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Background/Objectives: The importance of non-invasive biomarkers for the diagnosis and monitoring of allergic diseases in childhood is currently unknown. From this perspective, data on the role of the total (t) immunoglobulin E (IgE) in relation to different allergic diseases across different age groups until adulthood remain unclear. The potential association of tIgE levels with types of allergic diseases diagnosed in an specialized tertiary allergy center, in relation to sex and the age group spanning from birth to 20 years, are evaluated in the present study. Methods: In this retrospective study, the tIgE values were obtained from children assessed for allergy-associated symptoms in our department from January 2015 to December 2020. The tIgE values were analyzed in relation to age and diagnosis. Results: Data from 2127 patients (1321 boys (62.1%)), with a median age of 6.31 (3.01-9.95) years, were available. The tIgE median values for the studied population were 132 (37.7-367.5) kU/lt. The tIgE values showed a significant increase from 0-2 years to 2-5 and 5-12 years, but not from 5-12 to 12-20 years. Boys exhibited significantly higher tIgE values compared to girls. Furthermore, the tIgE levels were significantly increased in children with asthma, allergic rhinitis, food allergy, and atopic dermatitis in comparison to children without these diagnoses. Conclusions : The total IgE values exhibit a significant and progressive longitudinal increase in children with allergic diseases, particularly notable in the 0-2 and 5-12 age groups, in boys, and in children diagnosed with atopic conditions.

The asthma pandemic imposes a huge burden on patients and health systems in both developed and developing countries. Despite available treatments, symptom control is generally suboptimal, and hospitalizations and deaths remain at unacceptably high levels. A pivotal aspect of asthma that warrants further exploration is the influence of the respiratory microbiome and virome in modulating disease activity. A plethora of studies report that the respiratory microbiome is characteristically dysbiotic in asthma. In addition, our data suggest that dysbiosis is also observed on the respiratory virome, partly characterized by the reduced abundance of bacteriophages (phages). Even though phages can naturally infect and control their bacterial prey, phage therapy has been grossly neglected in the Western world, although more recently it is more widely used as a novel tool against bacterial infections. However, it has never been used for tackling microbiome dysbiosis in human non-communicable diseases. This review provides an up-to-date understanding of the microbiome and virome's role within the airways in relation to asthma morbidity. It also advances the rationale and hypothesis for the CURE project. Specifically, the CURE project suggests that managing the respiratory microbiome through phage therapy is viable and may result in restoring eubiosis within the asthmatic airway. This entails controlling immune dysregulation and the clinical manifestation of the disease. To accomplish this goal, it is crucial to predict the effects of introducing specific phage mixtures into the intricate ecology of the airways and devise suitable interventions., (© 2024. The Author(s).)

Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.

Introduction: Research has well demonstrated that the pandemic entailed several implications among university students worldwide in terms of increased use of Information and Communication Technologies (ICTs), technostress, disruptions in academic goals and motivation processes, and growing psychological suffering. Responding to the new research need to go in-depth into the processes linking technostress and motivation dimensions to inform current research/interventions, the present study aimed to explore the direct effects of perceived Technostress dimensions (Techno-Overload, Work-Home Conflict, Pace of Change, Techno-Ease, Techno-Reliability, and Techno-Sociality) and Academic Motivation dimensions (Amotivation, Intrinsic, and Extrinsic Motivation dimensions) on students' perceived levels of Anxiety/Depression and test the potential indirect effect (mediating role) of Academic Motivation dimensions in the associations between Technostress and psychological health conditions., Methods: Overall, 1,541 students from five European countries (Czech Republic, Greece, Italy, Serbia, United Kingdom) completed a survey comprising a Background Information Form, the Technostress Scale, the Academic Motivation Scale-College, and the Hospital Anxiety and Depression Scale. Hayes' PROCESS tool was used to test direct and indirect (mediating) effects., Results: Data revealed that Techno-Overload, Work-Home Conflict, Amotivation, and Extrinsic Motivation-Introjected had a direct negative effect, whereas Techno-Ease, Techno-Reliability, Techno-Sociality, all Intrinsic Motivation dimensions, and Extrinsic Motivation-Identified had a direct protective role for students' psychological health. The significant indirect role of motivation dimensions in the associations between Technostress dimensions and Anxiety/Depression was fully supported., Discussion: Findings allow gaining further insight into the pathways of relationships between technostress, motivation, and psychological health, to be used in the current phase, featured by the complete restoration of face-to-face contacts, to inform the development of tailored research and interventions, which address lights and shadows of the technology use, and which take into account the necessity to enhance its potentials yet without impairing students' motivation and psychological health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Vallone, Galvin, Cattaneo Della Volta, Akhtar, Chua, Ghio, Giovazolias, Kazakou, Kritikou, Koutra, Kovacevic, Lee-Treweek, Mašková, Mavritsaki, Nastic, Plassova, Stuchlíková and Zurlo.)

