Greater Athens Area Research Articles

Geographical Distribution of Small Physical Exercise Enterprises in the Greater Athens Area

Geographical Distribution of Small Physical Exercise Enterprises in the Greater Athens Area

Analysis of secondary inorganic aerosols over the greater Athens area using the EPISODE–CityChem source dispersion and photochemistry model

Abstract. Secondary inorganic aerosols (SIAs) are major components of fine particulate matter (PM2.5), having substantial implications for climate and air quality in an urban environment. In this study, a state-of-the-art thermodynamic model has been coupled to the source dispersion and photochemistry city-scale chemistry transport model EPISODE–CityChem, which is able to simulate pollutants at a horizontal resolution of 100 m×100 m, to determine the equilibrium between the inorganic gas and aerosol phases over the greater Athens area, Greece, for the year 2019. In agreement with in situ observations, sulfate (SO42-) is calculated to have the highest annual mean surface concentration (2.15 ± 0.88 µg m−3) among SIAs in the model domain, followed by ammonium (NH4+; 0.58 ± 0.14 µg m−3) and fine nitrate (NO3-; 0.24 ± 0.22 µg m−3). Simulations denote that NO3- formation strongly depends on the local nitrogen oxide emissions, along with the ambient temperature, the relative humidity, and the photochemical activity. Additionally, we show that anthropogenic combustion sources may have an important impact on the NO3- formation in an urban area. During the cold period, the combined effect of decreased temperature in the presence of non-sea-salt potassium favors the partitioning of HNO3 in the aerosol phase in the model, raising the NO3- formation in the area. Overall, this work highlights the significance of atmospheric composition and the local meteorological conditions for the equilibrium distribution of nitrogen-containing semi-volatile compounds and the acidity of inorganic aerosols, especially in urban areas where atmospheric trace elements from natural and anthropogenic sources coexist.

The state of emergency medicine in Greece: at critical momentum

Greece is a parliamentary republic in southeastern Europe populated by over 10 million permanent residents: 9 million reside on the mainland, with almost 4 million in the greater Athens area. The remaining 1 million populate the over 1200 Greek islands. In addition, more than 160,000 asylum-seekers reached Greece in 2022, and more than 25 million tourists have visited Greece in the last two years. Modern Greek Emergency Medicine (EM) is now in its 4th decade. The Greek government has focused the last few years on enhancing the quality of emergency services provided in public hospitals. Emergency Departments (EDs) are being modernized, undergraduate medical education gradually incorporates EM, and a specialty training program in emergency nursing has been established. However, the late recognition of the critical importance of EM as a specialty in Greece has resulted in the subsequent need to create three alternative pathways to EM, none of which are direct from residency. The first is a 24-month Emergency Medicine fellowship after completing a residency in another specialty and then passing the national exam. The second is for physicians who have worked in a public hospital ED (Gr: Ethniko Systima Ygeias (ESY) ESY for at least three years and successfully passed the national exam. The third, which no longer exists, is a ‘grandfather’ pathway for those physicians who worked in an ESY ED for five years prior to the creation of the fellowship training program. As a result, there is a critical shortage of EM-trained physicians, resulting in most care being provided by physicians without formal training in EM. This is further confounded by the country’s challenging geography, with frequent air transfers from the islands to mainland hospitals. Creating an EM Residency training program is a critical next step to overcoming many of the challenges facing EM provision in Greece today: it would address the shortage of EM-trained providers, decrease the need for costly ground and air transfers, and improve the quality of emergency care throughout Greece.

