Sociodemographic determinants of low birthweight in Greece: a population study.

A total population sample of 10,654 singleton births from the Greek National Perinatal Survey of April 1983 was analysed to identify factors independently associated with low birthweight (LBW). The sample was divided into two groups according to the gravidity of the mothers (3368 primigravidae and 7286 multigravidae). Data examined included regional characteristics, marital status, age at and duration of marriage, parental ages at delivery, crowding in the home, insurance status, parental occupational classification and parental education levels. Logistic regression was used to define the socio-economic and demographic characteristics independently associated with the delivery of an LBW singleton baby. Significantly different LBW rates were found among the two groups: 4.3% in the primigravidae and 5.2% for multigravidae. For primigravidae significant associations were found with marital status, maternal occupation and father's education, while for multigravidae significant features were mother's education and place (region) of residence. The study showed little to assist in devising strategies of primary prevention of LBW in Greece.

PIP: This study examines the sociodemographic determinants of low birth weight (LBW) in Greece. The study population comprised 10,654 singleton births (3368 primigravid and 7286 multigravid mothers) from the Greek National Perinatal Survey of April 1983 was used to identify factors associated with LBW. The study considered classifications based on parental occupations, educational levels, marital status and parental ages, with the ultimate aim of providing clues about causal etiology. The results indicated no significant correlation with paternal occupation group. There was, however, a significant association with maternal occupation group. The housewife, whether primigravid or multigravid, had the lowest risk of having an LBW baby as compared to laborers and commercial workers. In Greece, paternal and maternal education showed a significant relationship with LBW. Unmarried primigravidas had a significant residual risk of LBW; however, marital status was not an independent risk factor for multigravidas. The mother's age was significantly associated with LBW among multigravidas, the highest rate being found among the oldest group of mothers. Paternal age was also significantly related to LBW among multigravidas, with women whose husband was either a teenager or age 45 or older being most at risk. In conclusion, factors such as maternal age and social class based on the father's occupation are not independently associated with LBW in Greece. For primigravidas significant associations were found with marital status, maternal occupation and father's education, while for multigravidas significant features were the education and place of residence of the mother.

Molecular epidemiology of vertical human immunodeficiency virus type 1 transmission in Greece: evidence of non-B subtypes.

OBJECTIVES: To investigate the subtype classification of the circulating virus strains among human immunodeficiency virus type 1 (HIV-1)-infected children in Greece. STUDY DESIGN/METHODS: Since the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic in Greece in 1982, 23 children have been reported to be vertically infected with HIV-1. Blood samples were available for 19 of these children, and the C2-C4 env region was successfully amplified by nested polymerase chain reaction (PCR) for 16 subjects. HIV-1 subtype was established by the heteroduplex mobility assay (HMA) in 16 subjects and confirmed by DNA sequencing and phylogenetic analysis in 8 subjects. RESULTS: Most subjects (9; 56%) fell into subtype B. However, a substantial proportion (44%) were classified as subtypes A (3; 19%), C (1; 6%), D (1; 6%), and I (2; 12%). According to epidemiologic information, 5 of 7 children infected with non-B HIV-1 subtypes were born to Greek parents. CONCLUSION: These findings clearly suggest that non-B strains have been introduced into Greece, providing evidence that HIV epidemic in this country will probably change profile over time. In addition, subtype I was identified in 2 HIV-1-infected children, both of whom were born to Greek parents.

Analysis of low density lipoprotein receptor gene mutations and microsatellite haplotypes in Greek FH heterozygous children: six independent ancestors account for 60% of probands.

This study reports the characterization of 60% of low density lipoprotein receptor (LDLR) gene mutations in 150 unrelated Greek familial hypercholesterolaemia (FH) heterozygous children by the analysis of six LDLR gene mutations. The linkage disequilibrium of two polymorphic microsatellites (D19S394 and D19S221) flanking the LDLR gene on chromosome 19 to the four most common mutations strongly suggests that each mutation is identical-by-descent in the probands included in this study (this is also supported by the geographical distribution of FH families with these mutations throughout Greece) and permits an estimation of the number of generations from a common ancestor for each mutation. The characterization of 60% of LDLR mutations in a representative sample of Greek FH heterozygotes provides a basis for the diagnosis of FH through DNA analysis in Greece, by using single-strand conformation polymorphism analysis followed by allele-specific oligonucleotide hybridization (exon 6 mutations) or restriction endonuclease analysis (C152R, V408M). A rapid diagnostic assay positive for the mutation has been developed for the most common mutation, G528D. The application of simple DNA diagnostic assays for LDLR mutation analysis are appropriate for the early identification of FH heterozygotes in Greece and are useful for the primary prevention of coronary artery disease.

