Fotoula Babatsikou

Assessment of levels of organochlorine pesticides and their metabolites in the hair of a Greek rural human population

We present the assessment of chronic exposure of the rural population of Helia Peloponnesus, Greece to banned organochlorine pesticides, hexachlorocyclohexane (HCH), and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT), using hair analysis. A total of 222 head hair samples were collected and analyzed for the presence of those organochlorine pesticides and their metabolites or isomers. Gas chromatography coupled to mass spectrometry was used to measure the levels of the pollutants. The median concentrations of α-HCH, hexachlorobenzene, lindane, ortho para 1,1-dichloro-2,2-bis-(4-chlorophenyl)ethylene (opDDE), para para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (ppDDE), ortho para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (opDDD), para para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (ppDDD) + ortho para 1,1,1-trichloro-2,2-bis(4-chlorophenyl)-ethane, and para para 1,1,1-trichloro-2,2-bis(4-chlorophenyl)-ethane were determined at 40.4, 19.7, 124.2, 6.2, 7.8, 73.1, 8.0, and 5.7 pg/mg. The median concentration of total HCHs and DDTs were 117.8 pg/mg and 9.4 pg/mg, respectively. The levels of total HCHs were much higher than the levels of DDTs in the hair samples of the studied population. This may be attributed to the presence of lindane, a pesticide officially banned in 2002. It is interesting to see that DDTs are still traced in samples despite their use being banned for more than three decades. There was no difference in the levels of the detected pesticides in hair sampled from men or women. The concentration of HCHs remains high and relatively stable across the age groups, suggesting constant exposure until very recently. The concentration of the total DDTs and the parent compound, pp-DDT presents a statistically significant decreasing trend across the age groups.

Associations of xenobiotic-metabolizing enzyme genotypes PON1Q192R, PON1L55M and CYP1A1*2A MspI with pathological symptoms of a rural population in south Greece

Paraoxonases and cytochromes P450 constitute two major classes of xenobiotic-metabolizing enzymes involved in the detoxification of pesticide chemicals. In this study, we examined the distribution of two common genetic polymorphisms of the paraoxonase 1 gene and one common polymorphism of the CYP1A1 gene, in relation to pathological diseases occurring in a rural population. Blood and hair samples were collected from 220 participants of an agricultural cohort in the south of Greece for genotype and pesticide analysis. Demographic information and disease status of the participants was obtained by questionnaire, medical examination and medical record. Organochlorine pesticides and metabolites (DDTs, HCHs) were extracted from hair and analyzed using gas chromatography combined with mass spectrometry techniques. Our results indicate exposure of the rural population of Amaliada to organophosphate and past exposure to organochlorine pesticides. Genotypic analysis of PON1Q192R, PON1L55M and CYP1A1*2A MspI polymorphisms was performed using PCR-RFLP. The PON1 192R and 55M alleles absence was significantly associated with hypertension (OR: 2.59; 95% CI: 1.10–6.09) and hepatitis (OR: 21.43; 95% CI: 2.53–181.50), respectively, as indicated from backward logistic regression. Although the presence of PON1 192R allele significantly affected the occurrence of prostate hyperplasia (OR: 0.35; 95% CI: 0.03–0.40), no associations were obtained between the paraoxonase serum activity or the CYP1A1 genotype and the disease status.

Biomonitoring of dialkylphosphate metabolites (DAPs) in urine and hair samples of sprayers and rural residents of Crete, Greece.

PURPOSE The aim of this study was to evaluate the exposure of rural residents (control group) and occupational exposed population group of sprayers to organophosphorus pesticides (OPs) by measuring their non-specific dialkylphosphate metabolites (DAPs) in hair and in urine samples. All subjects (n=120) were residents of the municipality of Ierapetra, an area of intensive cultivation in Crete, Greece. METHODS The determined OPs metabolites were DMP, DEP, DETP and DEDTP. Two different approaches were used for the analysis of the collected samples; solid-liquid extraction with sonication for hair and liquid-liquid extraction for urine. Gas chromatography-mass spectrometry (GC-MS) analysis was performed after derivatization of the isolated analytes. RESULTS AND DISCUSSION The detection rates of DMP, DEP and DETP for both control and sprayers groups were high in both matrices, ranging from 91% to 100%. DEDTP was detected only in 9% of sprayers hair samples, while its detection rates in urine samples ranged from 83% to 90% for both population groups. Data analysis revealed significantly higher sumDAPs levels in urine of sprayers than in the urine of control group (p<0.001) and this is justified since sampling occurred during spraying periods. SumDAPs levels in hair samples of the sprayers were also significantly higher than in the hair of control group (p<0.001), confirming the long-term exposure to OPs. SumDAPs found levels in urine and hair samples of subjects were significantly correlated (Spearman׳s rho=0.728, p<0.001). Our study confirmed the elevated levels of DAPs in hair and urine samples in occupationally exposed group of sprayers in comparison to control group, even detected levels were similar in logarithmic scale.

