Readability levels of health pamphlets distributed in hospitals and health centres in Athens, Greece.

OBJECTIVES: Health literacy is important in the medical and social sciences due to its impact on behavioural and health outcomes. Nevertheless, little is known about it in Greece, including patients' level of understanding health brochures and pamphlets distributed in Greek hospitals and clinics. STUDY DESIGN: Observational study in the greater metropolitan area of Athens, Greece. METHODS: Pamphlets and brochures written in the Greek language were collected from 17 hospitals and healthcare centres between the spring and autumn of 2006. Readability of pamphlets using the Flesch-Kincaid, Simple Measure of Gobbledygook (SMOG) and Fog methods was calculated based on a Greek readability software. RESULTS: Out of 70 pamphlets collected from 17 hospitals, 37 pamphlets met the criteria for the study. The average readability level of all scanned pamphlets was ninth to 10th grade, corresponding to a readability level of 'average'. A highly significant difference (P<0.001) was found between private and public hospitals using the Flesch-Kincaid and SMOG readability scales. Pamphlets from private hospitals were one grade more difficult than those from public hospitals. CONCLUSION: Approximately 43.7% of the Greek population aged ≥20 years would not be able to comprehend the available pamphlets, which were found to have an average readability level of ninth to 10th grade. Further research examining readability levels in the context of health literacy in Greece is warranted. This effort paves the way for additional research in the field of readability levels of health pamphlets in the Greek language, the sources of health information, and the level of understanding of key health messages by the population.

Epidemiological and clinical characteristics of influenza A(H1N1)v infection in children: The first 45 cases in Cyprus, June - August 2009.

Following the first imported case in a tourist in Cyprus on 2 June 2009, the influenza A(H1N1)v virus has spread on the island affecting mainly young adults and children. We describe here the first 45 cases in children. Fever, cough, rhinorrhoea and sore throat were the most common symptoms of infection. Half of the children had fever for one day or only for a few hours. Five children were hospitalised, and overall their symptoms were mild. Adherence to oseltamivir treatment was very high, with low frequency of gastrointestinal side effects such as nausea and vomiting. Camping places and summer schools played a significant role in spreading the infection among children of school age.

Circulating serotypes and antimicrobial sensitivity of Streptococcus pyogenes isolates from children in Cyprus.

The most common T-serotypes among group A streptococci (n = 88) isolated from pharyngeal samples of children referred to a tertiary hospital in Cyprus for pharyngitis or scarlet fever during a 14-month period (2003-2004) were T28 (25%), T8/25/Imp19 (22.7%) and T12 (9.1%). All 88 isolates were sensitive to penicillin and clindamycin, but 1.1% and 18.2% of isolates were resistant to erythromycin and tetracycline, respectively. Macrolide consumption was estimated at 1.7 defined daily doses/1000 inhabitants/day. The low percentage of resistance to macrolides may have been related, at least in part, to the low consumption of macrolides.

Epidemiological study of Q fever in humans, ruminant animals, and ticks in Cyprus using a geographical information system.

A cross-sectional study of Q fever was conducted in a representative sample of the human and animal population in Cyprus in order to assess the seroprevalence of Q fever and the prevalence of related risk factors. A total of 583 human and 974 ruminant animal serum samples were collected and tested for the detection of antibodies against Coxiella burnetii phase II antigen using an indirect immunofluorescent assay. One hundred forty-one ticks were collected from the infested animals examined; the polymerase chain reaction and the shell-vial technique were used to detect and isolate C. burnetii. Standardized questionnaires were used to obtain information concerning inhabitants and their animals. A geographical information system was used to identify high-risk regions. The prevalence of IgG antibodies against C. burnetii phase II antigen was estimated at 52.7% for humans, 48.2% for goats, 18.9% for sheep, and 24% for bovines. C. burnetii was detected in 11 (7.8%) ticks. Using the geographical information system, two villages were identified as high-risk regions on the basis of high seroprevalence rates of IgG antibodies in humans and animals. Risk factors related to Q fever seropositivity were identified by logistic regression analysis and included age, residence, occupation, use of manure in the garden, ownership of animals (especially goats), and the presence of tick-infested or aborting animals. Q fever poses an occupational hazard to humans living in close contact with sheep and/or goats. In parallel, ticks should be considered an important aspect in the epidemiology of Q fever and should be further studied to better elucidate their role.

Perioperative anti-infective prophylaxis with teicoplanin compared to cephalosporins in orthopaedic and vascular surgery involving prosthetic material.

