Mediterranean diet and a health behavior index in relation to cardiovascular biomarkers: Data from the Health and Retirement Study.

BACKGROUND AND AIM: Although lifestyle factors have been repeatedly examined for their role on cardiovascular diseases, their composite effect has not been frequently explored. We aimed to investigate the relation of dietary patterns (DPs) and a health behavior index (HBI) with cardiovascular biomarkers. METHODS AND RESULTS: A cross-sectional analysis with data from 3461 US residents, participants in the Health and Retirement Study (HRS), was performed. Nutritional data were obtained with a food frequency questionnaire, while adherence to Mediterranean Diet (MD) was determined by the Mediterranean Diet Score. A posteriori DPs were estimated using principal component analysis and the HBI was constructed combining adherence to MD, smoking status, physical activity levels, alcohol consumption and body mass index. Multiple linear regression models were performed to examine the relation between DPs or HBI and levels of C-reactive protein (CRP), glycosylated hemoglobin (HbA1C), cystatin C (Cys C), total cholesterol (TC), high density lipoprotein (HDL) and TC:HDL in blood. Multiple linear regression showed that the "healthy" DP and the MD had a significant negative association with CRP and Cys C (p < 0.05), while the "Western-type" DP had a significant positive association with TC:HDL ratio, CRP and Cys C. Moreover, the HBI was positively associated with HDL (p < 0.05) and negatively associated with TC:HDL ratio, CRP and Cys C (p < 0.05). CONCLUSIONS: Adherence to MD and to a healthy dietary pattern was negatively associated with biomarkers of inflammation, while the HBI was associated with a better cardiometabolic profile, assessed with blood biomarkers.

Attitudes and Practices Related to COVID-19 Vaccination with the Second Booster Dose among Members of Athens Medical Association: Results from a Cross-Sectional Study.

BACKGROUND: There are limited data on the attitudes and acceptance of the second booster (fourth dose) of the COVID-19 vaccination among physicians. METHODS: A cross-sectional, questionnaire-based, online study was conducted among members of the Athens Medical Association (A.M.A.) who were invited to participate anonymously over the period from January to March 2023. RESULTS: From the 1224 members who participated in the survey, 53.9% did not receive the fourth dose of the COVID-19 vaccine. The main reasons for no vaccination were the lack of obligation to receive the fourth dose, the history of three doses of the COVID-19 vaccine and the lack of sufficient information about the effectiveness of the fourth dose. Over half of the three-dose-vaccinated participants were willing to receive the fourth dose in the near future. Interestingly, the vaccination coverage among participants who had been informed about the fourth dose through scientific sources was low. CONCLUSIONS: The low vaccination coverage with the fourth dose reported in this study can lead to broad and serious consequences, such as increase in COVID-19 infections, reduction of available healthcare staff and increased caseloads of COVID-19 in hospitals. Furthermore, hesitant physicians will adversely influence the vaccination uptake among the general population due to their key role in informing and recommending the vaccine. The healthcare system administration should acknowledge and address physician's concerns through effective communication and better support.

Indicators of Healthcare Services Utilization among the Syrian Refugee Population in Jordan: An Observational Study.

