N. Matsaniotis

NOISE POLLUTION IN NEONATAL UNITS: A POTENTIAL HEALTH HAZARD

Abstract. Anagnostakis, D., Petmezakis, J., Messaritakis, J. and Matsaniotis, N. (First Department of Pediatrics of Athens University, Athens, Greece). Noise pollution in neonatal units: a potential health hazard. Acta Paediatr Scand, 69:771, 1980.—Hospital noise levels were measured for four consecutive days every two hours throughout the day in a neonatal intensive care unit (NICU), a normal nursery room and inside infant incubators when the latter were associated with different types of life‐support equipment. There was a difference in the noise level between normal nursery and NICU, whereas a considerable increase of noise was recorded when the infant received supplemental oxygen, was under ventilator or when an air compressor was in operation. High noise levels were equally the same both in a.m. and p.m. hours in the NICU. As many high risk infants spend a long time in a NICU, there is an urgent need for further evaluation of noise levels and their effect on the outcome of infants.

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); childs 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 20m2, 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.

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

Abstract: 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, mothers 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 knowledge of sun protection and steadily incorporate it into their lifestyle.

Birthweight Specific Perinatal Mortality in Greece

ABSTRACT. Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1000 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, mothers 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.

2,3-DIPHOSPHOGLYCERATE LEVELS IN CHILDREN WITH IRON DEFICIENCY ANEMIA AND ACUTE LEUKEMIA

Abstract. Red cell organic phosphates and especially 2,3‐diphosphoglycerate (2,3‐DPG), lowers the oxygen affinity of hemoglobin (Hb) and shifts the oxygen dissociation curve to the right. Because of the importance of 2,3‐DPG (as regulator of the oxygen affinity of Hb), determinations were carried out on: 45 normal children, 7 children with iron deficiency anemia and 35 children with acute lymphoblastic leukemia. In normal children with Hb of 12.69±1.60 g/100 ml, 2,3‐DPG was 14.90±0.68 μmoles/g Hb. In children with iron deficiency anemia (Hb 7.94±1.20 g/100 ml), 2,3‐DPG was 20.87±3.11 μmoles/g Hb. 2,3‐DPG was normal (14.11±0.88 μmoles/g Hb), in 16 patients with acute lymphoblastic leukemia who had never relapsed, while in 19 patients with a history of one or more relapses, 2,3‐DPG levels were increased (22.05 ±2.75 μmoles/g Hb). No good explanation may be offered for the high 2,3‐DPG levels in these leukemic children.

IMMUNOGLOBULIN LEVELS IN CHILDREN WITH HOMOZYGOUS β‐THALASSEMIA

Abstract. Patients with hereditary hemolytic anaemias have been known to have immunoglobulin alterations related to an increased susceptibility to infection. In the present series, immunoglobulins G, A and M have been estimated in 50 thalassemic children aged 10 months to 13 years. No significant difference was found in any of the immunoglobulins between patients and age‐matched controls. No correlation could be shown between immunoglobulin levels and (a) the severity of anaemia, (b) the degree of hemosiderosis, and (c) the frequency of febrile infections per year. Against clinical impressions patients did not show any increased susceptibility to infections.

Evidence for an effect on erythrophilic IgG-globulin coat by the haemolytic process

Abstract Erythrophilic IgG globulin coat (IgG E-C) is a fraction separated from serum IgG-globulin by cellulose phosphate column chromatography. It is easily eluted from the red blood cells and may be quantitated by a method described in this paper. This method was applied to 20 completely healthy newborns and to 81 newborns with severe jaundice of various aetiology (i.e. ABO isoimmunisation, haemolysis severe; ABO isoimmunisation, haemolysis mild; G-6-PD deficiency, haemolysis severe; G-6-PD deficiency, haemolysis mild; ABO incompatibility; Rh isoimmunisation and unknown aetiology). It was also applied to 19 children with favism and 10 age matched symptomless children with G-6-PD deficiency. IgG E-C mean values were higher in newborns with severe jaundice due to ABO isoimmunisation or G-6-PD deficiency as compared to those with jaundice of other aetiology or the healthy controls. The difference was even more pronounced in cases with severe haemolysis (0.01 > p > 0.001). They were also higher in children with G-6-PD deficiency only during the crisis of favism (0.01 > p > 0.001). It is concluded that IgG E-C increases during acute haemolysis.

Inappropriate Days of Care in A Pediatric Hospital 49

To assess the extent of inappropriate hospital use in pediatric inpatients the “Pediatric Appropriateness Evaluation Protocol” was applied to 1,400 children, randomly admitted during one year in the bigest pediatric department in Greece, with a total of 6,450 days hospitalization .Results: The mean length of stay in hospital was found 4.6±4.4 days. Almost half of them (3.167 days, 49%) namely 2.26 days per child were found to be medically inappropriate. Factors significantly associated with inappropriate hospital use such as demographic and social characteristics, nature of disease, type of primary care offered to the child, process of hospital admission and medical intervantions during hospitalization were thrown into multiple regression model. It appeared that the number of tests done and the number of specialists examined the child attribute to increased inappropriate days. Children with infections disease, to divorced parents and non insured were more likely to fall into this category. Less inappropriate hospital days are associated with: the number of tests performed the day of admission: the flexibility of clinical hospital practice; the poor physical condition of the child and the admission in emergency at night .In conclusion, since social status and nature of disease are not changable better coordination of hospital diagnostic and therapeutic intervantions may reduce inappropriate hospital use and its consequences.

FROM BIRTH TO SEVEN YEARS: A GREEK NATIONAL LONGITUDINAL STUDY

In Greece all infants born in April 1983 were included in the National Perinatal Study. Out of those 10921 children-excluding dead, severely handicaped and those who immigrated-8158 were traced, only by their date of birth, 7 years later in primary school. Parents assisted by teachers completed a questionnaire covering important aspects of their physical, behavioural and social development. Checking for varius variables we showed that the bias introduced by missing 18% of the original cohort was not statistically significant. Moreover the two records for each individual child were matched for 70% of the cohort. The descriptive analyses gave a thesaurus of information on: family structure (5% single parents, 21% cohabitation with grandparents); childs medical history (31% hospitalization); motor ond sensory development (7% motor disability, 8.5% speech problems) accidents (34%, 1.25 per child); present health status (7.5% asthma, 7%, epilepsy); life-style (homework, T.V., sports, hobbies); preschool and primary school activities; behaviour both at school and home (3.6% bed wetting and 1% soiling at least once a week); socioeconomic status; attitudes towards rearing (18% physical punishment every day) and performance at school (2.6% severe learning problems).These findings mayserve, as guidelines for rational reorganisation of all pertinent services in Greece based on the real needs of our children and their families.