Artemios K. Artemiadis

Lifestyle and self-rated health: a cross-sectional study of 3,601 citizens of Athens, Greece

BackgroundSelf-rated health (SRH) is a popular health measure determined by multiple factors. International literature is increasingly focusing on health-related behaviors such as smoking, dietary habits, physical activity, even religiosity. However, population-based studies taking into account multiple putative determinants of SRH in Greece are scarce. The aim of this study was to clarify possible determinants of SRH with an emphasis on the relationship between SRH and lifestyle variables in a large sample of urban citizens.MethodsIn this one-year cross-sectional study, a stratified random sample of 3,601 urban citizens was selected. Data were collected using an interview-based questionnaire about various demographic, socioeconomic, disease- and lifestyle related factors such as smoking, physical activity, dietary habits, sleep quality and religiosity. Multivariate logistic regression was used separately in three age groups [15-29 (N = 1,360), 30-49 (N = 1,122) and 50+ (N = 1,119) years old] in order to identify putative lifestyle and other determinants of SRH.ResultsReporting of good SRH decreased with age (97.1%, 91.4% and 74.8%, respectively). Overall, possible confounders of the lifestyle-SRH relationship among age groups were sex, education, hospitalization during the last year, daily physical symptoms and disease status. Poor SRH was associated with less physical activity in the 15-29 years old (OR 2.22, 95%CI 1.14-4.33), with past or heavy smoking, along with no sleep satisfaction in the 30-49 years old (OR 3.23, 95%CI 1.35-7.74, OR 2.56, 95%CI 1.29-5.05, OR 1.79, 95%CI 1.1-2.92, respectively) and with obesity and no sleep satisfaction in the 50+ years old individuals (OR 1.83, 95%CI 1.19-2.81, OR 2.54, 95%CI 1.83-3.54). Sleep dissatisfaction of the 50+ years old was the only variable associated with poor SRH at the 0.001 p level of significance (OR 2.45, 99%CI 1.59 to 3.76). Subgroup analyses of the 15-19 years old individuals also revealed sleep dissatisfaction as the only significant variable correlated with SRH.ConclusionsSlight differences in lifestyle determinants of SRH were identified among age groups. Sleep quality emerged as an important determinant of SRH in the majority of participants.

Apoptosis of Oligodendrocytes and Post-Translational Modifications of Myelin Basic Protein in Multiple Sclerosis: Possible Role for the Early Stages of Multiple Sclerosis

Recent studies outline apoptosis of oligodendrocytes (OLDs) as an early event prior to the formation of the demyelinated plaque and post-translational modifications (PTMs) of myelin basic protein as characteristic processes of normal-appearing white matter in multiple sclerosis (MS). We reviewed reports using the following keywords: apoptosis, PTMs, autoimmunity and multiple sclerosis in all possible combinations. Introductory basic scientific information is included for the non-experts. Given the standard and ongoing studies, we raise the hypothesis that, at least in some cases, defective apoptosis of OLDs, early in the course of the disease, and post-translationally modified molecules lead to the activation of immune responses and eventually to autoimmunity. Autoimmune reactions and epitope spreading that take place in the course of the disease might obscure the initial events and leave most investigators blind to etiopathogenesis. Our paper outlines the need for studies at the very early stages of the disease, as well as sequential ones, in order to give us a valuable hint about the clarification of the cause(s) of the different clinical subtypes of MS.

Self-rated health in centenarians: a nation-wide cross-sectional Greek study.

Self-rated health (SRH) is an inclusive measure of public health that is correlated with quality of life and subsequent mortality. Extensive literature has identified multiple determinants of SRH in different populations. However, such studies on centenarians are scarce and parsimonious. Our objective is to identify SRH determinants in centenarians. This is a nationwide cross-sectional study on 400 Greek centenarians that was carried out between 2007 and 2010. SRH was evaluated by a simple question with a 5-point scale. Three categories of SRH were formed (very good/good/poor), which served as the dependent variable in multinomial regression models. Various sociodemographic, disease-related, lifestyle and psychosocial variables were assessed as candidate determinants of SRH. According to our results, SRH ratings among centenarians were better than that expected according to previous studies showing worse SRH ratings with increasing age in Greece. The 22.4% of the variance in SRH among centenarians was predicted by gender, habitat region and status, financial problems, disease presence and autonomy. Among lifestyle and psychosocial variables, obesity, good relationships with children, lack of feelings of loneliness, high optimism, adaptability and an internal health locus of control profile were independently associated with good SRH. These results indicate that SRH in individuals of extreme longevity were related to specific personal psychosocial factors that contribute to healthy aging and thus support the biopsychosocial model of health promotion.

