Demosthenes B Panagiotakos

Bentham Science Publishers, Ash Shāriqah, Ash Shāriqah, United Arab Emirates

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Publications (711)2761.72 Total impact

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    ABSTRACT: The aim of the this study was to establish age- and gender-specific physical fitness normative values and to compare percentiles and Z scores values in a large, nationwide sample of Greek children aged 6-18 years. From March 2014 to May 2014, a total of 424,328 boys and girls aged 6-18 years who attended school in Greece were enrolled. The studied sample was representative, in terms of age-sex distribution and geographical region. Physical fitness tests (i.e. 20 m shuttle run test (SRT), standing long jump, sit and reach, sit-ups, and 10 × 5 m SRT) were performed and used to calculate normative values, using the percentiles of the empirical distributions and the lambda, mu, and sigma statistical method. Normative values were presented as tabulated percentiles for five health-related fitness tests based on a large data set comprising 424,328 test performances. Boys typically scored higher than girls on cardiovascular endurance, muscular strength, muscular endurance, and speed/agility, but lower on flexibility (all p values <0.001). Older boys and girls had better performances than younger ones (p < 0.001). Physical fitness tests' performances tended to peak at around the age of 15 years in both sexes. The presented population-based data are the most up-to-date sex- and age-values for the health-related fitness of children and adolescents in Greece and can be used as standard values for fitness screening and surveillance systems and for comparisons among the same health-related fitness scores of children from other countries similar to Greece. Schools need to make efforts to improve the fitness level of the schoolchildren through the physical education curriculum to prevent cardiovascular risk.
    09/2015; DOI:10.1080/17461391.2015.1088577
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    ABSTRACT: Although hypertension, hypercholesterolemia and diabetes mellitus (DM) are recognized as major cardio-metabolic risk factors in primary Acute Coronary Syndrome (ACS) prevention, studies focusing on secondary ACS incidence are scarce. In the present study, the association between the aforementioned factors and 10-year ACS prognosis was evaluated. From October 2003 to September 2004 2,172 consecutive patients with ACS diagnosis, from 6 Greek hospitals, were enrolled. During 2013-14, the 10-year follow-up was performed in 1,918 participants. Baseline clinical factors were assessed through physical examination, medical records and pharmacological management. All-cause mortality and the development of fatal or non-fatal ACS events were recorded through medical records or hospital registries. Logistic regression models were applied to evaluate the impact of baseline clinical status on the ACS prognosis. The 10-year all cause and ACS mortality rate was 32.6 and 17.8%, respectively. Multi-adjusted analysis highlighted that, after taking into account various potential confounders, DM was the sole clinical factor associated with adverse effect on the 10-year ACS fatal incidence [Odds Ratio (OR)=1.35, 95% Confidence Interval (95% CI) 1.01, 1.80, p=0.04]. DM was the only clinical factor that aggravated ACS prognosis, whereas abnormal lipids profile and blood pressure did not seem to determine prognosis. Thus, glycaemic control may play a critical role in the secondary CVD prevention management of ACS patients.
