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1.  Subjective Risk Assessment and Perception in the Greek and English Bakery Industries 
Several factors influencing risk perception in the area of occupational health and safety are known, but there is still lack of a full understanding of the ways in which people characterize risk. This study aimed to provide an insight of employee risk assessment and perception in the bakery industry. 87 British and 64 Greek employees in two comparable bakery companies were asked to estimate and evaluate hazards at their workplace. The participants' judgments of 12 hazards—according to 7 risk aspects—were collected and analyzed. Subjective assessment on important occupational hazards included handling heavy loads, repetitiveness, high temperatures, high rate of work, stressful deadlines, and noise. Although limited in the population involved, our findings revealed strong cross-national differences in employee risk perception of specific groups of hazards in the bakery industry. Additional interviews revealed evidence that Greek employees' risk perception depends mostly on work experience while British employees were aware of risks due to company health and safety policy, recognizing that safety is the responsibility of both the management and the worker. Cross-national (cultural) factors that influence workforce risk perception and attitudes towards safety have to be taken into account by technical experts and policy makers in the designing of prevention strategies and risk communication.
PMCID: PMC2778446  PMID: 20041018
2.  Biological Monitoring of Hexavalent Chromium and Serum Levels of the Senescence Biomarker Apolipoprotein J/Clusterin in Welders 
Welding fumes contain metals and other toxic substances known or strongly suspected to be related with oxidative stress and premature cellular senescence. Apolipoprotein J/Clusterin (ApoJ/CLU) is a glycoprotein that is differentially regulated in various physiological and disease states including ageing and age-related diseases. In vitro data showed that exposure of human diploid fibroblasts to hexavalent chromium (Cr(VI)) resulted in premature senescence and significant upregulation of the ApoJ/CLU protein. In this study we analyzed blood and urine samples from shipyard industry welders being exposed to different levels of Cr(VI) over a period of five months in order to assay in vivo the relation of ApoJ/CLU serum levels with Cr(VI). Our findings confirmed the previously reported in vitro data since reduction of Cr levels, after a worksite intervention, associated with lower levels of ApoJ/CLU serum levels. We concluded that the human ApoJ/CLU gene is responsive to the acute in vivo oxidative stress induced by heavy metals such as hexavalent chromium.
PMCID: PMC2366075  PMID: 18464919
3.  The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ): a novel tool for assessing self-empowerment through a constellation of daily activities 
BMC Public Health  2014;14(1):995.
The 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.
Therefore, 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.
The 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.
The HLPCQ is a good tool for assessing the efficacy of future health-promoting interventions to improve individuals’ lifestyle and wellbeing.
PMCID: PMC4192765  PMID: 25253039
Health; Lifestyle; Wellbeing; Empowerment; Daily routine
4.  Exploring Stress Levels, Job Satisfaction, and Quality of Life in a Sample of Police Officers in Greece 
Safety and Health at Work  2014;5(4):210-215.
The ongoing economic crisis in Greece has affected both stress and quality of life (QoL) at all socioeconomic levels, including professionals in the police force. The aim of this study was to examine perceived stress, job satisfaction, QoL, and their relationships in a sample of police officers in Greece.
A cross-sectional study was conducted during the first trimester of 2011 in 23 police stations in the greater Athens area. A total of 201 police officers agreed to participate (response rate 44.6%). The General Health Questionnaire-28 (GHQ-28) was used to assess general health, and the World Health Organization Quality of Life-BREF Questionnaire and Perceived Stress Scale-14 (PSS-14) questionnaires were used to assess QoL and perceived stress, respectively.
