s) in RCA: 5153] [Impact Index Per Article: 858.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We thank Dr Rahman Shiri (1) for his careful reading of our systematic review and meta-analysis on suicide among agricultural, forestry, and fishery workers (2). Our paper had the objective of providing a pooled effect size of suicide for this occupational group. Suicide is a crucial issue in public and occupational health. Suicide has a multifactorial etiology and recent systematic reviews and meta-analyses have pointed out the role of occupational exposures, mainly psychosocial work stressors, as risk factors for suicide (3, 4). Suicide is a very rare event in the general population and still more seldom in the working population. Indeed, unemployed and economically inactive people have a higher risk of suicide compared to employed people (5, 6). However, the total number of suicides is greater in the employed population than among the economically inactive or unemployed (6). Shiri's letter (1) questioned several aspects of our review and meta-analysis. One comment related to the single reference database used in our review and a suggestion that our review could not be considered to be systematic. The review was based on Medline because our main interest was in quantitative epidemiologic studies. This is the largest database for biomedical literature and we would argue the most pertinent. Furthermore, we checked the reference lists of the most recent papers and literature reviews, and Shiri did not report any paper that was missing. No review, whether searching one or more databases, can expect to be totally exhaustive. There may always be missing studies, especially if we consider grey literature. Thus we assert that our review was systematic, while acknowledging that it may not be perfectly comprehensive. Shiri suggested an absence of quality assessment of the studies included in our meta-analysis. First, quality was considered in the context of our comments in the discussion section. Second, as suggested by Rothman et al (7), quality assessment was replaced by regression analyses of the effect of each quality item (study characteristics, ie, study design, effect measure, reference group, and adjustment). Third, because most studies included in this review were based on objective data (census, administrative, or register data), they were free of many of the sources of bias that exist in studies where information on exposure and outcome must be collected from participants. Consequently, many of the items related to quality were not pertinent, such as response and follow-up rates, coverage and representativeness of the sample, selection, etc. Contrary to what Shiri suggested, all study designs can be informative in this topic because all of them are able to provide an unbiased estimate of the effect size. In addition, the prospective and case-control studies may have shortcomings. For example, we excluded five studies including three prospective and case-control studies in the sensibility analysis because the group of interest was defined on the basis of the exposure to chemicals (pesticides) rather than job title. Our choice to retain the least adjusted models was justified because aggregated data were used for the meta-analysis. Therefore, unless all included studies adjusted for the same covariates measured in the same way, adjusted estimates cannot be meaningfully provided in an aggregate data meta-analysis. In addition, as the objective was above all descriptive and not etiological or explanatory, and as it is the norm in the exploration of social inequalities in health (8), the results from the least (gender- and age-) adjusted models were in line with the objective. Indeed, including more adjustment variables could lead to overadjustment as they may be intermediate variables on the causal pathways between occupation and suicide. Our strategy was in line with previous meta-analyses on similar topics (9-11). Consequently, we would argue that our results are not likely to be largely due to confounding, contrary to the comment by Shiri. Indeed, the study of the contribution of underlying factors in explaining social inequalities in health outcomes is a fully-fledged topic of research (12-15), but this is relevant research to conduct after demonstrating that inequalities exist between social or occupational groups. Several of Shiri's comments were about statistical aspects of our analyses. First, it was suggested that we did not correctly extract the confidence intervals for the estimates of several studies. We disagree. We used the STATA metan suite of commands using log-transformed effect sizes and standard errors. Our figure 1 and the values of effect sizes and confidence intervals were provided by STATA, this explains why there may be small differences in these values compared with the results published in some studies. Using log-transformed effect sizes and confidence intervals, the analysis provided the same results. Second, our subgroup comparison was based on subsamples that were independent. As not all studies provided information for these subgroups, each subgroup was treated as a unit of analysis. This strategy allows the use of all relevant subgroups and comparisons between them (16). Third, we were also criticized for the use of random-effects models. Random-effects models are generally more plausible for meta-analysis based on studies from the published literature, because the fixed-effect model assumed that the entire corpus of literature has been obtained, ie, that every study has been or ever will be written on the topic has been included, which is an implausible assumption. We also assumed differences in effect size between studies and between subgroups, and the use of random-effects models was consistent with such an assumption. However, random-effects models produce wider confidence intervals compared to fixed-effect models (16). These models are thus more conservative, making our results all the more robust. One of Shiri's comments related to the reference group used in the studies for the comparison of agricultural, forestry, and fishery workers. Although we reported that the studies using a specific occupational group as reference group provided a higher effect size than the studies using other reference groups, we did not explicitly recognize and state in the paper that the results for Japan were based on two studies using a specific occupational group as reference; we concede that this may explain why we found a much more elevated effect size for Japan. Shiri's results (1) allow to conclude that the difference between Japan and the other geographic areas could be explained by the choice of reference group-we are grateful to him for raising this point. However, we would note that the effect size of suicide was still elevated and significant for agricultural, forestry, and fishery workers even after this change in the reference group for these two studies. Nevertheless, the choice of the optimal reference group is not obvious. If we consider the general population as the reference group, as unemployed people and economically inactive people (including people who may not be working due to illness or disability) are part of it and have a higher risk of suicide than employed people, the effect size provided by the nine studies using the general population as the reference is likely to be underestimated, which may contribute to an underestimation of the observed effect size of suicide among agricultural, forestry, and fishery workers in our study. The comparison was made in our paper with the other occupational groups (ie, the working population except the group of interest) as the reference, which was used by nine other studies, but this did not allow to determine the exact rank of the group of interest in the occupational hierarchy. Another relevant choice would have been to retain the group with the lowest suicide risk (for example, the high-skilled occupational group) as the reference, which would have led to a much higher effect size of suicide for agricultural, forestry, and fishery workers. To conclude, as statistical power in detecting differences between subgroups may be low in subgroup analyses and meta-regression, the absence of significant results according to subgroups found in our results cannot be interpreted as evidence that the effect size is the same across subgroups. Consequently, our meta-analysis reporting a significant excess of risk of suicide among agricultural, forestry, and fishery workers may also be a good incentive for more research among this group of workers to (i) confirm this observed excess of risk using differing methodological approaches to meta-analysis and (ii) explore the potential differences within this group and the underlying factors that may explain this excess of risk. References 1. Shiri R. Suicide among agricultural, forestry, and fishery workers. Scand J Work Environ Health - online first. https://doi.org/10.5271/sjweh.3697 2. Klingelschmidt J, Milner A, Khireddine-Medouni I, Witt K, Alexopoulos EC, Toivanen S, et al. Suicide among agricultural, forestry, and fishery workers: a systematic literature review and meta-analysis. Scand J Work Environ Health - online first. https://doi.org/10.5271/sjweh.3682 3. Milner A, Witt K, LaMontagne AD, Niedhammer I. Psychosocial job stressors and suicidality: a meta-analysis and systematic review. Occup Environ Med - online first. https://doi.org/10.1136/oemed-2017-104531 4. Leach LS, Poyser C, Butterworth P. Workplace bullying and the association with suicidal ideation/thoughts and behaviour: a systematic review. Occup Environ Med. 2017;74(1):72-9. https://doi.org/10.1136/oemed-2016-103726 5. Milner A, Page A, LaMontagne AD. Long-term unemployment and suicide: a systematic review and meta-analysis. PLoS One. 2013;8(1):e51333. https://doi.org/10.1371/journal.pone.0051333 6. Milner A, Morrell S, Lamontagne AD. Economically inactive, unemployed and employed suicides in Australia by age and sex over a 10-year period: what was the impact of the 2007 economic recession? Int J Epidemiol. 2014;43(5):1500-7. https://doi.org/10.1093/ije/dyu148 7. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology - Third Edition. Philadelphia: Wolters Kluwer Health - Lippincott Williams & Wilkins; 2008. 8. Lundberg I, Hemmingsson T, Hogstedt C. Work and social inequalities in health in Europe. Brussels: P.I.E. Peter Lang SA; 2007. 9. Milner A, Spittal MJ, Pirkis J, Lamontagne AD. Suicide by occupation: systematic review and meta-analysis. Br J Psychiatry. 2013;203(6):409-16. https://doi.org/10.1192/bjp.bp.113.128405 10. Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003;157(2):98-112. https://doi.org/10.1093/aje/kwf182 11. Grittner U, Kuntsche S, Gmel G, Bloomfield K. Alcohol consumption and social inequality at the individual and country levels--results from an international study. Eur J Public Health. 2013;23(2):332-9. https://doi.org/10.1093/eurpub/cks044 12. Niedhammer I, Bourgkard E, Chau N. Occupational and behavioural factors in the explanation of social inequalities in premature and total mortality: a 12.5-year follow-up in the Lorhandicap study. Eur J Epidemiol. 2011;26(1):1-12. https://doi.org/10.1007/s10654-010-9506-9 13. Niedhammer I, Chastang JF, David S, Kelleher C. The contribution of occupational factors to social inequalities in health: findings from the national French SUMER survey. Soc Sci Med. 2008;67(11):1870-81. https://doi.org/10.1016/j.socscimed.2008.09.007 14. Chazelle E, Lemogne C, Morgan K, Kelleher CC, Chastang JF, Niedhammer I. Explanations of educational differences in major depression and generalised anxiety disorder in the Irish population. J Affect Disord. 2011;134(1-3):304-14. https://doi.org/10.1016/j.jad.2011.05.049 15. Niedhammer I, Lesuffleur T, Coutrot T, Chastang JF. Contribution of working conditions to occupational inequalities in depressive symptoms: results from the national French SUMER survey. Int Arch Occup Environ Health. 2016;89(6):1025-37.https://doi.org/10.1007/s00420-016-1142-6 16. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis: John Wiley & Sons, Ltd. ISBN: 978-0-470-05724-7; 2009. https://doi.org/10.1002/9780470743386.
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Affiliation(s)
- Isabelle Niedhammer
- INSERM, U1085, Research Institute for Environmental and Occupational Health (IRSET), Epidemiology in Occupational Health and Ergonomics (ESTER) Team, Angers, France.
