Elena Riza

Comparisons of cervical cancer screening programmes in the European Union

This paper summarises the similarities and differences between the cervical cancer screening programmes operating in the 15 Member States of the European Union as presented in the separate papers prepared by each country. The screening programmes are compared in terms of their duration of operation, type and sources of funding, invitation methodology, target population, organisation and quality assurance methodology with the aim of shedding some light upon the current situation of cervical cancer screening within the European Union.

Bladder cancer and arsenic through drinking water: A systematic review of epidemiologic evidence

Exposure to inorganic arsenic (As) through drinking water is a major international public health issue. We carried out a systematic review of the existing literature examining the association between the risk of bladder cancer in humans and exposure to arsenic through drinking water. We searched electronic databases for studies published from January 2000 up to April 2013. Eight ecological studies, six case-control studies, four cohort studies and two meta-analyses were identified. The vast majority of the studies were carried out in areas with high arsenic concentrations in drinking water such as southwestern and northeastern Taiwan, Pakistan, Bangladesh, Argentina (Cordoba Province), USA (southeastern Michigan, Florida, Idaho) and Chile. Most of the studies reported higher risks of bladder cancer incidence or mortality in areas with high arsenic concentrations in drinking water compared to the general population or a low arsenic exposed control group. The quality assessment showed that among the studies identified, arsenic exposure was assessed at the individual level only in half of them and only three assessed exposure using a biomarker. Further, five out of eight ecological studies presented results with adjustment for potential confounders except for age; all cohort and case-control studies presented results with adjustment for cigarette smoking status in the analysis. The majority of the studies with varying study designs carried out in different areas provided evidence of statistically siginificant increases in bladder cancer risk at high concentrations of arsenic (>50 μg L−1). Assessing bladder cancer risk at lower exposure concentrations requires further investigation.

Work-related leukemia: a systematic review

Leukemia is a complex disease, which only became better understood during the last decades following the development of new laboratory techniques and diagnostic methods. Despite our improved understanding of the physiology of the disease, little is yet known about the causes of leukemia. A variety of potential risk factors have been suggested so far, including personal habits and lifestyle, and a wide range of occupational or environmental exposures. A causal association with leukemia has only been documented to date for ionizing radiation, benzene and treatment with cytostatic drugs, but there is an ongoing scientific debate on the possible association of leukemia with a number of other work-related hazards. In this article, we have reviewed scientific studies, published over the past 5 years, which investigated potential associations between leukemia and exposure to occupational risk factors. The systematic literature review took place via electronic databases, using specific search criteria, and independent reviewers have further filtered the search results to identify the number of articles, presented in our paper. A large number of studies included in the review referred to the effects of ionizing radiation, where new data suggest that the effects of exposure to small doses of ionizing radiation should probably be reevaluated. Some other works appear to substantiate a potential association of the disease with certain pesticides. Further research is also suggested regarding the role of infectious agents or exposure to certain chemicals like formaldehyde or butadiene in the pathogenesis of leukemia.

Skin disease after occupational dermal exposure to coal tar: a review of the scientific literature.

For about a century, coal tar has been used in industry and has been applied in the therapeutic management of several skin diseases. However, in the last decades the benefits of coal tar exploitation for humans could not outweigh its harmful effects on health. The aim of this study is to present the main adverse effects of coal tar on skin, with the emphasis on occupational exposure. The scientific literature indicates that dermal exposure to coal tar and coal tar pitches can be the cause of phototoxic reactions, irritation and burn, allergic dermatitis, folliculitis, occupational acne, atrophy of the epidermis, and hyperpigmentation. Moreover coal tar has been implicated in tumorigenesis, a relationship shown in numerous studies but not confirmed yet as the mechanism has not been fully clarified. A common finding in most studies is that exposure over a long period is the main risk factor for malignancy development, even in low exposure levels. Additional prospective, well‐designed studies need to be performed to confirm the validity of the carcinogenic, mutagenic, and cytotoxic potential of coal tar on skin.

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.

The influence of a school-based intervention programme regarding adherence to a healthy diet in children and adolescents from disadvantaged areas in Greece: the DIATROFI study

Background To evaluate the effects, via a cohort study, of a food aid and promotion of healthy nutrition programme, implemented in areas of low socioeconomic status (SES) in Greece, on students’ diet quality. Methods From a total of 162 schools participating in the programme during the 2012–2013 school year, we collected 3941 individually linked questionnaires at baseline and at the end of the intervention, recording sociodemographic characteristics, lifestyle parameters and dietary habits of the students. For the assessment of diet quality, the KIDMED score was computed, along with food frequency consumption data regarding milk, fruits, vegetables and whole grain products. Pre–post intervention values were compared using non-parametric tests. Generalised estimating equations were used to explore the factors that influence changes in dietary habits. Results By the end of the intervention, favourable changes were observed regarding healthy eating; KIDMED increased statistically significantly in adolescent girls (p=0.042), while the consumption frequency of all foods promoted by the intervention, namely, milk, fruits, vegetables and whole grain products, increased for children and adolescents, boys and girls (p≤0.002). Factors indicating lower SES, such as foreign country of birth, lower education level, no income source and high levels of food insecurity, were associated with lower diet quality. Conclusions As low SES groups tend to adopt unhealthier dietary choices, it is of the outmost importance to take action for the promotion of healthy eating, directed especially to these at risk populations. School-based nutritional programmes can be considered as an effective policy measure towards this direction.

