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Aims: The purpose of this study is to examine the gender-specific associations of different dimensions of individual-level social capital with regular alcohol consumption and binge drinking in 16-17 years old adolescents in Crete, Greece. Methods: Of the 835 randomly selected students, 708 completed the Youth Social Capital Scale and the Health Behaviours in School-aged Children (HBSC) questionnaire from April through June 2008 and 650 (92%) were included in this analysis. The outcome of interest was regular alcohol use and binge drinking. A gender specific backward stepwise logistic multivariate regression was performed adjusted for potential confounders. Findings: For both boys and girls, higher score on some structural social capital subscales was associated, per unit increase, with increased likelihood of regular drinking. Neighbourhood connections were also associated with increased binge drinking in girls. Cognitive social capital subscales were associated with decreased likelihood of binge drinking in girls. For both genders, total social capital-score was positively associated with the probability of regular, but not of binge drinking. Conclusions: Cognitive and structural social capital dimensions have different patterns of association with regular and binge alcohol use in adolescent boys and girls. Social capital's dimensions should receive greater emphasis for the design of effective preventive interventions in adolescence, particularly in the light of an increasing prevalence of alcohol consumption in modern societies.

Objectives: This article describes the psychometric validation of the Youth Social Capital scale (YSCS) in 16- to 17-year-old students living in rural and urban areas in Crete, Greece. Methods: Sampling was performed among 27 secondary education units of Heraklion Prefecture. The self-reported questionnaire was answered by 692 participants (response rate 96.3%). The validation of the scale included both internal consistency and construct, convergent and discriminant validity tests. Results: Exploratory factor analysis yielded five social capital factors. The overall Cronbach's [alpha] was coefficient 0.771. Factor analysis revealed common patterns for many questions between the Greek and the original scales. Conclusions: This article supports the validity of the YSCS for assessing the social context of young individuals in Greece. (Contains 5 tables.)

Abstract: A sustainable business model is necessary for viable and future proof fiber-based Metropolitan Area Networks (MANs), in light of FTTH/O developments, which necessitate public initiatives, towards the leverage of broadband adoption. Following a detailed analysis and benchmarking of international practices, a pool of business solutions for the MANs development, especially for the Greek case, is presented. Taking into account pros and cons, a set of four appropriate business models is analyzed, and a quantitative financial analysis concludes the findings. Guidelines for the further development of these initiatives, useful for other countries with low broadband penetration, are presented and discussed. [ABSTRACT FROM AUTHOR]

Objective:We have evaluated the effects on mortality of habitual low carbohydrate–high-protein diets that are thought to contribute to weight control.Design:Cohort investigation.Setting:Adult Greek population.Subjects methods:Follow-up was performed from 1993 to 2003 in the context of the Greek component of the European Prospective Investigation into Cancer and nutrition. Participants were 22 944 healthy adults, whose diet was assessed through a validated questionnaire. Participants were distributed by increasing deciles according to protein intake or carbohydrate intake, as well as by an additive score generated by increasing decile intake of protein and decreasing decile intake of carbohydrates. Proportional hazards regression was used to assess the relation between high protein, high carbohydrate and the low carbohydrate–high protein score on the one hand and mortality on the other.Results:During 113 230 persons years of follow-up, there were 455 deaths. In models with energy adjustment, higher intake of carbohydrates was associated with significant reduction of total mortality, whereas higher intake of protein was associated with nonsignificant increase of total mortality (per decile, mortality ratios 0.94 with 95% CI 0.89 –0.99, and 1.02 with 95% CI 0.98 –1.07 respectively). Even more predictive of higher mortality were high values of the additive low carbohydrate–high protein score (per 5 units, mortality ratio 1.22 with 95% CI 1.09 –to 1.36). Positive associations of this score were noted with respect to both cardiovascular and cancer mortality.Conclusion:Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality.European Journal of Clinical Nutrition (2007) 61, 575–581. doi:10.1038/sj.ejcn.1602557; published online 29 November 2006 [ABSTRACT FROM AUTHOR]