The PSS and GHQ subscales and total scores exhibited strong, positive, and significant correlations coefficients (r): 0.52 for somatic disturbances, 0.56 for stress and insomnia, 0.40 for social dysfunction, and 0.37 for depression, yielding an r equal to 0.57 for the total GHQ score. A higher level of perceived stress was related to a lower likelihood of being satisfied with their job; in this regard, male participants and higher ranked officers reported lower job satisfaction. The PSS and GHQ scores were inversely, consistently, and significantly related to almost all of the QoL aspects, explaining up to 34% of their variability. Parenthood had a positive effect on QoL related to physical health, and women reported lower QoL related to psychological health.
Higher levels of stress are related to an increased risk of reporting suboptimal job satisfaction and QoL. The magnitude of these associations varied depending on age, gender, and rank, highlighting the need for stress-management training.
PMCID: PMC4266800  PMID: 25516814
health promotion; job satisfaction; occupational stress; police officers; quality of life
5.  Correlation between the Personal and Social Performance scale (PSP) and the Positive and Negative Syndrome Scale (PANSS) in a Greek sample of patients with schizophrenia 
BMC Psychiatry  2014;14:197.
Psychosocial dysfunction is one of schizophrenia’s core features, often leading to a deprecation of independent living and significant failure to maintain a competent quality of life. Cognitive and occupational performance as well as psychosocial functioning is moreover recognized as determinants of treatment response. Therefore, the elaboration of measures regarding social performance besides scales that assess psychopathology is essential. The Personal and Social Performance (PSP) scale has been found to be as much valid as reliable for assessing social functioning in the acute and stable stage of schizophrenia. The aim of this study was to estimate the correlation between the PSP and Positive and Negative Syndrome Scale (PANSS) (convergent validity) in patients with schizophrenia during routine clinical practice.
A longitudinal study with a six-month follow-up is presented. Correlation between the PSP scale and the Positive and Negative Syndrome Scale (PANSS) was conducted in a Greek sample of 2010 patients with schizophrenia in outpatient setting in two successive visits. PANSS and PSP scales were used for the assessment of psychopathological symptoms and social and personal functioning.
The PSP subscales scores were well correlated with each other with Spearman correlation coefficients (r) ranging from 0.56 to 0.76 on both visits in three out of the four main areas, whereas in the category of “disturbing and aggressive behavior” the correlations were lower but still significant. Furthermore, total PSP score showed high association to PANSS total score in the first (r = -0.59) as well as in the second visit (r = -0.50). Regression analysis showed that one point decrease of PANSS’s total score is associated with a 0.42 points increase on the PSP scale. PSP and PANSS scales exhibited high convergent validity.
The PSP could provide additional valuable information in the assessment of schizophrenia related social functioning and treatment response.
PMCID: PMC4227001  PMID: 25005616
PSP; PANSS; Correlation; Social functioning; Validity; Reliability
6.  Implementation of a worksite educational program focused on promoting healthy eating habits 
F1000Research  2014;2:201.
Objective: To estimate the effectiveness of a short-term educational-counseling worksite program focused on lipid intake, by monitoring the possible change on nutrition knowledge and eating habits.
Methods: an 8-week educational program based on the Health Belief Model was implemented in a honey packaging and sales company in Greece. 20 out of the 29 employees initially enrolled completed the program. Knowledge level and eating habits were evaluated prior and after the intervention by the “Nutrition Knowledge Questionnaire” and the “Food Habits Questionnaire”. ANOVA, Spearman rho test and paired Wilcoxon test were employed in statistical analysis.
Results: Non smokers and those with higher educational level had healthier eating habits. Knowledge following the intervention was significantly improved concerning recommendations and basic food ingredients but as far as eating habits were concerned, scores were not improved significantly, while intake of fried food was increased.
Conclusions and Implications: Short-term interventions may produce substantial improvement in knowledge but not necessarily modifications in unhealthy eating habits.
PMCID: PMC4197742  PMID: 25324961
7.  Sex discrepancies in COPD patients and burden of the disease in females: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study) 
The prevalence of chronic obstructive pulmonary disease (COPD) in females appears to be increasing. Recent studies have revealed that the percentage of women with COPD in Greece is approximately 12.5%.