BACKGROUND: Sufficient healthcare services utilization among the Syrian refugee population is one of the most important human rights. Vulnerable populations, such as refugees, are often deprived of sufficient access to healthcare services. Even when healthcare services are accessible, refugees vary in their level of utilization of these services and their health-seeking behavior. PURPOSE: This study aims to examine the status and indicators of healthcare service access and utilization among adult Syrian refugees with non-communicable diseases residing in two refugee camps. METHODS: The cross-sectional descriptive design was conducted by enrolling 455 adult Syrian refugees residing in the Al-Za'atari and Azraq camps in northern Jordan, using demographical data, perceived health, and the "Access to healthcare services" module, which is a part of the Canadian Community Health Survey (CCHS). A logistic regression model with binary outcomes was used to explore the accuracy of the variables influencing the utilization of healthcare services. The individual indicators were examined further out of 14 variables, according to the Anderson model. Specifically, the model consisted of healthcare indicators and demographic variables to find out if they have any effect on healthcare services utilization. RESULTS: Descriptive data showed that the mean age of the study participants (n = 455) was 49.45 years (SD = 10.48), and 60.2% (n = 274) were females. In addition, 63.7% (n = 290), of them were married; 50.5% (n = 230) held elementary school-level degrees; and the majority 83.3% (n = 379) were unemployed. As expected, the vast majority have no health insurance. The mean overall food security score was 13 out of 24 (±3.5). Difficulty in accessing healthcare services among Syrian refugees in Jordan's camps was significantly predicted by gender. "Transportation problems, other than fee problems" (mean 4.25, SD = 1.11) and "Unable to afford transportation fees" (mean 4.27, SD = 1.12) were identified as the most important barriers to accessing healthcare services. CONCLUSION: Healthcare services must imply all possible measures to make them more affordable to refugees, particularly older, unemployed refugees with large families. High-quality fresh food and clean drinking water are needed to improve health outcomes in camps.

Pet ownership and survival of European older adults.

With pet ownership on the rise, millions of individuals are exposed to this environmental exposure. Although the subject has been largely studied, more evidence is needed to clarify the potential association of pet ownership with human health. The aim of this research is to study the potential association of pet exposure (any pet, cat, dog, bird, fish) with all-cause, cardiovascular and cancer mortality of older ( ≥  50 years) European residents. To this end, a total of 23,274 participants from the Survey of Health Ageing and Retirement in Europe (SHARE) were employed (median follow-up 119 months). All-cause mortality (5163 events), as well as cardiovascular (CVD) (1832 events), and cancer mortality (1346 events) were examined using Cox Proportional Hazards models for their relation with pet exposure at baseline. Stratified analyses were also performed by gender and for single or multi-person households. No significant association was observed for any of the pets with all-cause mortality on the whole sample and the fully adjusted models. In stratified analyses, bird exposure significantly increased the risk of all-cause mortality in women [Hazard Ratio ( HR ) = 1.23 ; 95% CI 1.04-1.44] as well as women living alone ( HR = 1.38 ; 95% CI 1.02-1.85). Cause-specific models revealed an increased risk of death for women bird owners for causes other than cancer and CVD ( HR = 1.40 ; 95% CI 1.05-1.99). In conclusion, bird ownership may be negatively associated with survival of older women in Europe.

Using an IT-Based Algorithm for Health Promotion in Temporary Settlements to Improve Migrant and Refugee Health.

The application of the electronic algorithm developed by the Mig-Healthcare project was pilot tested in a sample of migrants and refugees in 2 Reception and Identification Centres (RICs), temporary settlements, in Greece using portable devices. The questions relate to health literacy issues, to mental health, to vaccination history, to lifestyle habits such as smoking, alcohol intake, diet, to the presence of diseases such as heart disease or diabetes, to the use of prevention services and to dental care. A total of 82 adults, 50 women and 32 men, participated. Data analysis showed that 67.1% (55) of the respondents had difficulty in understanding medical information and 57.3% (47) did not know where to seek medical help for a specific health problem. Four main areas of health problems were identified and further action is required: (A) mental health concerns, (B) vaccinations, (C) obesity, and (D) dental hygiene. Direct linkage with the "Roadmap and Toolbox" section of the project's website gave the respondents access to many sources and tools, while through the use of the interactive map, specific referral points of healthcare delivery in their area were identified. IT-based intervention in migrant and refugee populations in Greece are effective in increasing health literacy levels and identifying areas for health promotion interventions in these groups. Through linkage with the project's database, access to healthcare provision points and action to seek appropriate healthcare when necessary are encouraged. Given the attenuated vulnerability profile of people living in temporary settlements, this algorithm can be easily used in primary care settings to improve migrant and refugee health.

Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations.

BACKGROUND: Contact tracing as an epidemiological strategy has repeatedly contributed to the containment of various past epidemics and succeeded in controlling the spread of disease in the community. Systematic training of contact tracers is crucial in ensuring the effectiveness of epidemic containment. METHODS: An intensive training course was offered to 216 health and other professionals who work with vulnerable population groups, such as Roma, refugees, and migrants in Greece, by the scientific team of the postgraduate programme "Global Health-Disaster Medicine" of the Medical School, National and Kapodistrian University of Athens, with the support of the Swiss embassy in Greece. The course was delivered online due to the pandemic restriction measures and was comprised of 16 h over 2 days. The course curriculum was adapted in Greek using, upon agreement, a similar training course to what was developed by the Johns Hopkins University Bloomberg School of Public Health. Evaluation of the course was conducted in order to determine the short term satisfaction from participating in this training course. RESULTS: A total of 70% of the course participants completed the evaluation questionnaires and all trainers gave feedback on the course. The training modules were ranked as extremely useful by the majority of the participants and over 50% of the participants specifically stated that the course content was directly related to their work with vulnerable groups. Content about the ethics of contact tracing and the effective communication skills presented were deemed most useful. CONCLUSION: The course was well organised and provided the required skills for effective contact tracing. Many course participants intend to use some components in their work with vulnerable populations groups. Contact tracing efforts work best in a systematic and coordinated way and the provision of systematic and organised training can greatly increase its effectiveness.

Access to Healthcare for Migrant Patients in Europe: Healthcare Discrimination and Translation Services.

BACKGROUND: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. OBJECTIVES: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. METHODS: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. RESULTS: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191; 95% CI [0.029, 0.352]) and Austria (0.167; 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994; 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384; 95% CI [1.189, 1.611]), as opposed to Austria (0.763; 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613; 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292; 95% CI [1.585, 6.837]). CONCLUSIONS: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population.

Concordance of genotypic resistance interpretation algorithms in HIV-1 infected patients: An exploratory analysis in Greece.

PURPOSE: Genotypic resistance-related mutations in HIV-1 disease are often difficult to interpret. Different algorithms have been developed to provide meaningful application into clinical context. We aimed to compare, for the first time in Greece, the results of genotypic resistance derived from three interpretation algorithms. METHODS: The sequences of 120 HIV 1-infected patients were tested for genotypic resistance to 19 antiretroviral (ARV) drugs (n = 2280 sequences). The interpretation results of Rega, ANRS and ViroSeq algorithms were compared. RESULTS: Complete concordance was found for 2/19 ARV drugs, namely lamivudine and emptricitabine. Concordance was high for nucleoside reverse transcriptase inhibitors (NRTIs) and low for protease inhibitors (PIs). In inter-algorithm pairs, agreement was high between Rega and ViroSeq (kappa = 0.701), especially by ARV class, namely NRTIs (k = 0.869) and NNRTIs (k = 0.562). The only exception was noted for rilpivirine, where agreement was higher between ANRS and Rega (k = 0.410) compared to other inter-algorithm pairs (k = 0.018-0.055). By contrast, for PIs all comparisons yielded concordance equivalent to chance (k = 0.000). CONCLUSIONS: Our exploratory analysis provided evidence of significant inter-algorithm discordances, especially for PIs and NNRTIs highlighting the importance of matching the results of different algorithms to achieve optimized risk stratification. Ongoing research could assist clinical physicians in interpreting complex genotypic resistance patterns.

Management of Diabetes Mellitus in Refugee and Migrant Patients in a Primary Healthcare Setting in Greece: A Pilot Intervention.