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Niedhammer I, Milner A, Witt K, Klingelschmidt J, Khireddine-Medouni I, Alexopoulos EC, Toivanen S, Chastang JF, LaMontagne AD. Response to letter to the editor from Dr Rahman Shiri: The challenging topic of suicide across occupational groups. Scand J Work Environ Health 2017; 44:108-110. [PMID: 29218357 DOI: 10.5271/sjweh.3698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We thank Dr Rahman Shiri (1) for his careful reading of our systematic review and meta-analysis on suicide among agricultural, forestry, and fishery workers (2). Our paper had the objective of providing a pooled effect size of suicide for this occupational group. Suicide is a crucial issue in public and occupational health. Suicide has a multifactorial etiology and recent systematic reviews and meta-analyses have pointed out the role of occupational exposures, mainly psychosocial work stressors, as risk factors for suicide (3, 4). Suicide is a very rare event in the general population and still more seldom in the working population. Indeed, unemployed and economically inactive people have a higher risk of suicide compared to employed people (5, 6). However, the total number of suicides is greater in the employed population than among the economically inactive or unemployed (6). Shiri's letter (1) questioned several aspects of our review and meta-analysis. One comment related to the single reference database used in our review and a suggestion that our review could not be considered to be systematic. The review was based on Medline because our main interest was in quantitative epidemiologic studies. This is the largest database for biomedical literature and we would argue the most pertinent. Furthermore, we checked the reference lists of the most recent papers and literature reviews, and Shiri did not report any paper that was missing. No review, whether searching one or more databases, can expect to be totally exhaustive. There may always be missing studies, especially if we consider grey literature. Thus we assert that our review was systematic, while acknowledging that it may not be perfectly comprehensive. Shiri suggested an absence of quality assessment of the studies included in our meta-analysis. First, quality was considered in the context of our comments in the discussion section. Second, as suggested by Rothman et al (7), quality assessment was replaced by regression analyses of the effect of each quality item (study characteristics, ie, study design, effect measure, reference group, and adjustment). Third, because most studies included in this review were based on objective data (census, administrative, or register data), they were free of many of the sources of bias that exist in studies where information on exposure and outcome must be collected from participants. Consequently, many of the items related to quality were not pertinent, such as response and follow-up rates, coverage and representativeness of the sample, selection, etc. Contrary to what Shiri suggested, all study designs can be informative in this topic because all of them are able to provide an unbiased estimate of the effect size. In addition, the prospective and case-control studies may have shortcomings. For example, we excluded five studies including three prospective and case-control studies in the sensibility analysis because the group of interest was defined on the basis of the exposure to chemicals (pesticides) rather than job title. Our choice to retain the least adjusted models was justified because aggregated data were used for the meta-analysis. Therefore, unless all included studies adjusted for the same covariates measured in the same way, adjusted estimates cannot be meaningfully provided in an aggregate data meta-analysis. In addition, as the objective was above all descriptive and not etiological or explanatory, and as it is the norm in the exploration of social inequalities in health (8), the results from the least (gender- and age-) adjusted models were in line with the objective. Indeed, including more adjustment variables could lead to overadjustment as they may be intermediate variables on the causal pathways between occupation and suicide. Our strategy was in line with previous meta-analyses on similar topics (9-11). Consequently, we would argue that our results are not likely to be largely due to confounding, contrary to the comment by Shiri. Indeed, the study of the contribution of underlying factors in explaining social inequalities in health outcomes is a fully-fledged topic of research (12-15), but this is relevant research to conduct after demonstrating that inequalities exist between social or occupational groups. Several of Shiri's comments were about statistical aspects of our analyses. First, it was suggested that we did not correctly extract the confidence intervals for the estimates of several studies. We disagree. We used the STATA metan suite of commands using log-transformed effect sizes and standard errors. Our figure 1 and the values of effect sizes and confidence intervals were provided by STATA, this explains why there may be small differences in these values compared with the results published in some studies. Using log-transformed effect sizes and confidence intervals, the analysis provided the same results. Second, our subgroup comparison was based on subsamples that were independent. As not all studies provided information for these subgroups, each subgroup was treated as a unit of analysis. This strategy allows the use of all relevant subgroups and comparisons between them (16). Third, we were also criticized for the use of random-effects models. Random-effects models are generally more plausible for meta-analysis based on studies from the published literature, because the fixed-effect model assumed that the entire corpus of literature has been obtained, ie, that every study has been or ever will be written on the topic has been included, which is an implausible assumption. We also assumed differences in effect size between studies and between subgroups, and the use of random-effects models was consistent with such an assumption. However, random-effects models produce wider confidence intervals compared to fixed-effect models (16). These models are thus more conservative, making our results all the more robust. One of Shiri's comments related to the reference group used in the studies for the comparison of agricultural, forestry, and fishery workers. Although we reported that the studies using a specific occupational group as reference group provided a higher effect size than the studies using other reference groups, we did not explicitly recognize and state in the paper that the results for Japan were based on two studies using a specific occupational group as reference; we concede that this may explain why we found a much more elevated effect size for Japan. Shiri's results (1) allow to conclude that the difference between Japan and the other geographic areas could be explained by the choice of reference group-we are grateful to him for raising this point. However, we would note that the effect size of suicide was still elevated and significant for agricultural, forestry, and fishery workers even after this change in the reference group for these two studies. Nevertheless, the choice of the optimal reference group is not obvious. If we consider the general population as the reference group, as unemployed people and economically inactive people (including people who may not be working due to illness or disability) are part of it and have a higher risk of suicide than employed people, the effect size provided by the nine studies using the general population as the reference is likely to be underestimated, which may contribute to an underestimation of the observed effect size of suicide among agricultural, forestry, and fishery workers in our study. The comparison was made in our paper with the other occupational groups (ie, the working population except the group of interest) as the reference, which was used by nine other studies, but this did not allow to determine the exact rank of the group of interest in the occupational hierarchy. Another relevant choice would have been to retain the group with the lowest suicide risk (for example, the high-skilled occupational group) as the reference, which would have led to a much higher effect size of suicide for agricultural, forestry, and fishery workers. To conclude, as statistical power in detecting differences between subgroups may be low in subgroup analyses and meta-regression, the absence of significant results according to subgroups found in our results cannot be interpreted as evidence that the effect size is the same across subgroups. Consequently, our meta-analysis reporting a significant excess of risk of suicide among agricultural, forestry, and fishery workers may also be a good incentive for more research among this group of workers to (i) confirm this observed excess of risk using differing methodological approaches to meta-analysis and (ii) explore the potential differences within this group and the underlying factors that may explain this excess of risk. References 1. Shiri R. Suicide among agricultural, forestry, and fishery workers. Scand J Work Environ Health - online first. https://doi.org/10.5271/sjweh.3697 2. Klingelschmidt J, Milner A, Khireddine-Medouni I, Witt K, Alexopoulos EC, Toivanen S, et al. Suicide among agricultural, forestry, and fishery workers: a systematic literature review and meta-analysis. Scand J Work Environ Health - online first. https://doi.org/10.5271/sjweh.3682 3. Milner A, Witt K, LaMontagne AD, Niedhammer I. Psychosocial job stressors and suicidality: a meta-analysis and systematic review. Occup Environ Med - online first. https://doi.org/10.1136/oemed-2017-104531 4. Leach LS, Poyser C, Butterworth P. Workplace bullying and the association with suicidal ideation/thoughts and behaviour: a systematic review. Occup Environ Med. 2017;74(1):72-9. https://doi.org/10.1136/oemed-2016-103726 5. Milner A, Page A, LaMontagne AD. Long-term unemployment and suicide: a systematic review and meta-analysis. PLoS One. 2013;8(1):e51333. https://doi.org/10.1371/journal.pone.0051333 6. Milner A, Morrell S, Lamontagne AD. Economically inactive, unemployed and employed suicides in Australia by age and sex over a 10-year period: what was the impact of the 2007 economic recession? Int J Epidemiol. 2014;43(5):1500-7. https://doi.org/10.1093/ije/dyu148 7. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology - Third Edition. Philadelphia: Wolters Kluwer Health - Lippincott Williams & Wilkins; 2008. 8. Lundberg I, Hemmingsson T, Hogstedt C. Work and social inequalities in health in Europe. Brussels: P.I.E. Peter Lang SA; 2007. 9. Milner A, Spittal MJ, Pirkis J, Lamontagne AD. Suicide by occupation: systematic review and meta-analysis. Br J Psychiatry. 2013;203(6):409-16. https://doi.org/10.1192/bjp.bp.113.128405 10. Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003;157(2):98-112. https://doi.org/10.1093/aje/kwf182 11. Grittner U, Kuntsche S, Gmel G, Bloomfield K. Alcohol consumption and social inequality at the individual and country levels--results from an international study. Eur J Public Health. 2013;23(2):332-9. https://doi.org/10.1093/eurpub/cks044 12. Niedhammer I, Bourgkard E, Chau N. Occupational and behavioural factors in the explanation of social inequalities in premature and total mortality: a 12.5-year follow-up in the Lorhandicap study. Eur J Epidemiol. 2011;26(1):1-12. https://doi.org/10.1007/s10654-010-9506-9 13. Niedhammer I, Chastang JF, David S, Kelleher C. The contribution of occupational factors to social inequalities in health: findings from the national French SUMER survey. Soc Sci Med. 2008;67(11):1870-81. https://doi.org/10.1016/j.socscimed.2008.09.007 14. Chazelle E, Lemogne C, Morgan K, Kelleher CC, Chastang JF, Niedhammer I. Explanations of educational differences in major depression and generalised anxiety disorder in the Irish population. J Affect Disord. 2011;134(1-3):304-14. https://doi.org/10.1016/j.jad.2011.05.049 15. Niedhammer I, Lesuffleur T, Coutrot T, Chastang JF. Contribution of working conditions to occupational inequalities in depressive symptoms: results from the national French SUMER survey. Int Arch Occup Environ Health. 2016;89(6):1025-37.https://doi.org/10.1007/s00420-016-1142-6 16. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis: John Wiley & Sons, Ltd. ISBN: 978-0-470-05724-7; 2009. https://doi.org/10.1002/9780470743386.
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Affiliation(s)
- Isabelle Niedhammer
- INSERM, U1085, Research Institute for Environmental and Occupational Health (IRSET), Epidemiology in Occupational Health and Ergonomics (ESTER) Team, Angers, France.
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Klingelschmidt J, Milner A, Khireddine-Medouni I, Witt K, Alexopoulos EC, Toivanen S, LaMontagne AD, Chastang JF, Niedhammer I. Suicide among agricultural, forestry, and fishery workers: a systematic literature review and
meta-analysis. Scand J Work Environ Health 2017; 44:3-15. [DOI: 10.5271/sjweh.3682] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Papasotiriou AN, Prevezas N, Krikonis K, Alexopoulos EC. Recovery and Return to Work After a Pelvic Fracture. Saf Health Work 2016; 8:162-168. [PMID: 28593072 PMCID: PMC5447407 DOI: 10.1016/j.shaw.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/07/2016] [Accepted: 10/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background Pelvic ring fractures (PRFs) may influence the daily activities and quality of life of the injured. The aim of this retrospective study was to explore the functional outcomes and factors related to return to work (RTW) after PRF. Methods During the years 2003–2012, 282 injured individuals aged 20–55 years on the date of the accident, were hospitalized and treated for PRFs in a large tertiary hospital in Athens, Greece. One hundred and three patients were traced and contacted; 77 who were on paid employment prior to the accident gave their informed consent to participate in the survey, which was conducted in early 2015 through telephone interviews. The questionnaire included variables related to injury, treatment and activities, and the Majeed pelvic score. Univariate and multiple regression analyses were used for statistical assessment. Results Almost half of the injured (46.7%) fully RTW, and earning losses were reported to be 35% after PRF. The univariate analysis confirmed that RTW was significantly related to accident site (labor or not), the magnitude of the accident's force, concomitant injuries, duration of hospitalization, time to RTW, engagement to the same sport, Majeed score, and complications such as limp and pain as well as urologic and sexual complaints (p < 0.05 for all). On multiple logistic regression analysis, the accident sustained out of work (odds ratio: 6.472, 95% confidence interval: 1.626–25.769) and Majeed score (odds ratio: 3.749, 95% confidence interval: 2.092–6.720) were identified as independent predictive factors of full RTW. Conclusion PRFs have severe socioeconomic consequences. Possible predictors of RTW should be taken into account for health management and policies.