To evaluate the burden of COPD among males and females in Greece through a nationwide cross-sectional survey and to explore sex differences regarding functional characteristics and exacerbation frequency.
Data collection was completed in a 6-month period. The present study followed a nationwide sampling approach of respiratory medicine physicians. The sampling approach included three steps: 1) estimation of expected incidence and prevalence of COPD cases in each prefecture of Greece and in total; 2) estimation of expected incidence of COPD cases per physician in each prefecture; and 3) creation of a frame of three different sampling zones. Following this sampling, data were provided by 199 respiratory physicians.
The participating physicians provided data from 6,125 COPD patients. Female patients represented 28.7% of the study participants. Female COPD patients were, on average, 5 years younger than male COPD patients. Never smokers accounted for 9.4% within female patients, compared to 2.7% of males (P<0.001). Female patients were characterized by milder forms of the disease. Comorbidities were more prevalent in men, with the exception of gastroesophageal reflux (14.6% versus 17.1% for men and women, respectively, P=0.013). Female COPD patients had a higher expected number of outpatient visits per year (by 8.9%) than males (P<0.001), although hospital admissions did not differ significantly between sexes (P=0.116). Females had fewer absences from work due to COPD per year, by 19.0% (P<0.001), compared to males.
The differences observed between male and female COPD patients provide valuable information which could aid the prevention and management of COPD in Greece.
PMCID: PMC3933352  PMID: 24600217
chronic obstructive pulmonary disease; exacerbations; comorbidities
8.  Work-related Dermatoses in Greece 
Safety and Health at Work  2014;5(1):39-40.
PMCID: PMC4048003  PMID: 24932419
9.  Implementation of a worksite educational program focused on promoting healthy eating habits 
F1000Research  2013;2:201.
Objective: To estimate the effectiveness of a short-term educational-counseling worksite program focused on lipid intake, by monitoring the possible change on nutrition knowledge and eating habits.
Methods: an 8-week educational program based on the Health Belief Model was implemented in a honey packaging and sales company in Greece. 20 out of the 29 employees initially enrolled completed the program. Knowledge level and eating habits were evaluated prior and after the intervention by the “Nutrition Knowledge Questionnaire” and the “Food Habits Questionnaire”. ANOVA, Spearman rho test and paired Wilcoxon test were employed in statistical analysis.
Results: Non smokers and those with higher educational level had healthier eating habits. Knowledge following the intervention was significantly improved concerning recommendations and basic food ingredients but as far as eating habits were concerned, scores were not improved significantly, while intake of fried food was increased.
Conclusions and Implications: Short-term interventions may produce substantial improvement in knowledge but not necessarily modifications in unhealthy eating habits.
PMCID: PMC4197742  PMID: 25324961
10.  Sickness Absence in the Private Sector of Greece: Comparing Shipyard Industry and National Insurance Data 
Approximately 3% of employees are absent from work due to illness daily in Europe, while in some countries sickness absence exceeds 20 days per year. Based on a limited body of reliable studies, Greek employees in the private sector seem to be absent far less frequently (<5 days/year) compared to most of the industrialized world. The aim of this study was to estimate the levels of sickness absence in the private sector in Greece, using shipyard and national insurance data. Detailed data on absenteeism of employees in a large shipyard company during the period 1999–2006 were utilized. National data on compensated days due to sickness absence concerning all employees (around 2 million) insured by the Social Insurance Institute (IKA, the largest insurance scheme in Greece) were retrieved from the Institute’s annual statistical reports for the period 1987–2006. Sick-leave days per employee and sick-leave rate (%) were calculated, among other indicators. In the shipyard cohort, the employment time loss due to sick leave was 1%. The mean number of sick-leave days per employee in shipyards ranged between 4.6 and 8.7 and sick-leave rate (sickness absenteeism rate) varied among 2% and 3.7%. The corresponding indicators for IKA were estimated between 5 and 6.3 sick-leave days per insured employee (median 5.8), and 2.14–2.72% (median 2.49%), respectively. Short sick-leave spells (<4 days) may account at least for the 25% of the total number of sick-leave days, currently not recorded in national statistics. The level of sickness absence in the private sector in Greece was found to be higher than the suggested by previous reports and international comparative studies, but still remains one of the lowest in the industrialized world. In the 20-years national data, the results also showed a 7-year wave in sickness absence indexes (a decrease during the period 1991–1997 and an increase in 1998–2004) combined with a small yet significant decline as a general trend. These observations deserve detailed monitoring and could only partly be attributed to the compensation and unemployment rates in Greece so other possible reasons should be explored.