Effect of Perceived Social Support on the Levels of Anxiety and Depression of Hemodialysis Patients

Purpose: of this study was to explore the effect of social support on the levels of anxiety and depression of hemodialysis patients. Material and Methods: 258 patients undergoing hemodialysis were enrolled. A questionnaire developed for the purpose of the study was used to collect data through the interview process. Apart from socio-demographic, clinical and other characteristics, the questionnaire also included the Multidimensional Scale of Perceived Social Support (MSPSS) to assess social support from significant others, family and friends, and the questionnaire Hospital Anxiety and Depression Scale (HADs) to assess the levels of anxiety and depression of patients. Results: 53,9% of the participants were male while 34,1% of the participants were >70 years old. 32,9% and 30,2% of the participants felt high levels of anxiety and depression, respectively. Analysis of data showed a statistically significant association between anxiety/depression and social support from significant others, family and friends (p=<0,001 for all associations). In particular, patients with high levels of anxiety and depression felt less support from their significant others, family and friends. The multinomial logistic regression, showed a statistically significant effect of social support from friends in anxiety levels (p=0,004). An one point increase of the support from friends seems to reduce by 57% the probability of having high levels of anxiety. In addition, statistically significant effect of social support from significant others, family and friends was observed on the levels of depression (p=<0,001, p=0,001 & p=0,003, respectively). Specifically, an one point increase of the support from significant others, family and friends it was found to reduce by 77%, 71% and 56% respectively the probability of experiencing high levels of depression. Conclusions: Phyco-social evaluation is essential when providing holistic care to hemodialysis patients.

Factors Associated with Hemodialysis Machine Dependency

Introduction: Hemodialysis is one of major stresses in patients’ daily lives since there is no other path for life maintenance but to accept the machine and its’ related rules. Purpose: of this study was to explore factors associated with dependency on dialysis machine as reported by the patients. Material and Methods: The sample of the study included 250 patients undergoing hemodialysis. For data collection a questionnaire specially designed for the needs of the research was used. More specifically, socio-demographic and clinical characteristics as well as several other self-reported variables were collected. Results: Of the 250 participants, 53.2% was men while 65.2% was aged over 60 years. The study showed that 44% of the patients reported that their life depended very much on hemodialysis machine. Statistically significant association was observed between dependency on dialysis machine as reported by the patients and gender (p=0.030), education (p=0.022), job (p=0.001) and place of residence (p=0.001). Additionally, statistically significant association was observed between dependency on dialysis machine as reported by the patients and the degree of information about their problem (p=0.001) and whether patients reported adherence to treatment guidelines (p=0.001) or followed the proposed diet (p=0.001). Finally, statistically significant association was observed between dependency on dialysis machine as reported by the patients and relations with nursing staff (p=0.001), whether patients had noticed change in body image (p=0.001), whether they faced difficulties in social (p=0.001) and family environment (p=0.030), whether they hid their problem (p=0.006), whether they needed help in daily activities (p=0.001) and whether their lifestyle had changed (p=0.001). Conclusions: Socio-demographic and clinical characteristics as well as hemodialysis patients’ beliefs are associated with machine dependency. This study contributed in outlining factors affecting dependency on dialysis machine, thus reinforcing multidisciplinary health care teams to develop interventions in order to address hemodialysis patients’ needs.

Depressive symptomatology in relation to 10-year (2004–2014) acute coronary syndrome incidence; the moderating role of diet and financial status