    Current Vascular Pharmacology 09/2015; · 2.97 Impact Factor
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    ABSTRACT: Background: The traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. However, it is not clear whether novel lipid biomarkers are able to confer a better predictability of CVD risk, compared to traditional ones.Under this perspective, the aim of the present work was to evaluate the predictive ability of blood lipids' profile on all cause mortality as well as 10-year incidence of CVD, in a sample of apparently healthy adults of the ATTICA epidemiological study. Methods: From May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of any other chronic disease, at baseline, were enrolled. In 2011-12, the 10-year follow-up was performed in 2583 participants (85 % follow-up participation rate). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. Baseline serum blood lipids' profile (Total-C, HDL-, non HDL-, LDL-cholesterol, triglycerides (TG), apolipoprotein (Apo)A1 and B, and lipoprotein-(a) levels were also measured. Results: The 10-year all-cause mortality rate was 5.7 % for men and 2.0 % for women (p = 0.55). The, 10-year CVD incidence was 19.7 % in men and 11.7 % in women (p < 0.001). Multi-adjusted analysis revealed that TC, non-HDL-C, TG and TG/HDL-C ratio, were independent predictors of all cause mortality (RR per 1 mg/dL or unit (95 % CI): 1.006 (1.000-1.013), 1.006 (1.000-1.013), 1.002 (1.000-1.004), 1.038 (1.001-1.077), respectively). Moreover, TC, HDL-, LDL-, non-HDL-cholesterol, TG, apoA1, TC/HDL-C and TG/HDL-C were independently associated with CVD risk. Among all lipid indices the ratio of apoB/apoA1 demonstrated the best correct reclassification ability, followed by non-HDL-C and TC/HDL-C ratio (continuous Net Reclassification Index 26.1 and 21.2 %, respectively). Conclusion: Elevated levels of lipid biomarkers are independently associated with all-cause mortality, as well as CVD risk. The ratio of apoB/apoA1, followed by non-HDL-C, demonstrated the best correct classification ability of the developed CVD risk models.
    Lipids in Health and Disease 09/2015; 14(1):108. DOI:10.1186/s12944-015-0101-7 · 2.22 Impact Factor
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    ABSTRACT: The association between long-term coffee consumption and 10-year cardiovascular disease incidence among Acute Coronary Syndrome (ACS) patients was evaluated. From 2003 to 2004, 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed (88% participation rate) and recurrent fatal or non-fatal ACS was recorded. Baseline coffee consumption (cups/day) was assessed using a semi-quantitative Food Frequency Questionnaire. Multi adjusted analysis revealed that 1-2 cups of coffee/day versus no consumption had an adverse effect on the ACS incidence [odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.01, 1.79]. In subgroup analysis, with hypertension as strata, only the normotensive reached significance. Odds ratios for 1-2 and ≥3 cups relative to no consumption were [OR = 1.66, 95% CI 1.07, 2.60] and [OR = 1.86, 95% CI 1.06, 3.27], respectively, after controlling for potential confounders. Thus, avoidance of coffee may be of high importance to ameliorate disease prognosis among cardiac patients.
    International Journal of Food Sciences and Nutrition 08/2015; DOI:10.3109/09637486.2015.1077795 · 1.21 Impact Factor
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    ABSTRACT: Low socioeconomic status is associated with poorer cardiovascular health. The aim of the present work was to evaluate how social and economic factors influence modifiable cardiovascular disease risk factors and thus, acute coronary syndrome or ischemic stroke presence. One thousand participants were enrolled; 250 consecutive patients with a first acute coronary syndrome (83% were male, 60 ± 12 years old) and 250 control subjects, as well as 250 consecutive patients with a first ischemic stroke (56% were male, 77 ± 9 years old) and 250 control subjects. The control subjects were population-based and age-sex matched with the patients. Detailed information regarding their medical records, lifestyle characteristics, education level, financial status satisfaction, and type of occupation were recorded. After controlling for potential confounding factors, significant inverse associations were observed regarding financial status satisfaction and sedentary/mental type occupation with acute coronary syndrome or stroke presence, but not with the educational level. Nevertheless, further evaluation using path analysis, revealed quite different results, indicating that the education level influenced the type of occupation and financial satisfaction, hence affecting indirectly the likelihood of developing a cardiovascular disease event. Social and economic parameters interact with modifiable cardiovascular disease risk factors through multiple pathways. Copyright © 2015 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.