To investigate medical and nursing students' education on hand hygiene, their attitude on hand hygiene education and how this education influences their hand hygiene knowledge and practices. Hospital-acquired infections are associated with prolonged hospitalisation and mortality. The most effective measure for their control is healthcare workers' hand hygiene compliance. Since medical and nursing students constitute the future healthcare workers, our study focuses on them. Cross-sectional study This study was conducted during the academic year 2016–2017, using a modified World Health Organisation questionnaire. Our sample consisted of 132 medical and 111 nursing students from National and Kapodistrian University of Athens, Greece. In data analysis, the Mann-Whitney and Fisher's exact tests were applied to compare differences in continuous variables and proportions in categorical variables, respectively. Knowledge and practices overall scores were calculated per student group. Multiple linear regression analyses were performed to assess the influence of potential confounders on these scores. We found that 73.1% of medical and 98.2% of nursing students had received relevant education, which was reported as "only theoretical" by 77.4% of the former and as "hands-on and theoretical" by 88.1% of the latter group. Besides the risk of infection, knowledge acquired in lectures and trainer's behaviour were also considered very influential factors shaping hand hygiene attitude in both groups. Overall, medical students reported better hand hygiene practices than nursing ones (69.9% and 59.7%, respectively; p < 0.001). The opposite finding was observed regarding their overall knowledge on hand hygiene (57.2% of medical versus 60.4% of nursing students, p = 0.04). The majority of students (86.6% of all participants; p < 0.001) supported the inclusion of compulsory hand hygiene education in their curriculum. Compulsory education and seminars were assessed as the most effective measures to increase hand hygiene compliance (71.4% of all students). In our study, medical students scored better in practices questions than nursing students; this did not apply for the knowledge score. The majority of students supported the inclusion of compulsory education on hand hygiene principles in their Departments' curricula, highlighting compulsory education and seminars as the most effective measures to increase compliance with hand hygiene. [ABSTRACT FROM AUTHOR]

Data on COVID-19 mortality among patients in intensive care units (ICUs) from Eastern and/or Southern European countries, including Greece, are limited. The purpose of this study was to evaluate the ICU mortality trends among critically ill COVID-19 patients during the first two years of the pandemic in Greece and to further investigate if certain patients' clinical characteristics contributed to this outcome. We conducted a multi-center retrospective observational study among five large university hospitals in Greece, between February 2020 and January 2022. All adult critically ill patients with confirmed COVID-19 disease who required ICU admission for at least 24 h were eligible. In total, 1462 patients (66.35% males) were included in this study. The mean age of this cohort was 64.9 (±13.27) years old. The 28-day mortality rate was 35.99% ( n = 528), while the overall in-hospital mortality was 50.96% ( n = 745). Cox regression analysis demonstrated that older age (≥65 years old), a body mass index within the normal range, and a delay in ICU admission from symptom onset, as well as worse baseline clinical severity scores upon ICU admission, were associated with a greater risk of death. Mortality of critically ill COVID-19 patients was high during the first two years of the pandemic in Greece but comparable to other countries. Risk factors for death presented in this study are not different from those that have already been described for COVID-19 in other studies.

Prevalence of diet-related behaviors (i.e., breakfast consumption, eating with the family) and their association with a 17-point diet quality score, constructed on the basis of reported frequency (in days/week) of vegetable, fruit, sweets and sugar-sweetened beverages consumption, was investigated among 3525 adolescents (51.5% girls) aged 11, 13 and 15 years, who were participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) cross-sectional study, during 2018. Almost one-third (32.9%) of the sample had breakfast ≤1 day/weekdays, 20.2% rarely ate with the family, 26.1% had a meal while watching TV ≥5 days/week, 31.7% had a snack in front of a screen ≥5 days/week and 24.1% ate in fast-food restaurants at least once/week. Multivariable ordinal logistic regression revealed that eating breakfast ≤1 day/weekdays compared to 4-5 days/weekdays (Odds ratio (OR): 1.56, 95% con-fidence interval (CI): 1.34-1.82), eating rarely with the family compared to almost every day (OR: 1.35, 95% CI: 1.13-1.60) and eating in fast-food restaurants ≥2 times/week vs. rarely (OR: 4.59, 95% CI: 3.14-6.70) were associated with higher odds of having poor diet quality. High frequency of having meals/snacks in front of a screen/TV was also associated with poor diet quality. Efforts to prevent or modify these behaviors during adolescence may contribute to healthier diet.

