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Background Prior studies have shown that young people “not in education, employment or training” (“NEET”) are at higher risk for psychopathology and substance abuse. Similar studies are lacking in Southern European populations. We aimed to examine the associations of anxiety and depressive symptoms, and substance use with NEET status in a large, randomized population-based sample in Greece. Methods A telephone structured questionnaire was conducted in a representative sample of 2771 young Greeks aged 15–24 years. Anxiety and depressive symptoms were assessed with GAD-7 and PHQ-9 scales, respectively. Substances use and several sociodemographic parameters were also examined. Results In our sample 16.4% were NEETs. In multivariate analyses, NEETs compared to non-NEETs were older, with lower family income, without insurance and more likely to be married and smoke. Furthermore, NEET status was associated with a higher GAD-7 score among older NEETs and long-term NEETs (NEETs unemployed for more than a year). Moreover, being NEET among older participants was associated with severe symptoms of anxiety and moderate/severe symptoms of depression. Limitations This was a telephone survey and a clinical evaluation of the patients was not performed. Furthermore, the structured interview was not designed to detect the level of substance use or the reasons for being NEET. Conclusions NEET status is frequent among young Greeks. Older, and long-term NEETs appear to be at higher risk for presenting anxiety/depression symptoms. Whether NEET status is associated with adverse outcomes later in life requires longitudinal studies.

There is growing evidence associating inflammatory markers in complex, higher order neurological functions, such as cognition and memory. We examined whether high levels of various inflammatory markers are associated with cognitive outcomes at 4 years of age in a mother-child cohort in Crete, Greece (Rhea study). We included 642 children in this cross-sectional study. Levels of several inflammatory markers (IFN-γ, IL-1β, IL-6, IL-8, IL-17α, IL-10, MIP-1α, TNF-α and the ratios of IL-6 to IL-10 and TNF-α to IL-10) were determined in child serum via immunoassay. Neurodevelopment at 4 years was assessed by means of the McCarthy Scales of Children’s Abilities. Multivariate linear regression analyses were used to estimate the associations between the exposures and outcomes of interest after adjustment for various confounders. Our results indicate that children with high TNF-α concentrations (≥90th percentile) in serum demonstrated decreased scores in memory (adjusted β = −4.0; 95% CI: −7.7, −0.2), working memory (adjusted β = −4.0; 95% CI: −8.0, −0.1) as well as in memory span scale (adjusted β = −4.0; 95% CI: −7.9, −0.1). We also found that children with high IFN-γ serum levels showed lower scores in memory span scale (adjusted β = −3.4; 95% CI: −7.3, −0.4). Children with elevated TNF-α/IL-10 ratio demonstrated decreased quantitative (adjusted β = −4.3; 95% CI: −8.2, −0.4), motor (adjusted β = −3.5; 95% CI: −7.5, −0.5), executive function (adjusted β = −4.8; 95% CI: −8.5, −1.1), general cognitive (adjusted β = −3.6; 95% CI: −7.3, −0.1), memory (adjusted β = −3.8; 95% CI: −7.6, −0), working memory (adjusted β = −3.5; 95% CI: −7.5, −0.5) and memory span scores (adjusted β = −5.3; 95% CI: −9.1, −1.4) The findings suggest that high levels of TNF-α may contribute to reduced memory performance at preschool age.

Background Depression is a frequent and serious disease often undiagnosed in elderly. We aimed to examine (1) the prevalence/correlates associated with depression and (2) the magnitude of depression underdiagnosis/related factors, in a large community-dwelling elderly population in Crete/Greece visiting Primary Health Care (PHC) settings. Methods A sub-sample of 2428 non-demented individuals with Mini Mental State Examination (MMSE)>19 were recruited from a population-based cohort of 3140 elderly (>60 years). In phase I, all participants were assessed with a structured questionnaire including demographics, life-style, sleep, physical health and cognitive function. Diagnosis of depression was based on history/treatment of depression. In phase II, in a sub-sample of 293 participants, depression was diagnosed after a thorough extensive neuropsychiatric/neuropsychological evaluation. Results In phase I, 10.8% reported a diagnosis/treatment of depression. In multivariate analysis, female gender, lack of physical activity, caregiver dependence and use of benzodiazepines were associated with depression. In phase II, depression was prevalent in 28.7% of our sample, whereas about 61% of those diagnosed with depression were undetected in phase I. Factors associated with non-detection of depression were sleep complaints/subjective short sleep, low MMSE and medical comorbidities. Two screening questions related to mood increased possibility to detect undiagnosed depression up to 90%. Limitations Due to the cross-sectional design, causality between correlated factors cannot be examined. Conclusion Prevalence of depression is high and largely underdiagnosed in elderly in Crete/Greece. Sleep and memory complaints appear to be surrogate markers of depression, whereas screening mood in PHC settings may significantly increase detection of depression in elders.