    08/2015; DOI:10.1016/j.gheart.2015.01.002
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    ABSTRACT: Central obesity is a strong risk factor for metabolic disorders and cardiometabolic diseases in children and adolescents. The aim of the present study was to evaluate the prevalence of central obesity and to determine its cross-sectional association with lifestyle habits in a sample of school-aged children in Greece. The study sample consisted of 124,113 children (9.9 ± 1.1 years old, 51 % boys) attending the third and fifth grade of primary school. Anthropometric measurements were performed by trained physical education teachers, and central obesity was defined as waist-to-height ratio ≥0.5. Children's lifestyle habits were assessed through 7-day recall questionnaires. Of the participating children, 33.4 % were classified as centrally obese. Central obesity was significantly more prevalent in boys than in girls (36.0 vs. 30.7 %, P < 0.001) and was present in 95 % of obese children, as well as in a significant percentage of overweight (69.5 %) and normal-weight ones (12.0 %). Children with central obesity, compared to their non-centrally obese counterparts, reported poorer dietary habits and were less physically active. According to multiple logistic regression analysis, frequent breakfast (OR 0.72, 95 % CI 0.69-0.75) and snack consumption (OR 0.70, 95 % CI 0.67-0.74), as well as frequent participation in sedentary activities (OR 1.10, 95 % CI 1.07-1.14), were the strongest lifestyle determinants of central obesity. Strategies for the prevention of central obesity and associated comorbidities are urgently needed, for both obese and non-obese children. Our results suggest the need for a shift towards a healthier environment for our children, with emphasis on specific lifestyle habits, such as regular meal consumption and low sedentariness.
    European Journal of Nutrition 08/2015; DOI:10.1007/s00394-015-1008-9 · 3.47 Impact Factor
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    ABSTRACT: To summarise the evidence about the efficacy of a Mediterranean diet on the management of type 2 diabetes and prediabetic states. A systematic review of all meta-analyses and randomised controlled trials (RCTs) that compared the Mediterranean diet with a control diet on the treatment of type 2 diabetes and prediabetic states was conducted. Electronic searches were carried out up to January 2015. Trials were included for meta-analyses if they had a control group treated with another diet, if they were of sufficient duration (at least 6 months), and if they had at least 30 participants in each arm. A random-effect model was used to pool data. Adults with or at risk for type 2 diabetes. Dietary patterns that described themselves as using a 'Mediterranean' dietary pattern. The outcomes were glycaemic control, cardiovascular risk factors and remission from the metabolic syndrome. From 2824 studies, 8 meta-analyses and 5 RCTs were eligible. A 'de novo' meta-analysis of 3 long-term (>6 months) RCTs of the Mediterranean diet and glycaemic control of diabetes favoured the Mediterranean diet as compared with lower fat diets. Another 'de novo' meta-analysis of two long-term RCTs showed a 49% increased probability of remission from the metabolic syndrome. 5 meta-analyses showed a favourable effect of the Mediterranean diet, as compared with other diets, on body weight, total cholesterol and high-density lipoprotein cholesterol. 2 meta-analyses demonstrated that higher adherence to the Mediterranean diet reduced the risk of future diabetes by 19-23%. The Mediterranean diet was associated with better glycaemic control and cardiovascular risk factors than control diets, including a lower fat diet, suggesting that it is suitable for the overall management of type 2 diabetes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 08/2015; 5(8):e008222. DOI:10.1136/bmjopen-2015-008222 · 2.27 Impact Factor
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    ABSTRACT: Abstract BACKGROUND: Recent research has addressed the hypothesis that religiosity/spirituality and sense of coherence buffer the negative effects of stress on numerous health issues. The aim of the current study was to further this work by exploring potential links between psycho-social factors such as religiosity/spirituality and sense of coherence with depression. METHODS: A total number of 220 subjects of the SPILI III cohort (1988-2012) attending a primary care setting in the town of Spili on rural Crete represented the target group. All participants underwent a standardized procedure. Validated questionnaires were used to evaluate sense of coherence, depression levels and religious and spiritual beliefs. A multiple linear regression analysis of the Beck Depression Inventory Scale (BDI) in relation to demographic characteristics, scores on the Royal Free Interview for Spiritual and Religious Beliefs scale (RFI-SRB) and Sense of Coherence scale (SOC) was performed. RESULTS: A significant inverse association was found between BDI and RFI-SRB scale (B-coef = -0.6999, p < 0.001), as well as among BDI and SOC scale (B-coef = -0.556, p < 0.001). CONCLUSIONS: The findings of the current observational study indicate that highly religious participants are less likely to score high in the depression scale. Furthermore, participants with high SOC scored significantly lower in the BDI scale. Further research is required in order to explore the potential effect of SOC and religiosity/spirituality on mental health.