PMCID: PMC3366606  PMID: 22690189
sickness absence; sick leave; occupational health; social insurance; employment; compensation; shipyard; industry; Greece
11.  Determinants of Self-Rated Health in a Representative Sample of a Rural Population: A Cross-Sectional Study in Greece 
Self-rated health (SRH) is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity) were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%), 790 (52%) and 237 (15.6%) rated their health as “very good”, “good” and “poor” respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed.
PMCID: PMC3367289  PMID: 22690175
self-rated health; determinants; lifestyle; sleep; religiosity; cross-sectional
12.  Gender differences in Greek centenarians. A cross-sectional nation-wide study, examining multiple socio-demographic and personality factors and health locus of control 
BMC Geriatrics  2011;11:87.
Centenarians 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.
Nation -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.
Women 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.
Gender 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.
PMCID: PMC3282665  PMID: 22189185
centenarians; Greece; gender; longevity; personality
13.  Comparative analysis of induced sputum and bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers 
Biological monitoring of healthy workers exposed to hazardous dusts lack validated screening tools. Induced sputum (IS) cellular profile was compared with bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers in order to assess its usefulness in monitoring workers exposed to asbestos for a long period of time.
IS and BALF analysis was performed in 39 workers of a car brakes and clutches factory that uses chrysotile asbestos. Selection criteria were an employment history of > 15 years and the absence of a diagnosis of pneumonoconiosis. The type of cells, the existence of dust cells, of iron laden macrophages and of asbestos bodies were assessed and compared between IS and BALF samples.
35 IS samples (90%) had dust cells, 34 (87%) iron laden macrophages and in 8 samples (21%) asbestos bodies were found. In most samples neutrophils were dominated. Samples with asbestos bodies (ABs) had significantly higher lymphocytes and lower neutrophils count compared with the samples without ABs. Macrophages and neutrophils in IS and BALF exhibited significant inter-relations (Spearman's rho: 0.26-0.29, p < 0.05) while IS lymphocytes count showed an inverse relation with BALF neutrophils (Spearman's rho: -0.36). Neutrophils and dust cells were highly correlated between the samples (Spearman's rho: 0.35, p < 0.05) while IS dust cells and lymphocytes were inversely related (Spearman's rho: -0.36, p < 0.05). More years of employment in the company was related with more neutrophils (Spearman's rho: 0.26) and less lymphocytes (Spearman's rho: -0.33) count. In multivariate analysis the presence of AB in IS samples was strongly related to the presence of asbestos bodies and lymphocytes count in BALF samples.
IS and BALF analysis showed a similar cellular profile indicating that IS sampling in exposed workers to asbestos as a less invasive and expensive method may be useful in providing an insight both for inhalation of dusts and inflammatory processes in the lung.
PMCID: PMC3170282  PMID: 21838922
14.  Lifestyle and self-rated health: a cross-sectional study of 3,601 citizens of Athens, Greece 
BMC Public Health  2011;11:619.
Self-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.
In 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.
Reporting 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.
Slight 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.
