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Purpose: Few studies include data from different consecutive seasons to assess specific trends in injury risk over time. The current study aimed to investigate the presence and risk factors of injuries in professional football (soccer) players during four consecutive seasons. Methods: 166 professional football players in a Greek team were observed during four consecutive seasons, 2015/16 to 2018/19. Injuries were assessed and multiple regression analysis was used to evaluate the potential risk factors. Results: The prevalence of injured players was high (72.3%), with a mean number of 2.3 injuries per injured player, and the injury incidence was 86 injuries/1000 match-playing-exposure hours. The mean rehabilitation days were 29.0/injured player (95% CI 22.2–35.9) and 12.7/injury (95% CI 9.1–16.3). The majority of injuries were moderate-to-major/severe and most were traumatic rather than overuse (p < 0.05). The number of injuries was positively correlated with seasonal rotation from 2015/16 to 2018/19 (stand. beta = 0.123, p = 0.016), matches played (stand. beta = 0.203, p < 0.001), recurrence of injury (stand. beta = 0.527, p < 0.001) and days of rehabilitation (stand. beta = 0.372, p < 0.001). Conclusion: High prevalence of injuries was found while the increase of match-playing exposure hours, the frequency of official matches per week, the recurrence of injury, and the rehabilitation days were the main predicted risk factors. To reduce the risk of injuries, continuous efforts are required such as player rotation during the season. [ABSTRACT FROM AUTHOR]

Purpose: Current study aimed to establish percentile normative data and to find age differences in fitness performance tests of 14–19-year-old footballers played in a Greek elite youth football academy. Methods: A total of 216 male players from four different chronological age groups of the same club, from under 15 to under 19 (U-15, U16, U17 & U-19) for 5 consecutive years (2014–2018) who played in six different positions — as midfielders, defenders, wingbacks, wingers, forwards, and goalkeepers — participated in the study, with 426 measurements. Measured variables of weight, height, body mass index (BMI), squat jump (SJ), countermovement jump test (CMJ), countermovement jump test with arm swing (CMJAS) isokinetic strength peak torque (PT) ratio of hamstring (H) and quadriceps (Q) at speed of 60°·s−1, sit & reach test (i.e., flexibility), aerobic maximal exercise test on a treadmill to exhaustion (VO2max), and velocity at VO2max were recorded and compared among age groups during the period 2014–2018. Age and performance physical fitness parameters values (i.e., P3 to P97) were generated using Box–Cox power transformations. Results: The elite footballers had mean age of 15.6 ± 1.4 years, body weight 66.7 ± 7.8 kg, height 1.757 ± 0.064 cm and BMI 21.6 ± 1.7 kg·m−2. Performance across all testing variables was increased according to age, with each age scoring higher/better than their younger counterparts from the U-15 squad up. Velocity at lactate threshold (VLth-Km/h) was 13.6, 13.4, 13.1, and 13.2 Km/h, for the four age groups respectively, and 203.5, 201.9, 187.8, and 177.4 Nm in extension of left quadriceps in 60°·s−1 peak torque, Q (Nm). Moreover, the U-19 presented superior performance in VO2max (Vvo2max) to the other age categories (18.2, 17.9, 17.4, and 17.3 km/h, respectively). Footballers' flexibility and jump ability were more developed in U-19 age group compared with other group ages. Conclusion: Findings indicated that U-19 players performed better than younger players in all assessments. This may have been possible due to the differences in training experience, and individual levels of strength/power/endurance ability. Moreover, establishing normative performance values will allow practitioners to more accurately identify deficiencies in performance that are relative to their athletes. [ABSTRACT FROM AUTHOR]