    BMC Psychiatry 07/2015; · 2.21 Impact Factor
  • E Magriplis · P Farajian · G Risvas · D Panagiotakos · A Zampelas
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    ABSTRACT: A food index (FI) based on a priory knowledge was developed to assess the role of diet on overweight (OW) and obesity (OB) in school-aged children. This included «positive» and «negative» foods based on research evidence and food guidelines, with scores set accordingly. Statistical tests were used to strengthen the sensitivity of the index. The FI was validated using data from the GRECO study. The score ranged from 17 to 53.5 (mean 34.8 ± 5.01) and was inversely associated with body mass index (BMI) (-0.057 ± 0.02; 95% CI -0.098, -0.017) and waist circumference (WC) (-0.08 ± 0.03, 95% CI: -0.137, -0.022). Associations remained significant upon adjusting for age, gender and physical-inactivity (p = 0.02 ad 0.013, respectively). When stratified by gender, the association between FI and WC was not significant for boys (p = 0.08). The association with BMI remained significant for females and males (p = 0.047 and 0.037, respectively). The derived FI seems a valuable tool in detecting OW in children.
    International Journal of Food Sciences and Nutrition 07/2015; 66(6):1-10. DOI:10.3109/09637486.2015.1056109 · 1.21 Impact Factor
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    ABSTRACT: There is increasing interest in indexes that estimate the individual risk of developing a cardiovascular disease (CVD) event; the European Society of Cardiology (ESC), in the latest guidelines (2012) for CVD prevention, acknowledged the importance of risk evaluation through risk scores, i.e. the ESC SCORE (Systematic COronary Risk Estimation). However, there has been much discussion about the reliability of such CVD risk scores among different populations. The ESC SCORE is a CVD risk-specific tool for Europe, based on datasets from 12 European countries (Greece did not participate). In the mid-2000s the HellenicSCORE, a calibration of the ESC SCORE based on national mortality data and prevalence regarding risk factors as reported by the ATTICA study, was proposed for the Greek population and became a part of daily clinical practice. This validation of the HellenicSCORE was performed using the 10-year follow-up examination of the ATTICA study participants. Of the 3042 participants of the ATTICA study (enrolment 2001-2002), 2583 were contacted in the 10-year follow-up (2011-2012). The HellenicSCORE as calculated using participants' baseline characteristics was tested against the 10-year CVD event rates. The 10-year fatal or non-fatal CVD incidence rate was 15.7% (19.7% in men and 11.7% in women). The HellenicSCORE correctly predicted 95.6% of fatal CVD cases and 93.2% of the fatal and non-fatal CVD cases. No interactions with sex, age group or comorbidities were observed. The HellenicSCORE is a valid tool for CVD risk estimation in Greek subjects. The present work suggests a calibration methodology that could be used by other nations for CVD risk estimation.
    07/2015; 56(4):302-308.
