Vassiliki Benetou | National and Kapodistrian University of Athens (original) (raw)

Papers by Vassiliki Benetou

In Greece, the illegal dispensing of prescription-only medicines, including antibiotics, by pharm... more In Greece, the illegal dispensing of prescription-only medicines, including antibiotics, by pharmacies without the necessary medical prescription, remains standard practice (1,2). This has continued, despite the fact that the country has the highest rates of antibiotic consumption, both in hospitals and the community, as well as antibiotic resistance, compared to other European countries (3). The frequency of antibiotic administration without a prescription, and the factors associated with this practice, was evaluated in a sample of preschool children under the age of six years (range 10-65 months) in the Municipality of Athens, Greece. This article is protected by copyright. All rights reserved.

BMC Psychiatry, 2014

The present study's aim has been to investigate, identify and interpret the views of pediatric pr... more The present study's aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. Methods: Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation. Results: Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health. Conclusions: Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices.

Cancer Epidemiology, 2016

Serum liver biomarkers (gamma-glutamyl transferase, GGT; alanine aminotransferase, ALT; aspartate... more Serum liver biomarkers (gamma-glutamyl transferase, GGT; alanine aminotransferase, ALT; aspartate aminotransferase, AST; alkaline phosphatase, ALP; total bilirubin) are used as indicators of liver disease, but there is currently little data on their prospective association with risk of hepatobiliary cancers. A nested-case control study was conducted within the prospective EPIC cohort (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;520,000 participants, 10 European countries). After a mean 7.5 mean years of follow-up, 121 hepatocellular carcinoma (HCC), 34 intrahepatic bile duct (IHBC) and 131 gallbladder and biliary tract (GBTC) cases were identified and matched to 2 controls each. Circulating biomarkers were measured in serum taken at recruitment into the cohort, prior to cancer diagnosis. Multivariable adjusted conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95%CI). In multivariable models, 1SD increase of each log-transformed biomarker was positively associated with HCC risk (OR(GGT)=4.23, 95%CI:2.72-6.59; OR(ALP)=3.43, 95%CI:2.31-5.10;OR(AST)=3.00, 95%CI:2.04-4.42; OR(ALT)=2.69, 95%CI:1.89-3.84; OR(Bilirubin)=2.25, 95%CI:1.58-3.20). Each liver enzyme (OR(GGT)=4.98; 95%CI:1.75-14.17; OR(AST)=3.10, 95%CI:1.04-9.30; OR(ALT)=2.86, 95%CI:1.26-6.48, OR(ALP)=2.31, 95%CI:1.10-4.86) but not bilirubin (OR(Bilirubin)=1.46,95%CI:0.85-2.51) showed a significant association with IHBC. Only ALP was significantly associated with GBTC risk (OR(ALP)=1.59, 95%CI:1.20-2.09). This study shows positive associations between circulating liver biomarkers in sera collected prior to cancer diagnoses and the risks of developing HCC or IHBC, but not GBTC.

Bju Int, 2002

Objectives To investigate whether dietary factors that appear to affect the risk of prostate canc... more Objectives To investigate whether dietary factors that appear to affect the risk of prostate cancer may be similarly associated with serum levels of insulin-like growth factor 1 (IGF-1). Patients and methods In the context of a case-control study, 112 men were admitted to three teaching hospitals in Athens, Greece, for disorders other than cancer. Sociodemographic data and detailed histories of smoking, alcohol and coffee consumption were recorded. A validated food-frequency questionnaire was administered by an interviewer and serological measurements of IGF-1 and its binding protein-3 conducted. Results IGF-1 declined signi®cantly by almost 25% among men aged >75 years and there was a small reduction in IGF-1 levels with increased alcohol intake, with a mean (95% con®dence interval, CI) change of x1.6 (x2.2 to x0.9)% for an increment of one drink per day. There was no evidence for an effect of either smoking or coffee consumption on IGF-1 level. Among foods, the consumption of cooked tomatoes was substantially and signi®cantly inversely associated with IGF-1 levels, with a mean (95% CI) change of x31.5 (x49.1 to x7.9)% for an increment of one serving per day. Conclusions The strongest known dietary risk factor for prostate cancer (lycopene de®cit, as re¯ected in a reduced intake of cooked tomatoes) and an important endocrine factor in the aetiology of this disease (IGF-1) seem to be related in a way that suggests that at least one, and perhaps more, exogenous factors in the development of prostate cancer may be mediated through the IGF-1 system.