The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ): a novel tool for assessing self-empowerment through a constellation of daily activities

BackgroundThe main goal of stress management and health promotion programs is to improve health by empowering people to take control over their lives. Daily health-related lifestyle choices are integral targets of these interventions and critical to evaluating their efficacy. To date, concepts such as self-efficacy, self-control and empowerment are assessed by tools that only partially address daily lifestyle choices. The aim of this study is to validate a novel measurement tool, the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ), which aims to assess the concept of empowerment through a constellation of daily activities.MethodsTherefore, we performed principal component analysis (PCA) of 26 items that were derived from the qualitative data of several stress management programs conducted by our research team.ResultsThe PCA resulted in the following five-factor solution: 1) Dietary Healthy Choices, 2) Dietary Harm Avoidance, 3) Daily Routine, 4) Organized Physical Exercise and 5) Social and Mental Balance. All subscales showed satisfactory internal consistency and variance, relative to theoretical score ranges. Subscale scores and the total score were significantly correlated with perceived stress and health locus of control, implying good criterion validity. Associations with sociodemographic data and other variables, such as sleep quality and health assessments, were also found.ConclusionsThe HLPCQ is a good tool for assessing the efficacy of future health-promoting interventions to improve individuals’ lifestyle and wellbeing.

Gender differences in Greek centenarians. A cross-sectional nation-wide study, examining multiple socio-demographic and personality factors and health locus of control

BackgroundCentenarians are exceptional ageing paradigms, offering valuable information on achieving longevity. Although, there are several studies examining different biomedical factors as determinants of longevity in centenarians, little is known about gender differences with respect to personality traits and health locus of control.MethodsNation -wide study carried out in Greece, between 2007 and 2010. Our final sample of analysis consisted of 400 centenarians who reported on sociodemographic, disease-related and personality factors and health locus of control (HLC). Gender differences were investigated by simple nonparametric comparisons. Bivariate correlations between personality factors and internal and external HLC were obtained.ResultsWomen centenarians outnumbered men by a ratio of 1.68 to 1. Significant gender sociodemographic differences were noted, with men reporting less often widowhood, more often centenarian 1st degree relatives and smoking. Higher BMI score was measured in males than females. Concerning personality variables, females were more reward-dependent and adaptable than men, while men were more optimistic than women. No differences were found on health locus of control profile between the genders. Positive correlations between self-directness and spirituality with internal locus of control in men and negative correlations between optimism and external locus of control in women emerged as the main gender disparities in the correlation analyses. Self-directness in men and optimism in women were consistently correlated with the two HLC subscales.ConclusionsGender differences should be incorporated in future basic research and epidemiological studies of longevity. Informed policies on ageing and wellbeing programs should also take into account gender issues to increase efficacy by targeting health locus of control.

Visceral leishmaniasis infection in a fingolimod-treated multiple sclerosis patient

Dear Editor, Fingolimod, the first oral immunomodulatory treatment for relapsing multiple sclerosis (MS), acts by blocking lymph-node egress of T cells expressing the CCR7-receptor, such as CD4+ or CD8+ naive (TN), central memory (TCM) and Th17 and Th17/Th1-helper cells, all of which contribute to MS pathogenesis.1 So far, two serious herpetic infections both in the fingolimod 1.25 mg arm have been reported.2

Preliminary evidence for gender effects of levetiracetam monotherapy duration on bone health of patients with epilepsy

Enzyme-inducing antiepileptic drugs AEDs have adverse effects on bone mineral density (BMD), whereas studies on levetiracetam (LEV), a nonenzyme-inducing agent, have showed conflicting results. The aim of this study was to further elucidate the role of LEV in bone health. A sample of forty-six patients with epilepsy (mean age: 35.7 years, range: 20.2-64.2 years, 39.1% males) on LEV monotherapy for at least one year (range: 1.5-14.5 years, median 5.5 years) underwent femoral neck (FN) and lumbar spine (LS) BMD measurements. The T- and Z-scores were calculated. Results showed that 15.2% of the patients were identified with osteopenia and none with osteoporosis. Pearsons correlations revealed a negative but not significant association of LEV duration with bone-related measurements (range of rhos: from -0.004 to -0.23), except for LS T-scores. In terms of FN BMD measurements, Z-scores, and T-scores, longer LEV therapy duration had adverse but not significant effects on bone health after adjusting for age and gender. With regard to LS BMD measurements, Z-scores, and T-scores, men taking LEV for at least 5.5 years had better, although not significant, bone health compared with men with shorter LEV exposure, after adjusting for age. The opposite was found in women, although differences did not reach significance. These preliminary results are indicative of a differential effect of LEV therapy duration in men and women, which could presumably account for the incongruity of the already published studies. Also, LS assessments were more sensitive to these gender differences. Future larger studies should validate these results.