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    ABSTRACT: The purpose of this work was to investigate the association between coffee drinking and diabetes development and potential mediation by oxidative stress and inflammatory biomarkers. In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) were selected to participate in the ATTICA study (Athens metropolitan area, Greece). A validated food-frequency questionnaire was used to assess coffee drinking (abstention, casual, habitual) and other lifestyle and dietary factors. Evaluation of oxidative stress and inflammatory markers was also performed. During 2011-2012, the 10-year follow-up of the ATTICA study was carried out. The outcome of interest in this work was incidence of type 2 diabetes, defined according to American Diabetes Association criteria. During follow-up, 191 incident cases of diabetes were documented (incidence 13.4% in men and 12.4% in women). After various adjustments, individuals who consumed ⩾250 ml of coffee (≈1.5cup) had 54% lower odds of developing diabetes (95% confidence interval: 0.24, 0.90), as compared with abstainers. A dose-response linear trend between coffee drinking and diabetes incidence was also observed (P for trend=0.017). When controlling for several oxidative stress and inflammatory biomarkers, the inverse association between habitual coffee drinking and diabetes was found to be mediated by serum amyloid-A levels. This work highlights the significance of long-term habitual coffee drinking against diabetes onset. The anti-inflammatory effect of several coffee components may be responsible for this protection.European Journal of Clinical Nutrition advance online publication, 1 July 2015; doi:10.1038/ejcn.2015.98.
    European journal of clinical nutrition 07/2015; DOI:10.1038/ejcn.2015.98 · 2.71 Impact Factor
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    ABSTRACT: The purpose of this work was to investigate the potential mediating effect of oxidative stress, inflammation and coagulation on Mediterranean diet- diabetes link. In 2001-02, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study, where Athens is a major metropolis. A validated questionnaire was used to assess lifestyle and dietary factors. Adherence to Mediterranean diet was recorded using MedDietScore. Among others, oxidative stress and inflammatory biomarkers were recorded. During 2011-2012, the 10-year follow-up was performed. Diabetes incidence was defined according to American Diabetes Association criteria. 191 incident cases of diabetes were documented, yielding to an incidence of 12.9% (13.4% in men and 12.4% in women). Medium and high adherence were found to decrease diabetes risk by 49% (95%CI: 0.30, 0.88), and 62% (95%CI: 0.16, 0.88) respectively, compared to low adherence. A logarithmic trend between Mediterranean diet and diabetes incidence was also revealed (p for trend = 0.042). Individuals with abnormal waist circumference (>94 for men, >80 for women) were benefited the most. Wholegrain cereals, fruits and legumes had the greatest predictive ability. The anti-diabetic effect of Mediterranean diet was mediated by TNF-α, homocysteine and TAC. The reported results underline the role of Mediterranean diet as a promising dietary tool for the primary prevention of diabetes, by attenuating inflammation and fostering TAC; thus, this dietary pattern may have a therapeutic potential for a plethora of cardio-metabolic disorders, resulting from inflammation and/or oxidative stress. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 06/2015; DOI:10.1002/dmrr.2672 · 3.55 Impact Factor
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    ABSTRACT: The present study evaluated the association between long-term, exclusive olive oil consumption, in cooking preparation or as a dressing, and the 10-year (2004-2014) incidence of acute coronary syndrome (ACS) among cardiac patients. From October 2003 to September 2004, a sample of 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed in 1918 patients (88% participation rate). The development of fatal or nonfatal ACS was recorded through medical records or hospital registries. Among other dietary components, added fats (i.e. olive oil, butter, margarine and seed oils) consumption at baseline examination was assessed using a semi-quantitative food frequency questionnaire. Non-exclusive olive oil consumption on a daily basis was associated with an adverse effect on the ACS incidence after taking into account various potential confounders [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.05-1.86, P = 0.024]. However, significant interactions between olive oil consumption and body mass index (BMI) (P = 0.082) and educational level (P = 0.054) led to further stratified analysis. Using BMI as strata (i.e. ≤29.9 versus >29.9 kg m(-2) ), the above association remained significant only in obese patients (OR = 1.80, 95% CI = 1.03-3.12, P = 0.038), whereas, on examining the education status (i.e. ≤9 versus >9 years of school), a significant association was observed only among the higher educated patients (OR = 1.83, 95% CI = 1.01-3.32, P = 0.047). Exclusive use of olive oil, either as a salad dressing or in cooking, should be promoted through the dietary management of ACS patients, with the aim of reducing the likelihood of recurrent cardiac episodes. © 2015 The British Dietetic Association Ltd.