Nutritional survey in Greek children: nutrient intake.

The aim of the survey was to record the food habits and nutrient intake of Greek children. Data was obtained by a 3 d household measured diet record from a random stratified sample (1936 children aged 2-14 y). Mean daily protein intake was much higher than PRI and none of the children had lower intake than AR. Mean energy intake from protein was 15%, carbohydrate 44% and fat 41%. Eighty-four percent of children had energy intake from fat higher than the AR. Saturated fatty acids (SFA) provided approximately 15%, monounsaturated (MUFA) 17% and polyunsaturated (PUFA) 6% of energy. Eighty-seven percent of children had higher intake of SFA than the AR. Six percent of children had SFA intake lower than the AR and 50% higher than the AR. None of the children had PUFA intake lower than PRI and 0.3% higher than the maximum limit. 4.2% of children had calcium intake lower than LTI and 88% higher or equal to PRI. All children had phosphorus intake higher than PRI and less than the lower safe ratio of Ca/P; 50% of them had P intake higher than 1.5 g/d. The majority of children had sufficient iron intake with the exception of menstruated girls. Mean vitamin A intake was higher than PRI and lower than the toxic levels. All children had vitamin C intake higher than LTI. Median vitamin D intake varied from 1.7-2.1 micrograms. Median energy intake was higher than the AR in preschool children, but lower in the older children. We conclude that Greek children do not underintake energy and protein, overintake SFA, have safe intake of PUFA, vitamin A and C and high intake of MUFA, underintake carbohydrates, have adequate Ca, but a considerably high P intake. Vitamin D is low in small children, but the biological available vitamin D is obviously higher due to sunlight.

Factors modifying exposure to environmental tobacco smoke in children (Athens, Greece).

The aim of the study was to investigate individual, family, and environmental factors which may modify exposure of children to environmental tobacco smoke (ETS). A total of 2,108 children of both genders, aged up to 14 years old, were enrolled in the study. Parents of the children provided information concerning several factors that may affect exposure to ETS. Cotinine-to-creatinine ratios in spot urine samples were measured for each child. These values were logtransformed and regressed on a series of exposure variables. Among children, 73 percent were exposed to ETS generated by at least one smoker in the household. Exposure to ETS was affected by the following factors: cigarettes smoked by parents while the child was at home (increase by 37 percent per 10 cigarettes daily, 95 percent confidence interval [CI] = 32-43 percent); precautions taken by parents (no cf yes, increase by 38 percent, CI = 24-54 percent); child's age (decrease by nine percent per year, CI = -11-8 percent); gender (male lower than female by 13 percent, CI = -21-3 percent); day of the week (Monday cf Tuesday-through-Sunday, increase by 28 percent, CI = 14-44 percent); floor surface area (decrease by nine percent per 20 m2, CI = -14-5 percent); heating (central cf non-central decrease by 14 percent, CI = -25-2 percent); maternal education (decrease by nine percent per five years, CI = -18-0 percent); paternal education (decrease by seven percent per five years, CI = -15-2 percent). It is concluded that several household-related factors affect exposure to ETS and that this exposure can be reduced by about one-third by simple precautions taken by smoking parents.

The effects of television viewing in Greece, and the role of the paediatrician: a familiar triangle revisited.

UNLABELLED: To investigate the effects of television (TV) viewing on children, 4876 questionnaires on viewing habits completed by Greek children with the assistance of their parents were analysed. The most important results are summarized below. The mean time spent watching TV ranged from 21-32 h per week. The age when children started watching TV correlated with their later educational achievement: good students started watching TV earlier. Bad students, however, watched more TV, as did children from urban areas, and from lower socioeconomic groups. Children from households with more than one TV (especially if it was in the child's bedroom) also watched more. Children who watched more TV were less compliant with TV restrictions and more likely to imitate TV characters. Eating while watching TV was associated with obesity only in teenagers. Most children watched TV from appropriate distances, with the lights on, and with the sound at medium volume. CONCLUSION: This study of TV viewing habits in Greek children shows that certain patterns of watching TV may contribute to poor educational achievement, and obesity, in paediatric patients and, therefore, supports the idea of taking "televiewing histories" when treating these patients.

Mutation analysis of ten exons of the CFTR gene in Greek cystic fibrosis patients: characterization of 74.5% of CF alleles including one novel mutation.