Trends of the Global Burden of Disease Linked to Ground-Level Ozone Pollution: A 30-Year Analysis for the Greater Athens Area, Greece

The Greater Athens Area (GAA), situated in the southern part of the European continent (in Greece), has a Mediterranean climate characterized by hot, dry summers and mild, wet winters. As a result of increased sunshine and high temperatures, exceedances in ozone concentrations are often recorded during the hot period. In the present study, the monthly as well as daily variations of O3 concentrations at thirteen stations in the GAA were investigated for the period 1987–2019. Moreover, the impact of O3 on the people’s health in Greece was examined by using data from the Global Burden of Disease (GBD) study with the socio-economic conditions of the country. Ozone concentrations were found to be particularly high during the summer months, especially in suburban stations. Values ranged from 65 μg/m3 to 90 μg/m3 during the night, in contrast to urban areas and remain high for several hours. Comparing estimates from GBD, it was found that exposure to ozone can impair respiratory function, leading to death or susceptibility to respiratory diseases that reduce quality of life, especially for people over 55 years of age. Finally, since 2009, when the economic crisis began in Greece, an upward trend was observed for deaths and disability adjusted life years.

Exposure to PM2.5 on Public Transport: Guidance for Field Measurements with Low-Cost Sensors

Air pollution is one of the most important problems in big cities, resulting in adverse health effects. The aim of the present study was to characterize the personal exposure to indoor and outdoor pollution in the Greater Athens Area in Greece by taking measurements during a journey from suburban to mixed industrial–urban areas, encompassing walking, waiting, bus travel, and metro travel at various depths. For this reason, low-cost (LC) sensors were used, and the inhaled dose of particulate matter with an aerodynamic diameter of less than or equal to 2.5 μm (PM2.5) in different age groups of passengers was calculated. Specific bus routes and the Athens metro network were monitored throughout different hours of the day. Then, the average particulate matter (PM2.5) exposure for a metro passenger was calculated and evaluated. By considering the ventilation rate of a passenger, an estimation of the total PM2.5 inhaled dose for males and females as well as for different age groups was made. The results showed that the highest PM2.5 concentrations were observed inside the wagons with significant increases during rush hours or after rush hours. Furthermore, there should be a concern regarding older individuals using the subway network in Athens during rush hours and in general for sensitive groups (people with asthma, respiratory and cardiovascular problems, etc.).

Impact of peri-urban forest fires on air quality and aerosol optical and chemical properties: The case of the August 2021 wildfires in Athens, Greece

Wildfires occurring near urban areas are known to have exceedingly detrimental impacts on the environment, air quality, economy and human health. In this framework, this study examines the effects of peri-urban forest fires on atmospheric chemical composition, and aerosol physical-optical properties in Athens, Greece, during August 2021. Satellite imagery and air mass trajectories showed advection of intense smoke plumes over Athens from three forest fires persisting for 10 days in the greater Athens area and in Central Greece (Euboea). During August 1–20, 2021, daily PM2.5 concentrations ranged from 8.9 to 78.7 μg m−3, and were associated with high OC levels (2.3–27.8 μg m−3), while BC and BCbb concentrations on smoke-impacted days were 2.6 μg m−3 and 1.0 μg m−3, respectively (2–3 times higher than August mean levels). During the peak of biomass burning (BB) smoke transport over Athens, daily-average scattering and absorption coefficients at short wavelengths maximized at 313 Mm−1 and 171 Mm−1, respectively. There was also a large impact of ambient BrC (brown carbon) absorption (60 Mm−1), while the OC/EC ratio exhibited characteristically low values (3–4), linked to flaming combustion (modified combustion efficiency of 0.97–0.99). The absorption Ångström exponent (1.38) and single scattering albedo (0.74) indicated highly absorbing BB aerosol, deviating from the normal summer patterns. BB-tracers like nssK+ displayed strong correlations with OC, EC and BC concentrations, as well as with scattering and absorption coefficients. However, forest fires drastically modified the levels of additional chemical species, with enhancements observed for Ca2+, NO3−, Cl−, and for organic aerosol (OA) components such as BBOA and less-oxidized oxygenated OA (LO-OOA). Since under climate change conditions, the Mediterranean is anticipated to experience a dramatic rise in the frequency and intensity of wildfires, the results highlight the necessity for prevention and mitigation policies to safeguard urban air quality.