    Journal of Human Nutrition and Dietetics 06/2015; DOI:10.1111/jhn.12324 · 1.99 Impact Factor
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    ABSTRACT: Urine color (UC) is a practical tool for hydration assessment. The technique has been validated in adults, but has not been tested in children. The purpose of the study was to test the validity of the urine color scale in young, healthy boys and girls, as a marker of urine concentration, investigate its diagnostic ability of detecting hypohydration and examine the ability of children to self-assess UC. A total of 210 children participated (age: 8-14 years, body mass: 43.4 ± 12.6 kg, height: 1.49 ± 0.13 m, body fat: 25.2 ± 7.8 %). Data collection included: two single urine samples (first morning and before lunch) and 24-h sampling. Hydration status was assessed via urine osmolality (UOsmo) and UC via the eight-point color scale. Mean UC was 3 ± 1 and UOsmo 686 ± 223 mmol kg(-1). UC displayed a positive relationship as a predictor of UOsmo (R (2): 0.45, P < 0.001). Based on the receiver operating curve, UC has good overall classification ability for the three samples (area under the curve 85-92 %), with good sensitivity (92-98 %) and specificity (55-68 %) for detecting hypohydration. The overall accuracy of the self-assessment of UC in the morning or the noon samples ranged from 67 to 78 %. Further threshold analysis indicated that the optimal self-assessed UC threshold for hypohydration was ≥4. The classical eight-point urine color scale is a valid method to assess hydration in children of age 8-14 years, either by researchers or self-assessment.
    European Journal of Nutrition 04/2015; DOI:10.1007/s00394-015-0905-2 · 3.47 Impact Factor
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    ABSTRACT: The determinants that promote living beyond life expectancy and successful aging still remain unknown. The aim of the present work was to evaluate the role of energy balance in successful aging, in a random sample of older adults living in the Mediterranean basin. During 2005 to 2011, 2,663 older (aged 65-100 years) adults from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Dietary habits, energy intake, expenditure, and energy balance were derived throughout standard procedures. A successful aging index (range = 0-10) was used. After adjusting for several confounders, high energy intake (i.e., >1,700 kcal/day), b-coefficient [95% CI] = -0.21[-0.37, -0.05], as well as positive energy balance, b-coefficient [95% CI] = -0.21 [-0.37, -0.05], were inversely associated with successful aging. A diet with excessive energy intake and a positive energy balance seems to be associated with lower quality of life, as measured through successful aging. © The Author(s) 2015.
    Journal of Aging and Health 04/2015; DOI:10.1177/0898264315583053 · 1.56 Impact Factor
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    ABSTRACT: The protective role of Mediterranean diet on cardiovascular disease (CVD) risk has been extensively discussed in the literature, but its incremental effect over the use of CVD risk reducing agents (such as hypolipidemic treatment) has rarely been evaluated. The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89 years). Adherence to Mediterranean diet was assessed using the MedDietScore (range 0-55) and statin use was recorded for all subjects. During 2011-2012, 2583 out of the 3042 baseline participants attended the 10-year follow-up of the ATTICA study (15% lost-to-follow-up) and CVD development was recorded. Adherence to Mediterranean diet (highest tertile) decreased CVD risk by 29.3% (Hazard Ratio (HR): 0.707, 95% Confidence Intervals (CI): 0.537-0.831) as compared with the lowest tertile, independently of statin use. Patients with hyperlipidemia on a statin that had unhealthy dietary habits (lowest tertile) had 75% increased CVD risk than normolipidemic subjects with healthy dietary habits (HR=1.75, 95%CI: 1.33-2.29). The addition of Mediterranean diet tertiles in the multivariable model reclassified 46.7% of the participants to CVD risk categories. Adherence to Mediterranean diet confers a considerable reduction in CVD risk, independently of gender, age, family history of CVD, diabetes mellitus, smoking status, hypertension and physical activity status. Therefore, CVD prevention strategies should involve the implementation of a Mediterranean diet in both the general population and patients on a statin.