Background: the aim of the study is to investigate the validity of self-reported incident cardiov... more Background: the aim of the study is to investigate the validity of self-reported incident cardiovascular disease in the Greek EPIC cohort during follow up. Methods: cardiovascular disease was considered in 4 groups: Myocardial infarction (MI), Angina, Cerebrovascular disease, and other coronary heart disease (other CHD). Validation for all reported incident cardiovascular events was sought through medical records of hospitals around the country and local death registries. Results: in total, there had been 121 self reported incident cases of angina, 683 of MI, 622 of other CHD and 855 of cerebrovascular disease. Records were searched for 926 participants with reported cardiovascular disease (CVD), and from those, medical records for the 832 (90%) were obtained from the respective hospitals. Examination of the medical records that were obtained confirmed the self report in 72% of incident strokes, 65% of MIs, 55% of other CHD cases and 32% of angina. Conclusions: it appears that in ou...

Central European journal of public health

Breastfeeding is universally accepted as the optimal way to nourish infants. There is evidence th... more Breastfeeding is universally accepted as the optimal way to nourish infants. There is evidence that socio-demographic factors, including immigrant status, are related to infant feeding practices. The aim of the present study was to identify the factors which are associated with breastfeeding initiation and duration, with special focus on the role of immigrant status of the mother in breastfeeding practice. A sample of mothers giving birth and living in Athens, Greece, was investigated. 428 mothers (438 infants) were recruited in the maternity ward of a Tertiary University Hospital, and were interviewed using a structured questionnaire. Monthly telephone interviews were subsequently conducted until the sixth postpartum month. Multivariate logistic regression models were used to quantify the association of socio-demographic parameters with breastfeeding initiation. Cox regression analysis was employed to assess related factors that might influence breastfeeding duration. Being an immi...

$Research paper thumbnail of Education, marital status, and risk of hip fractures in older men and women: the CHANCES project$

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, Jan 28, 2015

The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of... more The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk. The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA. A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regressio...

Nutrition, metabolism, and cardiovascular diseases : NMCD, 2015

High glycemic load (GL) has been associated with increased coronary heart disease (CHD) risk. We ... more High glycemic load (GL) has been associated with increased coronary heart disease (CHD) risk. We evaluated whether preference of low-GL foods conveys incremental benefits with respect to CHD, especially to people adhering to the traditional Mediterranean diet (MD). We analyzed data from the Greek European Prospective Investigation into Cancer and Nutrition, including 20,275 participants free of cardiovascular diseases, cancer, or diabetes at baseline and without incident diabetes. Subjects completed a validated, semi-quantitative food frequency questionnaire at enrollment. We calculated a 10-point MD adherence score and the dietary GL, and estimated hazard ratios (HRs) for CHD incidence and mortality through Cox proportional hazard regression. After a median follow-up of 10.4 years, 417 participants developed CHD, and 162 died from the disease. A significant positive association of GL with CHD incidence emerged (HR for the highest versus the lowest tertile = 1.41, 95% confidence int...

British journal of cancer, Jan 8, 2008

Adherence to traditional Mediterranean diet (MD) has been reported to be inversely associated wit... more Adherence to traditional Mediterranean diet (MD) has been reported to be inversely associated with total, as well as cardiovascular, mortality. We have examined the relation between degree of such adherence and incidence of cancer overall in a general population sample of 25 623 participants (10 582 men, 15 041 women) of the Greek segment of the European Prospective Investigation into Cancer and nutrition (EPIC). All subjects completed a validated, interviewer-administered, semi-quantitative food-frequency questionnaire at enrolment. Degree of adherence to the traditional MD was assessed through a 10-point scale (0 minimal; 9 maximal) that incorporated key dietary characteristics. During a median follow-up of 7.9 years and 188 042 total person-years, 851 medically confirmed incident cancer cases (421 men, 430 women) were recorded. Using proportional hazards regression with adjustment for potential confounders, we found that a higher degree of MD adherence was associated with lower o...