Purpose: Thalassemia is one of the most common genetic disorders in the Mediterranean region, and is therefore considered a serious public health issue. In chronic conditions of this kind, survival and quality of life (QOL) of the patients are of the utmost importance and are influenced by psychological and social constraints. The current study aimed to examine various factors affecting the psychological burden, focusing on anxiety and depression levels, as well as the quality of life (QOL) of people suffering from thalassemia in Crete (Greece). Methods: A cross-sectional study was carried out in 2018 in 119 patients suffering from thalassemia from three hospitals. Validated scales were used to assess the relative parameters using multivariate regression analysis. Results: The data sample comprised 56 men (47.1%) and 63 women (52.9%) with an overall mean age of 39.7 years (± 8.5). Most of the participants exhibited low levels of anxiety/depression and high quality of life. Moreover, quality of life was found to relate positively with health status (p < 0.001), but multivariate logistic regression revealed that every unit on the anxiety score significantly increases the odds ratio for a lower quality of life score (OR: 1.66; 95% CI: 1.19–2.32) or a reverse relationship with health status (OR: 0.97; 95% CI: 0.94–1.00). Conclusion: Overall, the patients were found to have a fairly normal life, resembling the standards of the general population. They are highly aware of their quality of life and exhibit low levels of anxiety and depression. [ABSTRACT FROM AUTHOR]

Purpose: The current study aims to examine the use of preventive and other health services among adults aged 50+ in eleven European countries. Methods: The data used were derived from 16,120 adults aged 50+ years participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Preventive Health Services Utilization score (PHSUs) and Health Care Services Utilization score (HCSUs) were assessed as a composite value from answers to 12 and 16 questions respectively, on a scale ranging from 0 to 100. Estimations were based on a complex study design. Results: Participants from Central European countries were found to have significantly higher mean PHSU and HCSU scores than their counterparts in Northern and Southern regions, (p < 0.05) and also exhibited a greater gap between the two scores (29.3, 95% CI: 28.6–30.1). Overall mean PHSU score was 39.9 (95% CI: 39.4–40.4) and mean HCSU score 12.4 (95% CI: 12.2–12.7). Women have a higher mean PHSUs and HCSUs (p < 0.001); as age increases, PHSUs falls and HCSUs rises (p < 0.001). Better educated participants appear to have higher mean PHSUs and HCSUs (p < 0.001). In addition, both of the above scores increase in the presence of chronic diseases (p < 0.001). Conclusion: Strong correlation is seen between comorbidity, increasing age, educational level, and retirement on the one hand, and increased use of health services on the other hand. The use of health services is a major issue with regard to public health policy formulation. [ABSTRACT FROM AUTHOR]

Objective: Nutritional disorders cause secondary osteoporosis as well as musculoskeletal metabolism dysfunction. The Christian Orthodox Church's fasting in Mediterranean countries such Greece and Cyprus, or M.C.O.C. diet consists of self-restraint from food and/or food categories for 180 ± 19 days of total, especially of animal protein and dairy products. This case-control study attempts to investigate the effect of this fasting pattern on musculoskeletal metabolism and bone density.Design: One hundred fasters (or M.C.O.C. diet followers; 68 women and 32 men, mean 59 ± 6.5) with 32 years average fasting time and 100 non-fasters (66 females and 34 males, mean 58.1 ± 6.8; the control group of Mediterranean diet followers) over the age of 50, including menopausal women, were interviewed, as well as physically and laboratory examined along with DEXA measurements of the L2-4 vertebrae and hips. Nutrition data gathered through a 3-day food record during a non-fasting period, while energy intakes calculated on a daily food consumption basis.Results: Given the overall low incidence of osteoporosis in the Mediterranean diet, it appears to be more than three times higher than that of M.C.O.C. diet despite the periodic restriction of food intake of animal origin into a slightly hypothermic pattern, which in turn is characterized by increased consumption of multicolored vegetable foods.Conclusions: Abstinence from dairy products and meat does not adversely affect musculoskeletal metabolism or bone density. M.C.O.C. diet seems to be "healthy" eating habit for the musculoskeletal system, as future studies expected to confirm. [ABSTRACT FROM AUTHOR]