To initiate the complete characterization of mutations in the CFTR gene in Greek cystic fibrosis (CF) patients, we screened 184 patients for six relatively common mutations (delta F 508, G542X, G551D, 621 + 1 G-->T, N1303K, W1282X) using allele-specific hybridization and, in addition, analyzed exons 4, 5, 7, 8, 10, 11, 17b, 19, 20 and 21 using the method of denaturing gradient gel electrophoresis (DGGE). Six mutations accounted for 65.9% of the CF alleles in Greek patients, of which the delta F 508 mutation had a frequency of 52.7%. A further 15 previously described mutations accounted for another 8.3% CF alleles and one previously undescribed mutation (3272-4A-->G) was found in one chromosome. The W1282X mutation was not detected at all. Thus, so far, we have identified 21 mutations in the CFTR gene in Greek CF patients, accounting for 74.5% of the CF alleles.

Mothers' knowledge and practices related to sun protection in Greece.

We attempted to estimate the level of Greek mothers' knowledge relating to the harmful effects of sunlight and whether this knowledge led to protective measures for them and their children. Between September and November 1993, 315 mothers were randomly selected from the outpatient department of our hospital and interviewed by questionnaire about themselves and their children (56% boys, 44% girls, ages 1-12 yrs). Knowledge was estimated by an index score that for 28% of the mothers was considered poor, for 50% moderate, for 16% good, and for only 6% very good or excellent. The score was positively associated with parent education, urban residence, mother's job relevant to the cosmetics industry or the mass media, and history of sunburn in one or both parents. Scores were also established for sunlight-protective measures taken for themselves (28% poor, 45% moderate, 27% just good) and for their children (24% poor, 46% moderate, 30% just good). These scores were significantly associated only with mothers' knowledge of sun protection. Mothers who used sun protection for themselves also applied it to their children. This study shows that mothers in Greece should be encouraged both to increase their knowledge of sun protection and steadily incorporate it into their lifestyle.

Objective passive-smoking indicators and respiratory morbidity in young children.

Exposure to environmental tobacco smoke is associated with increased respiratory morbidity in young children, but few studies have assessed such exposure objectively by urinary cotinine measurements. 501 children aged 1-5 years, a random 5% sample of children attending an outpatient clinic, were classified as exposed or non-exposed to environmental tobacco smoke with a cut-off of 10 ng cotinine per mg creatinine in urine. Exposed children were 3.5 times (95% CI 1.56-7.90, p < 0.0024) more likely to have increased respiratory morbidity (three or more episodes during the previous 12 months) than non-exposed children after adjustment for potential confounding factors.

Dexamethasone therapy for bacterial meningitis in children: 2- versus 4-day regimen.

Four-day dexamethasone therapy has been used to treat bacterial meningitis. This prospective, randomized study compared the effect of a 2-day versus a 4-day regimen. Children (n = 118, ages 2.5 months to 15 years) were evaluated; 50% of the cases were due to Neisseria meningitidis and 40% to Haemophilus influenzae type b. Patients were treated intravenously (iv) mainly with conventional antimicrobial therapy and were randomly assigned to receive dexamethasone, 0.15 mg/kg iv every 6 h for 2 or 4 days. The clinical response was similar for both dexamethasone regimens. The meningococcal meningitis patients survived without neurologic or audiologic sequelae. On long-term follow-up, neurologic sequelae or moderate or more severe unilateral or bilateral hearing impairment (or both) were found in 1.8% and 3.8% of patients treated with dexamethasone for 2 and 4 days, respectively. The 2-day regimen appears appropriate for the treatment of H. influenzae and meningococcal meningitis.

Rectal-axillary temperature difference in febrile and afebrile infants and children.

The rectal-axillary temperature difference (R-A) was measured in the morning, at midday, and in the afternoon on 1,519 occasions in 1,149 children from birth to 5 years old. Of these, 302 children were febrile (rectal temperature > or = 38 degrees C) and 847 were afebrile. A wide range in R-A was found for each individual in both groups. The magnitude of this difference was not associated with sex or age. In febrile children, the R-A was significantly greater (P < .0001) at the apparent onset of fever (1.04 +/- 0.25 degrees C) than later, when fever had been present for at least two hours (0.53 +/- 0.22 degrees C). These findings indicate that it is impossible to find a standard number by which to convert axillary to rectal temperature or vice versa. Furthermore axillary temperature may be relatively low or even "normal" despite an elevated rectal temperature at the onset of fever.

High mebendazole doses in pulmonary and hepatic hydatid disease.

Thirty nine children with 71 hydatid cysts were given mebendazole orally in a dose of 100-200 mg/kg/day for 12 weeks and were followed up for a mean (SD) of 63 (24) months. Twenty children (three of them after a second course) were cured and another two avoided at least one operation. No serious side effects of the drug were observed.

