Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother-child cohort in Crete, Greece.

AIMS: Few epidemiological studies evaluated associations between perinatal complications and maternal mood at the early postpartum period and the findings are inconsistent. We aimed at investigating a wide range of complications during pregnancy, at delivery, and at the early postpartum period as determinants of postpartum depression (PPD) at 8 weeks postpartum. METHODS: A total of 1037 women who enrolled in the Rhea mother-child cohort in Crete, Greece participated in the present study. Information on pregnancy, perinatal and postpartum complications was obtained from clinical records or by questionnaires. Postpartum depressive symptoms were assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear and logistic regression models were fit to estimate the association between pregnancy, perinatal and postpartum complications and maternal depressive symptoms, adjusting also for potential confounders. RESULTS: The prevalence of women with probable depression (EPDS score ≥ 13) was 13.6% at 8 weeks postpartum. Gestational hypertension and/or preeclampsia (ß coefficient 1.86, 95% CI: 0.32, 3.41) and breastfeeding difficulties (ß coefficient 0.77, 95% CI: 0.02, 1.53) were significantly associated with higher PPD symptoms. Sleep patterns during pregnancy, such as sleep deprivation (OR = 3.57, 95% CI: 1.91, 6.67) and snoring (OR = 1.81, 95% CI: 1.11, 2.93), and breastfeeding duration less than 2 months (OR = 1.77, 95% CI: 1.19, 2.64) were significantly associated with increase in the odds for PPD. Some other complications, such as unplanned pregnancy and hospitalisation during pregnancy were also associated with EPDS score, but these associations were explained by socio-demographic characteristics of the mother. CONCLUSIONS: We found that several pregnancy, perinatal and postpartum complications may have an adverse effect on maternal mood at the early postpartum period. These findings have considerable implications for developing effective prevention and early psychoeducational intervention strategies for women at risk of developing PPD.

Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood.

BACKGROUND: In adults, adherence to the Mediterranean diet has been inversely associated with cardiovascular risk, but the extent to which diet in pregnancy is associated with offspring adiposity is unclear. We aimed to investigate the association between adherence to Mediterranean diet in pregnancy and offspring cardiometabolic traits in two pregnancy cohorts. METHODS: We studied 997 mother-child pairs from Project Viva in Massachusetts, USA, and 569 pairs from the Rhea study in Crete, Greece. We estimated adherence to the Mediterranean diet with an a priori defined score (MDS) of nine foods and nutrients (0 to 9). We measured child weight, height, waist circumference, skin-fold thicknesses, blood pressure, and blood levels of lipids, c-reactive protein and adipokines in mid-childhood (median 7.7 years) in Viva, and in early childhood (median 4.2 years) in Rhea. We calculated cohort-specific effects and pooled effects estimates with random-effects models for cohort and child age. RESULTS: In Project Viva, the mean (SD, standard deviation) MDS was 2.7 (1.6); in Rhea it was 3.8 (1.7). In the pooled analysis, for each 3-point increment in the MDS, offspring BMI z-score was lower by 0.14 units (95% CI, -0.15 to -0.13), waist circumference by 0.39 cm (95% CI, -0.64 to -0.14), and the sum of skin-fold thicknesses by 0.63 mm (95% CI, -0.98 to -0.28). We also observed lower offspring systolic (-1.03 mmHg; 95% CI, -1.65 to -0.42) and diastolic blood pressure (-0.57 mmHg; 95% CI, -0.98 to -0.16). CONCLUSION: Greater adherence to Mediterranean diet during pregnancy may protect against excess offspring cardiometabolic risk.

Early life determinants of dietary patterns in preschool children: Rhea mother-child cohort, Crete, Greece.

BACKGROUND/OBJECTIVES: The determination of dietary patterns in children examines the effects of the overall diet at early ages, instead of looking at individual foods or energy providing nutrients. The present analysis aims to identify the dietary patterns of preschool children and to examine their associations with multiple socio-economic and lifestyle characteristics. SUBJECTS/METHODS: Dietary data were collected for 1081 children participating in the Rhea mother-child cohort in Crete, Greece. Diet was assessed using a validated food frequency questionnaire, and dietary patterns were identified with principal component analysis. Multivariable linear regression models were used to examine factors associated with each dietary pattern. RESULTS: Three dietary patterns were identified explaining 45.8% of the total diet variation. The 'Mediterranean' pattern was based on pulses, olive oil, vegetables, fish and fruits; the 'Snacky' pattern included potatoes and other starchy roots, salty snacks, sugar products and eggs; the 'Western' pattern contained cereals, cheese, added lipids, beverages and meat. Preschool attendance and increased time spent with the mother (⩾2 h/day) were positively associated with the 'Mediterranean' pattern, whereas watching TV was inversely associated with this pattern. Lower parental education, maternal age and earlier introduction to solid foods were positively associated with the 'Snacky' pattern. Higher scores on the 'Western' type diet were associated with exposure to passive smoking and watching TV. No variation in energy providing nutrient intake was observed across tertiles of the identified dietary patterns. CONCLUSIONS: The results from this analysis indicate the important role of socio-demographic factors on children's dietary preferences in early age.