Purpose: Multiple behavioral risk factors (MBRFs) related to lifestyle have been associated with non-communicable diseases, but there is limited evidence on their prevalence in undergraduate medical students and their association with academic performance. Methods: During 1989–2017, data from 1447 medical students of the University of Crete, Greece (mean age 21.8 ± 2.2 years), were analyzed. MBRFs assessed included smoking, high body weight, physical inactivity, risky alcohol consumption and low consumption of fruits and vegetables. Academic performance was based on the grades received in the mandatory Clinical Nutrition course and the overall medical degree (scale of 0–10). Results: Of the sample, 25.8% were smokers, 30.7% had high body weight, and 67.2% had low consumption of fruits and vegetables. Prevalence of having 'no MBRFs' and having 'multiple clustering' and '3+ factors' was 15.8% and 12.3%, respectively. Men had almost twice the prevalence of multiple clustering compared with women (16.5% vs. 8.4%, p < 0.001). Participants who had none compared with 3+ MBRFs had higher mean grades in the Clinical Nutrition course (6.34 vs. 5.94, p = 0.027, p = 0.003) and overall degree (7.39 vs. 7.22, p = 0.021, p = 0.002). As the number of MBRFs increased (from 'none' to '1,' '2' and '3+' factors), the proportion of graduates receiving a distinction also decreased (6.1%, 3.3%, 3.3% and 0.0%, respectively, p = 0.001). Conclusion: Overall, high prevalence of MBRFs was observed in this sample of medical students, while MBRF clustering was prospectively inversely associated with academic performance. These findings highlight the need for preventive lifestyle strategies to improve these students' behavioral risk factors and academic performance during their studies. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the association of blood hypertension and certain behavioral risk factors with cognitive decline in elderly individuals. Methods: A subsample of 92 elderly people aged ≥ 75 years was taken from 411 people (aged 65+ years) living in a rural area of Crete, Greece. Detailed medical and family/social history data were recorded on a standard validated health card, and cognitive disorders were assessed using the Mini Mental State Examination (MMSE). The participants were evaluated for behavioral risk factors such as physical inactivity, smoking, alcohol consumption and dietary habits. Multiple logistic regression analysis was conducted to assess the risk (odds ratios, OR) of cognitive impairment. Results: The mean age of participants was 80.8 ± 4.3 years old with 66.3% being married, and their MMSE mean score was 23.4 ± 4.6; 46.7% had severe and/or mild symptoms of cognitive decline, while more than half (67.4%) had been diagnosed with hypertension. Living alone (OR: 3.48, p = 0.034), being physically inactive (OR: 5.65, p = 0.046) and low consumption of fruits and vegetables (OR: 4.16, p = 0.018) were found to increase the odds of cognitive impairment, while elderly people with hypertension were also found to have lower odds of cognitive impairment (OR: 0.42, p > 0.05). Conclusion: Although the observational character of this study carries some potential limitations, the reverse association of cognitive capacity with hypertension constitutes a 'paradox' phenomenon and is in contrast to the current literature. Further research with a larger sample is needed to better understand the observed association. [ABSTRACT FROM AUTHOR]

Purpose: To construct weight, height, head circumference and body mass index (BMI) percentile growth curves for Greek children 0–6.7 years old and to compare the BMI means and upper limits with both available Greek national and international data. Methods: Data were obtained from six cross-sectional and one longitudinal study, which included single, term healthy neonates, recruited at birth and followed until 6.7 years. A total of 12,619 measurements were performed on 7034 boys and girls from five counties in Greece in 1988–2005. The per gender-age percentile estimations were based on Box-Cox power transformations to normalize the data. BMI values were compared with available national data and with the CDC 2000 Growth Charts, the Euro-Growth Study, WHO 2006 Growth Standards and IOTF BMI values. Results: The mean birth weight was 3.5 kg in boys and 3.3 kg in girls, and all mean levels of body measurements were lower in girls than boys. The per gender-age mean BMI values were closer to the data of the Euro-Growth Study and significantly different from previous national and available international data. The 85th percentile of BMI was found significantly higher than all the international data. Conclusion: These growth curves could serve as an additional reference for Greece. That the 85th BMI percentile of this study was higher than all available data should be seriously addressed. Therefore, the growth patterns of preschool children from the present study could serve as approximate indicative values and assist in assessing the health level of the Greek child population. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe.Methods: Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators.Results: Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p < 0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p < 0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs = 2.08; 95% CI 1.24-3.48) and the third (ORs = 1.75; 95% CI 1.03-2.96) multiple regression models.Conclusion: In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population. [ABSTRACT FROM AUTHOR]