Over the past years there is a substantial wave of migrants and refugees all over the world. Europe accepts approximately one-third of the international migrant population with Greece, in particular, having received large numbers of refugees and migrants by land and sea since the beginning of the civil war in Syria. Diabetes, a non-communicable disease, is a global health problem, affecting people in developing countries, refugees and migrants, and its basic treatment tool includes self-management and education. In this pilot study, we organized educational, interactive group sessions for diabetic refugees, based on culture, health, and nutritional needs according to a questionnaire developed for the study. The sessions were weekly, for two months, in the context of primary healthcare, organized by a dietitian. Nine individuals completed the sessions, five of nine were diagnosed in Greece and seven of nine needed diabetes education. Their waist circumference was above normal and they were all cooking at home. Their nutritional habits improved by attending the sessions and the interaction helped their social integration. They all found the sessions useful, and felt more self-confident regarding diabetes control and healthier.

Transportation, the pathogen vector to rule them all: Evidence from the recent coronavirus pandemic.

Introduction: It is common knowledge that mobility refers to a distinct vector for pathogens, but the importance of prevention and the infusion of public health practices within transportation systems is not manifest. Replication studies of this effect are important because transportation remains veiled in modern societies, since its demand is not direct, but derived. Methods: Variables mirroring transportation and logistics' systems intensity (trade data, the logistics performance index, and investment in transportation) are cross-tabulated with epidemiological data from the recent coronavirus pandemic. As the samples of the data pertain to a dependent commonality, the statistical hypothesis test applicable is McNemar's test. In addition, the statistical power of the test(s) is calculated as a marker of methodological validity and reliability. To further strengthen the analytical methodology, a plethora of descriptive statistics have been calculated and multiple correspondence analysis (MCA) has been conducted. Results: This work confirms that the domain of transportation bears a strong association with not only mortality of a disease, but its recovery rates as well. All crosstabs provide statistically significant results and the statistical power calculated is very high, signifying the appropriateness of the methodology and the very low probability of Type II error. The MCA results are significant, as well. Conclusions: The impact, or even the presence of transportation is veiled, as transportation comprises of derived demand dynamics. As such, its activities and even the prerequisites for its efficient operations many times go unnoticed. This work replicates a known effect, that mobility exacerbates the presence of a pathogen. The significance of this research lies on the fact that distinct indicators that reflect transportation and logistics are (though a robust calculatory methodology) statistically associated with epidemiological data.

Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project.

In this study, we collect and synthesize information on the health status of the refugee/migrant population in ten European countries in order to map refugee/migrant health needs. With this information, we identify areas of intervention and healthcare system strengthening to provide the basis for future health planning and effective healthcare provision to migrants, asylum-seekers and refugees in the European Union (EU). METHODS: 1407 migrants in ten European Union countries (consortium members of the Mig-HealthCare project) were surveyed on general health, mental health, and specific diseases using an interviewer-administered questionnaire. Descriptive statistics and multivariable linear regression analyses were conducted to investigate the risk factors on general quality of life for migrants and refugees in the EU. RESULTS: Mean age was 31.9 (±11.05) years and 889 (63.1%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Having a mental health disorder or a chronic disease such as a heart or respiratory disease was associated with worse general health. On the other hand, having permission to stay in the country of interview and being interviewed in the country of final destination was associated with better general health. Access to health care services was fragmented or unavailable for some interviewees because of linguistic, cultural, or administrative barriers. CONCLUSIONS: The management of chronic diseases and mental health conditions in European migrants and refugees is a key priority for health service provision. Further efforts should be made to guarantee healthcare access for migrant and refugee populations.

Knowledge, Attitudes and Perceptions about Cervical Cancer Risk, Prevention and Human Papilloma Virus (HPV) in Vulnerable Women in Greece.