Background: Persistent Organic Pollutants (POPs) are highly-resistant compounds to environmental degradation and due to fat solubility they bioaccumulate through the food chain. As they cross the placenta, in utero exposure to POPs could disrupt child neurodevelopment as they are considered to be neurotoxic. Aims: We examined whether in utero exposure to levels of different POPs is associated with offspring cognitive and behavioral outcomes at 4 years of age in a mother-child cohort in Crete, Greece (Rhea study). Methods: We included 689 mother-child pairs. Concentrations of several polychlorinated biphenyls (PCBs) and other organochlorine compounds (dichlorodiphenyl dichloroethene [DDE], hexachlorobenzene [HCB]) were determined in maternal serum collected in the first trimester of pregnancy by triple quadrupole mass spectrometry. Neurodevelopment at 4 years was assessed by means of the McCarthy Scales of Children's Abilities. Behavioral difficulties were assessed by Strengths and Difficulties Questionnaire and Attention Deficit Hyperactivity Disorder Test. Linear regression analyses were used to estimate the associations between the exposures and outcomes of interest after adjustment for potential confounders. Results: Children with “high” HCB concentrations (≥90th percentile) in maternal serum, demonstrated decreased scores in perceptual performance (adjusted β = −6.07; 95% CI: −10.17, −1.97), general cognitive (adjusted β = −4.97; 95% CI: −8.99, −0.96), executive function (adjusted β = −6.24; 95% CI: −10.36, −2.11) and working memory (adjusted β = −4.71; 95% CI: −9.05, −0.36) scales at 4 years of age. High exposure to PCBs (≥90th percentile) during pregnancy was associated with a 4.62 points reduction in working memory score at 4 years of age (95% CI: −9.10, −0.14). Prenatal exposure to DDE, HCB and PCBs was not associated with child behavioral difficulties. Conclusions: The findings suggest that prenatal exposure to HCB and PCBs may contribute to reduced cognitive development at preschool age. Our results raise the possibility that exposure to HCB may play a more important role in child cognition than previously considered. Keywords: Persistent organic pollutants, PCBs, HCB, Neuropsychological development, Cognition, McCarthy Scales for Children’s Abilities

Studies on determinants affecting child development are still limited in Greece. The aim of the present study was to describe the socio-demographic characteristics associated with neurodevelopment in infants aged 18 months in the Mother-Child Cohort (Rhea Study) in Crete, Greece. A total of 599 (72.9%) mothers agreed to participate in the neurodevelopment protocol and 612 infants (586 singletons and 26 twins) were assessed by means of the Bayley Scales of Infant and Toddler Development (3rd edition). The present analysis includes 605 infants. Multivariable linear regression models were implemented to examine the associations between the Bayley-III standardised scores and different parental and infant characteristics, also adjusting for quality of assessment. Girls were found to have better neurodevelopmental outcomes in cognitive, receptive and expressive communication, fine motor and social-emotional development. Maternal higher education was positively associated to almost all aspects of infant neurodevelopment assessed. Increasing number of older siblings was negatively associated with cognitive development, communication skills and gross motor development. Our results, also, suggest a positive effect of maternal employment on infants' receptive and expressive communication, and gross motor scores. The results of the present study suggest that in the population on Crete social and environmental factors contributed more to infants' neurodevelopment at 18 months than biological factors.

Objective To evaluate the association of second-hand smoke exposure of pregnant mothers using urine cotinine with the neurodevelopment of their children at 18 months of age in the mother-child cohort in Crete (Rhea Study). Study design Selected participants were Greek mothers with singleton pregnancies, had never smoked, and had available urine cotinine measurements in pregnancy, and their children for whom a neurodevelopmental assessment was completed. We performed face-to-face interviews twice during pregnancy and postnatally, and assessed children's neurodevelopment at 18 months of age using the Bayley Scales of Infant and Toddler Development, Third Edition. We used linear regression and generalized additive models. Results Of 599 mothers, 175 (29%) met the inclusion criteria. Maternal urine cotinine levels were low (mean: 10.3 ng/mL, SD: 11.7 ng/mL). Reported passive smoking from different sources was strongly associated with urine cotinine levels. A negative association was observed between cotinine levels in pregnancy and child's gross motor function (beta = −3.22 per 10 ng/mL, 95% CI −5.09 to −1.34) after adjusting for factors potentially associated with neurodevelopment; results were similar in both sexes. A negative association was also observed for cognitive and receptive communication scales but the effect was small and not statistically significant. Conclusions Maternal exposure during pregnancy to second-hand smoke measured through urine cotinine was associated with a decrease in gross motor function among 18-month-old children, even at low levels of exposure.