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Affiliation(s)
- Antonios N Papasotiriou
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Academic Department of Trauma and Orthopaedics, Leeds General Infirmary Hospital, Leeds, UK
| | - Nikolaos Prevezas
- Orthopedic Department, Psychiko Clinic, Athens Medical Group, Greece
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8
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Kourmousi N, Alexopoulos EC. Stress Sources and Manifestations in a Nationwide Sample of Pre-Primary, Primary, and Secondary Educators in Greece. Front Public Health 2016; 4:73. [PMID: 27148519 PMCID: PMC4838612 DOI: 10.3389/fpubh.2016.00073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/06/2016] [Indexed: 11/23/2022] Open
Abstract
Background Teachers experience high levels of stress as a result of their professional duties, and research has shown a growing interest in this phenomenon during the recent years. Aim of this study was to explore the associations of stress sources and manifestations with individual and job-related characteristics in educators of all levels. Methods In a cross-sectional design, following an informative e-campaign on the study aims through the official and the main teachers’ portals in Greece, respondents completed online the teachers stress inventory (TSI) and the 14-item Perceived Stress Scale. Nine hundred seventy-four male and 2473 female pre-primary, primary, and secondary educators with a mean age of 41.2 years responded. Results Women and younger teachers reported significantly higher levels of stress, mainly due to lack of time and other work-related stressors, and also more emotional and gastronomic manifestations. Increased age and working experience were associated with lower levels of several stress sources. Teachers of administrative positions had increased time management stressors, but less professional distress, professional investment, and discipline and motivation stressors. Additionally, working and residing far from family increased teachers’ stress levels associated with control, motivation, and investment. Teachers of pre-primary education had reduced professional investment and motivation stress factors, while vocational lyceum teachers of secondary education reported less work-related stressors and manifestations and more discipline and motivation-related ones. Having students supported or in need of support from special educators and students with difficulties in speaking or comprehension was associated with most of the teachers’ stress sources and manifestations (i.e., TSI subscales). Finally, colleagues’ and mainly supervisors’ support seemed to provide a strong and consistent protection against both stress sources and manifestations. Conclusion Stress factors and manifestations vary among educators by gender, seniority, and teaching level. Training in coping and communication skills starting in teachers’ undergraduate studies might have a major impact on their stress alleviation.
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Affiliation(s)
- Ntina Kourmousi
- Directorate of Primary Education of Eastern Attica , Attica , Greece
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Bania EG, Daniil Z, Hatzoglou C, Alexopoulos EC, Mitsiki E, Gourgoulianis KI. COPD characteristics and socioeconomic burden in Hellenic correctional institutions. Int J Chron Obstruct Pulmon Dis 2016; 11:341-9. [PMID: 26929618 PMCID: PMC4760210 DOI: 10.2147/copd.s89027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/23/2022] Open
Abstract
Background The high prevalence of smoking (80%) in Greek correctional institutions is anticipated to result in high prevalence of COPD in such settings. Aim The aim of the Greek obstructive luNg disease epidemiOlogy and health economics Study In corrective institutionS (GNOSIS) is to determine the prevalence of smoking and COPD among inmates and to assess the health-related quality of life. Methods GNOSIS, a cross-sectional epidemiological study, was conducted between March 2011 and December 2011 in seven correctional institutions in Greece. Results A total of 552 participants, 91.3% male, median age of 43.0 years (interquartile range: 35–53), were enrolled. COPD prevalence was 6.0% and was found to increase with age (18.6% among those ≥60 years), length of prison stay, and length of sentence. Of the participants diagnosed with COPD, 36.4% were diagnosed with Global initiative for chronic Obstructive Lung Disease (GOLD) stage I and 51.5% were diagnosed with stage II. Dyspnea severity was assessed as grades 0–1 on the medical research council dyspnea scale for 88.3%, while 31% reported ≥2 COPD exacerbations in the past year. Seventy-nine percent of the total number of the participants were smokers, with a median smoking of 20.0 cigarettes per day, while 42.9% were assessed as having a strong addiction to nicotine. The median EuroQol visual analog scale score was 70.0 (interquartile range: 60.0–90.0). Problems in the dimension of anxiety/depression were reported by 82.8%. Conclusion The results of the study support the notion that the prevalence of COPD among inmates of Greek correctional institutions may increase in the following years. The findings underscore the importance of taking actions to limit COPD prevalence and its risk factors in the Greek correctional system.
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Affiliation(s)
- Eleni G Bania
- Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece
| | - Zoe Daniil
- Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece
| | - Chrysa Hatzoglou
- Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece
| | | | | | - Konstantinos I Gourgoulianis
- Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece
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Alexopoulos EC, Argyriou E, Bourna V, Bakoyannis G. Reliability and Validity of the Greek Version of the Job Content Questionnaire in Greek Health Care Workers. Saf Health Work 2016; 6:233-9. [PMID: 26929833 PMCID: PMC4674485 DOI: 10.1016/j.shaw.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/04/2014] [Revised: 02/03/2015] [Accepted: 02/07/2015] [Indexed: 01/05/2023] Open
Abstract
Background The Job Content Questionnaire (JCQ), which is based on the Demand–Control–Support model, is designed to measure the psychosocial characteristics of the respondent's work, and has been identified to predict health and psychological outcomes. The purpose of this study was to investigate the psychometric properties of this instrument and the subsequent adaptation of its scales to the population of Greek health workers. Methods The Greek version of the JCQ was developed by using forward- and back-translation in accordance with the JCQ policy. The reliability and validity of the measure were investigated in a sample of health workers working in a hospital in Athens, Greece. The internal consistency of the scales was examined based on Cronbach α coefficients, and the validity was evaluated subjecting the items of the three main scales of the JCQ (decision latitude, psychological job demands, and social support) to exploratory and confirmatory factor analysis. Results The reliability of the scales was found to be acceptable for all the scales, except for the skill discretion subscale. Confirmatory factor analysis confirmed a slightly modified version of the original construct including several items to more than one factor. Conclusion Our findings suggest that the Greek JCQ is reliable and valid for investigating psychosocial job characteristics among Greek health workers.
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Affiliation(s)
- Evangelos C Alexopoulos
- School of Social Sciences, Hellenic Open University, Patras, Greece; Occupational Health Department, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Evangelia Argyriou
- Department of Psychology, School of Philosophy, University of Athens, Athens, Greece
| | - Virginia Bourna
- Occupational Health Department, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Giorgos Bakoyannis
- Department of Biostatistics, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
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Xenouli G, Xenoulis K, Sarafis P, Niakas D, Alexopoulos EC. Validation of the World Health Organization Disability Assessment Schedule (WHO-DAS II) in Greek and its added value to the Short Form 36 (SF-36) in a sample of people with or without disabilities. Disabil Health J 2016; 9:518-23. [PMID: 26996759 DOI: 10.1016/j.dhjo.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/05/2015] [Revised: 01/05/2016] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is controversy and ongoing interest on the measurement of functionality in the personal and social level. OBJECTIVES (1) to validate the Greek version of the World Health Organization Disability Assessment Schedule (WHO DAS II) and (2) to determine its added value to the physical and psychological health subscales of the Short Form 36 (SF-36). METHODS In a cross-sectional design, data were collected between December 2014 and March 2015 by using three questionnaires (WHO DAS II, SF-36, PSS-14) in a sample of people with disabilities (n = 101) and without disabilities (n = 109) in Athens, Greece. WHO DAS II internal consistency, construct and criterion-related validity were assessed by Cronbach alpha, exploratory factor analysis and correlations; its added value by multivariable linear regression. RESULTS Cronbach Alpha's were satisfactory for the WHO DAS II, PSS-14 and SF-36 (0.85, 0.88 and 0.96 respectively). Exploratory factor analysis confirmed the existence of one or two factors in people with or without disabilities, respectively. WHO DAS II score showed significant negative correlation with the physical and mental health scale of SF-36 score, especially strong for physical health while was positively related to PSS-14 score. In multivariate analysis mental health appraisal was related to perceived stress in both groups. CONCLUSIONS This study support the validity of the Greek version of WHO DAS II and warranted its use in assessment and follow up of people with disabilities, contributing to the development of suitable policies to cover their needs and providing comparable data with other surveys using the same instrument.
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Affiliation(s)
- Georgia Xenouli
- Hellenic Open University, Parodos Aristotelous 18, GR-26 335 Patra, Greece.
| | - Kostis Xenoulis
- Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, GR- 15784 Athens, Greece
| | - Pavlos Sarafis
- Hellenic Open University, Parodos Aristotelous 18, GR-26 335 Patra, Greece
| | - Dimitris Niakas
- Hellenic Open University, Parodos Aristotelous 18, GR-26 335 Patra, Greece
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Alexopoulos EC, Malli F, Mitsiki E, Bania EG, Varounis C, Gourgoulianis KI. Frequency and risk factors of COPD exacerbations and hospitalizations: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study). Int J Chron Obstruct Pulmon Dis 2015; 10:2665-74. [PMID: 26715845 PMCID: PMC4686222 DOI: 10.2147/copd.s91392] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD exacerbations and hospitalizations have been associated with poor prognosis for the COPD patient. Objective To evaluate the frequency and risk factors of COPD exacerbations, hospitalizations, and admissions to intensive care units (ICUs) in Greece by a nationwide cross-sectional study. Materials and methods A nationwide observational, multicenter, cross-sectional study was conducted in the clinical practice setting of respiratory medicine physicians over a 6 month-period (October 2010 to March 2011). A total of 6,125 COPD patients were recruited by 199 respiratory physicians. Results Participants had a median age of 68.0 years, 71.3% were males, and 71.8% suffered from comorbidities. The median disease duration was 10.0 years. Of the patients, 45.3% were classified as having GOLD (Global initiative for chronic Obstructive Lung Disease) stage III or IV COPD. Patients with four or more comorbidities had 78.5% and threefold-higher than expected number of exacerbations and hospitalizations, respectively, as well as fivefold-higher risk of admission to the ICU compared to those with no comorbidities. Obese patients had 6.2% fewer expected exacerbations compared to those with a normal body mass index. Patients with GOLD stage IV had 74.5% and fivefold-higher expected number of exacerbations and hospitalizations, respectively, and nearly threefold-higher risk of admission to the ICU compared to stage I patients. An additional risk factor for exacerbations and hospitalizations was low compliance with treatment: 45% of patients reported forgetting to take their medication, and 81% reported a preference for a treatment with a lower dosing frequency. Conclusion Comorbidities, disease severity, and compliance with treatment were identified as the most notable risk factors for exacerbations, hospitalizations, and ICU admissions. The results point to the need for a multifactorial approach for the COPD patient and for the development of strategies that can increase patient compliance with treatment.