BACKGROUND The association between depression status and 10-year cardiovascular disease (CVD) incidence among acute coronary syndrome (ACS) patients, in relation to nutritional and financial status, was evaluated. METHODS From October 2003 to September 2004, a sample of 2172 consecutive ACS patients from 6 Greek hospitals was enrolled. In 2013-14, the 10-year follow-up was performed. Depressive symptoms were evaluated using the validated CES-D score (range 0-60). Adherence to Mediterranean diet was assessed through MedDietScore (range 0-55) and financial status was determined by the annual income. RESULTS Ranking from the 1st to 3rd CES-D tertile, recurrent fatal/non fatal ACS rates were 33%, 37% and 42%, respectively (p=0.006). Multiple logistic regression models revealed an adverse association of severe depression status (i.e. 3rd tertile) compared to no depression (i.e. 1st tertile) [odds ratio (OR)=1.31, 95% confidence interval (95% CI) 1.01, 1.69]. When controlling for financial status, the relationship between depression and ACS prognosis remained marginally significant; while subgroup analysis revealed that only patients with low/moderate income were negatively affected [OR=1.36, 95% CI 0.98, 1.88]. Further stratified analysis, by MedDietScore group, was applied; the above association remained significant only in patients with low compliance to this dietary pattern [OR=1.68, 95% CI 1.10, 2.18]. CONCLUSIONS ACS coexisting with severe depression status seems to result in adverse disease outcomes while financial status and Mediterranean diet are proposed as potential moderators. Public health programs should focus on vulnerable groups and minimize depressive symptoms through appropriate medical treatment and lifestyle interventions, so as to ameliorate the disease prognosis in clinical and community levels.

The impact of education on knowledge, adherence and quality of life among patients on haemodialysis

PurposeThe purpose of the study was to assess the impact of an educational intervention on the level of knowledge, quality of life (QoL) and adherence to the treatment regimen among haemodialysis (HD) patients as well as to describe the association between these variables.MethodsIn this quasi-experimental interventional study, 50 HD patients at a HD centre in Western Attica were randomly assigned into intervention (N = 25, received education and a booklet) and control (N = 25, received only the booklet) groups. Knowledge, adherence and quality of life were measured pre- and post-intervention using the Kidney Disease Questionnaire, the GR-Simplified Medication Adherence Questionnaire-HD and Missoula Vitas Quality of Life Index—15, respectively. The statistical analysis of the data was performed with the help of the Statistical Program SPSS version 19.0. The statistical significance level was set up at 0.05.ResultsThe increase of knowledge, adherence and QoL levels in the intervention group was significantly higher compared to the control group. There was no significant correlation between knowledge and adherence scores after the intervention. However, a significant positive correlation was found between the change in the overall QoL and the changes in the total adherence score as well as the adherence to the fluids and dietary behaviour.ConclusionsAn educational intervention can improve knowledge, adherence and QoL among HD patients. The increase of knowledge level is not associated with increased adherence. However, the increase of adherence may improve some dimensions of QoL.

Hemodialysis Patients Information and Associated Characteristics

Introduction: of this study was to explore characteristics associated with hemodialysis patients’ degree of information. Material and Methods: The sample of the study included 650 patients undergoing hemodialysis. For data collection a questionnaire specially designed for the needs of the research was used. More specifically, socio-demographic, clinical and other patients’ characteristics were associated with the degree of information as it was reported by patients. Results: of the 650 participants, 55.4% was men while 58.6% of the sample was aged over 60 years. Regarding information level, results showed that only 9.8% was “little” or “not all” informed about their health problem, 61,7% was “enough” informed whereas 28.5% were “very” informed. Statistically significant association was observed between degree of information and age (p=<0.001), family status (p=0.005), education (p=0.001), job (p=0.005) and number of children (p=0.019). In terms of clinical characteristics, statistically significant association was observed between the degree of information and whether patients had other disease or not (p=0.037), whether patients reported adherence to treatment guidelines (p=<0.001). Finally, statistically significant association was observed between the degree of information and relations with nursing staff (p=<0.001), doctors (p=0.007) and other patients (p=0.003), and whether patients faced difficulties in social (p=0.001) and family environment (p=0.002). Conclusion: Health professionals when planning information interventions for orienting hemodialysis patients is increasingly important to evaluate socio-demographic, clinical and other patients ‘ characteristics and incorporate them in their project.

Family Perceptions of Intensive Care Unit Nurses' Roles: A Greek Perspective.

This study was done in order to examine the role of the nurse in families with critically ill patients as perceived by family members. A descriptive design was conducted with 93 family members aged 18-53 years from a 6-bed intensive care unit in a Greek Hospital. An anonymous self-completed questionnaire recording demographic data and the questionnaire Family members perception of nurses behavioral role expectation/enactment scale of Hickey and Lewandowski was used. Parametric statistic tests were used to examine the research questions. Intensive care unit (ICU) patients’ family members expect nurses to make them feel they can ask whatever they want whenever they want, placing great emphasis on communicating with one another and on participating in decision making to the progress of patient care. The age seems to correlate with the expectation from nurse to meet the role of training on how to handle the patient. Nurses did well with regard to meeting family members’ expectations. Most family members assessed positively the role of ICU nurse confirming the need for communication, and clear support of families.