    Current Vascular Pharmacology 04/2015; · 2.97 Impact Factor
  • Anastasia Perikkou · Eleni Kokkinou · Demosthenes B. Panagiotakos · Mary Yannakoulia
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    ABSTRACT: Teachers’ attitudes about school food environments and their readiness to implement school-based nutrition programs were investigated. A total of 1,436 primary-school teachers filled out a questionnaire on their demographic and professional characteristics and their attitudes, beliefs, and barriers for implementing health educational programs. The transtheoretical model and the stages of change were used to assess teachers’ readiness to accomplish (1) a nutrition education program, (2) a nutrition education program with teachers being role models, and (3) a nutrition program including educational activities. Teachers were classified into three readiness stages: precontemplation, contemplation, and combined action stage. Age, self-perception of health, and barriers—lack of time and information—were associated with being in the contemplation compared to the precontemplation stage for a nutrition education program with teachers as role models. For implementing a program based on educational activities, only lack of information was significantly associated with the likelihood of being in the contemplation stage. Teaching experience appeared as a significant factor positively associated with being in the combined action stage for any type of nutrition education program.
    Journal of Research in Childhood Education 04/2015; 29(2):202-211. DOI:10.1080/02568543.2015.1009202
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    ABSTRACT: Arrhythmogenic right-ventricular cardiomyopathy (ARVC) is a genetically determined disorder, mostly caused by mutations in genes encoding desmosomal proteins. We evaluated phenotype/genotype characteristics to predict the risk for the first major arrhythmic event in desmosomal-mutation-associated ARVC families. A cohort of 105 desmosomal-mutation carriers belonging to 39 consecutive ARVC families was evaluated. Serial clinical work-up consisting of history, physical examination, 12-lead/signal-averaged/24 h ambulatory ECG, and two-dimensional echocardiography was performed every 6-12 months. The predictive value of gender and genotype for the first major arrhythmic event was investigated within the cohort using time-to-event analysis. ECG/echocardiographic features were evaluated at the time of event and associated with the outcome using an age-matched nested case-control study within the cohort. Forty-three (41%) participants experienced the primary arrhythmic outcome at median age of 29 (21-46) years. The first event was sustained ventricular tachycardia in 31 and sudden cardiac death in 12. Definite diagnosis according to the 2010 Task Force criteria, showed 57% positive and 100% negative predictive value for the occurrence of arrhythmic outcome. Male gender (hazard ratio = 3.26, 95%CI, 1.63-6.51), predicted the first major arrhythmic event, independently of genotype, on multivariable analysis. Repolarization abnormalities and left-ventricular dysfunction independently associated with clinical disease profile at the time of event. Male gender, independently of genotype is an arrhythmic risk predictor in ARVC-associated desmosomal-mutation carriers. Repolarization abnormalities and left-ventricular dysfunction are important components of the first event-associated clinical disease profile. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email:
    Europace 03/2015; DOI:10.1093/europace/euv061 · 3.67 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the gender-oriented differences in the outcomes of a lifestyle intervention trial (diet, smoking cessation, and exercise) among patients who had open heart surgery. A randomized, nonblind intervention study was performed on 500 patients who had open heart surgery. Immediately after hospital discharge, 250 patients were randomly allocated lifestyle intervention by receiving oral and written information in the form of a booklet with specific educational information for postoperative rehabilitation. The remaining 250 patients received the regular oral instructions. The applied lifestyle intervention proved to be beneficial only in men as far as quitting smoking (relative risk [RR]: 0.36, confidence interval [CI]: 0.16-0.80; P = .01) and returning to work (RR: 0.35, CI: 0.13-0.92; P = .03) are concerned. For both genders, no significant associations between dietary and physical activity recommendations were observed. Lifestyle nursing intervention immediately after open heart surgery had a beneficial effect on men 1 year after the surgery but not on women. Thus, there is a need for gender-specific studies among women. © The Author(s) 2015.