A multicenter study on the epidemiology of complicated parapneumonic effusion in the era of currently available pneumococcal conjugate vaccines

BackgroundParapneumonic effusion (PPE) is a common complication of pneumonia. Streptococcus pneumoniae is the most common cause of bacterial pneumonia. A reduction in pneumonia hospitalizations has been observed since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Despite this apparent benefit, an increase in the incidence of PPE was recorded in some countries following PCV7 implementation. As the 13-valent pneumococcal conjugate vaccine (PCV13) was expected to provide a wider protection against PPE, the aim of the present study was to evaluate the impact of PCV13 introduction on the epidemiology of complicated parapneumonic effusion (c-PPE) among children in the Athens greater area. MethodsAll cases of community-acquired pneumonia (CAP) with PPE requiring chest tube insertion (complicated PPE, c-PPE) hospitalized in the 3 public Children’s hospitals in Athens between 01/01/2004 and 31/12/2019 were included in the study. ResultsA total of 426 cases of c-PPE associated with pneumonia were recorded of which 198 were admitted during 2004–2010 (period A, prePCV13/PCV −7 introduction period) and 228 during 2011–2018 (period B, post - PCV13 period). A definite bacterial etiology was established in 44.4 % of all cases and of those 25.4 % were caused by S. pneumoniae. An increasing trend in c-PPE incidence was observed during period A; although, a significant decrease on c-PPE annual rates was observed during the period B (p = 0.011), a remarkable increase in serotype 3 cases was recorded. ConclusionA decreasing time trend in c-PPE cases among children was shown after the introduction of PCV13 in our area. However, serotype 3 is nowadays a common cause of PPE. Hence, continuous surveillance is imperative in order to follow c-PPE epidemiology over time.

Event Cocreation in Street Events: Evidence from Athens Pride

Despite the significant contribution of events in tourism and development of urban areas, the cocreation aspects of street events appear to be underresearched in the literature. Athens Pride is one of the largest street events in Athens and it aims to promote and support lesbian, gay, bisexual, transgender, and queer issues (LGBTQ+) in the greater Athens area, Greece. Using a sample of 312 Athens Pride adult attendees and employing linear analysis, this study focuses on the aspects that form this street event's cocreation. The findings reveal that participation incentives and emotional closeness are the main factors in order to formulate and strengthen event cocreation, followed by the community commitment and the brand image of the event. In addition, the study showcases the importance of three sociodemographics (age, level of education, sexual orientation) upon event cocreation. The research also provides managerial suggestions for event organizers in order to further strengthen street event cocreation and the experience of their attendees.

Adverse Health Effects (Bronchitis Cases) Due to Particulate Matter Exposure: A Twenty-Year Scenario Analysis for the Greater Athens Area (Greece) Using the AirQ+ Model

It is well known that air pollution has a negative impact on human health. Research has shown an increasing trend in hospital admissions due to respiratory and heart diseases during and after consecutive days of high or even medium air pollution levels. The objective of this paper is to provide quantitative and qualitative data concerning the impact of long-term air pollution on the health of residents living in the Greater Athens Area (GAA). More accurately, the prevalence of bronchitis in children and the incidence of chronic bronchitis cases in adults due to particulate matter exposure are estimated utilizing the AirQ+ model. For this purpose, daily average concentrations of particulate matter with an aerodynamic diameter less than or equal to 10 μm (PM10) from five different locations within the GAA, covering the period 2001–2020, are used. The results show a significant correlation between PM10 concentrations and adverse health effects (R2 = 0.9). Interestingly, there were more cases of children suffering from bronchitis disease than cases of adults. In addition, it was observed that the unhealthiest areas in the GAA are the center of Athens city (mean annual PM10 concentration in 2019: 36 μgr/m3), as well as suburban areas (Lykovrissi and Marousi: mean annual PM10 concentrations in 2019 were 27 μgr/m3 and 28 μgr/m3, respectively). Finally, a decreasing trend for both PM10 concentrations and the prevalence of chronic bronchitis across the GAA was observed through the examined 20 years, which was significantly higher over the period 2010–2020.

