Nikolaos Vlachadis

Mortality and the economic crisis in Greece.

Financial crisis can be a threat to health, and International Monetary Fund programmes have been associated with impeded efforts to control child and maternal mortality. In 2008, Greece entered the most serious socioeconomic downturn in the country’s modern history, which has steadily worsened over the following years. Vlachadis and Kornarou reported that an increase in stillbirths in Greece was linked to the economic crisis; stillbirth rate increased from 3·31 per 1000 livebirths in 2008 to 4·36 in 2010, but the study included only the fi rst 2 years of the crisis. Data for maternal health have not been analysed since 2006. In light of the socioeconomic crisis taking place in Greece, our aim was to investigate whether this crisis had an eff ect on stillbirths, and infant, child, and maternal mortality. We investigated the potential association between the financial crisis (2008–12) and stillbirths, and infant, child, and maternal mortality, using the precrisis period (2003–07) as the referent. Stillbirth, infant and child mortality (per 1000 livebirths), and maternal mortality (number of maternal deaths per 100 000 livebirths) are shown in the table. Infant mortality rate and child mortality rate did not diff er between the precrisis and crisis periods (3·83 [95% CI 3·56–4·10] vs 3·17 [2·63–3·72], and 4·56 [4·18–4·93] Mortality and the economic crisis in Greece

Increase in stillbirths in Greece is linked to the economic crisis

Gardosi and colleagues’ article has prompted us to highlight the recent increase in stillbirths in Greece.1 We analysed official data on stillbirths in Greece from the Hellenic Statistical Authority (ELSTAT). Stillbirth rates in Greece continuously decreased over 42 years, from …

Greece's economic crisis and suicide rates: overview and outlook

Rise in unemployment following the 2008 economic crisis has been associated with a significant increase in the suicide rates in European and American countries.1 From the fourth trimester of 2008 to the fourth trimester of 2012, Greece witnessed a snowballing 22% recession in gross domestic product at constant prices, accompanied by a soaring unemployment rate that shot up from 8% to 26%. There has been much discussion regarding the effects of the economic crisis on suicides in Greece with early conclusions being put forward quoting temporary leveling-off,2 increase3 or decline4 in suicide rates during the current economic recession. Here, we present recent trends in suicide rates in Greece based …

Genetic heterogeneity of platelet glycoproteins Ia and IIIa is associated with in vitro fertilisation implantation failure

Thrombophilic genetic factors have been shown to play an important role in implantation outcome after in vitro fertilisation (IVF). In this pilot study we investigated the frequencies of glycoprotein Ia (GpIa)-C807T and GpIIIa-PlA1/PlA2 polymorphisms in 60 nulligravidae women with a history of unexplained IVF implantation failures and compared them with 60 healthy fertile women. We found statistically significant associations between the GpIa-C807T and GpIIIa-PlA1/PlA2 polymorphisms and IVF implantation failure (odds ratio [OR] = 3.45, 95% confidence interval [CI]: 1.63–7.30, p = 0.001; and OR = 2.86, 95% CI: 1.27–6.45, p = 0.010, respectively) with the risk being higher for combined carriers of GpIa-807T and GpIIIa-PlA2 alleles (OR = 10.13, 95% CI: 2.85–35.99, p < 0.001), suggesting a synergistic effect of the two polymorphisms. The above associations were strongest for the youngest age group. Our results indicate that GpIa-807T and GpIIIa-PlA2 may be susceptibility alleles for IVF implantation failure.

The Janus face of maternal serum relaxin: a facilitator of birth, might it also induce preterm birth?

Abstract Objective: Preterm birth is a major cause of neonatal morbidity and mortality in the developed world. In order to better understand the pathophysiological pathway of this condition, the role of genetic factors and/or inflammation-associated molecules, as well as of socioeconomic parameters, is therefore under intense investigation. The purpose of this review study was to examine the potential role of maternal serum relaxin levels in the etiology of preterm birth. Methods: Electronic databases (Pubmed, Embase, Cochrane Library) were searched for previously published research studies that investigated the biological role of relaxin and the mechanisms in which this hormone is involved during pregnancy and labor. Results: It is evident that while relaxin is an essential endometrial/decidual angiogentic factor playing a vital role in maternal accommodation of pregnancy, elevated levels of this hormone could well be associated with preterm birth. Conclusions: There are strong indications that maternal serum hyperrelaxinemia correlates with an increased risk of preterm birth.

The incidence of preeclampsia and eclampsia in Australia: 2000 through 2008

REFERENCES 1. Aitken DA, Mccaw G, Crossley JA, et al. First trimester biochemical screening for fetal chromosome abnormalities and neural tube defects. Prenat Diagn 1993;13:681-9. 2. Bernard J-P, Cuckle HS, Bernard M, Brochet C, Salomon LJ, Ville Y. Combined screening for open spina bifida at 11-14 weeks using fetal biparietal diameter and maternal serum markers. Am J Obstet Gynecol 2013;209:223.e1-5. 3. Bredaki FE, Poon LC, Birdir C, Escalante D, Nicolaides KH. Firsttrimester screening for neural tube defects using alpha-fetoprotein. Fetal Diagn Ther 2012;31:109-14. 4. Wald NJ, Cuckle H. Maternal serum alpha-fetoprotein measurement in antenatal screening for anencephaly and spina bifida in early pregnancy. Report of the UK Collaborative Study on Alpha-Fetoprotein in Relation to Neural-Tube Defects. Lancet 1977;1:1323-32. 5. Nicolaides KH, Wright D, Poon LC, Syngelaki A, Gil M. Ultrasound Obstet Gynecol 2013;42:41-50. 6. Evans MI, Krantz DA, Hallahan TW, Galen RS. Meta-analysis of first trimester Down syndrome screening studies: free beta-human chorionic gonadotropin significantly outperforms intact human chorionic gonadotropin in a multimarker protocol. Am J Obstet Gynecol 2007;196: 198-205.