Predicting caregiving status and caregivers’ burden in multiple sclerosis. A short report

Abstract Objectives: Predicting caregiving status (CS) in multiple sclerosis (MS) is of both clinical and health policy-making value. The aim of this cross-sectional study was to assess the clinical predictors of CS, along with factors related to caregivers’ stress. Methods: A sample of 342 clinically definite MS patients (67.5% females, 67.8% relapsing MS, mean age 43.1 ± 11.4 year-old, mean disease duration 147 ± 105.4 months, median Expanded Disability Status Scale -EDSS-3.0) was screened for CS. The Multiple Sclerosis Quality of Life-54 and Zarit Burden Interview were used to measure quality of patients’ life and the their caregivers’ burden, respectively. Results: In total, 57.9% of patients reported at least one caregiver, 97% of which were relatives or friends. Higher EDSS was associated with higher chance of reporting a caregiver. Two EDSS cut-offs were recognized; 2.0 and 4.5, the former with increased sensitivity (78.8%) and the latter with increased specificity (82.3%) to predict CS. Patients in the mild disability group (EDSS: 0–1.5) needing a caregiver had higher subjective cognitive function, implying presumably a beneficial role of care in cognition. Age and education were showed to affect CS in the moderate disability group (EDSS: 2.0–4.5). Physical and mental disability was more pronounced in patients reporting at least one caregiver in the high disability group (EDSS above 4.5). Caregivers’ stress was significantly positively correlated with age, EDSS, and duration of the disease and negatively with cognitive, physical, and mental health. Discussion: In conclusion, the clinical predictors of CS are known to serve well both the researchers and the clinicians.

Self-esteem is associated with perceived stress in multiple sclerosis patients

Abstract Previous studies have showed that perceived stress (PS) in patients with multiple sclerosis (MS) constitutes an important factor for disease onset, relapse, symptomatology and psychological adjustment. Objectives: The aim of this pilot cross-sectional study was to examine the role of self-esteem in PS, after controlling for sociodemographical characteristics, depression and personality in MS patients. Methods: Sixty-six relapsing-remitting MS patients (66.67% females, mean age of 40 ± 11.1 years old, mean duration of disease 133.6 ± 128.8 months) were studied. Perceived stress, self-esteem, depression and personality type were assessed using self-administered questionnaires. Hierarchical multivariate regression modelling was used. Results: Higher education and depression and lower self-esteem were independently and significantly associated with increased PS, accounting for 40.5% of its variance. Univariate analyses revealed that low extroversion and openness and higher neurotism were associated with higher PS, although no significant after adjusting for other factors. Discussion: Although our findings need further confirmation, psychological interventions targetting self-esteem are strongly encouraged.

Religiosity as a predictor of mortality: A retrospective cohort study in 1519 rural citizens in Greece

Objective: Investigating the role of religiosity in mortality. Design: A retrospective cohort study (mean follow-up period 131.2 ± 30.8 months) in 1519 rural citizens in Greece (57.1% women, mean age 56.9 ± 20.4 years). Main outcome measures: Measurements included education, disease status, body mass index, lifestyle, sleep-quality and self-rated health (SRH). Religiosity was assessed as composite score of praying and church attendance. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHR) for all-cause and cardiovascular mortality. Results: A total of 293 deaths were recorded, 59.2% of which had occurred due to cardiovascular diseases, followed by cancer diseases (17%). All-cause mortality was found increased for older people (aHR: 1.10, 95%CI: 1.08–1.11, p < .0001), for males (aHR: 1.44, 95%CI: 1.14–1.83, p = .002), for people reporting good SRH (aHR: .66, 95%CI: .51–.87, p = .003). Moreover, with increasing age the practice of regular exercise decreases all-causes mortality by approximately 3.5% by each year. Participants in the moderate category of religiosity were found to have decreased risk for all-cause mortality (aHR: .61, 95%CI: .46–.83, p = .001) compared to those in the low religiosity category. Cardiovascular mortality was also significantly associated with SRH and religiosity. Conclusion: Religiosity predicts mortality, in a rural population in Greece. Deciphering the mediators of religiosity and mortality relationship could facilitate future health policies.