    Angiology 03/2015; DOI:10.1177/0003319715577293 · 2.97 Impact Factor
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    ABSTRACT: The aim of the present work was to examine the association of depression and marital status, with the long-term prognosis of Acute Coronary Syndrome (ACS), among a Greek sample of cardiac patients. From October 2003-September 2004 a sample of 2,172 consecutive ACS patients from 6 hospitals was enrolled. In 2013-14, the 10-year follow-up was performed in 1,918 participants. Depressive symptoms were evaluated using the validated CES-D score (range 0-60), while marital status was classified as: single, married/cohabitants, divorced and widowed at the time of entry to the study. patients in the upper tertile of CES-D (>20 score) had 41% (95%CI 14%, 75%) higher risk of ACS incidence as compared with those in the lowest (<7 score). In contrary, married patients had 29% lower risk (95%CI 6%, 46%) of ACS mortality compared with single, widowed or divorced. Multi-adjusted analysis revealed that, among the "not married" patients, 1-point increase in the CES-D score was associated with 2% (p=0.02) and 4% (p=0.001) higher risk of having non- fatal or fatal cardiac events, respectively. The present study highlights the important role of depression in the context of marital relationships among ACS patients. Secondary public health care intervention programs are needed to improve patient outcomes and minimize disease burden in clinical and community setting.
    Psychology & Health 03/2015; 30(9):1-25. DOI:10.1080/08870446.2015.1034720 · 1.95 Impact Factor

Publication Stats

13k Citations
2,761.72 Total Impact Points


  • 2014
    • Bentham Science Publishers
      Ash Shāriqah, Ash Shāriqah, United Arab Emirates
  • 2001–2014
    • Harokopion University of Athens
      • Department of Nutrition and Dietetics
      Athínai, Attica, Greece
  • 2012
    • Agricultural University of Athens
      • Department of Food Science and Technology
      Athínai, Attica, Greece
  • 2007–2012
    • Attikon University Hospital
      • • Department of Cardiology
      • • Department of Internal Medicine IV
      Athínai, Attica, Greece
    • Hygeia Hospital
      Athínai, Attica, Greece
  • 2005–2012
    • Onassis Cardiac Surgery Center
      • Department of Cardiology
      Kallithea, Attica, Greece
  • 2004–2012
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
    • Κεντρική Κλινική Αθηνών
      Athínai, Attica, Greece
    • Technological Educational Institute of Piraeus
      Athínai, Attica, Greece
  • 2011
    • Saint Louis University
      • Department of Nutrition and Dietetics
      Сент-Луис, Michigan, United States
  • 2007–2011
    • University of Patras
      • Department of Paediatrics
      Rhion, West Greece, Greece
  • 2009
    • University of Crete
      • Division of Social Medicine
      Réthymnon, Kriti, Greece
  • 2005–2009
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
  • 2008
    • University General Hospital
      Houston, Texas, United States
  • 2004–2008
    • Κωνσταντοπούλειο νοσοκομείο Νέας Ιωνίας (Η Αγία Όλγα)
      Athínai, Attica, Greece
  • 2002–2008
    • Hippokration General Hospital, Athens
      Athínai, Attica, Greece
  • 2006
    • National and Kapodistrian University of Athens
      • Department of Medicine
      Athínai, Attica, Greece
  • 2003–2006
    • Georgetown University
      • Division of Cardiology
      Washington, Washington, D.C., United States
  • 2003–2004
    • Ευρωκλινική
      Athínai, Attica, Greece