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Affiliation(s)
| | - Foteini Malli
- Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece
| | | | - Eleni G Bania
- Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece
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Vervainioti A, Alexopoulos EC. Job-Related Stressors of Classical Instrumental Musicians: A Systematic Qualitative Review. Med Probl Perform Art 2015; 30:197-202. [PMID: 26614973 DOI: 10.21091/mppa.2015.4037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Epidemiological studies among performing artists have found elevated stress levels and health effects, but scarcely the full range of stressors has been reported. We review here the existing literature on job-related stressors of classical instrumental musicians (orchestra musicians). PubMed, Google Scholar and JSTOR databases were screened for relevant papers indexed up to August 2012. A total of 122 papers was initially identified which, after exclusion of duplicates and those not meeting eligibility criteria, yielded 67 articles for final analysis. We identified seven categories of stressors affecting musicians in their everyday working lives: public exposure, personal hazards, repertoire, competition, job context, injury/illness, and criticism, but with interrelated assigned factors. The proposed categories provide a framework for future comprehensive research on the impact and management of musician stressors.
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Affiliation(s)
- A Vervainioti
- 13, Makedonias Str., 22 100 Tripoli, Greece. Tel 0030 697 47 696 47.
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Alexopoulos EC, Kavalidou K, Messolora F. Suicide Mortality Across Broad Occupational Groups in Greece: A Descriptive Study. Saf Health Work 2015; 7:1-5. [PMID: 27014484 PMCID: PMC4792908 DOI: 10.1016/j.shaw.2015.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022] Open
Abstract
Background Several studies have investigated the relationship between specific occupations and suicide mortality, as suicide rates differ by profession. The aim of this study was to investigate suicide mortality ratios across broad occupational groups in Greece for both sexes in the period 2000–2009. Methods Data of suicide deaths were retrieved from the Hellenic Statistical Authority and comparative mortality ratios were calculated. Occupational classification was based on the International Classification of Occupations (ISCO-88) and the coding for Intentional self-harm (X60–X84) was based on the international classification of diseases (ICD-10). Results Male dominant occupations, mainly armed forces, skilled farmers and elementary workers, and female high-skilled occupations were seen as high risk groups for suicide in a period of 10 years. The age-productive group of 30–39 years in Greek male elementary workers and the 50–59 age-productive group of Greek professional women proved to have the most elevated number of suicide deaths. Conclusion Further research is needed into the work-related stressors of occupations with high suicide mortality risk and focused suicide prevention strategies should be applied within vulnerable working age populations.
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Affiliation(s)
| | - Katerina Kavalidou
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Fani Messolora
- Peristeri's Regional Health Unit, Social Insurance Institute (IKA), Athens, Greece
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Alexopoulos EC, Kalyva A, Merekoulias G, Niakas D. Monitoring interhospital transfers in Western Greece during 2003-2011: its role in health policy. Rural Remote Health 2015; 15:3228. [PMID: 26458418] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Interhospital transfers (ITs) could provide insight into regional healthcare efficiency and evidence for policy-making. The aim of this study was to analyse ITs carried out in the Western Greece region over a nine-year period. METHODS Archives of the National Center of Emergency Medical Services of Patras and official healthcare resources were used to analyze patient transfers from rural to 'reception' hospitals in the area, during the period 2003-2011, by hospital, medical, seasonal and population variations. RESULTS A total of 2500 ITs from the eight rural hospitals to the central ones in the metropolitan area of Patras were monitored yearly. Transfer rates per population ranged between less than 0.3% and more than 1.0%. Only a few patients transferred outside the area (0.9%). Almost 10% of total transfers regarded diagnostic evaluation (mostly CT scan). Transfer rates were inversely related to hospital admission rates (Pearson -0.973, p=0.027), while time (in minutes) (Pearson -0.903, =0.036) and distance (in kilometers) between the rural and central hospitals (Pearson -0.907, p=0.034) also exhibited significant relationships. The level of understaffing does not have a clear effect on ITs. CONCLUSIONS By monitoring ITs, it becomes evident where efforts should be prioritized and which of the interconnections should be optimized in a specific network of health care. In this case, interventions should be focused towards the (a) very high transfer rates from the general hospital (GH) of Aigio, (b) lack of orthopedists at GH Kalavryta, which could provide a 24 hour emergency service in a tourist ski area, (c) understaffing in the microbiological laboratory and lack of a CT scanner at GH Mesologi, and (d) lack of radiologists in several hospitals, rendering the installed equipment worthless. By monitoring the ITs, real needs and win-win actions may emerge in the complex interplay of infrastructural factors.
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Affiliation(s)
| | - Athanasia Kalyva
- Hellenic Open University, School of Social Sciences, Patras, Greece.
| | | | - Dimitris Niakas
- Hellenic Open University, School of Social Sciences, Patras, Greece.
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Mitsiki E, Bania E, Varounis C, Gourgoulianis KI, Alexopoulos EC. Characteristics of prevalent and new COPD cases in Greece: the GOLDEN study. Int J Chron Obstruct Pulmon Dis 2015; 10:1371-82. [PMID: 26229456 PMCID: PMC4516213 DOI: 10.2147/copd.s81468] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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] [Indexed: 12/04/2022] Open
Abstract
Background Greece has one of the highest rates of smoking and chronic obstructive pulmonary disease (COPD) in Europe. Aim The study aimed to record both the disease characteristics among a sample of Greek COPD patients and the nationwide rates of newly diagnosed COPD cases. Methods In this noninterventional, epidemiological cross-sectional study, a representative nationwide sample of 45 respiratory centers provided data on the following: 1) the demographic and clinical characteristics of COPD patients and 2) newly diagnosed COPD cases monitored over a period of 6 months by each physician. Results Data from 6,125 COPD patients were collected. Advanced age (median age: 68 years), male predominance (71.3%), largely overweight status with median body mass index (BMI) =27.5 kg/m2, high percentage of current and ex-smokers (89.8%), and presence of comorbidities (81.9%) were evident in the sample. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 criteria, majority of the COPD patients had moderate or severe airflow limitation (61%). Severity of airflow limitation was significantly associated with older age, male sex, obesity, ex-smoking status, and presence of comorbidity (all P-values <0.001). A total of 61.3% of the patients received medication, mostly bronchodilators (64.4%) and fixed-dose combinations of long-acting β2-agonists and inhaled corticosteroids (39.9%), while 35.9% reported taking medication on demand. The majority (81.1%) of patients reported a preference for fewer inhalations of their bronchodilator therapy. Based on the mixed-effect Poisson model, the rate of newly diagnosed COPD cases was estimated to be 18.2% (95% confidence interval: 14.9–22.3) per pulmonologist/3 months. Of those newly diagnosed, the majority of patients had mild or moderate airflow limitation (78.2%). Conclusion The Greek Obstructive Lung Disease Epidemiology and health ecoNomics study reflected the real-life profile of COPD patients and provided evidence on the profile of new COPD cases in Greece. Various demographic factors were delineated, which can assist in designing more effective diagnostic and management strategies for COPD in Greece.
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Affiliation(s)
| | - Eleni Bania
- Department of Respiratory Medicine, Medical School, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | | | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, Medical School, University of Thessaly, University Hospital of Larissa, Larissa, Greece
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Abstract
Background: Noise-induced hearing loss (NIHL) is one of the most prevalent occupational illnesses, with a higher incidence in the heavy industry. Objectives of the Study: The aim of this study is to investigate the prevalence of NIHL in Greece and explore its correlations with other job and individual-related factors. Materials and Methods: Questionnaires were administered, and audiograms were conducted to 757 employees of a shipyard company in Greece, both white- and blue-collar, during the period 2006–2009. A modification of the 1979' equation of the American Academy of Otolaryngology was used to calculate hearing loss. Statistical analysis was conducted by means of the SPSS v. 17. Results: A 27.1% of the employees were hearing handicap. Hearing loss was correlated with age, past medical history of ear disease (Meniere's disease, acoustic neuroma, otosclerosis) or injury, hyperlipidemia, job title and level of education. A few questions on subjective hearing ability and symptoms showed strong discriminatory power of hearing pathology. Conclusions: The results of this study emphasize the burden of disease in the shipyard industry, and the need for continuous monitoring, implementation of preventive measures and hearing conservation programs.
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Affiliation(s)
- Evangelos C Alexopoulos
- Department of Public Health, Medical School, University of Patras, Patras, Greece ; School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Thomaella Tsouvaltzidou
- Department of Public Health, Medical School, University of Patras, Patras, Greece ; GP Section, General Hospital of Aigio, Aigio, Greece
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Kourmousi N, Darviri C, Varvogli L, Alexopoulos EC. Teacher Stress Inventory: validation of the Greek version and perceived stress levels among 3,447 educators. Psychol Res Behav Manag 2015; 8:81-8. [PMID: 25834469 PMCID: PMC4358647 DOI: 10.2147/prbm.s74752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Teacher Stress Inventory (TSI) is an instrument for measuring occupational stress in teachers. This study aimed to translate and adapt it for use in Greece, and then assess its reliability and validity. METHODS The Greek versions of the TSI and the 14-item Perceived Stress Scale (PSS-14) were posted on all Greek educators' official sites during May 2012. A nationwide sample of 3,447 teachers of all levels and specialties completed the questionnaires via the Internet. Reliability was determined by the calculation of Cronbach's alpha coefficient. Confirmatory factor analysis was conducted and validity was further examined by investigating the correlation of the TSI with the PSS-14 and their association with demographics and work-related factors. RESULTS Satisfactory Cronbach's alpha values (above 0.70) were found for all TSI dimensions. Confirmatory factor analysis confirmed the two-factor construct of TSI (root mean square error of approximation, comparative fit index, and goodness-of-fit index values were 0.079, 0.956, and 0.951, respectively), confirming the pre-established theory for the two latent variables, Stress Sources and Stress Manifestations. Significant correlations were found between TSI subscales, PSS-14 sex, age, lack of support, and students' difficulties. CONCLUSION The Greek version of the TSI was found to have satisfactory psychometric properties, and its use for assessing stress in Greek teachers is warranted.
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Affiliation(s)
| | | | - Liza Varvogli
- School of Medicine, University of Athens, Athens, Greece
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Pateraki NS, Mantzourani E, Darvyri PP, Alexopoulos EC, Varvogli L, Mamoulakis D, Christina D, Chrousos GP. Stress Management in Parents of Children with Diabetes Type 1: A Randomized Controlled Trial. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/psych.2015.68101] [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: 11/20/2022]
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Affiliation(s)
- Andreas Tsounis
- Centers for the Prevention of Addictions and Promoting Psychosocial Health of Municipality of Thessaloniki-OKANA, Thessaloniki, Greece
| | - Pavlos Sarafis
- Department of Nursing, Technological Educational Institute of Lamia, 35100 Lamia, Greece.