Multifractal Patterns in 17-Year PM10 Time Series in Athens, Greece

This paper reports the multifractal characteristics of lengthy PM10 time series from five stations in the Greater Athens Area (GAA), Greece. A novel methodology based on the multifractal detrended fluctuation analysis (MFDFA) is applied to raw and shuffled series in 74 segments in 11 date-periods, previously located, with very strong self-organised critical (SOC) and fractal properties. The MFDFA identified multifractality in all segments. Generalised and classical Hurst exponents are in the range 0.8–1.5 and 9–4.5 for the raw and shuffled series, while the multifractal f(a)−a is within 0.5–1.2 and 0.1–2, respectively. The f(a)−a data are fitted to polynomials to calculate the multifractal parameters W, FWHM and fmax. While these are bimodal, a new parameter, FWHM/fmax, is normally distributed, and due to this, it is employed to locate the important multifractal behaviour via the FWHM/fmax outliers. Five date-periods are found. The date-period 8 January 2015 has extraordinary multifractality for raw and shuffled series for both the AGP and LYK stations. This date-period is one of the three reported in the most recent combination study. Finally, sliding window MFDFA evolution plots of all the series are given. The results provide very strong evidence of the multifractality of the PM10 time series.

Egg Consumption, Cardiovascular Disease and Cardiometabolic Risk Factors: The Interaction with Saturated Fatty Acids. Results from the ATTICA Cohort Study (2002-2012).

Purpose: To examine the association of egg intake with 10-year risk of cardiovascular disease (CVD) and other cardiometabolic risk factors in a sample of individuals of Mediterranean origin. Methods: In 2001−2002, n = 1514 men and n = 1528 women (>18 years old) from the greater Athens area, Greece, were enrolled. Information on any egg intake, eaten as a whole, partly or in recipes was assessed via a validated semi-quantitative food frequency questionnaire. Follow-up for CVD evaluation (2011−2012) was achieved in n = 2020 participants (n = 317 CVD cases). Results: Ranking from lowest (<1 serving/week) to intermediate (1−4 servings/week) and high (4−7 servings/week) egg consumption tertiles, lower CVD incidence was observed (18%, 9% and 8%, respectively, p-for-trend = 0.004). Unadjusted analysis revealed that 1−3 eggs/week and 4−7 eggs/week were associated with a 60% and 75%, respectively, lower risk of developing CVD compared with the reference group (<1 egg/week). When adjusting for sociodemographic, lifestyle and clinical factors, significance was retained only for 1−3 eggs/week (hazard ratio (HR) = 0.53, 95% confidence interval (95% CI) = 0.28, 1.00). When total saturated fatty acid (SFA) intake was taken into account, this inverse association was non-significant. Multi-adjusted analysis revealed that in participants of low SFA intake, 1 serving/day increase in egg intake resulted in 45% lower risk of developing CVD. In the case of higher SFA consumption, only 1−3 eggs/week seemed to protect against CVD (HR = 0.25, 95% CI = 0.07, 0.86). In the case of intermediate cardiometabolic disorders, no significant trend was observed. Conclusions: Overall dietary habits principally in terms of SFA intake may be detrimental to define the role of eggs in cardiac health.

