Publications by authors named "Katerina Pantavou"

42 Publications

Haemostatic profile of riboflavin-treated apheresis platelet concentrates.

Blood Transfus 2021 May 21. Epub 2021 May 21.

Laboratory of Haematology and Blood Bank Unit, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Background: The haemostatic activity of platelet concentrates (PCs) treated with pathogen reduction technology (PRT) remains a subject of debate. Our aim was to investigate the effect of Mirasol PRT on the haemostatic properties of PCs stored in plasma.

Material And Methods: Untreated and Mirasol-treated platelets stored in plasma and derived from ten split double-dose apheresis PCs were evaluated in vitro on days 1, 3 and 5 post collection for functionality, microparticle procoagulation activity (MPA), endogenous thrombin potential (ETP), and haemostatic profile using rotational thromboelastometry (ROTEM).

Results: P-selectin expression was significantly higher in Mirasol-treated platelets compared with untreated counterparts on days 3 and 5 (p=0.003 and p=0.002, respectively). Clot strength, as shown by EXTEM maximum clot firmness (MCF), was significantly lower in the Mirasol-treated platelets at all time points (days 1, 3, 5) than in untreated platelets (p=0.009, p<0.001, p<0.001, respectively). There was a considerable increase in MPA over time (p<0.001) and this was significantly higher in the Mirasol-treated platelets on day 5 (p=0.015). A notable acceleration of decrease in ETP values was observed for Mirasol-treated PCs over time (p<0.001), with significant differences between PRT-treated and untreated PCs on days 3 and 5 (p=0.038 and p=0.019, respectively). Clot strength attenuation was significantly associated with pH reduction (p<0.001, Spearman's rho: 0.84), increased microparticle procoagulant activity (p<0.001, Spearman's rho: -0.75), and with decreased ETP (p<0.032, Spearman's rho: 0.41).

Discussion: Increased platelet activation induced by PRT treatment leads to a decrease in in vitro haemostatic capacity as seen by reduced clot strength and thrombin generation capacity over time. The clinical relevance of this needs to be investigated.
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http://dx.doi.org/10.2450/2021.0089-21DOI Listing
May 2021

Sociometric Risk Network Structure, HIV Prevalence, and Drug Injection-Related Norms among People Who Inject Drugs (PWID) in Athens, Greece.

Subst Use Misuse 2021 11;56(8):1190-1201. Epub 2021 May 11.

Medical School, University of Cyprus, Nicosia, Cyprus.

Structural properties of sociometric networks have been associated with behaviors related to HIV transmission. Very few studies, however, have explored the correlation between sociometric network factors and drug injection-related norms. This exploratory work: (i) describes basic structural qualities of a sociometric risk network of participants in the Transmission Reduction Intervention Project (TRIP) in Athens, Greece, in the context of a large HIV outbreak among people who inject drugs (PWID); (ii) measures HIV prevalence within specific structures within the sociometric risk network of PWID in TRIP; and (iii) explores the association of structural properties of the sociometric risk network in TRIP with drug injection-related norms. The sociometric risk network in TRIP consisted of a large component (=241, 67.8%), a few small components (=36, 10.1%) with 2-10 individuals each, and some isolates (=79, 22.2%). HIV prevalence was significantly higher in the large component (55.6%), the 2-core (59.1%) and 3-core (66.3%) of the large component, and the 3-cliques of the cores. Drug injection-related norms were significantly associated with structural characteristics of the sociometric risk network. A safe behavioral pattern (use of unclean cooker/filter/rinse water was never encouraged) was significantly (=0.03) less normative among people who TRIP participants of the 2-core injected with (40.5%) than among network contacts of TRIP participants outside the 2-core (55.6%). On the contrary, at drug-using venues, 2-core members reported that safer behaviors were normative compared to what was reported by those without 2-core membership. Sociometric network data can give useful insights into HIV transmission dynamics and inform prevention strategies.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1914103 .
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http://dx.doi.org/10.1080/10826084.2021.1914103DOI Listing
June 2021

Mental Health and Perceived Access to Care among People Who Inject Drugs in Athens, Greece.

J Clin Med 2021 Mar 12;10(6). Epub 2021 Mar 12.

Medical School, University of Cyprus, Nicosia 2029, Cyprus.

Poor mental health among human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) may contribute to stigma, and together they act as barriers to medical care. This analysis aims to examine factors associated with the mental health of PWID and their network contacts, and the association of poor mental health with the experience of HIV-related stigmatizing events, with HIV-related social support, and with perceived access to care. Data were collected during the Transmission Reduction Intervention Project (TRIP) conducted in Athens, Greece (2013-2015). PWID ( = 292; = 122 HIV-positive) were interviewed both at baseline and follow-up. Items of depression, anxiety, and general positive affect subscales of the Mental Health Inventory were used to explore the psychological distress and well-being of participants at follow-up. Items of the Access to Care Scale were used to evaluate perceived access to medical care at baseline and follow-up. Linear regression showed that unemployment was positively related to depression (β = 1.49, = 0.019), while injecting drug use was a risk factor for a low general positive affect score (β = -3.21, = 0.015). Poor mental health was not linked to HIV-related stigma or social support. Positive perception of access to care was associated in multivariable analyses with low depression (β = -0.22, = 0.049). The perceived access to care score improved from baseline to follow-up ( = 0.019) and HIV-positive participants had a higher score than HIV-negative participants. Future interventions should include targets to improve the mental well-being of participants, reduce psychosocial distress, and minimize perceived barriers to accessing medical care.
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http://dx.doi.org/10.3390/jcm10061181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002050PMC
March 2021

Drug Injection-Related and Sexual Behavior Changes in Drug Injecting Networks after the Transmission Reduction Intervention Project (TRIP): A Social Network-Based Study in Athens, Greece.

Int J Environ Res Public Health 2021 03 1;18(5). Epub 2021 Mar 1.

Medical School, University of Cyprus, Nicosia 2029, Cyprus.