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Darviri C, Legaki PE, Chatzioannidou P, Gnardellis C, Kraniotou C, Tigani X, Alexopoulos EC. Adolescent Stress Questionnaire: Reliability and validity of the Greek version and its description in a sample of high school (lyceum) students. J Adolesc 2014; 37:1373-7. [DOI: 10.1016/j.adolescence.2014.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
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Darviri C, Alexopoulos EC, Artemiadis AK, Tigani X, Kraniotou C, Darvyri P, Chrousos GP. The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ): a novel tool for assessing self-empowerment through a constellation of daily activities. BMC Public Health 2014; 14:995. [PMID: 25253039 PMCID: PMC4192765 DOI: 10.1186/1471-2458-14-995] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/18/2014] [Indexed: 01/16/2023] Open
Abstract
Background The main goal of stress management and health promotion programs is to improve health by empowering people to take control over their lives. Daily health-related lifestyle choices are integral targets of these interventions and critical to evaluating their efficacy. To date, concepts such as self-efficacy, self-control and empowerment are assessed by tools that only partially address daily lifestyle choices. The aim of this study is to validate a novel measurement tool, the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ), which aims to assess the concept of empowerment through a constellation of daily activities. Methods Therefore, we performed principal component analysis (PCA) of 26 items that were derived from the qualitative data of several stress management programs conducted by our research team. Results The PCA resulted in the following five-factor solution: 1) Dietary Healthy Choices, 2) Dietary Harm Avoidance, 3) Daily Routine, 4) Organized Physical Exercise and 5) Social and Mental Balance. All subscales showed satisfactory internal consistency and variance, relative to theoretical score ranges. Subscale scores and the total score were significantly correlated with perceived stress and health locus of control, implying good criterion validity. Associations with sociodemographic data and other variables, such as sleep quality and health assessments, were also found. Conclusions The HLPCQ is a good tool for assessing the efficacy of future health-promoting interventions to improve individuals’ lifestyle and wellbeing.
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Affiliation(s)
- Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Soranou Ephessiou 4, GR-11527 Athens, Greece.
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Alexopoulos EC, Palatsidi V, Tigani X, Darviri C. Exploring stress levels, job satisfaction, and quality of life in a sample of police officers in Greece. Saf Health Work 2014; 5:210-5. [PMID: 25516814 PMCID: PMC4266800 DOI: 10.1016/j.shaw.2014.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/13/2014] [Accepted: 07/14/2014] [Indexed: 11/22/2022] Open
Abstract
Background The ongoing economic crisis in Greece has affected both stress and quality of life (QoL) at all socioeconomic levels, including professionals in the police force. The aim of this study was to examine perceived stress, job satisfaction, QoL, and their relationships in a sample of police officers in Greece. Methods A cross-sectional study was conducted during the first trimester of 2011 in 23 police stations in the greater Athens area. A total of 201 police officers agreed to participate (response rate 44.6%). The General Health Questionnaire-28 (GHQ-28) was used to assess general health, and the World Health Organization Quality of Life-BREF Questionnaire and Perceived Stress Scale-14 (PSS-14) questionnaires were used to assess QoL and perceived stress, respectively. Results The PSS and GHQ subscales and total scores exhibited strong, positive, and significant correlations coefficients (r): 0.52 for somatic disturbances, 0.56 for stress and insomnia, 0.40 for social dysfunction, and 0.37 for depression, yielding an r equal to 0.57 for the total GHQ score. A higher level of perceived stress was related to a lower likelihood of being satisfied with their job; in this regard, male participants and higher ranked officers reported lower job satisfaction. The PSS and GHQ scores were inversely, consistently, and significantly related to almost all of the QoL aspects, explaining up to 34% of their variability. Parenthood had a positive effect on QoL related to physical health, and women reported lower QoL related to psychological health. Conclusion Higher levels of stress are related to an increased risk of reporting suboptimal job satisfaction and QoL. The magnitude of these associations varied depending on age, gender, and rank, highlighting the need for stress-management training.
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Affiliation(s)
- Evangelos C Alexopoulos
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Athens, Greece
| | - Vassiliki Palatsidi
- Technological Educational Institution of Athens, Department of Health Visitors, Athens, Greece
| | - Xanthi Tigani
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Athens, Greece
| | - Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Athens, Greece
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Jelastopulu E, Giourou E, Merekoulias G, Mestousi A, Moratis E, Alexopoulos EC. Correlation between the Personal and Social Performance scale (PSP) and the Positive and Negative Syndrome Scale (PANSS) in a Greek sample of patients with schizophrenia. BMC Psychiatry 2014; 14:197. [PMID: 25005616 PMCID: PMC4227001 DOI: 10.1186/1471-244x-14-197] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial dysfunction is one of schizophrenia's core features, often leading to a deprecation of independent living and significant failure to maintain a competent quality of life. Cognitive and occupational performance as well as psychosocial functioning is moreover recognized as determinants of treatment response. Therefore, the elaboration of measures regarding social performance besides scales that assess psychopathology is essential. The Personal and Social Performance (PSP) scale has been found to be as much valid as reliable for assessing social functioning in the acute and stable stage of schizophrenia. The aim of this study was to estimate the correlation between the PSP and Positive and Negative Syndrome Scale (PANSS) (convergent validity) in patients with schizophrenia during routine clinical practice. METHODS A longitudinal study with a six-month follow-up is presented. Correlation between the PSP scale and the Positive and Negative Syndrome Scale (PANSS) was conducted in a Greek sample of 2010 patients with schizophrenia in outpatient setting in two successive visits. PANSS and PSP scales were used for the assessment of psychopathological symptoms and social and personal functioning. RESULTS The PSP subscales scores were well correlated with each other with Spearman correlation coefficients (r) ranging from 0.56 to 0.76 on both visits in three out of the four main areas, whereas in the category of "disturbing and aggressive behavior" the correlations were lower but still significant. Furthermore, total PSP score showed high association to PANSS total score in the first (r = -0.59) as well as in the second visit (r = -0.50). Regression analysis showed that one point decrease of PANSS's total score is associated with a 0.42 points increase on the PSP scale. PSP and PANSS scales exhibited high convergent validity. CONCLUSIONS The PSP could provide additional valuable information in the assessment of schizophrenia related social functioning and treatment response.
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Affiliation(s)
- Eleni Jelastopulu
- Department of Public Health, School of Medicine, University of Patras, Rio-Patras GR-26500, Greece.
| | - Evangelia Giourou
- Department of Public Health, School of Medicine, University of Patras, Rio-Patras GR-26500, Greece
| | - Giorgos Merekoulias
- Department of Public Health, School of Medicine, University of Patras, Rio-Patras GR-26500, Greece
| | | | | | - Evangelos C Alexopoulos
- Department of Public Health, School of Medicine, University of Patras, Rio-Patras GR-26500, Greece
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Alexopoulos EC. Work-related Dermatoses in Greece. Saf Health Work 2014; 5:39-40. [PMID: 24932419 PMCID: PMC4048003 DOI: 10.1016/j.shaw.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tragea C, Chrousos GP, Alexopoulos EC, Darviri C. A randomized controlled trial of the effects of a stress management programme during pregnancy. Complement Ther Med 2014; 22:203-11. [DOI: 10.1016/j.ctim.2014.01.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 01/14/2014] [Accepted: 01/22/2014] [Indexed: 11/25/2022] Open
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Tsiouli E, Pavlopoulos V, Alexopoulos EC, Chrousos G, Darviri C. Short-Term Impact of a Stress Management and Health Promotion Program on Perceived Stress, Parental Stress, Health Locus of Control, and Cortisol Levels in Parents of Children and Adolescents With Diabetes Type 1: A Pilot Randomized Controlled Trial. Explore (NY) 2014; 10:88-98. [DOI: 10.1016/j.explore.2013.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Indexed: 11/29/2022]
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Papaioannou AI, Bania E, Alexopoulos EC, Mitsiki E, Malli F, Gourgoulianis KI. Sex discrepancies in COPD patients and burden of the disease in females: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study). Int J Chron Obstruct Pulmon Dis 2014; 9:203-13. [PMID: 24600217 PMCID: PMC3933352 DOI: 10.2147/copd.s52500] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of chronic obstructive pulmonary disease (COPD) in females appears to be increasing. Recent studies have revealed that the percentage of women with COPD in Greece is approximately 12.5%. Aims To evaluate the burden of COPD among males and females in Greece through a nationwide cross-sectional survey and to explore sex differences regarding functional characteristics and exacerbation frequency. Methods Data collection was completed in a 6-month period. The present study followed a nationwide sampling approach of respiratory medicine physicians. The sampling approach included three steps: 1) estimation of expected incidence and prevalence of COPD cases in each prefecture of Greece and in total; 2) estimation of expected incidence of COPD cases per physician in each prefecture; and 3) creation of a frame of three different sampling zones. Following this sampling, data were provided by 199 respiratory physicians. Results The participating physicians provided data from 6,125 COPD patients. Female patients represented 28.7% of the study participants. Female COPD patients were, on average, 5 years younger than male COPD patients. Never smokers accounted for 9.4% within female patients, compared to 2.7% of males (P<0.001). Female patients were characterized by milder forms of the disease. Comorbidities were more prevalent in men, with the exception of gastroesophageal reflux (14.6% versus 17.1% for men and women, respectively, P=0.013). Female COPD patients had a higher expected number of outpatient visits per year (by 8.9%) than males (P<0.001), although hospital admissions did not differ significantly between sexes (P=0.116). Females had fewer absences from work due to COPD per year, by 19.0% (P<0.001), compared to males. Conclusion The differences observed between male and female COPD patients provide valuable information which could aid the prevention and management of COPD in Greece.
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Affiliation(s)
- Andriana I Papaioannou
- 3rd Respiratory Medicine Department, Sismanoglio General Hospital, Marousi, Athens, Greece ; Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece
| | - Eleni Bania
- Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece
| | | | | | - Foteini Malli
- Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece
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Alexopoulos EC, Zisi M, Manola G, Darviri C. Short-term effects of a randomized controlled worksite relaxation intervention in Greece. Ann Agric Environ Med 2014; 21:382-387. [PMID: 24959794 DOI: 10.5604/1232-1966.1108609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the short-term benefits of simple relaxation techniques in white-collar employees. MATERIALS AND METHODS The study was a two-arm parallel group randomized controlled trial. 152 employees were randomly assigned to receive the 8-week programme (N=80) (relaxation breathing and progressive muscle relaxation, twice a day) or not (wait-list group N=72). Self-reported validated measures were used to evaluate perceived stress, health locus of control, job and lifestyle related variables. Saliva cortisol were also sampled and measured. Adjusted mean changes on outcomes were estimated by linear mixed model analysis. 127 employees were finally analyzed (68 in the intervention and 59 in the control group). RESULTS Specific stress-related symptoms, psychological job demands and cortisol levels were found to be significantly decreased after 8-weeks in the intervention group. The result was probably affected by the general socio-economic condition during the study period. Cortisol levels were also significantly related with age, family situation, gender and sampling time. CONCLUSIONS Simple relaxation training (diaphragmatic breathing and progressive muscle relaxation) could benefit employees and it is strongly proposed that these and other similar techniques should be tested in various labour settings.
