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.

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.

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.

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.

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.

Enterobacter sepsis in infants and children due to contaminated intravenous fluids.

Sixty-three cases of nosocomial sepsis occurring from April through October 1981, in a 500-bed pediatric hospital, were traced to bacterial contamination of intravenous fluid produced by a single manufacturer. Two species of uncommon blood stream pathogens, Enterobacter cloacae and Enterobacter agglomerans contaminated the fluid. Infections with these organisms might have contributed to the death of four patients; two who were immunosuppressed, one who was asplenic and one premature infant. Epidemiologic and laboratory investigations identified the site of contamination to be within the screw-caps of the bottles containing the intravenous fluid. Contamination occurred during insertion of the intravenous fluid administration set into the bottle. The "epidemic" terminated when the hospital discontinued the use of infusion fluids from that manufacturer. We conclude that intravenous fluids should be examined during outbreaks of nosocomial bacteremia due to unusual pathogens.

Colloid clearance rate changes in children with homozygous-beta-thalassemia in relation to blood transfusion.

The plasma clearance rate of heat denatured human serum albumin (DHAI-125, 5 mg/kg body weight) was studied in 20 children with homozygous-beta-thalassemia before and 7--10 days after blood transfusion. A significant increase of the DHAI-125 clearance rate (P less than 0.02) was found 7--10 days after blood transfusion while the spleen presented its minimum size. This finding may be relevant to the improved intrasplenic blood circulation after blood transfusion due to the release of the blood trapped within the spleen.