PMCID: PMC3161893  PMID: 21816035
self-rated health; health promotion; sleep; health inequalities; lifestyle; public health
15.  Perceived Stress Scale: Reliability and Validity Study in Greece 
To translate the Perceived Stress Scale (versions PSS-4, −10 and −14) and to assess its psychometric properties in a sample of general Greek population.
941 individuals completed anonymously questionnaires comprising of PSS, the Depression Anxiety and Stress scale (DASS-21 version), and a list of stress-related symptoms. Psychometric properties of PSS were investigated by confirmatory factor analysis (construct validity), Cronbach’s alpha (reliability), and by investigating relations with the DASS-21 scores and the number of symptoms, across individuals’ characteristics. The two-factor structure of PSS-10 and PSS-14 was confirmed in our analysis. We found satisfactory Cronbach’s alpha values (0.82 for the full scale) for PSS-14 and PSS-10 and marginal satisfactory values for PSS-4 (0.69). PSS score exhibited high correlation coefficients with DASS-21 subscales scores, meaning stress (r = 0.64), depression (r = 0.61), and anxiety (r = 0.54). Women reported significantly more stress compared to men and divorced or widows compared to married or singled only. A strong significant (p < 0.001) positive correlation between the stress score and the number of self-reported symptoms was also noted.
The Greek versions of the PSS-14 and PSS-10 exhibited satisfactory psychometric properties and their use for research and health care practice is warranted.
PMCID: PMC3166743  PMID: 21909307
Perceived Stress Scale; translation; psychometric properties; validation; Greece
16.  Cigarette smoking among university students in Greece: a comparison between medical and other students 
The purpose of the study was to investigate the smoking habits of medical and other students and to explore the most important factors associated with students’ smoking.
University students were surveyed in late spring 2006 regarding their smoking status and additional health- and behavior-related characteristics.
A total of 1205 (269 medical and 936 nonmedical) students participated in the study. Of these 47% reported being current smokers (35% among medical students), and 30% of the smokers had already started smoking at the age of 16 years. Smokers reported a significantly higher prevalence of cough and respiratory infections and a decrease in physical fitness. The most important factor associated with smoking prevalence was friendship with smokers and maternal smoking. A better knowledge of harmful effects showed a strong association with nonsmokers. Although nonmedical students exhibited a greater possibility to be a smoker, awareness of harmful effects among medical students was not as significant as factor against smoking compared with among nonmedical students.
This study shows that smoking prevalence among medical and other students in Greece is extremely high. A lack of effective education against smoking in medical students was evident and this underlines the need to identify the factors to be included in planning effective antismoking programs.
PMCID: PMC2824102  PMID: 19802656
University; Smoking; Prevalence; Risk awareness; Students; Medical students; Education
17.  Lymphocyte to monocyte ratio as a screening tool for influenza 
PLoS Currents  2010;2:RRN1154.
In fall 2009 the emergency department of a clinic in Greece with increased patient visits due to influenza-like illness observed a particular pattern in the complete blood count (CBC) of these patients. In 90% of all patients with probable influenza, lymphopenia and/or monocytosis were present. Relative lymphopenia with or without monocytosis appears to be a laboratory marker for H1N1 virus infection, a finding that could play a major role in early identifying and treating patients with new influenza A. A ratio of lymphocytes to monocytes below 2 is proposed as a screening tool for influenza infection instead of rapid tests.