THE GREEN LINE | A biodiversity corridor along the past and present Athens railway network

The Green Line concerns the study of the introduction of an urban green route in proximity to the railway network of TRAINOSE in the greater area of Athens, Greece. The active and inactive railway network that runs through Athens has posed a challenge to good management, due to the empty spaces and derelict facilities it leaves behind as well as the urban fragmentation it causes. At the same time, Athens, in the midst of the global climate crisis, is in need of a long overdue introduction of urban green, in order to enhance the city’s resilience to extreme weather conditions and threats to biodiversity, especially to the urban and peri-urban fauna. The main motivation of all interventions is the introduction, mobility and enhancement of urban biodiversity. The means to achieve this is both the selection of ecologically valuable plant species able to attract and host important pollinator species and other urban fauna, and their interaction with humans. This interaction is examined in separate cases, depending on the urban and social conditions of each location, and incorporates urban farming (communal gardens, orchards, meeting and education points), urban beekeeping and pollinator care (urban beehives, bee and butterfly beds, bee hotels). These interventions are found along and in the vicinity of the railway network of TRAINOSE, which is divided into typologies and takes the form of individual design case studies. In its current state, this area bisects the city, creates problem areas and runs through densely populated areas with low incomes and a significantly low amount of green spaces, while, the conversions the railway network has undergone in recent decades leave behind areas ready to receive new uses. Most importantly, it can create a functional and practical green route that starts, passes through and ends at key points in the city.

Heatwaves and forest fires and their combined effects in the Greater Athens area

Background: Previous severe heatwaves in Athens were associated with excess mortality. As example, the heatwave in July 1987 led to 100% increase in the monthly number of deaths. Also, the occurrence of forest fires burning more than 30km2 of land are associated with increased mortality (&amp;#x3e;90% increase in respiratory deaths). The aim of the present work is to quantify the effects of a heatwave combined with a forest fire event in July-August 2021. Methods: Data for weekly and daily temperature, particulate air pollution and number of deaths were recorded for the summer 2021 and the 10 previous years. For the 2020-21 period the daily number of deaths due to COVID-19 was also available. A Poisson regression analysis was applied to estimate the effect of the heatwave and forest fire episode on mortality. A comparison with what would be expected in terms of excess deaths, if the same associations observed in the 1987 heatwave were still applicable, was undertaken. Results: PM2.5 concentrations were increased to 73&amp;#x3bc;g/m3 on the 9th heatwave day (2nd forest fire day). The weekly number of deaths increased up to 80% compared to the observed number of deaths during the same time period in 2017-2020. However, the observed impact in 2021 was smaller to what would be expected based on projections using exposure-response functions estimated for the 1987 heat wave. The increase in mortality during the 2021 heatwave could not be explained by an increase in COVID-19 related deaths. Conclusions: The impact of the 2021 heatwave–forest fire event on the number of deaths for the Athens population was very severe. However, it was less than expected based on observations from an important heatwave in the same period in 1987. The difference is probably due to raised awareness and behavioral adaptation. Key words: heatwave, forest fire, mortality, Athens

Inventory of Commercial Cooking Activities and Emissions in a Typical Urban Area in Greece

The pollutants emitted during meal preparation in restaurants deteriorate the air quality. Thus, it is an environmental issue that needs to be addressed, especially in areas where these activities are densely located. The purpose of this study is to examine the impact on air quality from commercial cooking activities by performing a qualitative and quantitative analysis of the related parameters. The area of interest is located in the southeastern Mediterranean (Greater Athens area in Greece). Due to the lack of the necessary activity information, a survey was conducted. Emissions from the fuel burnt during the cooking procedures were calculated and it was found that, overall, 940.1 tonnes are attributed to commercial cooking activities annually (generated by classical pollutants, heavy metals, particulates and polycyclic aromatic hydrocarbon emissions). Comparing the contribution of different sources to the pollutants emitted, it was found that commercial cooking is responsible for about 0.6%, 0.8% and 1.0% of the total CO, NOx and PM10 values. Cooking organic aerosol (COA) and volatile organic compound (VOC) emissions from grilled meat were also calculated, accounting for 724.9 tonnes and 37.1 tonnes, respectively. Monthly, daily and hourly profiles of the cooking activities were developed and emissions were spatially disaggregated, indicating the city center as the area with higher values. Numerical simulations were performed with the WRF/CAMx modeling system and the results revealed a contribution of about 6% to the total PM10 concentrations in the urban center, where the majority of restaurants are located.