Introduction: The transition from secondary to tertiary education seems to be a stressful period for many students since they need to adjust to the new academic environment., Method: This article is a systematic review of 4,285 articles. The aim of this review was to investigate the factors in the university environment associated with emotion regulation, academic buoyancy, and academic adjustment of tertiary students within a self-determination theory framework in combination with the nascent third wave of Positive Psychology. Forty-one articles met the inclusion criteria, all of which were rated as either good or moderate quality., Results: The bulk of the studies included in the systematic review reported individual factors, i.e., self-efficacy, intrinsic motivation, academic factors, i.e., intention to drop out, learning climate, and family and social factors i.e., faculty, peer, and parental autonomy support., Discussion: In accordance with the third wave of Positive Psychology that focuses on how interpersonal and ecological factors create nurturing environments and positive institutions, the systematic review highlighted the factors that institutes should consider in order to help students adjust better to the academic environment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kritikou and Giovazolias.)

The European Anaphylaxis Registry (NORA) was designed in order to create a comprehensive Anaphylaxis Registry regarding anaphylactic reactions characteristics and management in several European countries, including Greece. This study aims to analyze Greek data obtained in the NORA framework and describe anaphylaxis' characteristics in this pediatric cohort. An online questionnaire was filled out by the Allergy Unit of the 2nd Pediatric Department of NKUA, regarding reported anaphylaxis characteristics. A total of 284 pediatric patients were analyzed. Patients were predominantly male. A previous, mild reaction (59.5%) to the same allergen was documented in 44.4% of patients. The most common system involved was skin and/or mucosa, followed by the respiratory system. Food was the most common eliciting factor (82.4%). First line treatment was most administered solely by a healthcare professional, followed by a lay person (38.7%). Auto injected adrenaline use by lay persons was third in frequency (29.2%). Most patients received post-reaction counseling and appropriate drug prescription. This study provides insight in anaphylactic cases' characteristics and management in a Greek pediatric cohort. A low rate of adrenaline autoinjector administration was noted in lay people; however, drug prescription and counseling following the reaction could help increase correct acute anaphylaxis management in the future.

Bioinspired scaffolds mimicking natural bone-tissue properties holds great promise in tissue engineering applications towards bone regeneration. Within this work, a way to reinforce mechanical behavior of bioinspired bone scaffolds was examined by applying a physical crosslinking method. Scaffolds consisted of hydroxyapatite nanocrystals, biomimetically synthesized in the presence of collagen and l-arginine. Scaffolds were characterized by X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), microcomputed tomography, and nanoindentation. Results revealed scaffolds with bone-like nanostructure and composition, thus an inherent enhanced cytocompatibility. Evaluation of porosity proved the development of interconnected porous network with bimodal pore size distribution. Mechanical reinforcement was achieved through physical crosslinking with riboflavin irradiation, and nanoindentation tests indicated that within the experimental conditions of 45% humidity and 37 °C, photo-crosslinking led to an increase in the scaffold's mechanical properties. Elastic modulus and hardness were augmented, and specifically elastic modulus values were doubled, approaching equivalent values of trabecular bone. Cytocompatibility of the scaffolds was assessed using MG63 human osteosarcoma cells. Cell viability was evaluated by double staining and MTT assay, while attachment and morphology were investigated by SEM. The results suggested that scaffolds provided a cell friendly environment with high levels of viability, thus supporting cell attachment, spreading and proliferation.