PMCID: PMC2847387  PMID: 20383263
18.  Indoor Air in Beauty Salons and Occupational Health Exposure of Cosmetologists to Chemical Substances 
The indoor environment in four beauty salons located in Athens (Greece) was examined in order to investigate the occupational health exposure of cosmetologists to various chemical products typically used in their work. Chemical substances chosen for investigation were volatile organic compounds (VOCs), formaldehyde, ozone and carbon dioxide. Total VOCs levels measured showed significant variation (100–1,450 μg m−3) depending on the products used and the number of treatments carried out, as well as ventilation. The main VOCs found in the salons were aromatics (toluene, xylene), esters and ketones (ethyl acetate, acetone, etc.) which are used as solvents in various beauty products; terpenes (pinene, limonene, camphor, menthenol) which have a particular odor and others like camphor which have specific properties. Ozone concentrations measured in all salons were quite low (0.1 and 13.3 μg m−3) and formaldehyde concentrations detected were lower than the detection limit of the method in all salons (<0.05 ppm). Carbon dioxide levels ranged between 402 and 1,268 ppm, depending on the number of people present in the salons during measurements and ventilation. Cosmetologists may be exposed to high concentrations of a mixture of volatile organic compounds although these levels could be decreased significantly by following certain practices such as good ventilation of the areas, closing the packages of the beauty products when not in use and finally selecting safer beauty products without strong odor.
PMCID: PMC2819791  PMID: 20195448
cosmetologists; beauty salons; nail salons; indoor air; occupational health; chemical exposure; volatile organic compounds; toluene; Greece
19.  Musculoskeletal Disorders among Cosmetologists 
A cross-sectional study was performed to investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of low back, neck, shoulder, hand/wrist and knee musculoskeletal complaints among cosmetologists in Athens, Greece. The study population consisted of 95 female and seven male beauty therapists (response rate 90%) with a mean age and duration of employment of 38 and 16 years, respectively. Neck pain was the most prevalent musculoskeletal complaint, reported by 58% of the subjects, while hand/wrist and low back complaints resulted more frequently in self-reported consequences (chronicity, care seeking and absenteeism). Significant relationships were found between self-reported physical risk factors like prolonged sitting, use of vibrating tools, reaching far and awkward body postures and the occurrence of musculoskeletal disorders at various body sites. Among psychosocial variables co-worker support and skill discretion seem to be the most important reflecting organizational problems and cognitive-behavioral aspects. The study results also suggest that effective intervention strategies most likely have to take into account both ergonomic improvements and organizational aspects.
PMCID: PMC2800326  PMID: 20049238
cosmetologists; beauty therapists; aestheticians; beauty salons; musculoskeletal complaints; occupational health; epidemiology; Greece
20.  Fenticonazole Activity Measured by the Methods of the European Committee on Antimicrobial Susceptibility Testing and CLSI against 260 Candida Vulvovaginitis Isolates from Two European Regions and Annotations on the Prevalent Genotypes▿  
The activity of fenticonazole was studied against 260 West and Southeast European vulvovaginal candidiasis isolates, and low MICs were displayed. Fenticonazole was assessed by European Committee on Antimicrobial Susceptibility Testing and CLSI microdilution methods for the first time, and the results showed excellent agreement (97%) and significant interclass correlation coefficient (P < 0.0001). Also, the levels of agreement for the results for itraconazole, fluconazole, and ketoconazole were 84%, 90%, and 98% (P < 0.0001), respectively. Multilocus typing by PCR fingerprinting and subsequent cluster analysis delineated geographically associated alignments for Candida albicans and fluconazole resistance-related clusters for Candida glabrata.
PMCID: PMC2681495  PMID: 19223627
21.  Self-Rated Health: Inequalities and Potential Determinants 
Understanding social inequalities in health is of great importance; it provides the conceptual frame for investigating the social factors that affect health, together with empirical evidence for improving population health. Individual and socioeconomic data, disease related conditions and self rated health (SRH) ratings were collected from a representative sample of 1,000 participants in order to study health inequalities in Greece. 20.8% of men and 37.2% of women reported poor health status. Significant inequalities in SRH were observed. Strong associations of poor SRH with gender, age, insurance coverage and chronic diseases were identified. Social insurance scheme captured partly the effects of educational level, income and residence area in SRH in multivariate analysis. Respondents under chronic treatment and those suffering from cardiovascular, musculoskeletal and neurological/psychiatric disorders exhibited the highest risk of reporting poor SRH. Our findings provide decision-makers with insights into how to manage health inequalities by prioritizing preventive measures and consequently, progress towards the fair distribution of healthcare resources.