The effect of Greek herbal tea consumption on thyroid cancer: a case-control study

BACKGROUND Although in the last decade several studies have addressed the protective role of black and green tea on several diseases, including cancer, there are only few and controversial studies on the effect of tea on benign and malignant thyroid diseases. METHODS An age and gender group matched case-control study conducted in Athens, Greece, was designed. 113 Greek patients with histologically confirmed thyroid cancer and 286 patients with benign thyroid diseases along with 138 healthy controls were interviewed with a pre-structured questionnaire in person by trained interviewers. RESULTS An inverse association between chamomile tea consumption and benign/malignant thyroid diseases was found (P < 0.001). The odds of chamomile tea consumption, two to six times a week, after controlling for age, gender and BMI, were 0.30 (95% CI: 0.10-0.89) and 0.26 (95% CI: 0.12-0.5) for developing thyroid cancer and benign thyroid diseases, respectively when compared with not consumption. The duration of consumption was also inversely associated with the diseases. Thirty years of consumption significantly reduced the risk of thyroid cancer and benign thyroid diseases development by almost 80%. Similar, although weaker protective association, was found for sage and mountain tea. Adjustment for smoking, alcohol and coffee consumption did not alter the results. CONCLUSIONS Our findings suggest for the first time that drinking herbal teas, especially chamomile, protects from thyroid cancer as well as other benign thyroid diseases.

Does socio-economic status in Greece affect participation in cancer screening programmes during the period of financial crisis?

AbstractᅟPrimary health care reflects a country’s health level in relation to the current social and economic conditions according to the Declaration of Alma Ata (1978). Secondary prevention activities (Pap smear test, mammogram) promote public health through the early diagnosis of a disease. Since 2011 in Greece, due to the financial crisis, a significant reduction of national public health funding has occurred, along with substantial annual family income suppression and an increasing use of public health services.AimTo investigate the socio-economic features of women participating in secondary prevention of breast and cervical cancer in an austerity setting.MethodCross-sectional study in 225 women through an anonymous self-administered questionnaire in the outpatient clinic of a large anti-cancer hospital in Athens.ResultsThe majority of participants (56.9%) are unemployed and 24.1% declare no income. The main reason for choosing a state hospital is purely financial (55.1%). Women with higher educational level are 1.85 times more likely to get regular Pap smear tests (p = 0.026) compared to less educated women, and they also have the highest percentage (85.1%) of getting regular mammograms.ConclusionThe financial crisis is complex and several factors affect all levels of the health system. Greece has no organised population-based screening programme. Mean annual income and education level determine participation in cancer screening in women visiting a major state anticancer hospital. Moreover, reduced public health spending in a prolonged austerity setting will hinder the participation of unemployed and less educated women in regular preventive activities, thus breaching the human right to access to health prevention.

The Legal Context for Workplace Safety and Health Promotion: Thinking of Women

The main focus of this chapter is to describe the current legislative and policy context of Occupational Safety & Health (OSH) and Workplace Health Promotion (WHP) for women workers across the European Union (EU). Since the foundation of the European Community, numerous directives and amendments concerning OSH have been issued. The directives are mandatory and in their majority have been fully incorporated into the national legislations of member states, with the exception of cases where national legislation is even more stringent. Furthermore, there are a number of nonmandatory resolutions or communication documents addressed to member states, that are aimed at harmonizing the European regulatory environment on OSH issues. Most directives pertaining to specific workplace conditions and hazards do not refer specifically to male or female workers, because the relevant risk factors can affect both sexes and therefore there is no legitimate reason to consider either of them as more vulnerable. The only exception is Council Directive 92/85/EEC, which refers to the protection of pregnant and breast-feeding working women. It is therefore important to investigate whether the EU legal context concerning OSH sufficiently covers the needs of female workers. In the next section, the most important EU directives are discussed in that respect, and the specificities of female workers regarding OSH are highlighted.

Environmental Pollution Effects on Mortality in an Industrial and a Non-industrial Municipality, in Voiotia Prefecture, Greece

In the Oinofita region, there was strong evidence of air pollution and hexavalent chromium (Cr(VI))-contaminated drinking water due to the increased number of industries, in contrast to the closely-located region of Arachova, which served as a control. To examine the health effects of environmental pollution, we performed an ecological study to compare the all-cause and cause-specific mortality. We considered the registered citizens of both study areas during an 11-year period (1999-2009) and we used the direct method of standardization to calculate the age, gender and period standardized rates (ASRs) and the standardized rate ratios (SRRs), using the greater Prefecture of Voiotia as the standard population. Statistically significantly higher rates of all-cause mortality (SRR = 1.22, 95% confidence intervals (CI) 1.1-1.4), cardiovascular (SRR = 1.36, 95% CI 1.1-1.7) and cerebrovascular diseases (SRR = 2.93, 95% CI 1.8-4.8) were identified for Oinofita compared to Arachova. Furthermore, suggestive results were found for cardiopulmonary diseases among males (SRR = 1.52, 95% CI 1.0-2.4) and leukaemias (SRR = 4.65, 95% CI 0.9-25.3). Elevated SRRs, not statistically significant though, were also observed for respiratory diseases, all cancers and specific cancer sites (lip, oral cavity and pharynx, liver, stomach, pancreas, lung, prostate, colon and kidney and other genitourinary organs among females). Increased mortality rates in the Oinofita region support the hypothesis of adverse health effects association with air pollution and Cr(VI)-contaminated drinking water. Further studies are needed to determine if this association is causal and to establish preventive guidelines and public health recommendations.