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Affiliation(s)
- Evangelos C Alexopoulos
- Onassis Cardiac Surgery Centre, Occupational Health Department, Athens, Greece, Postgraduate Course Stress Management and Health Promotion, Kapodistrian National University Medical School, Athens, Greece
| | - Marilena Zisi
- Postgraduate Course Stress Management and Health Promotion, Kapodistrian National University Medical School, Athens, Greece
| | - Georgia Manola
- Postgraduate Course Stress Management and Health Promotion, Kapodistrian National University Medical School, Athens, Greece
| | - Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, Kapodistrian National University Medical School, Athens, Greece
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Christaki E, Kokkinos A, Costarelli V, Alexopoulos EC, Chrousos GP, Darviri C. Stress management can facilitate weight loss in Greek overweight and obese women: a pilot study. J Hum Nutr Diet 2013; 26 Suppl 1:132-9. [PMID: 23627835 DOI: 10.1111/jhn.12086] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stress and negative emotions have been shown to be critical factors in inducing overeating as a form of maladaptive coping in obese people. METHODS The present study aimed to evaluate the efficacy of an 8-week stress management programme that includes progressive muscle relaxation (PMR) and diaphragmatic breathing on weight loss and eating behaviour in a sample of overweight and obese women who started a weight-loss programme. A total of 34 women with a mean (SD) body mass index of 38.17 (7.19) kg m(-) ² and mean (SD) age 47.35 (11.64) years were recruited from the outpatients Obesity Clinic of a public hospital in Athens. Participants were randomly assigned into a Stress Management (SM) and a control group. Anthropometric measurements were taken before and after the intervention, and the participants completed the following questionnaires: Dutch Eating Behaviour Questionnaire (DEBQ), Eating Attitudes Test (Eat-26), Health Locus of Control (HLC) and Perceived Stress Scale (PSS) before and after the intervention. RESULTS The findings indicated a significant improvement in weight loss in the SM group [4.44 (0.83) kg] after intervention compared to the control group [1.38 (0.78) kg] (P < 0.05). A higher restrained eating behaviour was observed in the SM group after intervention compared to the control group, although there was no significant difference in perceived stress levels. CONCLUSIONS The intervention group showed greater weight reduction, possibly because of the stress management programme, and a greater dietary restraint was demonstrated by them compared to the control group. It is likely that stress management could facilitate weight loss in obese women; however, more studies are needed to confirm this hypothesis.
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Affiliation(s)
- E Christaki
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Athens, Greece
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Bougea AM, Spandideas N, Alexopoulos EC, Thomaides T, Chrousos GP, Darviri C. Effect of the Emotional Freedom Technique on Perceived Stress, Quality of Life, and Cortisol Salivary Levels in Tension-Type Headache Sufferers: A Randomized Controlled Trial. Explore (NY) 2013; 9:91-9. [DOI: 10.1016/j.explore.2012.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Indexed: 11/26/2022]
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Tsiouli E, Alexopoulos EC, Stefanaki C, Darviri C, Chrousos GP. Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes: Systematic review. Can Fam Physician 2013; 59:143-149. [PMID: 23418238 PMCID: PMC3576940] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the way that family stress influences glycemic control among patients with diabetes who are younger than 18 years of age. DATA SOURCES PubMed and Scopus were searched for relevant studies published since 1990 using the following key words: diabetes type 1, glycemic control, family stress, family conflict, and family function. STUDY SELECTION In total, 1478 papers were identified in the initial search. The final review included 6 cohort studies, 3 cross-sectional studies, and 1 qualitative review in which family stress was assessed using specific diabetes-related conflict measurement instruments, and glycemic control was evaluated by glycosylated hemoglobin measurement. SYNTHESIS In most studies family stress was negatively correlated with patients' glycemic control. Family function was strongly related to patients' glycemic control, while family conflict was adversely associated with glycemic control. Families of low socioeconomic status, those of adolescents with diabetes, and those of single parents were more prone to diabetes-related stress and thus more susceptible to worse glycemic control. CONCLUSION Therapeutic psychological interventions and educational programs can help alleviate family diabetes-related stress and will likely improve glycemic control.
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Affiliation(s)
- Elina Tsiouli
- Biomedical Research Foundation, Academy of Athens, Soranou Ephessiou Str, 4, GR-115-27, Athens, Greece
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Abstract
Objective: To estimate the effectiveness of a short-term educational-counseling worksite program focused on lipid intake, by monitoring the possible change on nutrition knowledge and eating habits. Methods: an 8-week educational program based on the Health Belief Model was implemented in a honey packaging and sales company in Greece. 20 out of the 29 employees initially enrolled completed the program. Knowledge level and eating habits were evaluated prior and after the intervention by the “Nutrition Knowledge Questionnaire” and the “Food Habits Questionnaire”. ANOVA, Spearman rho test and paired Wilcoxon test were employed in statistical analysis. Results: Non smokers and those with higher educational level had healthier eating habits. Knowledge following the intervention was significantly improved concerning recommendations and basic food ingredients but as far as eating habits were concerned, scores were not improved significantly, while intake of fried food was increased. Conclusions and Implications: Short-term interventions may produce substantial improvement in knowledge but not necessarily modifications in unhealthy eating habits.
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Affiliation(s)
- Dimitra Tanagra
- Postgraduate Course of Health Promotion & Education, Medical School, University of Athens, Athens, Greece
| | - Dimitris Panidis
- Laboratory of Biopharmaceutics and Pharmacokinetics, School of Pharmacy, University of Athens, Athens, Greece
| | - Yannis Tountas
- Postgraduate Course of Health Promotion & Education, Medical School, University of Athens, Athens, Greece
| | - Elina Remoudaki
- Postgraduate Course of Health Promotion & Education, Medical School, University of Athens, Athens, Greece
| | - Evangelos C Alexopoulos
- Postgraduate Course of Health Promotion & Education, Medical School, University of Athens, Athens, Greece ; Department of Occupational Health, Onassis Cardiac Surgery Center, Athens, Greece
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Gika DM, Artemiadis AK, Alexopoulos EC, Darviri C, Papanikolaou K, Chrousos GP. Use of a Relaxation Technique by Mothers of Children with Autism: A Case-Series Study. Psychol Rep 2012; 111:797-804. [DOI: 10.2466/20.15.21.pr0.111.6.797-804] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mothers of children with autism are subject to considerable stress by having to adjust to the disorder and to cope with practical and social issues. Evidence on the effects of relaxation training on stress of these mothers is scarce. The purpose of this pilot case-series study was to examine the role of a simple 6-week daily stress management technique on mothers of children with autism. Mothers' stress measurements and children's functionality were assessed using validated instruments. Participants were 11 mothers of children with autism seen consecutively in the autism clinic of a children's hospital. Statistically significant median reductions of perceived and parental stress were noted after the 6-week intervention. Median stress scores were lower by 37.1% and 33% from the baseline values of the perceived stress scale and parental stress index, respectively. Stress was not significantly correlated with children's functioning. Stress management seems to have benefits for mothers of children with autism.
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Vlachos C, Gaitanis G, Alexopoulos EC, Papadopoulou C, Bassukas ID. Phospholipase activity after β-endorphin exposure discriminates Malassezia strains isolated from healthy and seborrhoeic dermatitis skin. J Eur Acad Dermatol Venereol 2012; 27:1575-8. [PMID: 22757641 DOI: 10.1111/j.1468-3083.2012.04638.x] [Citation(s) in RCA: 16] [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: 12/19/2022]
Abstract
BACKGROUND Phospholipase activity and its induction by β-endorphin have been associated with pathogenic Malassezia pachydermatis animal isolates. OBJECTIVE To evaluate Malassezia phosholipase activity in human isolates from seborrhoeic dermatitis (SD) and healthy controls before and after β-endorphin exposure. METHODS Eighty-four volunteers with or without SD (N = 41) were sampled. Isolated Malassezia strains were incubated in Dixon's medium with and without 100 nmol/L β-endorphin. Subsequently, phospholipase activity was assessed in egg-yolk agar and the results were compared employing Wilcoxon sign test for paired data, chi-squared test and multinomial logistic regression analysis. RESULTS A total of 64 Malassezia strains were isolated. SD strains tended to have decreased phospholipase activity before (P = 0.057) and increased after exposure to β-endorphin (P = 0.061) compared to isolates from healthy skin. Phospholipase activity after β-endorphin exposure related to basal enzyme activity as a measure of per strain phospholipase inducibility by β-endorphin did not depend on Malassezia species (P = 0.652). However, this latter biochemical trait discriminates strains isolated from SD lesional and healthy skin (P = 0.036). CONCLUSION β-endorphin exposure modifies the in vitro phosholipase activity in Malassezia species isolated from SD lesional skin. This is in accordance with emerging evidence that enhanced local lipase activity is involved in the pathogenesis of SD.
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Affiliation(s)
- Ch Vlachos
- Departments ofSkin and Venereal DiseasesMicrobiology, University of Ioannina Medical School, Ioannina, Greece
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Jelastopulu E, Kallianezos P, Merekoulias G, Alexopoulos EC, Sapountzi-Krepia D. Prevalence and risk factors of excess weight in school children in West Greece. Nurs Health Sci 2012; 14:372-80. [PMID: 22631878 DOI: 10.1111/j.1442-2018.2012.00691.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present study estimated the prevalence of childhood obesity and identified risk factors in 10-13 year old children. A cross-sectional study was conducted, including 200 children and their parents, in seven randomly-selected primary schools across Patras, Greece. Height, weight, and waist circumference were measured, and self-reported information was collected via face-to-face interviews. Body mass index was calculated for the children and their parents. The effect of risk factors on overweight and obesity was analyzed using regression analysis. The prevalence of overweight and obesity was 32% and 10.5%, respectively. The odds of being overweight/obese increased in children whose parents had a lower educational level and/or higher body mass index. Fewer daily meals and more time spent in front of the television and/or on the computer were significantly associated with obesity in 10-13 year old children. The prevalence of excess weight in primary school children in Patras is of concern, especially for boys. Children's nutritional habits, leisure activities, and parental characteristics influence their somatometric characteristics. These findings highlight the need for future weight loss interventions targeted at this population.