Genetic heterogeneity of platelet glycoproteins Ia and IIIa and the risk of spontaneous miscarriages

Abstract Objective: The aim of this study was to investigate the association between the genetic heterogeneity of platelet glycoproteins Ia (GpIa-C807T) and IIIa (GpIIIa-PlA1/PlA2) and spontaneous abortions. Study design: Two hundred and twenty two women with a history of unexplained spontaneous miscarriages and no successful pregnancy, and 60 fertile women serving as controls were genotyped for the GpIa-C807T and GpIIIa-PlA1/PlA2 polymorphisms by pyrosequencing. Results: In comparison with the common alleles homozygotes, GpIa-807T and GpIIIa-PlA2 carriers had an increased risk of fetal loss (OR = 3.36, 95%CI: 1.85–6.11, p < 0.001, and OR = 2.58, 95%CI: 1.30–5.13, p = 0.006, respectively). For subjects who were combined carriers of the GpIa-807T and GpIIIa-PlA2 alleles, the risk increased further (OR = 9.13, 95%CI: 2.99–27.82, p < 0.001). The above ORs were highest for women who were younger than 30 years of age. Conclusions: The GpIa-C807T and GpIIIa-PlA1/PlA2 polymorphisms and more pronouncedly their combination are associated with increased risk of spontaneous abortions. The correlations were stronger for younger patients. Our results indicate that GpIa-807T and GpIIIa-PlA2 are susceptibility alleles for fetal loss in the Greek population.

Cancer mortality in Greece during the financial crisis

Christianen MEMC, Schilstra C, Beetz I, Muijs CT, [9] Chouvalova O, Burlage FR, et al. Predictive modelling for swallowing dysfunction after primary (chemo)radiation: Results of a prospective observational study. Radiother Oncol 2012;105:107–14. Dijkema T, Raaijmakers CPJ, Ten Haken RK, Roesink JM, [10] Braam PM, Houweling AC, et al. Parotid gland function after radiotherapy: The combined michigan and utrecht experience. Int J Radiat Oncol Biol Phys 2010;78:449–53. Deasy JO, Moiseenko V, Marks L, Chao KSC, Nam J, [11] Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 2010;76:S58–63. Bedford JL. Treatment planning for volumetric modulated [12] arc therapy. Med Phys 2009;36:5128. Cao D, Afghan MKN, Ye J, Chen F, Shepard DM. [13] A generalized inverse planning tool for volumetric-modulated arc therapy. Phys Med Biol 2009;54:6725–38. Cameron C. Sweeping-window arc therapy: An implementa[14] tion of rotational IMRT with automatic beam-weight calculation. Phys Med Biol 2005;50:4317–36. Chi A, Ma P, Fu G, Hobbs G, Welsh JS, Nguyen NP, [15] et al. Critical structure sparing in stereotactic ablative radiotherapy for central lung lesions: helical tomotherapy vs. volumetric modulated arc therapy. PLoS One 2013;8:e59729. Guckenberger M, Richter A, Krieger T, Wilbert J, Baier K, [16] Flentje M. Is a single arc suffi cient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes? Radiother Oncol 2009;93:259–65. Vanetti E, Nicolini G, Nord J, Peltola J, Clivio A, Fogliata A, [17] et al. On the role of the optimization algorithm of RapidArc(®) volumetric modulated arc therapy on plan quality and effi ciency. Med Phys 2011;38:5844–56. Bzdusek K, Friberger H, Eriksson K, Hå rdemark B, [18] Robinson D, Kaus M. Development and evaluation of an effi cient approach to volumetric arc therapy planning. Med Phys 2009;36:2328. Ong CL, Cuijpers JP, Senan S, Slotman BJ, Verbakel [19] WFAR. Impact of the calculation resolution of AAA for small fi elds and RapidArc treatment plans. Med Phys 2011;38:4471–9.

Cardiovascular mortality and the financial crisis in Greece: Trends and outlook

At the end of 2008, Greece was hit by an unprecedented financial crisis, the most serious that any western country has experienced in peacetime, with GDP falling by 22% at constant prices and unemployment rising from 8% to 26% in just four years.

Preterm births in countries with a very high human development index

www.thelancet.com Vol 381 April 20, 2013 1355 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ to 5·22 per 100 livebirths—an increase of 145%), followed by those born between 32 and 35+6 weeks (from 2·17 to 4·68 per 100 livebirths—an increase of 116%); the proportion of infants born at less than 32 weeks rose 29%, from 1·00 to 1·29 per 100 livebirths. The dramatic increase in PBR in Greece is of great public health concern, since preterm birth is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health.