Investigation of the gridded flash flood Guidance in a Peri-Urban basin in greater Athens area, Greece

In this research work, an implementation of the gridded Flash Flood Guidance (FFG) method is conducted for the prediction and evaluation of flash floods in Greece. The FFG system is a well-established Early Warning System (EWS) for the estimation of flash flood threats, especially in small ungauged basins, where flash floods are the most dominant form of flooding. First, an overview of the gridded FFG system is conducted, where all computations are performed at grid level. The methodology applied consists of the derivation of the threshold rainfall, referred to as the FFG. The catastrophic flash flood event that occurred on the 15th of November 2017 and caused the loss of 24 human lives and extensive economic damage within the Mandra settlement, in the Attica region in Greece, is used to assess the lead time provided by the system. Finally, a sensitivity analysis is performed regarding the two main aspects of the system, i.e. the threshold runoff and the estimation of the soil moisture conditions, and their impact on the generated lead times. Results show that the most crucial aspect of the system is the soil moisture conditions, since in wet conditions a 10% deviation on a scale from zero to one, can result in a complete time-step loss of the possibilities provided lead time, while in dry conditions the deviation is much larger. Finally, concerning the studied event, results show that if the system was operational, and the forecasted rainfall matched the values of the actual rainfall, at least a five-hour lead time warning could have been issued based on the results of the system.

Liver steatosis, metabolically healthy obesity and ten-year cardiovascular disease risk: results from a population based cohort study

Abstract Background/Introduction Inclusion of non-alcoholic fatty liver disease (NAFLD) as a component of metabolic syndrome (MetS) and/or a criterion for defining metabolically healthy vs. unhealthy obese (MHO vs MUO) status remains to be decided. Purpose The present work evaluated the role of NAFLD at baseline in the transition of MHO to MUO status, and its role in predicting cardiovascular disease (CVD) incidence ten years later. Methods A prospective longitudinal study was performed between 2001 and 2012 studying 1,514 (49·8%) men and 1,528 (50.2%) women (&amp;gt;18 years old) free of CVD at baseline and residing in the greater Athens area, Greece. Follow-up assessment of first fatal/non fatal CVD event (2011–2012) was achieved in n=2,020 participants (n=317 cases). Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices. Results Among obese participants, MHO prevalence was 9.8% (n=277). Only half of the MHO subjects retained their metabolically healthy status one decade later. NAFLD was an important predictor of this transition; MHO participants with NAFLD at baseline had about two times higher odds to develop unhealthy metabolic status compared with their non-NAFLD counterparts. Subsequently, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio=2.90 95%Confidence Interval (1.35, 5.40)) in contrast to their non-NAFLD MHO counterparts. C-statistics revealed that NAFLD significantly increased the discriminative ability of the standardly defined metabolic status (p for C-index change=0.002), yet in the total sample its contribution to the model seemed to be similar with the common metric of central obesity i.e. waist circumference (CNAFLD=0.711 vs. Cwc=0.710). When the analysis was restricted to the obese subset, it was revealed that the discriminative ability of the model adjusted for NAFLD was significantly higher compared with the one adjusted for waist circumference (CNAFLD=0.719 vs. Cwc=0.702). Conclusions Taking under consideration NAFLD – via validated indices – in the clinical assessment of an apparently healthy obese individual contributes to better defining future risk of conversion to metabolically unhealthy obesity and future cardiometabolic risk. Funding Acknowledgement Type of funding sources: None.