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Alexopoulos EC, Merekoulias G, Tanagra D, Konstantinou EC, Mikelatou E, Jelastopulu E. Sickness absence in the private sector of Greece: comparing shipyard industry and national insurance data. Int J Environ Res Public Health 2012; 9:1171-81. [PMID: 22690189 PMCID: PMC3366606 DOI: 10.3390/ijerph9041171] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 12/05/2011] [Revised: 02/22/2012] [Accepted: 03/28/2012] [Indexed: 12/03/2022]
Abstract
Approximately 3% of employees are absent from work due to illness daily in Europe, while in some countries sickness absence exceeds 20 days per year. Based on a limited body of reliable studies, Greek employees in the private sector seem to be absent far less frequently (<5 days/year) compared to most of the industrialized world. The aim of this study was to estimate the levels of sickness absence in the private sector in Greece, using shipyard and national insurance data. Detailed data on absenteeism of employees in a large shipyard company during the period 1999–2006 were utilized. National data on compensated days due to sickness absence concerning all employees (around 2 million) insured by the Social Insurance Institute (IKA, the largest insurance scheme in Greece) were retrieved from the Institute’s annual statistical reports for the period 1987–2006. Sick-leave days per employee and sick-leave rate (%) were calculated, among other indicators. In the shipyard cohort, the employment time loss due to sick leave was 1%. The mean number of sick-leave days per employee in shipyards ranged between 4.6 and 8.7 and sick-leave rate (sickness absenteeism rate) varied among 2% and 3.7%. The corresponding indicators for IKA were estimated between 5 and 6.3 sick-leave days per insured employee (median 5.8), and 2.14–2.72% (median 2.49%), respectively. Short sick-leave spells (<4 days) may account at least for the 25% of the total number of sick-leave days, currently not recorded in national statistics. The level of sickness absence in the private sector in Greece was found to be higher than the suggested by previous reports and international comparative studies, but still remains one of the lowest in the industrialized world. In the 20-years national data, the results also showed a 7-year wave in sickness absence indexes (a decrease during the period 1991–1997 and an increase in 1998–2004) combined with a small yet significant decline as a general trend. These observations deserve detailed monitoring and could only partly be attributed to the compensation and unemployment rates in Greece so other possible reasons should be explored.
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Affiliation(s)
- Evangelos C. Alexopoulos
- Public Health Department, Medical School, University of Patras, 26504, Greece; (G.M.); (D.T.); (E.J.)
- Occupational Health Department, Onassis Cardiac Surgery Center, Athens, 17674, Greece
- Author to whom correspondence should be addressed; or ; Tel.: +30-210-949-3189; Fax: +30-210-949-3305
| | - Georgios Merekoulias
- Public Health Department, Medical School, University of Patras, 26504, Greece; (G.M.); (D.T.); (E.J.)
| | - Dimitra Tanagra
- Public Health Department, Medical School, University of Patras, 26504, Greece; (G.M.); (D.T.); (E.J.)
| | - Eleni C. Konstantinou
- Faculty of Health and Caring Professions, Technological Educational Institute of Athens, 12210, Greece; (E.C.K.); (E.M.)
| | - Efi Mikelatou
- Faculty of Health and Caring Professions, Technological Educational Institute of Athens, 12210, Greece; (E.C.K.); (E.M.)
| | - Eleni Jelastopulu
- Public Health Department, Medical School, University of Patras, 26504, Greece; (G.M.); (D.T.); (E.J.)
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Darviri C, Fouka G, Gnardellis C, Artemiadis AK, Tigani X, Alexopoulos EC. Determinants of self-rated health in a representative sample of a rural population: a cross-sectional study in Greece. Int J Environ Res Public Health 2012; 9:943-54. [PMID: 22690175 PMCID: PMC3367289 DOI: 10.3390/ijerph9030943] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [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: 01/20/2012] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 11/17/2022]
Abstract
Self-rated health (SRH) is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity) were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%), 790 (52%) and 237 (15.6%) rated their health as "very good", "good" and "poor" respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed.
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Affiliation(s)
- Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Soranou Ephessiou Street, 4, 11527 Athens, Greece; (C.D.); (A.K.A.); (E.C.A.)
| | - Georgia Fouka
- Technological Education Institute of Athens, Ag Spyridonos Street, Egaleo, 12210 Athens, Greece;
| | | | - Artemios K. Artemiadis
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Soranou Ephessiou Street, 4, 11527 Athens, Greece; (C.D.); (A.K.A.); (E.C.A.)
| | - Xanthi Tigani
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Soranou Ephessiou Street, 4, 11527 Athens, Greece; (C.D.); (A.K.A.); (E.C.A.)
| | - Evangelos C. Alexopoulos
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Soranou Ephessiou Street, 4, 11527 Athens, Greece; (C.D.); (A.K.A.); (E.C.A.)
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Tigani X, Artemiadis AK, Alexopoulos EC, Chrousos GP, Darviri C. Self-rated health in centenarians: a nation-wide cross-sectional Greek study. Arch Gerontol Geriatr 2012; 54:e342-8. [PMID: 22360829 DOI: 10.1016/j.archger.2012.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/25/2012] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
Self-rated health (SRH) is an inclusive measure of public health that is correlated with quality of life and subsequent mortality. Extensive literature has identified multiple determinants of SRH in different populations. However, such studies on centenarians are scarce and parsimonious. Our objective is to identify SRH determinants in centenarians. This is a nationwide cross-sectional study on 400 Greek centenarians that was carried out between 2007 and 2010. SRH was evaluated by a simple question with a 5-point scale. Three categories of SRH were formed (very good/good/poor), which served as the dependent variable in multinomial regression models. Various sociodemographic, disease-related, lifestyle and psychosocial variables were assessed as candidate determinants of SRH. According to our results, SRH ratings among centenarians were better than that expected according to previous studies showing worse SRH ratings with increasing age in Greece. The 22.4% of the variance in SRH among centenarians was predicted by gender, habitat region and status, financial problems, disease presence and autonomy. Among lifestyle and psychosocial variables, obesity, good relationships with children, lack of feelings of loneliness, high optimism, adaptability and an internal health locus of control profile were independently associated with good SRH. These results indicate that SRH in individuals of extreme longevity were related to specific personal psychosocial factors that contribute to healthy aging and thus support the biopsychosocial model of health promotion.
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Affiliation(s)
- Xanthi Tigani
- First Department of Pediatrics, Children's Hospital Aghia Sofia, School of Medicine, University of Athens, Thivon & Papadiamantopoulou Str., GR-115-27 Athens, Greece.
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Tigani X, Artemiadis AK, Alexopoulos EC, Chrousos GP, Darviri C. Gender differences in Greek centenarians. A cross-sectional nation-wide study, examining multiple socio-demographic and personality factors and health locus of control. BMC Geriatr 2011; 11:87. [PMID: 22189185 PMCID: PMC3282665 DOI: 10.1186/1471-2318-11-87] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 12/21/2011] [Indexed: 11/18/2022] Open
Abstract
Background Centenarians are exceptional ageing paradigms, offering valuable information on achieving longevity. Although, there are several studies examining different biomedical factors as determinants of longevity in centenarians, little is known about gender differences with respect to personality traits and health locus of control. Methods Nation -wide study carried out in Greece, between 2007 and 2010. Our final sample of analysis consisted of 400 centenarians who reported on sociodemographic, disease-related and personality factors and health locus of control (HLC). Gender differences were investigated by simple nonparametric comparisons. Bivariate correlations between personality factors and internal and external HLC were obtained. Results Women centenarians outnumbered men by a ratio of 1.68 to 1. Significant gender sociodemographic differences were noted, with men reporting less often widowhood, more often centenarian 1st degree relatives and smoking. Higher BMI score was measured in males than females. Concerning personality variables, females were more reward-dependent and adaptable than men, while men were more optimistic than women. No differences were found on health locus of control profile between the genders. Positive correlations between self-directness and spirituality with internal locus of control in men and negative correlations between optimism and external locus of control in women emerged as the main gender disparities in the correlation analyses. Self-directness in men and optimism in women were consistently correlated with the two HLC subscales. Conclusions Gender differences should be incorporated in future basic research and epidemiological studies of longevity. Informed policies on ageing and wellbeing programs should also take into account gender issues to increase efficacy by targeting health locus of control.
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Affiliation(s)
- Xanthi Tigani
- First Department of Pediatrics, Children's Hospital Aghia Sofia, School of Medicine, University of Athens, Thivon & Papadiamantopoulou Str,, GR-115-27, Athens, Greece.
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Alexopoulos EC, Koutsogiannou P, Moratis E, Mestousi A, Jelastopulu E. Pain in cancer patients: The Greek experience. Eur J Oncol Nurs 2011; 15:442-6. [DOI: 10.1016/j.ejon.2010.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 10/19/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
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Bougea A, Darviri C, Alexopoulos EC. A systematic review of randomized controlled interventions for parents' distress in pediatric leukemia. ISRN Oncol 2011; 2011:959247. [PMID: 22091439 PMCID: PMC3195328 DOI: 10.5402/2011/959247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/04/2011] [Indexed: 11/23/2022]
Abstract
Objective. This review aims to summarize the existing evidence concerning interventions towards reducing stress in parents with a child with leukemia and their effect in child and family wellbeing. Methods. A systematic review strategy was conducted using MEDLINE covering the period January 1980 to June 2010. Results. Seven randomized controlled trials met the inclusion criteria including in total 1045 parents participants. A variety of cognitive-behavioral interventions problem-solving skills training programs have been used for managing distress in parents and children. Outcome measures are assessed by self-report, observer report, behavioral/psychological, and physiological measures. The most prominent methodological problems were the marked heterogeneity in stress measurement and the relative absence of proper measurement and adjustment of moderating and mediating factors. The largest effect has been obtained by combined cognitive-behavioral interventions with promising but limited evidence for several other psychological interventions. Conclusions. Recommendations for future RCTs are provided, and particular attention to the quality of trial design and reporting is highlighted.