PMCID: PMC2760422  PMID: 19826556
self-rated health; health inequalities; social determinants; chronic diseases; Greece
22.  Risk factors for sickness absence due to low back pain and prognostic factors for return to work in a cohort of shipyard workers 
European Spine Journal  2008;17(9):1185-1192.
The purpose of this study was to determine risk factors for the occurrence of sickness absence due to low back pain (LBP) and to evaluate prognostic factors for return to work. A longitudinal study with 1-year follow-up was conducted among 853 shipyard workers. The cohort was drawn around January 2004 among employees in the shipyard industry. Baseline information was obtained by questionnaire on physical and psychosocial work load, need for recovery, perceived general health, musculoskeletal complaints, sickness absence, and health care use during the past year. During the 1-year follow-up for each subject medical certifications were retrieved for information on the frequency and duration of spells of sickness absence and associated diagnoses. Cox regression analyses were conducted on occurrence and on duration of sickness absence with hazard ratios (HR) with 95% confidence interval (95% CI) as measure of association. During the 1-year follow-up period, 14% of the population was on sick leave at least once with LBP while recurrence reached 41%. The main risk factors for sickness absence were previous absence due to a health problem other than LBP (HR 3.07; 95%CI 1.66–5.68) or previous sickness absence due to LBP (HR 6.52; 95%CI 3.16–13.46). Care seeking for LBP and lower educational level also hold significant influences (HR 2.41; 95%CI 1.45–4.01 and HR 2.46; 95%CI 1.19–5.07, respectively). Living with others, night shift and supervising duties were associated with less absenteeism due to LBP. Workers with a history of herniated disc had a significantly decreased rate of returning to work, whereas those who suffered from hand-wrist complaints and LBP returned to work faster. Prior sick leave due to LBP partly captured the effects of work-related physical and psychosocial factors on occurrence of sick leave. Our study showed that individual and job characteristics (living alone, night shift, lower education, sick leave, or care seeking during the last 12 months) influenced the decision to take sick leave due to LBP. An increased awareness of those frequently on sick leave and additional management after return to work may have a beneficial effect on the sickness absence pattern.
PMCID: PMC2527417  PMID: 18649089
Low back pain; Sick leave; Prognosis; Recurrence; Return to work
23.  Musculoskeletal disorders in shipyard industry: prevalence, health care use, and absenteeism 
It is unclear whether the well-known risk factors for the occurrence of musculoskeletal disorders (MSD) also play an important role in the determining consequences of MSD in terms of sickness absence and health care use.
A cross-sectional study was conducted among 853 shipyard employees. Data were collected by questionnaire on physical and psychosocial workload, need for recovery, perceived general health, occurrence of musculoskeletal complaints, and health care use during the past year. Retrospective data on absenteeism were also available from the company register.
In total, 37%, 22%, and 15% of employees reported complaints of low back, shoulder/neck, and hand/wrist during the past 12 months, respectively. Among all employees with at least one MSD, 27% visited a physician at least once and 20% took at least one period of sick leave. Various individual and work-related factors were associated with the occurrence of MSD. Health care use and absenteeism were strongest influenced by chronicity of musculoskeletal complaints and comorbidity with other musculoskeletal complaints and, to a lesser extent, by work-related factors.
In programmes aimed at preventing the unfavourable consequences of MSD in terms of sickness absence and health care use it is important to identify the (individual) factors that determine the development of chronicity of complaints. These factors may differ from the well-know risk factors for the occurrence of MSD that are targeted in primary prevention.