The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk., Introduction: Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults., Methods: A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis., Results: A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, p heterogeneity  = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence., Conclusions: In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

Objectives: Treatment of rheumatoid arthritis (RA) with disease-modifying anti-rheumatic drugs (DMARDs), either synthetic (sDMARDs) or biologic agents (bDMARDs) has significantly improved disease outcome. However, the impact of therapy-related adverse events (AEs), mild, moderate or serious, on disease outcome is under debate. The purpose of the study was to test the hypothesis that AEs, including infections, are rather common in patients receiving bDMARDs than in those receiving sDMARDs., Methods: Analysis of the medical records of patients followed in a single outpatient clinic was performed. In total, 1403 adults (295 men, 1108 women) were included in the analysis (969 treated with sDMARDs only, 434 with bDMARDs). All AEs and infections were recorded and their severity was graded according to international criteria. Incident rates were calculated and Kaplan-Meier plots as well as Cox proportional-hazards models were performed to examine the association of treatment groups with the risk of any AE., Results: The risk of any AE, irrespective of severity, was significantly higher in patients with bDMARDs with the adjusted hazard ratio being 1.98 (95% CI: 1.64 to 2.39). Patients in the biologic group treated initially with infliximab or adalimumab had a higher risk of AE compared to patients receiving etanercept or other biologic agents. Among patients treated with methotrexate, those receiving a dose below 10 mg had a higher risk of any AE when compared to those receiving higher doses., Conclusions: The risk of any AE among RA patients treated with bDMARDs was significantly higher compared to those treated with sDMARDs.

Adherence to traditional Mediterranean diet (MD) has been reported to be inversely associated with total, as well as cardiovascular, mortality. We have examined the relation between degree of such adherence and incidence of cancer overall in a general population sample of 25 623 participants (10 582 men, 15 041 women) of the Greek segment of the European Prospective Investigation into Cancer and nutrition (EPIC). All subjects completed a validated, interviewer-administered, semi-quantitative food-frequency questionnaire at enrolment. Degree of adherence to the traditional MD was assessed through a 10-point scale (0 minimal; 9 maximal) that incorporated key dietary characteristics. During a median follow-up of 7.9 years and 188 042 total person-years, 851 medically confirmed incident cancer cases (421 men, 430 women) were recorded. Using proportional hazards regression with adjustment for potential confounders, we found that a higher degree of MD adherence was associated with lower overall cancer incidence. A two-point increase in the score corresponded to a 12% reduction in cancer incidence (adjusted hazard ratio, 0.88 (95% confidence interval 0.80, 0.95)). The association was exposure-dependent and stronger among women. This inverse association with MD adherence was considerably stronger than that predicted on the basis of the associations of the individual components of this diet and points to the value of analysing dietary patterns in cancer studies.

Objectives: To evaluate the effect on overall and cardiovascular mortality of diet and physical activity amongst diabetic persons., Design: Population-based prospective investigation, from 1993 to mid-2004, in the Greek arm of the European Prospective Investigation into Cancer and Nutrition., Setting: Volunteers from the general adult Greek population., Subjects: From an original sample of 28 572 volunteers, 1013 were taking at enrolment drugs for diabetes mellitus, had no missing information on the study variables and no comorbidity. Diet was assessed at baseline through a validated questionnaire. Proportional hazards regression was used to assess the relation of dietary factors and physical activity with mortality., Interventions: None., Main Outcome Measures: Mortality ratios overall and from cardiovascular causes., Results: During 4579 person-years, 80 deaths have occurred, 46 of which from cardiovascular causes. Physical activity was strongly inversely associated with mortality. Two nutritional variables were significantly associated with diabetic mortality, with hazard ratios for increases of daily intake by one standard deviation being 1.31 for eggs [95% confidence interval (95% CI) 1.07 to 1.60] and 1.82 for saturated lipids (95% CI, 1.14 to 2.90). These two associations were considerably stronger for cardiovascular mortality. Waist-to-height ratio was positively, whereas hip circumference inversely associated with mortality. No significant interactions with gender for any of the study variables were evident., Discussion: Amongst confirmed diabetic persons, increased physical activity is associated with significant reduction of mortality, whereas increased consumption of eggs and saturated fats is associated with significant increase of mortality. Monounsaturated lipids are preferable for diabetic persons.