The Transmission Reduction Intervention Project (TRIP) was a network-based, enhanced contact tracing approach, targeting recently HIV-infected people who inject drugs (PWID) in Athens, Greece (2013-2015). This analysis examines behavioral changes of participants in TRIP and their determinants between baseline and follow-up visits to the program. All participants of TRIP were tested for HIV and interviewed using a questionnaire with items on drug injection-related and sexual behaviors. Multivariable logistic regression models were used to examine potential relationships between participants' behaviors and sociodemographic or other characteristics. The analysis included 292 participants. At follow-up, the percentage of participants who injected drugs decreased [92.5%, = 270 versus 72.3%, = 211 ( < 0.001)], and more participants adopted safer behaviors. Employment, age, and gender were significantly associated with some behavioral changes. For instance, unemployed participants were half as likely as the employed to stop drug injection [adjusted odds ratio (aOR): 0.475, 95% confidence interval (CI): 0.228, 0.988]. Increasing age was associated with lower probability of sharing syringes at follow-up (aOR: 0.936, 95%CI: 0.887, 0.988). Finally, females were less likely than males to improve their behavior related to sharing cookers, filters, or rinse water (aOR: 0.273, 95% CI: 0.100, 0.745). In conclusion, adoption of safer behaviors was observed following TRIP implementation. Future prevention programs should focus on younger PWID and especially females. Social efforts to support employment of PWID are also important.
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http://dx.doi.org/10.3390/ijerph18052388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967732PMC
March 2021

Air quality and meteorological patterns of an early spring heatwave event in an industrialized area of Attica, Greece.

EuroMediterr J Environ Integr 2021 25;6(1):25. Epub 2021 Jan 25.

Laboratory of General and Agricultural Meteorology, Agricultural University of Athens, Athens, Greece.

Heatwaves-excessively hot ambient conditions that are considered a serious threat to human health-are often associated with poor air quality. The aim of this study was to examine the impact of an early heatwave episode in an industrialized plain in the eastern Mediterranean region (Thriasio, Greece) on human thermal discomfort and urban air quality. The heatwave occurred in mid (15-20) May 2020, shortly after some of the restrictions that were improsed to halt the spread of coronavirus disease 2019 (COVID-19) in Greece were lifted (on 4 May). The discomfort index (DI) and the daily air quality index (DAQI) were calculated on an hourly basis throughout spring 2020 (March, April, May) using data from two stations that measure meteorological parameters and air pollutant concentrations in the Thriasio Plain. The analysis showed that the air temperature increased during 7-17 May to levels that were more than 10 °C above the monthly average value (25.8 °C). The maximum measured air temperature was 38 °C (on 17 May). The results showed a high level of thermal discomfort. The DI exceeded the threshold of 24 °C for several hours during 13-20 May. Increased air pollution levels were also identified. The average DAQI was estimated as 0.83 ± 0.1 and 1.14 ± 0.2 at two monitoring stations in the region of interest during the heatwave. Particulate matter (diameter < 10 μm) appeared to contribute significantly to the poor air quality. Significant correlations between the air temperature, DI, and AQSI were also identified.
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http://dx.doi.org/10.1007/s41207-020-00237-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829091PMC
January 2021

Effect of early application of social distancing interventions on COVID-19 mortality over the first pandemic wave: An analysis of longitudinal data from 37 countries.

J Infect 2021 Jan 1;82(1):133-142. Epub 2020 Dec 1.

Medical School, University of Cyprus, Nicosia, Cyprus.

Objectives: To estimate the effect of early application of social distancing interventions on Covid-19 cumulative mortality during the first pandemic wave.

Methods: Ecological longitudinal study using multivariable negative binomial regression for panel data. Daily numbers of Covid-19 cases and deaths, and data on social distancing interventions, for the 37 member countries of the Organization for Economic Cooperation and Development (OECD) were analysed.

Results: Covid-19 cumulative mortality over the first pandemic wave varied widely across countries (range, 4.16 to 855 deaths per million population). On average, one-day delay in application of mass gatherings ban was associated with an adjusted increase in Covid-19 cumulative mortality by 6.97% (95% CI, 3.45 to 10.5), whilst a one-day delay in school closures was associated with an increase of 4.37% (95% CI, 1.58 to 7.17) over the study period. We estimated that if each country had enacted both interventions one week earlier, Covid-19 cumulative mortality could have been reduced by an average of 44.1% (95% CI, 20.2 to 67.9).

Conclusions: Early application of mass gatherings ban and school closures in outbreak epicentres was associated with an important reduction in Covid-19 cumulative mortality during the first pandemic wave. These findings may support policy decision making.
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http://dx.doi.org/10.1016/j.jinf.2020.11.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706420PMC
January 2021

Drug Injection-Related Norms and High-Risk Behaviors of People Who Inject Drugs in Athens, Greece.

AIDS Res Hum Retroviruses 2021 02 26;37(2):130-138. Epub 2020 Nov 26.

Medical School, University of Cyprus, Nicosia, Cyprus.

Drug use involves social interactions. Therefore, norms in the proximal environment of people who inject drugs (PWID) can favor behaviors that may result in HIV transmission. This work aimed at studying drug injection-related norms and their potential association with risky behaviors among PWID in Athens, Greece, in the context of economic recession and political activism that followed the fiscal crisis and soon after a recent HIV outbreak had leveled off. The Transmission Reduction Intervention Project (TRIP) was a social network-based approach (June 2013 to July 2015) that involved two groups of PWID seeds-with recent HIV infection and with long-term HIV infection and one control group of HIV-negative PWID. Network contacts of seeds were also enrolled. TRIP participants answered a questionnaire that included items on injection-related norms and behaviors. TRIP recruited 320 PWID (HIV positive, 44.4%). TRIP participants, especially those without HIV, often recalled or perceived as normative among their partners and in their networks some behaviors that can lead to HIV transmission. TRIP participants who recalled that they were encouraged by their regular drug partners to use an unclean syringe were almost twice as likely to report that they share syringes [odds ratio (OR) = 2.03; 95% confidence interval (CI) = 1.86-2.21], or give syringes to someone else (OR = 1.70; 95% CI = 1.42-2.04) as those who did not recall such an encouragement. Associations were modified by HIV status. HIV negatives, who were reportedly encouraged to share nonsyringe injecting equipment, were almost 4.5 times as likely to share that material as HIV-negative participants who were not encouraged (OR = 4.59, 95% CI = 4.12-5.11). Further research is needed on the multiple determinants (social, economic, and political) of norms in the social environments of PWID. Since peer norms are associated with risky behaviors, interventions should be developed to encourage norms and peer pressure against the sharing of injection equipment.
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http://dx.doi.org/10.1089/AID.2020.0050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020521PMC
February 2021

Data on verbal expressions for thermal sensation and comfort in the Greek language.