Aim: The Seven Countries’ Study showed that in the 1960s, participants in the island of Crete, Greece, had among the lowest cardiovascular (CVD) mortality rates in the world, but in recent years CVD rates in Crete have increased. This study aimed to assess changes in CVD-risk occurring since the Seven Countries’ Study.Subject and methods: Secondary analysis was performed in two cohorts of men (aged 40-60 years) in Crete-Greece, in 1960 (Seven Countries’ Study’s participants) and 1997 (random sample of men of the same age and residence areas). The HeartScore was used to estimate the (1) 10-year CVD-risk and (2) 10-year CVD-risk based on body mass index (BMI), of 627 (1960 cohort) and 93 (1997 cohort) Cretan men.Results: Between 1960 and 1997, 10-year CVD-risk (3.4 vs. 4.7%, P < 0.001) and risk based on BMI (1.6 vs. 3.0%, P < 0.001) increased by 38 and 88%, respectively. During this period, the proportion of overweight/obese participants (21.8 vs. 83.9%, P < 0.001) and participants with hypercholesterolemia (51.5 vs. 81.7%, P < 0.001), as well as physical inactivity (37.3 vs. 56.0%, P = 0.001) increased. The prevalence of high and very high CVD-risk (≥5%) almost doubled (+90%), mainly due to concomitant increases in total cholesterol levels (+84%, P < 0.001) during this period. CVD-risk increased between 1960 and 1997 in this population of Cretan men.Conclusions: Appropriate public health initiatives are needed to promote the traditional, health-promoting lifestyle of men in Crete observed in the 1960s in the Seven Countries’ Study. [ABSTRACT FROM AUTHOR]

Purpose: The current study aims to examine the utilization of preventive health services in relation to social isolation among older Europeans adults. Methods: Data on 5,129 adults 65 years of age and older was obtained from the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004/05). Prevalence of social isolation indicators (living arrangements, marital status, number of children, contact with children, proximity to children, activity participation, social exchange) was assessed in relation to preventive health services utilization, which was ascertained by a 12-item composite score (PHSUs). Estimations were based on the complex study design. Results: Diverse facets of social isolation were differently associated to preventive care. Significantly lower mean PHSUs were found for adults living unpartnered, who were unmarried, had no children and were socially disengaged. A similar pattern was thus drawn regarding the clustering of social isolation indicators (4+). Considerable variations were detected across SHARE countries in the distribution of PHSUs among socially isolated adults. Conclusion: Socially isolated individuals were found to receive fewer preventive services. This finding confers important evidence on the potential factors that affect the use of preventive health services among older adults. It is also suggestive of the need to develop public health and social policies with the aim to alleviate social isolation and as a means to enhance preventive care uptake in later life. [ABSTRACT FROM AUTHOR]

The article focuses on the relationship between well-being and a socially-engaged lifestyle among Europeans aged 64 and above, in which topics discussed include the impact of activity participation on older people's health, and how the findings compared with data from the first Wave of the Survey of Health, Aging and Retirement in Europe. Also mentioned are activities that fall under the socially and productively oriented category and the definition of well-being.