PMCID: PMC1676002  PMID: 17125504
24.  Case report: hydroquinone and/or glutaraldehyde induced acute myeloid leukaemia? 
Exposures to high doses of irradiation, to chemotherapy, benzene, petroleum products, paints, embalming fluids, ethylene oxide, herbicides, pesticides, and smoking have been associated with an increased risk of acute myelogenous leukemia (AML). Although there in no epidemiological evidence of relation between X-ray developer, fixer and replenisher liquids and AML, these included glutaraldehyde which has weakly associated with lymphocytic leukemia in rats and hydroquinone has been increasingly implicated in producing leukemia, causing DNA and chromosomal damage, inhibits topo-isomerase II, alter hematopoiesis and inhibit apoptosis of neoplastic cells.
Case presentation
Two white females (A and B) hired in 1985 as medical radiation technologists in a primary care center, in Greece. In July 2001, woman A, 38-years-old, was diagnosed as having acute monocytic leukaemia (FAB M5). The patient did not respond to therapy and died threeweeks later. In August 2001, woman B, 35-year-old, was diagnosed with acute promyelocytic leukaemia (FAB M3). Since discharge, she is in continuous complete remission. Both women were non smokers without any medical history. Shortly after these incidents official inspectors and experts inspected workplace, examined equipment, archives of repairs, notes, interviewed and monitored employees. They concluded that shielding was inadequate for balcony's door but personal monitoring did not show any exceeding of TLV of 20 mSv yearly and cytogenetics analysis did not reveal findings considered to be characteristics of ionizing exposure. Equipment for developing photos had a long list of repairs, mainly leakages of liquids and increases of temperature. On several occasions the floor has been flooded especially during 1987–1993 and 1997–2001. Inspection confirmed a complete lack of ventilation and many spoiled medical x-ray films. Employees reported that an "osmic" level was continuously evident and frequently developed symptoms of respiratory irritation and dizziness.
The findings support the hypothesis that the specific AML cases might have originated from exposure to chemicals, especially hydroquinone and/or glutaraldehyde. The report also emphasises the crucial role of inspection of facilities and enforcement of compliance with regulations in order to prevent similar incidents.
PMCID: PMC1544343  PMID: 16872480
25.  An analysis of factors that influence personal exposure to toluene and xylene in residents of Athens, Greece 
BMC Public Health  2006;6:50.
Personal exposure to pollutants is influenced by various outdoor and indoor sources. The aim of this study was to evaluate the exposure of Athens citizens to toluene and xylene, excluding exposure from active smoking.
Passive air samplers were used to monitor volunteers, their homes and various urban sites for one year, resulting in 2400 measurements of toluene and xylene levels. Since both indoor and outdoor pollution contribute significantly to human exposure, volunteers were chosen from occupational groups who spend a lot of time in the streets (traffic policemen, bus drivers and postmen), and from groups who spend more time indoors (teachers and students). Data on individual and house characteristics were obtained using a questionnaire completed at the beginning of the study; a time-location-activity diary was also completed daily by the volunteers in each of the six monitoring campaigns.
Average personal toluene exposure varied over the six monitoring campaigns from 53 to 80 μg/m3. Urban and indoor concentrations ranged from 47 – 84 μg/m3 and 30 – 51 μg/m3, respectively. Average personal xylene exposure varied between 56 and 85 μg/m3 while urban and indoor concentrations ranged from 53 – 88 μg/m3 and 27 – 48 μg/m3, respectively. Urban pollution, indoor residential concentrations and personal exposures exhibited the same pattern of variation during the measurement periods. This variation among monitoring campaigns might largely be explained by differences in climate parameters, namely wind speed, humidity and amount of sunlight.
In Athens, Greece, the time spent outdoors in the city center during work or leisure makes a major contribution to exposure to toluene and xylene among non-smoking citizens. Indoor pollution and means of transportation contribute significantly to individual exposure levels. Other indoor residential characteristics such as recent painting and mode of heating used might also contribute significantly to individual levels. Groups who may be subject to higher exposures (e.g. those who spent more time outdoors because of occupational activities) need to be surveyed and protected against possible adverse health effects.
PMCID: PMC1434731  PMID: 16504175

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