Data Brief 2020 Aug 2;31:105807. Epub 2020 Jun 2.

Laboratory of General and Agricultural Meteorology, Agricultural University of Athens, Athens, Greece.

This article presents data collected during a web-based survey on expressions used to describe thermal sensation and comfort in the Greek language. The survey used a structured questionnaire and delivered through Google Forms. The survey was promoted through social networks and conducted in spring 2019. The data presented herein comprise of the participants' responses to the questionnaire. A total of 359 questionnaires were completed. The participants were Greek speakers, older than 12, with at least a basic knowledge of the English language. The participants were asked to: (a) select the most appropriate translation, from English to Greek, of the nine-point ISO 10551 scale of perceptual judgment on personal thermal state, (b) formulate five, seven and nine-point thermal sensation scales, (c) report the category of the thermal sensation scale that signifies thermal comfort and (d) to assess the relative distances between the thermal sensation categories of the five, seven and nine-point thermal sensation scales. For the translation of the ISO 10551, the respondents were allowed to choose from a list of 30 Greek wordings. The data have been analysed in the research article entitled "Native influences on the construction of thermal sensation scales" [1].
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http://dx.doi.org/10.1016/j.dib.2020.105807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298396PMC
August 2020

Native influences on the construction of thermal sensation scales.

Int J Biometeorol 2020 Sep 13;64(9):1497-1508. Epub 2020 May 13.

Laboratory of General and Agricultural Meteorology, Agricultural University of Athens, Iera Odos 75, 118 55, Athens, Greece.

Thermal scales assess thermal environments in terms of thermal sensation and comfort. The number of scale's categories and their verbal realization/labels, especially when translated for local applications, are subjects of research. This study examined variations from the ISO 10551 thermal scale when translated into Greek language. We conducted an online survey asking participants to translate the English ISO 10551 scale, develop their own scales (five, seven and nine-point), report a wording for thermal comfort, and assign discrete values to scales' categories proportional to their perceived distances. Overall, 357 participants enrolled in the survey while data from 321 questionnaires included in the analysis. The interpretations of ISO 10551 categories varied (6-18) although the majority consisted of the exact translation. The wordings of the formulated scales differed from ISO 10551 scale indicating a more intense expression mode. The labels overlapped in the extreme categories of the nine-point scale supporting the use of the seven-point scale. Most participants (~ 65%) reported thermal comfort equivalent to neutrality. About half of the participants reported equal distances between the categories of the scales. The results can be applied on thermal sensation studies having a possible impact on the use of outdoor spaces under various contexts, i.e., public health, urban design, and energy conservation.
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http://dx.doi.org/10.1007/s00484-020-01927-8DOI Listing
September 2020

High-risk behaviors and their association with awareness of HIV status among participants of a large-scale prevention intervention in Athens, Greece.

BMC Public Health 2020 Jan 28;20(1):105. Epub 2020 Jan 28.

Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.

Background: Aristotle was a seek-test-treat intervention during an outbreak of human immunodeficiency virus (HIV) infection among people who inject drugs (PWID) in Athens, Greece that started in 2011. The aims of this analysis were: (1) to study changes of drug injection-related and sexual behaviors over the course of Aristotle; and (2) to compare the likelihood of risky behaviors among PWID who were aware and unaware of their HIV status.

Methods: Aristotle (2012-2013) involved five successive respondent-driven sampling rounds of approximately 1400 PWID each; eligible PWID could participate in multiple rounds. Participants were interviewed using a questionnaire, were tested for HIV, and were classified as HIV-positive aware of their status (AHS), HIV-positive unaware of their status (UHS), and HIV-negative. Piecewise linear generalized estimating equation models were used to regress repeatedly measured binary outcomes (high-risk behaviors) against covariates.

Results: Aristotle recruited 3320 PWID (84.5% males, median age 34.2 years). Overall, 7110 interviews and blood samples were collected. The proportion of HIV-positive first-time participants who were aware of their HIV infection increased from 21.8% in round A to 36.4% in the last round. The odds of dividing drugs at least half of the time in the past 12 months with a syringe someone else had already used fell from round A to B by 90% [Odds Ratio (OR) (95% Confidence Interval-CI): 0.10 (0.04, 0.23)] among AHS and by 63% among UHS [OR (95% CI): 0.37 (0.19, 0.72)]. This drop was significantly larger (p = 0.02) among AHS. There were also decreases in frequency of injection and in receptive syringe sharing in the past 12 months but they were not significantly different between AHS (66 and 47%, respectively) and UHS (63 and 33%, respectively). Condom use increased only among male AHS from round B to the last round [OR (95% CI): 1.24 (1.01, 1.52)].

Conclusions: The prevalence of risky behaviors related to drug injection decreased in the context of Aristotle. Knowledge of HIV infection was associated with safer drug injection-related behaviors among PWID. This highlights the need for comprehensive interventions that scale-up HIV testing and help PWID become aware of their HIV status.
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http://dx.doi.org/10.1186/s12889-020-8178-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986033PMC
January 2020

Correction to: Thermal sensation and climate: a comparison of UTCI and PET thresholds in different climates.

Int J Biometeorol 2020 02;64(2):301

Meteorology Laboratory, Agricultural University of Athens, Athens, Greece.

The article was published without special issue designation resulting in regular issue compilation. The author group and publisher regret the error and ask the article be considered for Special Issue: Subjective approaches to thermal perception.
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http://dx.doi.org/10.1007/s00484-019-01820-zDOI Listing
February 2020

Efficacy and safety of biologic agents and tofacitinib in moderate-to-severe ulcerative colitis: A systematic overview of meta-analyses.