Maternal personality traits and risk of preterm birth and fetal growth restriction.

BACKGROUND/AIMS: Maternal personality may increase vulnerability to stress, which could lead to an unfavourable intrauterine environment to the fetus. We sought to investigate the impact of maternal personality traits on adverse birth outcomes such as preterm birth, and fetal growth restriction in the mother-child cohort study (RHEA Study) in Crete, Greece 2007-2009. METHODS: Five hundred and eighty pregnant women participating in "Rhea" cohort study completed the Eysenck Personality Questionnaire-Revised (EPQ-R) at 28-32 weeks of gestation. Information on anthropometric measures at birth was obtained from the hospital delivery logs and medical records. Fetal growth restriction was based on a customized model, and multivariate logistic regression models were used adjusting for confounders. RESULTS: A per unit increase in the EPQ Neuroticism scale increased the risk for fetal weight growth restriction by 9% [odds ratio (OR)=1.09, 95 percent CI: 1.01, 1.19)], and for fetal head circumference growth restriction by 6% [OR=1.06, 95 percent CI: 1.01, 1.18] after adjusting for maternal age, education, origin, marital status, working status, pre-pregnancy BMI, delivery type, parity, smoking, and alcohol intake during pregnancy. CONCLUSIONS: Maternal neuroticism, which predisposes to negative mood, may be a risk factor for fetal growth restriction.

Impact of influenza infection on children's hospital admissions during two seasons in Athens, Greece.

A prospective epidemiologic surveillance of hospitalizations associated with influenza was conducted in order to calculate population-based hospitalization rates. Eligible children were 6 months to 13 years of age and were admitted to one of the two large children's hospitals in the Athens area during two influenza seasons. Nasopharyngeal aspirates were tested for influenza by a polymerase reaction assay. Influenza accounted for 9.9-11.8% of all admissions during the influenza season and the overall annual rate of hospitalizations was 13.6-16.8 cases per 10,000 children being highest for children under 5 years of age (26-31.2/10,000 children). Febrile seizures and acute otitis media were the two most common complications associated with influenza and antibiotics were administered to 61% of flu positive patients. Influenza is associated with high hospitalization rates among young children and these may be substantially reduced with the introduction of routine immunization.

Performance of rapid influenza testing in hospitalized children.

Influenza infection is associated with high hospitalization rates among young children. Rapid diagnosis of influenza infection is particularly useful in order to prevent nosocomial infection and allows for the timely initiation of antiviral treatment. We evaluated the performance of a rapid influenza test in hospitalized children during the influenza season. All children (aged 6 months to 14 years) hospitalized with fever and/or respiratory symptoms, admitted during the 2005 influenza season, participated in the study. A multiplex reverse transcriptase polymerase chain reaction (RT-PCR), able to identify IFV-A H1N1, H3N2, and IFV-B subtypes, was performed on nasopharyngeal aspirates. The nasal swab was tested with a lateral-flow immunoassay (QuickVue Influenza Test). The performance of the rapid test was compared with the results of PCR. Influenza infection was diagnosed by PCR in 41/217 (19%) patients. Infection with influenza A virus (H3N2) was diagnosed in all cases. The performance of the QuickVue Influenza Test was estimated as follows: sensitivity 67.5%, specificity 96%, positive predictive value 79%, and negative predictive value 93%. The sensitivity of the test was higher in infants aged 6-12 months, in those with short duration of symptoms, and in the peak phase of the epidemic. The QuickVue Influenza Test is useful and reasonably accurate to detect influenza infection in hospitalized children during the influenza season. Infection with influenza virus is unlikely if the test is negative. A positive result suggests that infection is probable if influenza virus circulates in the community.

Budesonide and formoterol inhibit inflammatory mediator production by bronchial epithelial cells infected with rhinovirus.