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Affiliation(s)
- A Bougea
- Stress Management and Health Promotion Postgraduate Course, Medical School, University of Athens, 115 27 Athens, Greece
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Alexopoulos EC, Bouros D, Dimadi M, Serbescu A, Bakoyannis G, Kokkinis FP. Comparative analysis of induced sputum and bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers. J Occup Med Toxicol 2011; 6:23. [PMID: 21838922 PMCID: PMC3170282 DOI: 10.1186/1745-6673-6-23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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] [Received: 09/22/2010] [Accepted: 08/14/2011] [Indexed: 11/17/2022] Open
Abstract
Background Biological monitoring of healthy workers exposed to hazardous dusts lack validated screening tools. Induced sputum (IS) cellular profile was compared with bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers in order to assess its usefulness in monitoring workers exposed to asbestos for a long period of time. Methods IS and BALF analysis was performed in 39 workers of a car brakes and clutches factory that uses chrysotile asbestos. Selection criteria were an employment history of > 15 years and the absence of a diagnosis of pneumonoconiosis. The type of cells, the existence of dust cells, of iron laden macrophages and of asbestos bodies were assessed and compared between IS and BALF samples. Results 35 IS samples (90%) had dust cells, 34 (87%) iron laden macrophages and in 8 samples (21%) asbestos bodies were found. In most samples neutrophils were dominated. Samples with asbestos bodies (ABs) had significantly higher lymphocytes and lower neutrophils count compared with the samples without ABs. Macrophages and neutrophils in IS and BALF exhibited significant inter-relations (Spearman's rho: 0.26-0.29, p < 0.05) while IS lymphocytes count showed an inverse relation with BALF neutrophils (Spearman's rho: -0.36). Neutrophils and dust cells were highly correlated between the samples (Spearman's rho: 0.35, p < 0.05) while IS dust cells and lymphocytes were inversely related (Spearman's rho: -0.36, p < 0.05). More years of employment in the company was related with more neutrophils (Spearman's rho: 0.26) and less lymphocytes (Spearman's rho: -0.33) count. In multivariate analysis the presence of AB in IS samples was strongly related to the presence of asbestos bodies and lymphocytes count in BALF samples. Conclusions IS and BALF analysis showed a similar cellular profile indicating that IS sampling in exposed workers to asbestos as a less invasive and expensive method may be useful in providing an insight both for inhalation of dusts and inflammatory processes in the lung.
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Affiliation(s)
- Evangelos C Alexopoulos
- Occupational Health Unit, Department of Public Health, Medical School, University of Patras, GR-26500 Rio Patras, Greece.
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Darviri C, Artemiadis AK, Tigani X, Alexopoulos EC. Lifestyle and self-rated health: a cross-sectional study of 3,601 citizens of Athens, Greece. BMC Public Health 2011; 11:619. [PMID: 21816035 PMCID: PMC3161893 DOI: 10.1186/1471-2458-11-619] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 08/04/2011] [Indexed: 11/21/2022] Open
Abstract
Background Self-rated health (SRH) is a popular health measure determined by multiple factors. International literature is increasingly focusing on health-related behaviors such as smoking, dietary habits, physical activity, even religiosity. However, population-based studies taking into account multiple putative determinants of SRH in Greece are scarce. The aim of this study was to clarify possible determinants of SRH with an emphasis on the relationship between SRH and lifestyle variables in a large sample of urban citizens. Methods In this one-year cross-sectional study, a stratified random sample of 3,601 urban citizens was selected. Data were collected using an interview-based questionnaire about various demographic, socioeconomic, disease- and lifestyle related factors such as smoking, physical activity, dietary habits, sleep quality and religiosity. Multivariate logistic regression was used separately in three age groups [15-29 (N = 1,360), 30-49 (N = 1,122) and 50+ (N = 1,119) years old] in order to identify putative lifestyle and other determinants of SRH. Results Reporting of good SRH decreased with age (97.1%, 91.4% and 74.8%, respectively). Overall, possible confounders of the lifestyle-SRH relationship among age groups were sex, education, hospitalization during the last year, daily physical symptoms and disease status. Poor SRH was associated with less physical activity in the 15-29 years old (OR 2.22, 95%CI 1.14-4.33), with past or heavy smoking, along with no sleep satisfaction in the 30-49 years old (OR 3.23, 95%CI 1.35-7.74, OR 2.56, 95%CI 1.29-5.05, OR 1.79, 95%CI 1.1-2.92, respectively) and with obesity and no sleep satisfaction in the 50+ years old individuals (OR 1.83, 95%CI 1.19-2.81, OR 2.54, 95%CI 1.83-3.54). Sleep dissatisfaction of the 50+ years old was the only variable associated with poor SRH at the 0.001 p level of significance (OR 2.45, 99%CI 1.59 to 3.76). Subgroup analyses of the 15-19 years old individuals also revealed sleep dissatisfaction as the only significant variable correlated with SRH. Conclusions Slight differences in lifestyle determinants of SRH were identified among age groups. Sleep quality emerged as an important determinant of SRH in the majority of participants.
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Affiliation(s)
- Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Soranou Ephessiou Str,, 4, Postal code: GR-115-27, Athens, Greece
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Geitona M, Hatzikou M, Steiropoulos P, Alexopoulos EC, Bouros D. The cost of COPD exacerbations: a university hospital--based study in Greece. Respir Med 2011; 105:402-9. [PMID: 20970310 DOI: 10.1016/j.rmed.2010.09.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 09/24/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hospitalization attributed to severe exacerbations is the major cost driver of Chronic Obstructive Pulmonary Disease (COPD). Given that in Greece no previous studies have addressed the economic burden of COPD, the aim of the study was to examine the hospitalization cost of COPD patients with severe exacerbations in the region of Thrace. METHODS Sample consisted of 142 COPD patients with severe exacerbations who were admitted to the pneumonology department of the University Teaching Hospital of Alexandroupolis (UTHA) in 2006 and 2007. Data collection was performed retrospectively and resource utilization was derived from patients' files. General Linear Model univariate analysis was applied in order to test the influence of disease severity on costs. RESULTS Mean actual cost per severe exacerbation was €1711; the amount of €621 is reimbursed by social security funds. Price discrepancies are observed between the actual and the nominal cost per patient in all disease stage categories. Mean hospitalization cost per COPD patient increases slightly with the severity of the disease. However, in the very severe stage it greatly increases mainly due to Intensive Care Unit (ICU) admission. In multivariate analysis the length of stay and the stage of the disease were both related to significantly increased costs, while the existence of co-morbidities exhibited marginal significant relation to increased cost. CONCLUSIONS The cost estimation of severe exacerbations is important as it could trigger further research and also provide the opportunity of creating national epidemiological and economic data. Such data could contribute to the estimation of the total economic and societal burden of COPD in the country.
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Affiliation(s)
- Mary Geitona
- Department of Social Policy, University of Peloponnese, Korinthos, Greece
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Kokkinis FP, Bouros D, Hadjistavrou K, Ulmeanu R, Serbescu A, Alexopoulos EC. Bronchoalveolar lavage fluid cellular profile in workers exposed to chrysotile asbestos. Toxicol Ind Health 2011; 27:849-56. [DOI: 10.1177/0748233711399315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The cellular profile of bronchoalveolar lavage fluid (BALF) in asbestos-exposed population remains controversial. We, therefore, aimed to investigate BALF in apparently healthy individuals that were exposed in asbestos-related work for a long period of time. Participants were selected among employees of a car brakes and clutches factory that used chrysotile asbestos. Selection criteria were an employment history of ≥15 years and the absence of severe respiratory disease. The total number and type of BALF cells, the existence of dust cells, iron-laden macrophages and asbestos bodies were assessed. Thirty-nine workers (25 men), with a mean age of 46.2 ± 4.2 years and a mean employment time of 23.5 ± 4 years, participated. Asbestos bodies were observed in 14 out of 39 (36%) specimens, dust cells in 37 and iron-laden macrophages in all. Those with asbestos bodies had at least 3 times higher probability to have lymphocytosis (lymphocytes > 11%: 64% vs 28%, p = 0.027) and had an increased percentage of iron-laden macrophages compared to those without asbestos bodies (median values: 42% vs 13%, p = 0.08). Smokers (36%) had less lymphocytes compared to non and ex-smokers (median values: 6% vs. 13%, p = 0.002), and iron-laden macrophages count had a positive relation (r = 0.31, p = 0.05) to lymphocyte count. Asbestos-exposed asymptomatic individuals with the presence of asbestos bodies in the BALF are more likely to have lymphocytic alveolitis while concurrent dust exposure and smoking habits hold a significant role.
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Affiliation(s)
| | - Demosthenes Bouros
- Department of Pneumonology, Medical School, Democritus University of Thrace, Greece
| | | | | | | | - Evangelos C Alexopoulos
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, University of Athens, Greece,
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Alexopoulos EC, Messolora F, Tanagra D. Comparative mortality ratios of cancer among men in Greece across broad occupational groups. Int Arch Occup Environ Health 2011; 84:943-9. [PMID: 21331610 DOI: 10.1007/s00420-011-0622-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
AIM The purpose of this study was to compare site-specific cancer death rates in male workforce across major occupational groups in Greece. METHODS Data on cancer mortality in men aged 25-69 years during the period 2000-2005 were obtained from National Statistical Service of Greece. Age- and site (ICD-10)-specific cancer death rates and the ratio of standardized cancer death rates (i.e. the comparative mortality ratio and 95% confidence interval) across seven major occupational groups (ISCO-88) were calculated. RESULTS The proportion of total deaths due to cancer was ranged between 6.6, 24.3, 37.4, and 39.4% for the age groups of 15-39, 40-49, 50-59, and 60-69 years, respectively. Respiratory and gastrointestinal malignancies constituted 70% of the total cancer mortality in our population. Groups of elementary occupations, skilled agricultural workers, and plant workers showed very high mortality ratios of respiratory cancer while low ratios were found for the groups of professionals, legislators, senior officials, and managers and paradoxically for craft and related workers. Compared to the other groups, skilled agricultural and elementary groups showed higher rates of gastrointestinal and other or no determined malignancies in the age groups of 40-49 and 50-59 years old. Plant workers and machine operators/assemblers exhibited high mortality rates for most cancer sites especially in the elders group (60-69 years) and a mortality ratio of genitourinary cancer that differed significantly compared to any other group. CONCLUSIONS Up to 3.5-fold variations were found in site-specific cancer mortality ratios among men in Greece across broad occupational groups. The extent of the variation attributed to specific socioeconomic and/or occupational factors could not be estimated in the current study but the observed differences might stimulate thinking and preventive actions as well as point to potential hypotheses to pursue using research methods in which job and life related factors should be directly measured and controlled.
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Affiliation(s)
- Evangelos C Alexopoulos
- Occupational Health Unit, Department of Public Health, School of Medicine, Patras University, 26500, Rio Patras, Greece.
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Artemiadis AK, Anagnostouli MC, Alexopoulos EC. Stress as a Risk Factor for Multiple Sclerosis Onset or Relapse: A Systematic Review. Neuroepidemiology 2011; 36:109-20. [DOI: 10.1159/000323953] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 12/31/2010] [Indexed: 11/19/2022] Open
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Alexopoulos EC, Tanagra D, Detorakis I, Gatsi P, Goroyia A, Michalopoulou M, Jelastopulu E. Knee and low back complaints in professional hospital nurses: Occurrence, chronicity, care seeking and absenteeism. Work 2011; 38:329-35. [DOI: 10.3233/wor-2011-1136] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Dimitra Tanagra
- Department of Public Health, School of Medicine, University of Patras, Greece
| | - Ioannis Detorakis
- Department of Public Health, School of Medicine, University of Patras, Greece
| | - Panagiota Gatsi
- Department of Nursing, Healthcare School, TEI of Patras, Greece
| | | | | | - Eleni Jelastopulu
- Department of Public Health, School of Medicine, University of Patras, Greece
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