United European Gastroenterol J 2019 12 17;7(10):1285-1303. Epub 2019 Oct 17.

Medical School, University of Cyprus, Nicosia, Cyprus.

Background: Ulcerative colitis (UC) is an inflammatory disease of the colon and rectum. Treatment options include biologics and tofacitinib.

Objectives: We aim to summarize the evidence on efficacy and safety of biologics and tofacitinib in moderate-to-severe UC.

Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched to identify meta-analyses of randomized controlled trials assessing adalimumab, golimumab, infliximab, vedolizumab, and tofacitinib in UC. Efficacy outcomes included induction and maintenance of clinical response, clinical remission and mucosal healing. Safety outcomes included adverse events and serious adverse events.

Results: The overview involved 31 meta-analyses. All four biologics and tofacitinib were superior to placebo regarding efficacy. Indirect comparisons suggested that infliximab may be better than adalimumab and golimumab to induce clinical response and mucosal healing. Safety analyses indicated no increased rates of adverse events, except for infliximab.

Conclusions: Biologics and tofacitinib are efficacious and safe for treating UC. These findings can support clinical decision-making.
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http://dx.doi.org/10.1177/2050640619883566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894001PMC
December 2019

Comparative assessment of budesonide-MMX and mesalamine in active, mild-to-moderate ulcerative colitis: A systematic review and network meta-analysis.

Br J Clin Pharmacol 2019 10 31;85(10):2244-2254. Epub 2019 Jul 31.

Department of Biomedical Sciences, Humanitas University, Milan, Italy.

Aims: The comparative efficacy, safety and tolerability of budesonide-MMX and oral mesalamine in active, mild-to-moderate ulcerative colitis (UC) are unclear. We conducted a network meta-analysis to fill this evidence gap.

Methods: We searched PubMed, Scopus, Embase, the Cochrane Library, clinical trial registries, regulatory agencies' websites and international conference proceedings, up to July 2018, to identify randomized controlled trials of adult patients with active, mild-to-moderate UC, comparing budesonide-MMX or mesalamine against placebo, or against each other, or different dosing strategies, for induction of remission. Two reviewers independently abstracted study data and outcomes, and assessed each trial's risk-of-bias.

Results: We identified and synthesized evidence from 15 eligible trials including 4083 participants. Budesonide-MMX 9 mg/day and mesalamine >2.4 g/day had similar efficacy for induction of clinical and endoscopic remission (OR = 0.97; 0.59-1.60), both showing superiority over placebo (OR = 2.68; 1.75-4.10, and OR = 2.75; 1.94-3.90, respectively). Furthermore, mesalamine >2.4 g/day was more efficacious than mesalamine 1.6-2.4 g/day (odds ratio = 1.27; 1.03-1.56). Secondary analyses showed that mesalamine >2.4 g/day ranks at the top among comparator treatments regarding safety (serious adverse events; surface under the cumulative ranking area [SUCRA] 79.2%) and tolerability (treatment discontinuations or withdrawals from the study due to adverse events; SUCRA 96.7%). There was no evidence of inconsistency, while heterogeneity between studies and risk of publication bias were low.

Conclusion: Budesonide-MMX and mesalamine >2.4 g/day had similar efficacy for induction of clinical and endoscopic remission in active, mild-to-moderate UC; however, mesalamine >2.4 g/day showed better tolerability. Further high-quality research is warranted.
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http://dx.doi.org/10.1111/bcp.14051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783624PMC
October 2019

State of knowledge of human papillomavirus (HPV), HPV vaccine and testing: a cross-sectional study among female university students in Cyprus.

Women Health 2020 01 6;60(1):26-42. Epub 2019 May 6.

Medical School, University of Cyprus, Nicosia, Cyprus.

This study aimed to evaluate human papillomavirus (HPV)-related knowledge of women aged 18-25 years and estimate the reported uptake of HPV vaccine and testing. A cross-sectional study was conducted among female students of the University of Cyprus between March and April 2017. The participants self-completed a questionnaire, which consisted of 37 items on demographics, general HPV-related knowledge, and HPV vaccination and testing. In total, 283 young females (mean age: 19.7 ± 1.5 years) took part in the study. Of these, about half (53.7%) reported that they were aware of HPV; one-third (30.7%) reported having been vaccinated; 38.8% had been informed of the recent introduction of the HPV vaccine in the National Immunization Schedule in Cyprus, while 14.3% reported a previous Pap-test and 3.4% a previous HPV DNA test. The mean Overall Knowledge Index (max: 25 correct answers) was 6.1 (±3.8) and was positively associated with the reported uptake of the HPV vaccine (adjusted Odds ratio: 1.14, 95% Confidence Interval (CI): 1.04-1.24). Knowledge about HPV has to be improved as it is associated with increased reported rates of HPV vaccination.
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http://dx.doi.org/10.1080/03630242.2019.1610825DOI Listing
January 2020

Season of birth and multiple sclerosis: a systematic review and multivariate meta-analysis.

J Neurol 2020 Oct 4;267(10):2815-2822. Epub 2019 May 4.

Department of Computer Science and Biomedical Informatics, University of Thessaly, Papasiopoulou 2-4, 35100, Lamia, Greece.

Season of birth is considered to be associated with multiple sclerosis (MS) although some findings opposing to this assumption raise doubts about the seasonality pattern in MS births. The present work synthesizes the evidence of previous published studies aiming at examining whether the month of birth is associated with a higher number of MS births. Pubmed and Scopus were systematically searched and a multivariate meta-analysis of case-control studies was conducted. Data of healthy controls births were retrieved from census reports when not included in the studies. For comparisons, October was set as a reference month and autumn (September-October-November) as a reference season. The meta-analysis included studies that provided the number of MS births for each month or season. Twenty-two eligible studies were included in the meta-analysis involving twenty-four different populations and overall 145,672 MS patients and 75,169,550 healthy controls. The multivariate analysis supports that MS births in spring are higher compared to autumn [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.04, 1.24]. Univariate analyses confirm the same for April (OR 1.12, 95% CI 1.05, 1.21), March (OR 1.05, 95% CI 1.00, 1.11) and May (OR 1.07, 95% CI 1.00, 1.14). A reduction of MS births was found in November (OR 0.96, 95% CI 0.93, 0.99). The month and the season of birth are significantly associated with MS births.
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http://dx.doi.org/10.1007/s00415-019-09346-5DOI Listing
October 2020

Mortality attributable to seasonal influenza in Greece, 2013 to 2017: variation by type/subtype and age, and a possible harvesting effect.