Aim: The current study aims to assess the relationship between behavioral risk factors (BRFs) for chronic diseases and preventive health services utilization among European adults. Subjects and Methods: We used data from 16,125 adults, aged 50+ years, from 11 countries participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Prevalence of BRFs (high body weight, smoking, physical inactivity and risky alcohol consumption) was examined in relation to preventive health services utilization, which was assessed via a 12-component score (PHSUs) (scale: 0-100). Estimations were based on the complex study design. Results: Of the participants, 90.7% were seeing a general practitioner (GP) and 52.7% had 2+ BRFs. Adults with high body weight had lower odds of seeing a dentist (0.75, p < 0.05) or having sigmoidoscopy/colonoscopy (0.70, p < 0.05) and higher odds of receiving GP advice to exercise regularly (1.56, p < 0.05). Smokers had lower odds of having mammograms (0.76, p < 0.05), sigmoidoscopy/colonoscopy (0.72, p < 0.05) and being tested for hidden blood in stool (0.63, p < 0.05). Risky drinkers had lower odds of having mammograms (0.23, p < 0.05). Lower mean PHSUs were found for adults with high body weight ( p = 0.001), smokers ( p = 0.001) and risky drinkers ( p = 0.008), while PHSUs did not differ by BRF clusters ( p = 0.218). In adults with 2+ BRFs, Greece was the country with the lowest mean PHSUs (28.0, p < 0.05). Conclusion: Adults with high body weight, those who smoked and were risky drinkers used fewer preventive health services. Primary prevention programs should be developed to reduce BRF prevalence and promote preventive health services use in this population. [ABSTRACT FROM AUTHOR]

Aim: To assess the clustering of behavioral risk factors (BRFs) for chronic noncommunicable diseases and their association with biological factors and cardiorespiratory fitness levels among adolescents in Crete, Greece. Subjects and methods: Among 589 adolescents aged 14.0-16.6 years, five BRFs (smoking, physical inactivity, sedentary behavior, alcohol consumption, high body weight) were estimated, and a clustering score of 0, 1, 2 or 3+ BRFs was calculated. Biological factors (blood pressure, blood glucose, serum lipids) and cardiorespiratory fitness were also assessed, and their associations with BRFs were examined. Results: Physical inactivity was the most prevalent risk factor (48.2 %), whereas smoking was the least prevalent (8.7 %). Approximately 11.4 % of the adolescents displayed none of the five BRFs, while 19.5 % displayed 3 + factors (boys: 23.2 %, girls: 16.3 %, p > 0.05). High body weight was related to almost all biological factors ( p < 0.05), while cardiorespiratory fitness was related to all BRFs ( p < 0.05). Compared to adolescents with no BRFs, adolescents with 3+ BRFs had higher mean levels of systolic blood pressure (BP) (122.5 vs. 116.8 mmHg, p = 0.001) and triglycerides (73.5 vs. 58.9 mg/dl, p = 0.006), and lower levels of HDL-cholesterol (47.1 vs. 53.5 mg/dl, p < 0.001) and cardiorespiratory fitness (2.8 vs. 4.8 stages, p < 0.001). Only 10 % of the adolescents with no BRFs had low cardiorespiratory fitness, in contrast to 44.8 % of the adolescents with 3+ factors ( p < 0.001). Conclusion: Physical inactivity was the most prevalent individual risk factor, while one-fifth of the Cretan adolescents had an extended clustering of BRFs. Systolic BP, lipid levels and cardiorespiratory fitness were related to BRF clustering. Public health providers should adopt measures to improve these factors when designing health-care programs aimed at adolescents. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to estimate the differences in prevalence of multiple behavioral risk factors (MBRFs) for chronic diseases in European adults, from eleven North, Central and South European countries. Subjects and methods : We used data from 26,656 adults, aged 50+ years, participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Physical inactivity, high body weight, smoking and risky alcohol consumption were assessed and estimated based on sampling weights, controlling for socioeconomic characteristics. Results: 53.4 % of adults had 2+ MBRFs. Prevalence in the total sample was highest for physical inactivity (71.2 %) and lowest for smoking (18.1 %). The cluster of high body weight and physical inactivity had the highest prevalence of MBRFs (35.4 %), with higher prevalence in Southern Europe ( p < 0.05). Smoking and alcohol consumption presented the greatest degree of clustering (observed to expected ratio = 2.44). Spain and Greece had the highest prevalence of clustering 2+ MBRFs, whereas Southern European countries had a higher mean number of MBRFs, compared to North and Central European regions ( p < 0.05). Conclusion: Prevalence of MBRFs varied between countries, with Southern European countries engaging in more risky behaviors. Primary prevention programmes should be developed to reduce MBRFs in this population. [ABSTRACT FROM AUTHOR]