International Journal of Cancer, 2015

Whether risk factors for epithelial ovarian cancer (EOC) differ by subtype (i.e., dualistic pathw... more Whether risk factors for epithelial ovarian cancer (EOC) differ by subtype (i.e., dualistic pathway of carcinogenesis, histologic subtype) is not well understood; however, data to date suggest risk factor differences. We examined associations between reproductive and hormone-related risk factors for EOC by subtype in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Among 334,126 women with data on reproductive and hormone-related risk factors (follow-up: 1992-2010), 1,245 incident cases of EOC with known histology and invasiveness were identified. Data on tumor histology, grade, and invasiveness, were available from cancer registries and pathology record review. We observed significant heterogeneity by the dualistic model (i.e., type I [low grade serous or endometrioid, mucinous, clear cell, malignant Brenner] vs. type II [high grade serous or endometrioid]) for full-term pregnancy (phet = 0.02). Full-term pregnancy was more strongly inversely associated with type I than type II tumors (ever vs. never: type I: relative risk (RR) 0.47 [95% confidence interval (CI): 0.33-0.69]; type II, RR: 0.81 [0.61-1.06]). We observed no significant differences in risk in analyses by major histologic subtypes of invasive EOC (serous, mucinous, endometrioid, clear cell). None of the investigated factors were associated with borderline tumors. Established protective factors, including duration of oral contraceptive use and full term pregnancy, were consistently inversely associated with risk across histologic subtypes (e.g., ever full-term pregnancy: serous, RR: 0.73 [0.58-0.92]; mucinous, RR: 0.53 [0.30-0.95]; endometrioid, RR: 0.65 [0.40-1.06]; clear cell, RR: 0.34 [0.18-0.64]; phet = 0.16). These results suggest limited heterogeneity between reproductive and hormone-related risk factors and EOC subtypes.

Maternal & Child Nutrition, 2010

This paper presents a review of the current knowledge regarding the macro-and micronutrient requi... more This paper presents a review of the current knowledge regarding the macro-and micronutrient requirements of infants and discusses issues related to these requirements during the first year of life. The paper also reviews the current reference values used in European countries and the methodological approaches used to derive them by a sample of seven European and international authoritative committees from which background scientific reports are available. Throughout the paper, the main issues contributing to disparities in micronutrient reference values for infants are highlighted. The identification of these issues in relation to the specific physiological aspects of infants is important for informing future initiatives aimed at providing standardized approaches to overcome variability of micronutrient reference values across Europe for this age group.

Scandinavian Journal of Public Health, 2000

To examine the relationship between educational level, a powerful indicator of socioeconomic stat... more To examine the relationship between educational level, a powerful indicator of socioeconomic status in Greece, total cholesterol and HDL-cholesterol in a large sample of Greek adults. The study sample consisted of 11,645 subjects, 4,398 men and 7,247 women, aged 23-86 years, who voluntarily participated in the Greek component of the EPIC study during 1994-98. Educational attainment was divided into low, medium, and high. Linear regression analyses were performed, in men and women separately, using total and HDL-cholesterol as dependent variables and educational level as independent, while controlling for age. Total blood cholesterol values are inversely associated with educational level in both genders, a pattern contrasting with that found 20 years ago. The association is more prominent among women. HDL-cholesterol values are inversely associated with educational level in men, whereas the association is less consistent in women.

Public Health Nutrition, 2013

Objective: To review evidence on the associations between vitamin B 12 intake and its biomarkers,... more Objective: To review evidence on the associations between vitamin B 12 intake and its biomarkers, vitamin B 12 intake and its functional health outcomes, and vitamin B 12 biomarkers and functional health outcomes. Design: A systematic review was conducted by searching electronic databases, until January 2012, using a standardized strategy developed in the EURRECA network. Relevant articles were screened and sorted based on title and abstract, then based on full text, and finally included if they met inclusion criteria. A total of sixteen articles were included in the review. Setting: Articles covered four continents: America (n 4), Europe (n 8), Africa (n 1) and Asia (n 3). Subjects: Population groups included healthy infants, children and adolescents, and pregnant and lactating women. Results: From the total number of 5815 papers retrieved from the initial search, only sixteen were eligible according to the inclusion criteria: five for infants, five for children and adolescents, and six for pregnant and lactating women. Conclusions: Only one main conclusion could be extracted from this scarce number of references: a positive association between vitamin B 12 intake and serum vitamin B 12 in the infant group. Other associations were not reported in the eligible papers or the results were not provided in a consistent manner. The low number of papers that could be included in our systematic review is probably due to the attention that is currently given to research on vitamin B 12 in elderly people. Our observations in the current systematic review justify the idea of performing well-designed studies on vitamin B 12 in young populations.

$Research paper thumbnail of Mediterranean diet and incidence of hip fractures in a European cohort$

Osteoporosis International, 2013

Prevention of hip fractures is of critical public health importance. In a cohort of adults from e... more Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men. Introduction Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries. Methods A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders. Results Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI)00.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR0 0.86; 95 % CI00.79-0.94) and high fruit (HR00.89; 95 % CI00.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR01.18; 95 % CI01.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate01.74; 95 % CI01.32-2.31) was also a risk factor. Conclusions In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.