Euro Surveill 2019 Apr;24(14)

4th Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece.

IntroductionEstimating the contribution of influenza to excess mortality in the population presents substantial methodological challenges.AimIn a modelling study we combined environmental, epidemiological and laboratory surveillance data to estimate influenza-attributable mortality in Greece, over four seasons (2013/14 to 2016/17), specifically addressing the lag dimension and the confounding effect of temperature.MethodsAssociations of influenza type/subtype-specific incidence proxies and of daily mean temperature with mortality were estimated with a distributed-lag nonlinear model with 30 days of maximum lag, separately by age group (all ages, 15-64 and ≥ 65 years old). Total and weekly deaths attributable to influenza and cold temperatures were calculated.ResultsOverall influenza-attributable mortality was 23.6 deaths per 100,000 population per year (95% confidence interval (CI): 17.8 to 29.2), and varied greatly between seasons, by influenza type/subtype and by age group, with the vast majority occurring in persons aged ≥ 65 years. Most deaths were attributable to A(H3N2), followed by influenza B. During periods of A(H1N1)pdm09 circulation, weekly attributable mortality to this subtype among people ≥ 65 years old increased rapidly at first, but then fell to zero and even negative, suggesting a mortality displacement (harvesting) effect. Mortality attributable to cold temperatures was much higher than that attributable to influenza.ConclusionsStudies of influenza-attributable mortality need to consider distributed-lag effects, stratify by age group and adjust both for circulating influenza virus types/subtypes and daily mean temperatures, in order to produce reliable estimates. Our approach addresses these issues, is readily applicable in the context of influenza surveillance, and can be useful for other countries.
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http://dx.doi.org/10.2807/1560-7917.ES.2019.24.14.1800118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462785PMC
April 2019

Identifying, linking, and treating people who inject drugs and were recently infected with HIV in the context of a network-based intervention.

AIDS Care 2019 11 2;31(11):1376-1383. Epub 2019 Apr 2.

Medical School, University of Cyprus , Nicosia , Cyprus.

Identifying and linking people to care soon after HIV infection could limit viral transmission and protect their health. This work aims at describing the continuum of care among recently HIV-infected people who inject drugs (PWID) and participated in an intervention in the context of an HIV outbreak in Athens, Greece. The Transmission Reduction Intervention Project (TRIP) conducted risk network-based contact tracing and screened people for recent HIV infection. A comprehensive approach with a case management component that aimed to remove barriers to accessing care was adopted. Follow-up data on antiretroviral treatment (ART) and HIV-RNA levels were obtained from HIV clinics. TRIP enrolled 45 recently HIV-infected PWID (80% male) with a median viral load at recruitment of 5.43 log copies/mL. Of the recently infected persons in TRIP, 87% were linked to care; of these, 77% started ART; and of those on ART, 89% achieved viral load <200 copies/mL. TRIP and its public health allies managed to get most of the recently HIV-infected PWID who were identified by the program into care and many of them onto ART. This resulted in very low HIV-RNA levels. Treatment as prevention can work if individuals are aided in overcoming difficulties in entry to, or attrition from care.
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http://dx.doi.org/10.1080/09540121.2019.1601671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818705PMC
November 2019

Data on knowledge and beliefs of students, physicians and other health professionals about ethical issues in Cyprus.

Data Brief 2019 Feb 22;22:1031-1035. Epub 2019 Jan 22.

Medical School, University of Cyprus, Nicosia, Cyprus.

This article presents data collected in a field, questionnaire-based survey about ethical issues in the Republic of Cyprus. The participants were students of the University of Cyprus, and physicians and other health professionals of the Medical School, University of Cyprus and of the Archbishop Makarios III Hospital. The questionnaire included items on sociodemographic characteristics of the participants, and on their knowledge and beliefs about three different ethical issues. Beliefs on the same ethical issues but under specific, hypothetical scenarios were also reported by the participants. The ethical issues examined included euthanasia, assisted suicide, and gender selection through in vitro fertilization. Data from 259 questionnaires were collected in March and April of 2018.
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http://dx.doi.org/10.1016/j.dib.2019.01.046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355997PMC
February 2019

Near Full-length Genomic Sequencing and Molecular Analysis of HIV-Infected Individuals in a Network-based Intervention (TRIP) in Athens, Greece: Evidence that Transmissions Occur More Frequently from those with High HIV-RNA.

Curr HIV Res 2018 ;16(5):345-353

Medical School, University of Cyprus, Nicosia, Cyprus.

Background: TRIP (Transmission Reduction Intervention Project) was a network-based, contact tracing approach to locate and link to care, mostly people who inject drugs (PWID) with recent HIV infection.

Objective: We investigated whether sequences from HIV-infected participants with high viral load cluster together more frequently than what is expected by chance.

Methods: Paired end reads were generated for 104 samples using Illumina MiSeq next-generation sequencing.

Results: 63 sequences belonged to previously identified local transmission networks of PWID (LTNs) of an HIV outbreak in Athens, Greece. For two HIV-RNA cut-offs (105 and 106 IU/mL), HIV transmissions were more likely between PWID with similar levels of HIV-RNA (p<0.001). 10 of the 14 sequences (71.4%) from PWID with HIV-RNA >106 IU/mL were clustered in 5 pairs. For 4 of these clusters (80%), there was in each one of them at least one sequence from a recently HIVinfected PWID.

Conclusion: We showed that transmissions are more likely among PWID with high viremia.
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http://dx.doi.org/10.2174/1570162X17666190130120757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446520PMC
July 2019

Perceived air quality and particulate matter pollution based on field survey data during a winter period.

Int J Biometeorol 2018 Dec 26;62(12):2139-2150. Epub 2018 Oct 26.