To determine the prevalence of metabolic syndrome in children and adolescents in Crete (Greece) and examine associations with diet quality and physical fitness. A representative sample of 1,209 Cretan children and adolescents aged 3–17 1/2 years participated in this cross-sectional survey. The study took place in kindergartens, primary and secondary schools in the cities of Heraklion and Chania and kindergartens and schools in semi-urban and rural regions outside Heraklion. The metabolic syndrome was defined as the presence of ≥3 of: impaired fasting blood glucose, hypertension, abdominal obesity, hypertriglyceridaemia, and low HDL-cholesterol. Diet quality was assessed by the Healthy Eating Index score (USDA) and physical fitness by the 20-m shuttle run test. Approximately 4% of Cretan children and adolescents assessed (4.2% of boys, 3.6% of girls) had three or more metabolic syndrome factors. Over 25% of the subjects had a “poor” diet, defined as Healthy Eating Index <51, and higher diet quality scores correlated with decreased mean body mass index, waist/height ratio, systolic blood pressure, total cholesterol, and number of metabolic syndrome risk factors present. Clustering of metabolic syndrome risk factors was also associated with decreased physical fitness, as well as increased body mass index, waist/height ratio and total cholesterol/HDL-cholesterol ratio. Presence of three or more factors related to the metabolic syndrome was strongly associated with poor diet quality and low physical fitness, as well as overweight, in Cretan children and adolescents. Health promotion strategies in childhood should encourage weight control, the establishment of healthier dietary patterns, and adequate physical activity, as a means of preventing the increase in the prevalence of this public health issue. [ABSTRACT FROM AUTHOR]

Background: Greece has the highest adult smoking prevalence in the European Union, affecting not only those who smoke but also threatening the health of those who are involuntarily exposed to passive smoke, especially young Greek children.Objective: The aim of this study was to quantify passive smoking biomarkers (serum nicotine and cotinine levels) among preschool children in Crete in relation to parental smoking habits.Methods: All children enrolled in kindergarten in western Crete (1,757 preschool children and 2,809 parents) were interviewed during the 2004-2005 Cretan health promotion programme out of which a sample of 81 children was randomly selected according to parental smoking status and blood samples for cotinine and nicotine assay were taken.Results: The geometric means of serum nicotine values in children with both parents current smokers and in those with both parents non-smokers were 0.71 ng/ml (95%CI 0.62, 0.80) and 0.59 ng/ml (95%CI 0.49, 0.69), respectively, (p=0.073). Cotinine geometric mean values were found at 1.69 ng/ml (95%CI 0.93, 3.06) and 0.15 ng/ml (95%CI 0.09, 0.28), respectively, (p<0.001). Girls with smoker parents had also greater cotinine geometric mean values than boys (3.35 versus 0.85 ng/ml, respectively, p=0.018).Conclusion: Our findings prove that Greek preschool children, especially young girls, are exposed to substantial levels of passive smoke which therefore stresses the need for immediate action so as to prevent the predisposition and early addiction of Greek preschool children to tobacco. [ABSTRACT FROM AUTHOR]