Land Use Regression Modelling of traffic-related noise in Athens, Greece for use in epidemiological studies

BACKGROUND AND AIM: Even though exposure to noise has been associated with higher blood pressure and sleep disturbance, a very limited number of studies have developed Land Use Regression (LUR) models to estimate exposure to transportation noise. Our aim was to develop a LUR model that estimates long-term exposure to road-traffic noise, within the greater Athens area in Greece, for subsequent use in epidemiological studies. METHODS: We developed a LUR model for road-traffic noise exposure to Lday-evening-night (Lden) using noise measurements conducted at 241 points in the study area, during 2014-2015. We applied a semiparametric approach including linear and smooth functions of spatial covariates and a bivariate smooth thin plate function for the geographical coordinates of the monitoring sites. The final set of explanatory variables was selected based on the adjusted-R2. We tested the final model’s performance using 10-fold cross-validation (CV). Subsequently, we applied the developed model to estimate exposure to road-traffic noise of 1,321 participants in the National Survey of Morbidity and Risk Factors (EMENO), at their residential addresses. Logistic and linear regression models were used to evaluate the association between exposure to road-traffic noise and the risk of hypertension and mean arterial blood pressure (MAP). RESULTS:The final set of predictor variables included traffic load variables, number and surrounding area of bus lanes, open space areas and nearest building height. The R2 of the developed model was 0.51 (CV-R2:0.39). Mean exposure (SD) of participants to Lden was 56.8 (2.54)dB. A 10dB increase in Lden was associated with an odds ratio (OR) for hypertension of 1.69 (95% confidence interval (CI):0.84, 3.41) and an increase in MAP of 1.3mmHg (95% CI: -2.00, 4.60 mmHg). CONCLUSIONS:LUR modeling provides a useful tool for estimating exposure to transportation noise for subsequent use in epidemiological studies, but further improvements of exposure are needed. KEYWORDS: Environmental epidemiology, Exposure assessment, Noise, Long-term exposure, Cardiovascular diseases

Bridging the Gap: Community Pharmacists’ Burgeoning Role as Point-Of-Care Providers During the COVID-19 Pandemic Through the Integration of Emerging Technologies

Community pharmacies are an under-utilized setting for the provision of primary and preventative care measures, especially the provision of clinical dietary care. The SARS-CoV-2 pandemic presented a unique opportunity to study pharmacist-based nutritional counseling in the absence of ready access to primary nutritional care. In the present interventional pilot study, we analyzed the efficacy of a Clinical Decision Support System (CDSS) for community pharmacy integration on patient weight management, monitoring, and goal setting over a 4-week period. 57 Greek adult patients (16 males and 41 females) of a community pharmacy in the greater Athens area were enrolled in the intervention and subsequently assigned a hypo- or iso-caloric diet according to baseline anthropometric measurements, total daily energy expenditure, medical history, and drug treatment status as assessed by the CDSS. At the end of the intervention period participant weight (kg) and corresponding Body Mass Index (BMI) (kg/ m2) calculations were recorded to gauge sample diet and CDSS recommendation efficacy. Among patients who remained diet compliant to study completion, body weight and BMI were significantly decreased in the hypo-caloric diet group compared to baseline (n=13) (mean difference = -2.685 kg, p = 0.004; mean difference = -1.112 kg/m2, p = 0.004, respectively). No significant change in body weight nor BMI from baseline of isocaloric diet compliant patients was registered (n=9) (p=0.273; p=0.320, respectively), succeeding in the purported goal of weight maintenance. This study provides preliminary evidence for the efficacy of a CDSS in assisting pharmacists with nutritional assessment, screening, and sample diet counselling concordant with patient dietary and weight-loss requirements. This trial also builds on emerging research into the broadening purview of traditional pharmacy services in primary care settings.