Medical School, University of Cyprus, P.O. Box: 20537, 2029, Strovolos, Nicosia, Cyprus.

Outdoor air pollution and especially particulate matter pollution is a major environmental health issue that raises concerns of scientists and policy makers. This study focuses on air quality perception in relation to particulate matter in order to find potential patterns. Field questionnaire-based surveys were conducted among pedestrians on two central sites in the city of Athens, Greece, during the winter period while particulate matter of 10 μm or less in diameter (PM) were concurrently measured on-site at 1-min resolution. The participants were asked to evaluate the dust and the overall pollution-related air quality based on 5-point bipolar scales. Air quality perception patterns were explored considering PM concentration, meteorological and thermal conditions, and subjective variables including gender, age, smoking status, and health status. An effect of PM on dust perception was identified, suggesting that dusty air quality conditions are reported more frequently when particulate concentration increases. Health status, exposure time, smoking status, and gender were found to affect air quality perception. Participants experiencing health symptoms, exposed to outdoor conditions for more than 30 min, smokers, and females were more likely to report unfavorable air quality conditions. The comparison with the results of a previous study obtained using air pollution station data confirmed the dependence of air quality perception on participants' characteristics and particularly on their health status. Ordinal logistic regression models showed that for pedestrians who were neither smokers nor experiencing health symptoms and were exposed to outdoor conditions for more than 30 min, a PM concentration around 64 μg·m could be a threshold, to perceive dusty air quality conditions.
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http://dx.doi.org/10.1007/s00484-018-1614-3DOI Listing
December 2018

Laboratory Assessment of the Anticoagulant Activity of Apixaban in Patients With Nonvalvular Atrial Fibrillation.

Clin Appl Thromb Hemost 2018 Dec 1;24(9_suppl):194S-201S. Epub 2018 Oct 1.

Laboratory of Haematology & Blood Bank Unit, "Attiko" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Our aim is to determine the most appropriate laboratory tests, besides anti-factor Xa (anti-FXa) chromogenic assays, to estimate the degree of anticoagulation with apixaban and compare it with that of rivaroxaban in real-world patients. Twenty patients with nonvalvular atrial fibrillation treated with apixaban 5 mg twice daily and 20 patients on rivaroxaban 20 mg once daily were studied. Conventional coagulation tests, thrombin generation assay (TGA), and thromboelastometry (nonactivated TEM [NATEM] assay) were performed in the 40 patients and 20 controls. The anti-FXa chromogenic assays were used to measure apixaban and rivaroxaban plasma levels. The NATEM measurements showed no significant difference between the 2 groups of patients. Concerning TGA, endogenous thrombin potential (ETP) was significantly decreased in patients on rivaroxaban as compared to those treated with apixaban ( < .003). A statistically significant, strong inverse correlation between apixaban plasma concentrations and ETP ( < .001) was observed. Apixaban significantly reduces ETP compared to controls, but to a lesser extent than rivaroxaban. Thrombin generation assay might provide additional information on apixaban exposure, which is required in order to individualize treatment especially for patients with a high bleeding risk. Our findings have to be further investigated in studies with larger sample sizes, in the entire range of apixaban exposure, with other direct oral anticoagulants, and in relation to clinical outcomes.
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http://dx.doi.org/10.1177/1076029618802364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714834PMC
December 2018

Safety of biological therapies in ulcerative colitis: An umbrella review of meta-analyses.

Best Pract Res Clin Gastroenterol 2018 Feb - Apr;32-33:43-47. Epub 2018 Jun 11.

Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; IBD Center, Humanitas Clinical and Research Center, 20089, Rozzano, Milan, Italy. Electronic address:

Biological agents have proven clinical efficacy in the treatment of ulcerative colitis (UC). Their adverse effects have also been studied in a substantial number of primary studies and meta-analyses. Given the large volume of information that has been published, the aim of this umbrella review was to effectively summarize the accumulated evidence from randomized controlled trials (RCTs) on the safety of biological therapies for UC into one accessible and usable document. Pubmed and Scopus databases were systematically searched through November 2017 to identify meta-analyses of RCTs that have investigated potential harms of biological agents (adalimumab, golimumab, infliximab, and vedolizumab) in patients with UC. Ten eligible meta-analyses were included. The body of available evidence supports the safety of biologic therapies in UC. Further research is needed to clarify the risk of any infection with biologics, for elderly and high-risk groups, for longer-term effects, and for head-to-head comparisons between the different biologics.
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http://dx.doi.org/10.1016/j.bpg.2018.05.005DOI Listing
September 2018

Comparison between Nageotte and flow cytometric counting of residual leucocytes in freshly prepared leucocyte-reduced red blood cell components.

Transfus Apher Sci 2018 Aug 7;57(4):544-548. Epub 2018 Jun 7.

Laboratory of Haematology & Blood Bank Unit, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462, Athens, Greece. Electronic address:

Background: Flow cytometry (FC) and Nageotte hemocytometry represent the most widely accepted methods for counting residual white blood cells (rWBCs) in leucocyte-reduced (LR) blood components. Our aim was to study the agreement between the two methods, under real working blood bank conditions.

Materials And Methods: 94 freshly produced LR red blood cell (RBC) units were tested for rWBC concentrations by FC and Nageotte. To assess the precision of each method, we calculated the intra-assay coefficients of variation (CV), and followed the Bland-Altman methodology to study the agreement between the two methods.

Results: CV was 18.5% and 26.2% for the Nageotte and the FC, respectively. However, the agreement between the duplicate observations, using the binary cut-off threshold of 1 × 10 WBCs per unit to define the results as "pass/fail", was 71.9% for the Nageotte and 93.3% for the FC. Linear regression analysis did not show any correlation (R-squared = 0.01, p = 0.35) between the two methods, while the Bland-Altman analysis for the measuring agreement showed a bias toward a higher Nageotte count of 0.77 × 10 leucocytes per unit (p < 0.001) with the 95% limits of agreement (d ± 2 sd) ranging from -0.40 × 10 to 1.94 × 10 leucocytes per unit.