BACKGROUND: Rhinoviruses (RVs) are responsible for the majority of acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations. RVs infect the lower airways and induce the production of pro-inflammatory and remodelling-associated mediators. Budesonide (BUD) and formoterol (FORM) synergize in controlling asthma and COPD exacerbations; however, their effects on virus-induced inflammation and remodelling are less known. OBJECTIVE: We investigated whether BUD and FORM synergize in suppressing RV-induced inflammation and remodelling in the airways. METHODS: In vitro models of RV infection of BEAS-2B and primary normal human bronchial epithelial (NHBE) cells were used. We assessed the effects of individual and combined drugs administered post-infection, at a clinically relevant concentration range (10(-6)-10(-10) m), on the production of CCL5, CXCL10, CXCL8, IL-6 and the remodelling-associated VEGF and bFGF, using ELISA and RT-PCR. RESULTS: BUD effectively suppressed RV-mediated induction of all mediators studied, in a concentration-dependent manner. FORM alone suppressed the production of CXCL8 and bFGF. The combination of BUD and FORM had concentration-dependent, additive or synergistic effects in the suppression of RV-induced CCL5, CXCL8 and CXCL10 in both cell types as well as VEGF in NHBE only. Combination treatment also resulted in an enhanced suppression of RV-induced IL-6, and CCL5 at the mRNA level as compared with BUD or FORM alone. CONCLUSION: BUD and FORM suppress RV-induced chemokines and growth factors in bronchial epithelial cells in a concentration-dependent, synergistic or additive manner. These data further support the combined use of BUD and FORM in asthma and COPD and intensification of this therapy during exacerbations.

Determination of malathion, coumaphos, and fluvalinate residues in honey by gas chromatography with nitrogen-phosphorus or electron capture detectors.

A rapid, reliable, and inexpensive extraction method was developed to determine acaricide residues in honey by gas chromatography (GC) with nitrogen-phosphorus (NP) or electron capture (EC) detectors. Because of the high selectivity of the NP detector, no interfering peaks were present and no cleanup was necessary. A simple cleanup step is proposed for the GC-ECD analysis. Recoveries from spiked honey samples ranged from 79 to 94.4%, with coefficients of variation of 0.3-18.5%. The quantitation limit obtained was 0.015 mg/kg for malathion, 0.020 mg/kg for coumaphos, and 0.005 mg/kg for fluvalinate. The method was used to determine the disappearance of malathion and coumaphos residues from honey samples collected from beehives treated with these acaricides. The disappearance of both acaricides was rapid and followed a first-order model for the duration of the experiment.

The impact of cytotoxic chemotherapy--perspectives from patients, specialists and nurses.

This study, carried out in three European countries, elicited the views and impact of three medical groups involved in patient care. Their views were compared with patients' perspectives of their condition. The main stage of the study was carried out by self-completion questionnaires by 300 patients across Italy, France and the U.K. The views of the medical profession were quantified via 150 hospital specialists, 75 cancer care nurses and 30 general practitioner interviews. Patients' symptoms most frequently seen by the medical profession were nausea, tiredness, loss of hair, vomiting, worrying and lack of appetite. On a scale of 1-4 (1 = not at all; 4 = very much) the frequency of these side effects were rated at 2.8 or over. Intensity of concern was highest for nausea and vomiting. These two symptoms was most frequently highlighted as one of the three highest concerns respectively for 74% and 54% of specialists, 64% and 60% of nurses and 50% of general practitioners. Patients on average reported a lower frequency of major symptoms. Most frequent were loss of hair, tiredness, lack of energy, nausea and decreased sexual interest. In terms of the impact of these problems, tiredness, nausea and loss of hair were the most frequently mentioned. Vomiting bothered them more than the frequency would suggest. 1 in 10 patients claim to have delayed their treatment because of previous experiences of side effects. The main impact on patient's quality of life related to the aspects of worrying and the effects on the family. In terms of communication, both the medical profession and the patients felt that patients were well informed about the disease and treatment. However, differences emerged between what patients claim to have been told about the disease and its treatment and what nurses and doctors claim to have said.

The contribution of right ventricular angiocardiography to the diagnosis of tricuspid valvular stenosis (Observations made on 3 patients).

The right ventricular angiocardiographic findings, in the anterioposterior projection, are described on three patients with tricuspid valvular stenosis. During diastole, the tricuspid valve was delineated as an arcline contour, placed between the non opacified right atrium and the opacified right ventricle, and it was displaced to the left of the spine. Its mobility was diminished. Right ventricular angiocardiography seems to be a useful method for the diagnosis of the tricuspid valvular stenosis and the estimation of the pathology and the functional condition of the tricuspid valve. The method is recommended for further evaluation.

The significance of intraventricular electrocardiogram in artificial heart pacing. Observations made on 232 patients.

From 1972-1975, 232 consecutive patients suffering from A/V block were paced intravenously in the Cardiac Department. Medical School, University of Athens. Of these, 124 were female and 108 male. Their age range was between 49 and 85 years. Besides fluoroscopic and threshold control, the intraventricular electrocardiogram (E.C.G.)., recorded from the tip of the electrode, was used as a guide for the accurate positioning of the catheter-electrode in the right ventricle. An injury pattern with an elevation of the ST segment of at least 3 mV and characteristic and steady morphology was obtained when the electrode tip was satisfactorily impacted in the right position. As a consequence of this, an initial stimulation threshold below 0.7 mA was obtained in all cases and pacing failure, due to catheter displacement was noted in only 11 cases (5%), without any apparent increase in the incidence of right ventricular perforation.