Application of non-HDL cholesterol for cardiovascular risk prediction in apparently healthy men and women: Results from the ATTICA prospective epidemiological study

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003]. Background/Introduction: Consistent evidence exists for a causal association between blood cholesterol and cardiovascular disease (CVD) yet alternative lipid markers are still discussed. To this issue, non-High Density Lipoprotein (non-HDL) cholesterol offers a simple way to analyze the total amount of pro-atherogenic lipoproteins containing apolipoprotein B100. Purpose: The aim of the present work was to evaluate the 10-year first fatal/non fatal CVD incidence related to non-HDL cholesterol on the basis of existing thresholds suggested by the European Society of Cardiology (ESC) in a sample with prevalent CVD. Methods: ATTICA study was conducted during 2001-2012 including n = 1,514 men and n = 1,528 women (aged &amp;gt;18 years old) from the greater Athens area, Greece. Baseline serum blood lipids profile was measured. Non-HDL cholesterol was evaluated according to the formula "total cholesterol minus HDL cholesterol" and the following categories were used: &amp;lt;100 mg/dL; 100 to &amp;lt;145 mg/dL; 145 to &amp;lt;185 mg/dL; 185 to &amp;lt;220 mg/dL, and ≥220 mg/dL. Ten-year follow up was performed (2011-12) in 2,020 participants (n = 317 cases, man-to-woman CVD incidence ratio = 1.66). Results: About 42% of women had non-HDL values within the range of 100 to &amp;lt;145 mg/dL while in case of men about one third of them had non-HDL values within the range of 100 to 185mg/dL. Ranking from low to high non-HDL cholesterol CVD incidence was 5.3%, 13.3%, 18.0%, 20.0% and 28.9%. The man-to-woman age-standardized CVD incidence ratio was 1.50, 1.93, 1.37, 1.24, 1.64, respectively; indicating a steep rise in CVD incidence rate in favor of men when non-HDL cholesterol levels reached the 2nd category levels (i.e. 100 to &amp;lt;145 mg/dL) while women seemed to present CVD incidence rates closer to their men counterparts in case of higher non-HDL cholesterol values (i.e. 145 to &amp;lt;220 mg/dL). Multi-adjusted Cox regression analysis revealed that 30mg/dL increase in non-HDL cholesterol values corresponded to 34% higher risk to develop CVD within the decade (Hazard ratio (HR)=1.34, 95% Confidence Interval (95%CI) (1.00, 1.81)). The association remained significant only in case of men (p for gender interaction = 0.01); HR = 1.45, 95%CI (1.09, 1.95). Additionally, when the categorical non-HDL variable was used, its independent aggravating effect on CVD outcome reached the level of significance only for non-HDL cholesterol values &amp;gt;220mg/dL; HR5th vs. 1st category = 1.95, 95%CI (1.10, 4.30). Sex-based stratified analysis revealed significance only in men and particularly HR5th vs. 1st category = 3.14, 95%CI (1.26, 5.10). In case of women the aggravating effect was retained yet without reaching the level of significance. Conclusion: Even if non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic CVD, its use in daily clinical practice is challenged. These outcomes could be useful for physician–patient communication about primary prevention strategies.

Comparative Analysis of Rain Gauge and Radar Precipitation Estimates towards Rainfall-Runoff Modelling in a Peri-Urban Basin in Attica, Greece

In this research work, an analysis is conducted concerning the impact on rainfall-runoff simulations of utilizing rain gauge precipitation measurements against weather radar quantitative precipitation estimates. The study area is the Sarantapotamos river basin, a peri-urban basin located in the greater area of Athens, and measurements from a newly installed X-Band weather radar system, referred to as rainscanner, along with ground rain gauge stations were used. Rainscanner, in contrast to rain gauges, is able to provide with higher resolution surface precipitation datasets, but due to signal errors, uncertainty is involved, and thus proper calibration and evaluation of these estimates must be first performed. In this context, this research work evaluates the impact of adopting different precipitation datasets and interpolation methods for generating runoff, through the use of a lumped based rainfall-runoff model. Initially, the analysis focuses on the correlation between the rain gauge and the rainscanner estimations for each station, as well as for the calculated mean areal precipitation. The results of the rainfall-runoff simulations show that even though a different spatial and temporal variability of the rainfall field is calculated through the two datasets, in a lumped-based scheme, the most important factor that dictates the runoff generation is the amount of total precipitation.