Conclusion: The absence of agreement between Nageotte and FC method, with the differences within d ± 2 sd being of high clinical importance, suggests that the two methods cannot be used for clinical purposes interchangeably. The Nageotte seems unsuitable for quality control even with a pass-fail criterion, under real working blood bank conditions.
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http://dx.doi.org/10.1016/j.transci.2018.06.002DOI Listing
August 2018

Epidemiology of breast cancer in Cyprus: Data on newly diagnosed cases and survival rates.

Data Brief 2018 Aug 19;19:353-369. Epub 2018 May 19.

Medical School, University of Cyprus, Nicosia, Cyprus.

This article presents analyzed data on new diagnoses and mortality of breast cancer, between 2005 and 2013, in the Republic of Cyprus. New diagnoses are presented by demographic and clinical/histological variables that include cancer grade, behaviour, stage, and histological type at diagnosis (always as a primary site). Breast cancer-related deaths are presented by gender. Net survival rates based on cohort and period methods are presented by age group, cancer grade, behaviour, and stage at diagnosis, for all cases and for cases of Greek-Cypriot ethnicity. The unprocessed data of the Cyprus Cancer Registry were provided by the Health Monitoring Unit of the Ministry of Health of the Republic of Cyprus.
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http://dx.doi.org/10.1016/j.dib.2018.05.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993104PMC
August 2018

Thermal sensation and climate: a comparison of UTCI and PET thresholds in different climates.

Int J Biometeorol 2018 Sep 7;62(9):1695-1708. Epub 2018 Jun 7.

Meteorology Laboratory, Agricultural University of Athens, Athens, Greece.

The influence of physiological acclimatization and psychological adaptation on thermal perception is well documented and has revealed the importance of thermal experience and expectation in the evaluation of environmental stimuli. Seasonal patterns of thermal perception have been studied, and calibrated thermal indices' scales have been proposed to obtain meaningful interpretations of thermal sensation indices in different climate regions. The current work attempts to quantify the contribution of climate to the long-term thermal adaptation by examining the relationship between climate normal annual air temperature (1971-2000) and such climate-calibrated thermal indices' assessment scales. The thermal sensation ranges of two thermal indices, the Universal Thermal Climate Index (UTCI) and the Physiological Equivalent Temperature Index (PET), were calibrated for three warm temperate climate contexts (Cfa, Cfb, Csa), against the subjective evaluation of the thermal environment indicated by interviewees during field surveys conducted at seven European cities: Athens (GR), Thessaloniki (GR), Milan (IT), Fribourg (CH), Kassel (DE), Cambridge (UK), and Sheffield (UK), under the same research protocol. Then, calibrated scales for other climate contexts were added from the literature, and the relationship between the respective scales' thresholds and climate normal annual air temperature was examined. To maintain the maximum possible comparability, three methods were applied for the calibration, namely linear, ordinal, and probit regression. The results indicated that the calibrated UTCI and PET thresholds increase with the climate normal annual air temperature of the survey city. To investigate further climates, we also included in the analysis results of previous studies presenting only thresholds for neutral thermal sensation. The average increase of the respective thresholds in the case of neutral thermal sensation was about 0.6 °C for each 1 °C increase of the normal annual air temperature for both indices, statistically significant only for PET though.
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http://dx.doi.org/10.1007/s00484-018-1569-4DOI Listing
September 2018

Multivariate Methods for Meta-Analysis of Genetic Association Studies.

Methods Mol Biol 2018 ;1793:157-182

Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece.

Multivariate meta-analysis of genetic association studies and genome-wide association studies has received a remarkable attention as it improves the precision of the analysis. Here, we review, summarize and present in a unified framework methods for multivariate meta-analysis of genetic association studies and genome-wide association studies. Starting with the statistical methods used for robust analysis and genetic model selection, we present in brief univariate methods for meta-analysis and we then scrutinize multivariate methodologies. Multivariate models of meta-analysis for a single gene-disease association studies, including models for haplotype association studies, multiple linked polymorphisms and multiple outcomes are discussed. The popular Mendelian randomization approach and special cases of meta-analysis addressing issues such as the assumption of the mode of inheritance, deviation from Hardy-Weinberg Equilibrium and gene-environment interactions are also presented. All available methods are enriched with practical applications and methodologies that could be developed in the future are discussed. Links for all available software implementing multivariate meta-analysis methods are also provided.
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http://dx.doi.org/10.1007/978-1-4939-7868-7_11DOI Listing
February 2019

Interleukin gene polymorphisms and susceptibility to HIV-1 infection: a meta-analysis.

J Genet 2018 Mar;97(1):235-251

Hellenic Centre for Disease Control and Prevention, 15123 Athens, Greece.

Some subjects are repeatedly exposed to human immunodeficiency virus (HIV), yet they remain uninfected. This suggests the existence of host-resistance mechanisms. The current study synthesizes the evidence regarding the association between interleukin (IL) gene polymorphisms and HIV susceptibility. Medline, Scopus and the Web of Science databases were systematically searched, and a meta-analysis of case-control studies was conducted. Univariate and bivariate methods were used. The literature search identified 42 eligible studies involving 15,727 subjects. Evidence was obtained on eight single-nucleotide polymorphisms (SNPs): IL1A -889 C>T (rs1800587), IL1B +3953/4 C>T (rs1143634), IL4 -589/90 C>T (rs2243250), IL6 -174 G>C (rs1800795), IL10 -592 C>A (rs1800872), IL10-1082 A>G (rs1800896), IL12B -1188 A>C (rs3212227) and IL28B C>T (rs12979860). The IL1B +3953/4 C>T variant appears to increase the risk of HIV acquisition, under the assumption of a recessive genetic model (odds ratio (OR): 4.47, 95% CI: 2.35-8.52). The AA homozygotes of the IL10 -592 C>A SNP had an increased, marginally nonsignificant, risk (OR: 1.39, 95% CI: 0.97-2.01). It reached, however, significance in sub analyses (OR: 1.49, 95% CI: 1.04-2.12). Finally, the well-studied hepatitis C virus (HCV) infection IL28B (rs12979860) CT/TT genotypes were associated with a 27% decrease in HIV infection risk, especially in populations infected with HCV (OR: 0.73, 95% CI: 0.57-0.95). Interleukin signalling is perhaps important in HIV infection and some interleukin genetic variants may affect the risk of HIV acquisition. Approaches targeting specific genes and genome wide association studies should be conducted to decipher the effect of these polymorphisms.
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March 2018

Molecular investigation of HIV-1 cross-group transmissions during an outbreak among people who inject drugs (2011-2014) in Athens, Greece.