Cervical cancer can be largely preventable through primary and secondary prevention activities. Following the financial crisis in Greece since 2011 and the increased number of refugees/migrants since 2015 the proportion of vulnerable population groups in Greece increased greatly and the ability of the healthcare sector to respond and to cover the health needs of the population is put under tremendous stress. A cross-sectional study was designed to assess the characteristics of vulnerable women in Greece regarding cervical cancer risk factors, prevention through screening activities and Human Papilloma Virus (HPV) knowledge. Two cohorts of women aged 18 to 70 years were studied (142 in 2012 and 122 in 2017) who completed an interviewer-administered questionnaire based on the behavioural model for vulnerable populations. According to this model, the factors that affect the behaviour of women in relation with their knowledge, attitudes and beliefs towards cervical cancer and the HPV vaccine in our study sample are categorised in predisposing factors (age, educational status, nationality menopausal status and housing) and enabling factors (lack of insurance coverage). Results from both univariate and multivariate analyses show that older age, low educational background, refugee/migrant or ethnic minority (Roma) background, menopausal status, housing conditions and lack of insurance coverage are linked with insufficient knowledge on risk factors for cervical cancer and false attitudes and perceptions on cervical cancer preventive activities (Pap smear and HPV vaccine). This is the first study in Greece showing the lack of knowledge and the poor attitudes and perceptions on cervical cancer screening and the HPV vaccine in various groups of vulnerable women. Our results indicate the need of health education and intervention activities according to the characteristics and needs of each group.

Migrants' and refugees' health status and healthcare in Europe: a scoping literature review.

BACKGROUND: There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. METHODS: This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants' access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards. RESULTS: The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described. CONCLUSIONS: The European situation concerning migrants' and refugees' health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants' health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants' own views on their health and barriers to access to healthcare is key.

Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices.

BACKGROUND: Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS: A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS: In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION: A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.

Policy Makers', NGO, and Healthcare Workers' Accounts of Migrants' and Refugees' Healthcare Access Across Europe-Human Rights and Citizenship Based Claims.

Freely available healthcare, universally accessible to the population of citizens, is a key ideal for European welfare systems. As labor migration of the twentieth century gave way to the globalized streams of the twenty-first century, new challenges to fulfilling these ideals have emerged. The principle of freedom of movement, together with large-scale forced migration have led to large scale movements of people, making new demands on European healthcare systems which had previously been largely focused on meeting sedentary local populations' needs. Drawing on interviews with service providers working for NGOs and public healthcare systems and with policy makers across 10 European countries, this paper considers how forced migrants' healthcare needs are addressed by national health systems, with factors hindering access at organizational and individual level in particular focus. The ways in which refugees' and migrants' healthcare access is prevented are considered in terms of claims based on citizenship and on the human right to health and healthcare. Where claims based on citizenship are denied and there is no means of asserting the human right to health, migrants are caught in a new form of inequality.

Anthropometric characteristics, physical activity and risk of hematological malignancies: A systematic review and meta-analysis of cohort studies.

Overweight/obesity, adult attained height and physical activity are possible risk factors for hematological malignancies. This meta-analysis aims to evaluate the associations between these factors and hematological cancer risk in adults. Eligible cohort studies were sought in PubMed up to May 31, 2016; overall, 44 studies were included in the present analyses. Pooled relative risk estimates were calculated using random-effects models; separate analyses were conducted for non-Hodgkin lymphoma (NHL) and subtypes (diffuse large B-cell lymphoma, DLBCL; follicular cell lymphoma; small lymphocytic lymphoma/chronic lymphocytic leukemia, SLL/CLL), Hodgkin lymphoma (HL), multiple myeloma (MM), leukemia and subtypes (acute lymphoblastic leukemia, acute myeloid leukemia, AML). Obesity was associated with increased risk of NHL, HL, MM, leukemia overall and AML in both sexes, as well as with higher DLBCL risk in women; the dose-response meta-regression analysis confirmed these associations. Less pronounced effects were observed regarding overweight, as it was associated with increased MM risk in both sexes, NHL risk in males, DLBCL and overall leukemia risk in females. Taller men presented with significantly higher risk of NHL and taller women were affected by higher risk of NHL, DLBCL, FL, CLL/SLL, MM, leukemia and AML. On the other hand, physical activity and abdominal fatness were not associated with the risk of hematological malignancies. In conclusion, this meta-analysis highlights the pivotal role of anthropometric measures in shaping the risk of hematological malignancies in adults. Additional, well-designed studies stemming from all the continents are needed for the further substantiation and generalization of the results.