A meta-analysis of randomised controlled trials evaluated the effectiveness and safety of teicoplanin compared to first- or second-generation cephalosporins for perioperative anti-infective prophylaxis in orthopaedic and vascular surgery involving prosthetic material. No differences were found between teicoplanin and cephalosporins with respect to the development of infection at the site of surgery or in remote areas of the body. In addition, there were no significant differences in reported adverse effects or mortality. These findings indicate that both regimens are equally effective in preventing post-operative infections in orthopaedic and vascular surgery involving prosthetic materials.

Secondary hyperparathyroidism and bone turnover in elderly blacks and whites.

This study was undertaken to describe the prevalence of secondary hyperparathyroidism in African-American and Caucasian participants in the Boston Low-Income Elderly Osteoporosis Study and to examine and compare associations of hyperparathyroidism with biochemical markers of bone turnover and bone density in the two racial groups. Serum osteocalcin and serum cross-linked N-telopeptides of type I collagen, and calcaneal bone mineral density were measured in February or March in 255 men and women, 64 yr of age and older. Subjects were categorized as normal or as having hyperparathyroidism, based on a serum PTH concentration below or above the top of the normal range (6.9 pmol/liter), respectively. The prevalence of hyperparathyroidism was 38% in the 144 black subjects and 20% in the 111 white subjects. Serum osteocalcin and cross-linked N-telopeptides of type I collagen were significantly higher in both black and white hyperparathyroid subjects (P < 0.05), and the hyperparathyroid-related difference in osteocalcin was greater among black than white subjects. Hyperparathyroidism was significantly associated with reduced heel bone mineral density in blacks (P = 0.008) but not in whites. This study provides evidence that secondary hyperparathyroidism is prevalent in elderly adults, both black and white, and that it should not be viewed as a benign condition in either group. Recent public health efforts to promote higher calcium and vitamin D intakes, targeted predominantly to older Caucasians, should also be directed to older African-Americans.

Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population.

This report examines the wintertime vitamin D and PTH status of 308 participants in the Boston Low Income Elderly Osteoporosis Study of noninstitutionalized low income elderly men and women (age, 64-100 yr) living in subsidized housing in Boston, MA. Twenty-one percent of the 136 black subjects and 11% of the 110 whites had very low plasma 25-hydroxyvitamin D (25OHD) concentrations (<25 nmol/L), and 73% of the blacks and 35% of the whites had 25OHD concentrations less than 50 nmol/L. The mean 25OHD levels of the smaller Hispanic and Asian subsets were generally similar to those of the white subjects. In addition to race, significant predictors of 25OHD included vitamin D intake (positive association) and smoking (inverse association), but not sex or age. Low 25OHD concentrations were associated with increased PTH and reduced serum calcium. The PTH level in the black subjects was substantially higher than that in the white subjects, and this difference was only partially explained by the racial difference in 25OHD. Elderly individuals who live in northern areas, particularly African-Americans, should be strongly encouraged to increase their vitamin D intake, especially in winter.

Epidemiological study of brucellosis in eight Greek villages using a computerised mapping programme.

A Computerised Mapping Programme (CMP) was created step by step to cover all the needs of a cross sectional population survey conducted in eight villages of Fokida, a rural area of central Greece. The maps of Greece (boundary) and the topographical maps of the eight villages were created using the CMP. A volunteer sample of 1121 out of 2607 inhabitants of the study area participated in the population survey. The participants were tested for brucellosis using serological tests (ELISA and Rose Bengal) and the intradermal reaction test. A questionnaire was used to obtain information concerning the risk factors for brucellosis. The risk factors found through statistical analysis were occupation (RR: 5.81, p < 0.00001), consumption of raw milk (RR: 1.98, p < 0.001) and unpasteurised fresh cheese (RR: 2.13, p < 0.01). The same factors were indicated by the CMP. The CMP also indicated manure-contaminated playgrounds in residential yards as a potential risk factor for children. The origin and dissemination were delineated using time space association display. The CMP proved to be a useful tool in this epidemiological study.

Surveillance of brucellosis in a rural area of Greece: application of the computerized mapping programme.

Long term active surveillance of brucellosis was implemented in a rural area (Fokida) of Greece from 1989 to 1993 while the rural area of Grevena was selected as a control area. The computerised mapping programme was used to identify and protect the suspected animal brucellosis free zones. Health education of the inhabitants was further used to teach them how to avoid the risk factors. Three suspected brucellosis free zones were identified and two of them were successfully protected. The incidence for the 10 year period (1979-1988) was estimated at 1.4/1000/year for the study area and 1.6/1000/year for the control area. During the surveillance period the incidence in the study area dropped to 0.2/1000/year while in the control area it decreased to 1.0/1000/year. The methodology of identification and protection of suspected brucellosis free zones combined with health education proved to be efficient in reducing the incidence of the disease. The same methodology could be used in the country level, in countries where it is difficult to implement and maintain an animal control programme in the whole country.