Infect Genet Evol 2018 08 10;62:11-16. Epub 2018 Apr 10.

Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

New diagnoses of HIV-1 infection among people who inject drugs (PWID) rocketed in Athens, Greece between 2011 and 2014 (HIV-1 outbreak). Our aim was to identify, during that period, potential cross-group transmissions between the within-Greece PWID and other risk or national groups using molecular methods. Sequences from 33 PWID were outside the PWID-outbreak networks in Greece (PWID-imported transmissions). Phylogenetic analyses on 28 of these sequences (subtypes A and B) showed that 11 subtype B infections originated from Greece, whereas 8 and 7 subtype A strains were from former Soviet Union countries (A) and Greece, respectively. The putative source in half of the PWID-imported transmissions with Greek origin was an individual who acquired HIV via sexual contact. During four years of an HIV-1 outbreak among PWID in Athens, Greece, 33 individuals in this group (4.6% of all diagnoses with phylogenetic analyses) are likely to represent infections, sexually or injection-acquired, outside the within-Greece-PWID-outbreak networks. Combined molecular and traditional HIV surveillance to monitor introductions of new strains, and interventions that aim at reducing the rate of both injection and sexual risky practices are needed during drug injection-related HIV outbreaks.
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http://dx.doi.org/10.1016/j.meegid.2018.04.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179947PMC
August 2018

Thromboelastometry for diagnosis of neonatal sepsis-associated coagulopathy: an observational study.

Eur J Pediatr 2018 Mar 18;177(3):355-362. Epub 2017 Dec 18.

Laboratory of Haematology and Blood Bank Unit, School of Medicine, "Attiko" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Athens, Greece.

Our aim was to evaluate the potential role of standard extrinsically activated thromboelastometry (EXTEM) assay in the early detection of neonatal sepsis. We studied 91 hospitalized neonates categorized in two groups: group A included 35 neonates with confirmed sepsis, while group B included 56 neonates with suspected sepsis; 274 healthy neonates served as controls. Whenever sepsis was suspected, EXTEM assay was performed, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE) and Tοllner score were calculated, and clinical findings and laboratory results were recorded. Septic neonates had significantly prolonged clotting time (CT) and clot formation time (CFT), and reduced maximum clot firmness (MCF), compared to neonates with suspected sepsis (p values 0.001, 0.001, and 0.009, respectively) or healthy neonates (p values 0.001, 0.001, and 0.021, respectively). EXTEM parameters (CT, CFT, MCF) demonstrated a more intense hypocoagulable profile in septic neonates with hemorrhagic diathesis than those without (p values 0.021, 0.007, and 0.033, respectively). In septic neonates, CFT was correlated with platelet count, SNAPPE, Tollner score, and day of full enteral feeding (p values 0.01, 0.02, 0.05, and 0.03, respectively).

Conclusions: A ROTEM hypocoagulable profile at admission seems promising for the early detection of sepsis in neonates while the degree of hypocoagulation may be associated with sepsis severity. What is Known: • The early phase of septicemia might be difficult to be recognized in neonates. In adult septic patients, the diagnostic and prognostic role of thromboelastometry (ROTEM) have been extensively investigated. • Limited data are available on the role of ROTEM as an indicator of early neonatal sepsis. What is New: • ROTEM measurements indicate an early appearance of hypocoagulability in neonatal sepsis, while the degree of hypocoagulation might be associated with severity of sepsis. • ROTEM could be a useful tool in the early detection of sepsis in neonates.
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http://dx.doi.org/10.1007/s00431-017-3072-zDOI Listing
March 2018

Knowledge, Normative Beliefs and Attitudes Related to Recent HIV Infection among People who Inject Drugs in Athens, Greece.

Curr HIV Res 2017 ;15(6):386-395

Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Background: Despite great improvements in prevention over the last years, much has to be done to reduce new human immunodeficiency virus (HIV) infections. Substantial evidence shows that the six-month period of recent HIV infection contributes disproportionately to HIV transmission.

Objective: This study aims to investigate knowledge, normative beliefs, and attitudes of people who inject drugs (PWID) regarding recent HIV infection.

Methods: People who inject drugs in Athens, Greece were recruited in the fifth round of a respondent- driven sampling program (ARISTOTLE). The participants were tested for HIV and answered a structured questionnaire, which also included items on knowledge, normative beliefs, and attitudes regarding recent infection to address needs of the social network-based Transmission Reduction Intervention Project. The multivariable analyses included logistic regression models, which produced odds ratios (OR) and 95% confidence intervals (CI).

Results: In total, 1,407 people (mean age: 36.3 ± 7.9 years old; males: 81.9%) took part in the fifth round of ARISTOTLE. Of these, 61.5% knew that HIV-infected people who are not on treatment are more likely to transmit HIV during the first six months of their infection and 58.4% reported that people in their network would react positively towards a recently HIV-infected person. People who inject drugs who were knowledgeable of recent HIV infection were more likely to disagree with statements such as that one should avoid all contact with a person recently infected by HIV (adjusted OR: 1.510, 95% CI: 1.090, 2.091) or more likely to agree with statements such as that an HIV+ person is much less likely to transmit HIV when h/she is on combination antiretroviral treatment (adjusted OR: 2.083, 95% CI: 1.231, 3.523).

Conclusion: A considerable proportion of PWID in Athens, Greece, were aware of the high HIV transmission risk of recent HIV infection, although improvement is needed for some population segments. People who inject drugs who were knowledgeable of the role of recent HIV infection were more likely to have normative beliefs and attitudes that favor behaviors that could help rather than harm or stigmatize people who have recently been infected with HIV. Interventions that are based on the role of recent HIV infection in HIV transmission could be important to HIV prevention.
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http://dx.doi.org/10.2174/1570162X15666171122165636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816016PMC
April 2019
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