Socio-economic factors associated with preterm delivery in Greece: a population-based study.

A total population sample of singleton births to mothers with certain last menstrual period dates was identified from the Greek National Perinatal Survey of April 1983. Two groups were considered (3116 primigravidae and 6524 multigravidae) with preterm rates of 5.9% and 8.4% respectively. Of all 17 factors considered, primigravidae showed unadjusted significant associations between preterm delivery and marital status, region of mother's residence, maternal occupation, maternal education and paternal education level. Multigravidae preterm deliveries were associated with marital status, mother's age at marriage, father's age at marriage, mother's age at delivery, mother's education, father's education and maternal smoking at the end of the pregnancy. Logistic regression was used to identify the socio-economic and demographic characteristics independently associated with preterm delivery. For primigravidae, the only significant factors were maternal marital status and region of the country. For multigravidae, significant factors were maternal age at delivery, marital status and smoking habit at the end of pregnancy.

Birthweight specific perinatal mortality in Greece.

Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1,000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983, revealed the Greek rates to be three times higher than those in Denmark. When divided by time of death, the Greek stillbirth rates were two times higher and the early neonatal mortality rates were four times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. We conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques.

Are there gaps in the provision of perinatal care in Greece?

STUDY OBJECTIVE: The objective was to test the hypothesis that easy access to sophisticated hospitals is associated with a reduction in perinatal mortality. DESIGN: The study was a nationwide questionnaire survey of a birth cohort. SUBJECTS: All deliveries greater than 500g weight of singleton live births and stillbirths occurring throughout Greece during April 1983 were included. Completed questionnaires were returned for 10,953 deliveries (8% of total annual registered births in Greece), and data on 10,790 singleton births were analysed, including 127 stillbirths and 137 early neonatal deaths. MEASUREMENTS AND MAIN RESULTS: The questionnaires contained information on demographic characteristics of each parent, mother's reproductive history, and clinical course of pregnancy, labour and perinatal period. Mothers living in big urban centres were compared with the rest of the country. Overall mortality rates were similar but births in the big urban centres were of significantly lower weight due to fetal growth retardation. Logistic regression analysis, taking account of birthweight, parity, maternal age, and maternal education showed that there was an advantage to mothers living in big urban centres, perinatal mortality being 63% higher in the rest of the country (chi 2 = 7.4, p less than 0.01). CONCLUSION: The evidence obtained supports the original hypothesis and suggest that a reduction in the high perinatal mortality rate in Greece may be achieved by restructuring the perinatal services.

Medical services and socioeconomic factors: determinants of infant mortality in Greece.

Socioeconomic factors are at least as important as narrowly defined medical care factors in determining the health status of the population. They also provide a stimulus for further research in the field of socioeconomic epidemiology.

The Greek National Perinatal Survey. II: Socioeconomic factors and perinatal mortality in Greece.

Information concerning all 10,859 singleton deliveries in Greece in April 1983, were analysed to assess the contribution of socioeconomic factors to the perinatal mortality rate. Statistically significant associations were initially found with parental education, parental ages, duration of marriage, paternal occupation and parity. There was no association with maternal smoking habit, maternal occupation during pregnancy, type of health insurance or housing conditions. Once logistic regression analyses had taken account of the strong parity effect (P less than 0.0001), only a moderate association with maternal age (P less than 0.05) remained statistically significant, together with a marginally significant (P less than 0.05) association with maternal education level. Mothers who were moderately well educated had the lowest risk of loosing their baby. It is concluded that traditional measures of social deprivation appeared to have little effect on perinatal mortality in Greece in 1983.

Tumours of the head and neck in children. A clinico-pathological analysis of 1,007 cases.

Tumours of the head and neck in children are uncommon, representing only 2-3% of all head and neck tumours. During the twenty year period 1964-1983, 12,876 childhood tumours were submitted for pathological diagnosis. Of these 1,007 (7.8%) were in the head and neck region, and it is this group that has been analysed. 30.6% (308 cases) were malignant neoplasms, 27.8% (280 cases) were benign neoplasms, 24.2% (244 cases) presented as tumour-like conditions and 17.4 (175 cases) were dysplasias arising from embryonal remnants. The overall sex ratio was 1.5:1 in favour of males. Lymphomas accounted for 15.9% overall (52.3% of the malignant neoplasms). Of benign tumours, haemangiomas were the most frequent (38.5%) and of the tumour-like conditions, dermoid and epidermoid cysts accounted for 36.1%. Of the embryonal remnant dysplasias, thyroglossal duct cysts accounted for 71.4%.