Background: Inflammation is an important component of carcinogenesis but little research has been conducted on whether inflammation markers can be predictive of cancer risk in humans., Methods: We analyzed C-reactive protein (CRP), a marker of inflammation, in plasma samples of 496 cases of cancer and 996 controls selected among participants in a prospective study from Greece., Results: Plasma CRP level was higher in cancer cases than controls (odds ratio for increase in CRP level of 3.2 mg/L, 1.20; 95% confidence interval, 1.10-1.32): The corresponding odds ratio after exclusion of the first year of follow-up and of individuals with CRP level above 20 mg/L was 1.32 (95% confidence interval, 1.15-1.52). Although based on small number of cases, the association between elevated plasma CRP level and risk was stronger for cancers of the liver, lung, skin, kidney, and bladder, as well as for lymphoma and leukemia than for other neoplasms., Conclusions: Our results confirm the important role of inflammation in human cancer and suggest that plasma CRP level is a potential marker of increased cancer risk.

Background: Adherence to a Mediterranean diet has been reported to increase longevity, but concerns have been expressed that such a diet may promote overweight and obesity., Objective: The objective was to investigate whether adherence to the traditional Mediterranean diet, as operationalized in a Mediterranean diet score, is associated with body mass index (BMI) and waist-to-hip ratio (WHR)., Design: In a general population sample of 23,597 adult men and women participating in the Greek European Prospective Investigation into Cancer and Nutrition Study, a validated food-frequency questionnaire was interviewer-administered, and anthropometric, sociodemographic, physical activity, and other lifestyle characteristics were recorded. BMI and WHR were regressed on a score that reflects adherence to the traditional Mediterranean diet and potentially confounding variables., Results: In models in which total energy intake was included, adherence to the Mediterranean diet was unrelated to BMI in both sexes and was weakly related to WHR only in women. When energy intake was not controlled for, a 2-point increase in the score was found to correspond to increases of approximately 650 and 150 g in the weight of an average-height man and woman, respectively, whereas the WHR was found to increase by approximately 0.001 units in men and 0.004 units in women., Conclusions: Adherence to a Mediterranean diet was essentially unrelated to BMI, with small differences depending on model choice and having no practical consequences. Overweight is a genuine problem in Greece and perhaps other Mediterranean countries, but it is likely to be related to limited physical activity in conjunction with excessive positive energy balance.

Background: Premature mortality from cardiovascular diseases could be prevented by the effective control of hypertension. Nationwide data for the status of hypertension in the adult Greek population are not available., Methods: In the context of the Greek component of the European Prospective Investigation into Cancer and nutrition (EPIC), 26 913 volunteers, aged 20-86 years, were recruited from several regions of Greece. Blood pressure measurements were taken by trained physicians and standard interviewing procedures were used to record medical history, and socio-demographic and lifestyle characteristics. The data were modelled through multiple regression., Results: The prevalence of hypertension (based on two arterial blood pressure measurements on a single occasion) is 40.2% for men and 38.9% for women (age-adjusted to the adult Greek population of 2001). In the sample examined, awareness among hypertensives is 54.4%, pharmaceutical treatment among those aware is 83.9%, and effective control among hypertensives is 15.2%. Prevalence of hypertension increases with age and is higher in rural areas and among individuals of lower education. Awareness and control of hypertension is higher among older individuals, among women and among the highly educated. Moreover, awareness of hypertension is higher among rural residents, whereas control of hypertension is more effective among urban residents., Conclusions: In a large sample of the general Greek population, the prevalence of hypertension among men is lower than the average among the EU countries, whereas the corresponding prevalence among women is higher. Awareness and control of hypertension is lower in Greece than in other western countries, making them public health priorities.