Prognostic Role of BRAF Mutations in Colorectal Cancer Liver Metastases.

BACKGROUND/AIMS: The impact of tumor biology on prognosis in patients with colorectal liver metastasis (CRLM) has been the topic of intense research. Specifically, the presence of BRAF mutations has been recently associated with adverse long-term outcomes. We examined the existing literature on the prognostic implications of BRAF mutations in patients with CRLM. MATERIALS AND METHODS: A structured review of the literature was performed between 5/1/2016 and 6/1/2016 using the PubMed database. Original research articles published between 1/1/2010 and 4/01/2016 were considered eligible. The primary end-points were overall survival (OS)/disease-specific survival (DSS) and recurrence-free survival (RFS) among patients with BRAF mutated CRLM who underwent resection. RESULTS: Eight studies were included. All studies reported on OS/DSS, while 6 reported on RFS. BRAF mutant status was a strong independent predictor of both worse OS/DSS and RFS in 7 and 4 studies, respectively. CONCLUSION: BRAF-mutant lesions are consistently associated with poor prognosis. Consequently, the indications of CRLM resection in this patient group should be reconsidered.

Promotion of healthy nutrition among students participating in a school food aid program: a randomized trial.

OBJECTIVES: To evaluate the potential benefits on students' eating habits, of incorporating healthy nutrition education as part of a school food aid program. METHODS: 146 schools participating in the DIATROFI Program in Greece during the 2013-2014 school year were randomly allocated to the environmental intervention (received a healthy daily meal) and the multicomponent intervention (MI) group (in addition to the meal, a healthy nutrition educational program was applied). The analysis, based on 3627 pre-post intervention questionnaire pairs, was stratified for children (ages 4-11 years) and adolescents (ages 12-18 years). RESULTS: Children participating in the MI group displayed 25 % higher odds of increasing the weekly consumption of milk/yoghurt and fruits, 61 % higher odds of improving BMI from overweight/obese to normal and 2.5 times higher odds of improving from underweight to normal. For adolescents in the MI group, the odds of increasing the consumption of vegetables were 40 % higher. In both intervention groups, approximately one in four overweight/obese adolescents reached normal weight. CONCLUSIONS: Educational programs on healthy nutrition might be considered worth implementing in the framework of school food aid programs.

The impact of a school food aid program on household food insecurity.

BACKGROUND: We had a unique opportunity to establish the extent of food insecurity and the potential impact of a large-scale school-based nutritional program, in low-socioeconomic status districts of Greece, during the current economic crisis. METHODS: Around 162 schools with 25 349 students participated during the 2012-2013 school year. Each student received a daily healthy meal designed by nutrition specialists. Food insecurity levels, measured using the Food Security Survey Module were assessed at baseline and after a 1-8-month intervention period. Pre-post intervention responses were matched at an individual level. RESULTS: Around 64.2% of children's households experienced food insecurity at baseline. This percentage decreased to 59.1% post-intervention,P< 0.001. On an individual level, food insecurity score diminished by 6.5%,P< 0.001. After adjustment for various socioeconomic factors, for each additional month of participation, the odds of reducing the food insecurity score increased by 6.3% (OR = 1.06, 95% CI: 1.02-1.11). Those experiencing food insecurity with hunger at baseline were more likely to improve food insecurity score than those who did not (OR = 3.51, 95%CI: 2.92-4.21). CONCLUSION: Children and families residing in low socioeconomic areas of Greece, experience high levels of food insecurity. Our findings suggest that participation in a school-based food aid program may reduce food insecurity for children and their families in a developed country in times of economic hardship.