Oncology, 2001

Liver disease in men has been associated with an imbalance of serum estradiol and testosterone. W... more Liver disease in men has been associated with an imbalance of serum estradiol and testosterone. We have evaluated whether serum estradiol and testosterone levels are altered in male liver cancer patients as a result of a specific effect of the disease or because of the associated liver damage. We have performed a hospital-based case-control study in Greece. The study subjects were all men; 73 patients with hepatocellular carcinoma (HCC), 25 with metastatic liver cancer (MLC) patients and 111 control subjects. Serum estradiol, testosterone and sex hormone binding globulin (SHBG) levels were measured for each subject. Data were analyzed by multiple linear regression. Mean serum estradiol levels were significantly higher among HCC patients as well as among patients with MLC compared to controls. Mean serum testosterone levels were significantly lower among HCC patients as well as among patients with MLC compared to controls. The mean SHBG levels did not differ significantly between the groups. After controlling for the degree of liver damage, the elevated serum estradiol and reduced serum testosterone levels among HCC and MLC patients were no longer significant. Changes in sex steroid levels among patients with liver damage are due to the liver damage per se and not to specific disease processes.

Journal of Obstetrics & Gynaecology, 2005

Journal of Epidemiology & Community Health, 2002

Background: To decide whether a person with certain characteristics should be given any kind of i... more Background: To decide whether a person with certain characteristics should be given any kind of intervention to prevent a cardiovascular event, it would be helpful to classify subjects in low, medium and high risk categories. The study evaluated which well known cerebrovascular and cardiovascular correlates, in particular fibrinogen level and ECG characteristics, are able to predict the occurrence of stroke in men of the general population using data from three European cohorts participating in EUROSTROKE. Methods: EUROSTROKE is a collaborative project among ongoing European population based cohort studies and designed as a prospective nested case-control study. For each stroke case two controls were sampled. Strokes were classified according to MONICA criteria or reviewed by a panel of four neurologists. Complete data were available of 698 men (219 stroke events) from cohorts in Cardiff (84 cases/200 controls), Kuopio (74/148) and Rotterdam (61/131). Multivariable logistic regression modeling was used to evaluate which information from history, physical examination (for example, blood pressure), blood lipids, and fibrinogen and ECG measurements independently contributed to the prediction of stroke. The area under receiver operating characteristic curve (ROC area) was used to estimate the predictive ability of models. Results: Independent predictors from medical history and physical examination were age, stroke history, medically treated hypertension, smoking, diabetes mellitus and diastolic blood pressure. The ROC area of this model was 0.69. After validating and transforming this model to an easy applicable rule, 40% of all future stroke cases could be predicted. Adding pulse rate, body mass index, blood lipids, fibrinogen level and ECG parameters did not improve the classification of subjects in low, medium and high risk. Results were similar when fibrinogen was dichotomised at the upper tertile or quintile. Conclusion: In the general male population the future occurrence of stroke may be predicted using easy obtainable information from medical history and physical examination. Measurement of pulse rate, body mass index, blood lipids, fibrinogen level and ECG characteristics do not contribute to the risk stratification of stroke and have no value in the screening for stroke in the general male population.

Sozial- und Pr�ventivmedizin SPM, 2001

Little is known about the etiology of cholangiocarcinoma, apart from its association with liver f... more Little is known about the etiology of cholangiocarcinoma, apart from its association with liver f~uke infestation. Methods: A case-control study was conducted in Athens and included six cho~angiocardnoma cases, 333 hepatoceiMar card~ noma cases and 360 controls with minor ailments or injuries.

$Research paper thumbnail of Factors affecting the risk of hip fractures$

Injury, 2007

Hip fractures constitute a major cause of morbidity and mortality among the elderly, and are asso... more Hip fractures constitute a major cause of morbidity and mortality among the elderly, and are associated with a considerable and increasing economic burden. It has been estimated that the worldwide annual number of hip fractures will increase to 6.26 million by year 2050. The purpose of the current article was to review the factors affecting the risk of hip fractures. Original data for inclusion in this systematic review were identified through a MEDLINE search of the literature. Several factors seem to affect the risk of hip fracture. The effect of each individual factor on hip fracture risk can be considered moderate; however, their summation can cause a substantial impact. Recognising and a better understanding of the factors affecting the risk of hip fracture could aid to the planning of prophylactic strategies for reducing the problem and help the elderly remain independent and have a higher quality of life in their late years.