Pancreatic cancer (PC) has an exceptionally low survival rate and primary prevention strategies are limited. Folate plays an important role in one-carbon metabolism and has been associated with the risk of several cancers, but not consistently with PC risk. We aimed to investigate the association between dietary folate intake and PC risk, using the standardised folate database across 10 European countries. A total of 477,206 participants were followed up for 11 years, during which 865 incident primary PC cases were recorded. Folate intake was energy-adjusted using the residual method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. In multivariable analyses stratified by age, sex, study centre and adjusted for energy intake, smoking status, BMI, educational level, diabetes status, supplement use and dietary fibre intake, we found no significant association between folate intake and PC risk: the HR of PC risk for those in the highest quartile of folate intake (≥353 μg/day) compared to the lowest (<241 μg/day) was 0.81 (95% CI: 0.51, 1.31; p trend = 0.38). In current smokers, a positive trend was observed in PC risk across folate quartiles [HR = 4.42 (95% CI: 1.05, 18.62) for ≥353 μg/day vs. <241 μg/day, p trend = 0.01]. Nonetheless, there was no significant interaction between smoking and dietary folate intake (p interaction = 0.99). We found no association between dietary folate intake and PC risk in this large European study., (© 2018 UICC.)

Objective: An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment., Method: A two-arm digital intervention with 269 men and 395 women (M age  = 41.2, SD age  = 11.45; range: 19-66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform., Results: Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes., Conclusion: FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount of planning. Initial motivation, as indicated by outcome expectancies, seemed to be beneficial for men. Self-efficacious individuals benefitted from their engagement in planning, but self-efficacy did not compensate for failing to plan.

We identified urinary polyphenol metabolite patterns by a novel algorithm that combines dimension reduction and variable selection methods to explain polyphenol-rich food intake, and compared their respective performance with that of single biomarkers in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The study included 475 adults from four European countries (Germany, France, Italy, and Greece). Dietary intakes were assessed with 24-h dietary recalls (24-HDR) and dietary questionnaires (DQ). Thirty-four polyphenols were measured by ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS-MS) in 24-h urine. Reduced rank regression-based variable importance in projection (RRR-VIP) and least absolute shrinkage and selection operator (LASSO) methods were used to select polyphenol metabolites. Reduced rank regression (RRR) was then used to identify patterns in these metabolites, maximizing the explained variability in intake of pre-selected polyphenol-rich foods. The performance of RRR models was evaluated using internal cross-validation to control for over-optimistic findings from over-fitting. High performance was observed for explaining recent intake (24-HDR) of red wine ( r = 0.65; AUC = 89.1%), coffee ( r = 0.51; AUC = 89.1%), and olives ( r = 0.35; AUC = 82.2%). These metabolite patterns performed better or equally well compared to single polyphenol biomarkers. Neither metabolite patterns nor single biomarkers performed well in explaining habitual intake (as reported in the DQ) of polyphenol-rich foods. This proposed strategy of biomarker pattern identification has the potential of expanding the currently still limited list of available dietary intake biomarkers., Competing Interests: The authors declare no conflict of interest.

Background: The relationship between body size and prostate cancer risk, and in particular risk by tumour characteristics, is not clear because most studies have not differentiated between high-grade or advanced stage tumours, but rather have assessed risk with a combined category of aggressive disease. We investigated the association of height and adiposity with incidence of and death from prostate cancer in 141,896 men in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort., Methods: Multivariable-adjusted Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average of 13.9 years of follow-up, there were 7024 incident prostate cancers and 934 prostate cancer deaths., Results: Height was not associated with total prostate cancer risk. Subgroup analyses showed heterogeneity in the association with height by tumour grade (P heterogeneity  = 0.002), with a positive association with risk for high-grade but not low-intermediate-grade disease (HR for high-grade disease tallest versus shortest fifth of height, 1.54; 95% CI, 1.18-2.03). Greater height was also associated with a higher risk for prostate cancer death (HR = 1.43, 1.14-1.80). Body mass index (BMI) was significantly inversely associated with total prostate cancer, but there was evidence of heterogeneity by tumour grade (P heterogeneity  = 0.01; HR = 0.89, 0.79-0.99 for low-intermediate grade and HR = 1.32, 1.01-1.72 for high-grade prostate cancer) and stage (P heterogeneity  = 0.01; HR = 0.86, 0.75-0.99 for localised stage and HR = 1.11, 0.92-1.33 for advanced stage). BMI was positively associated with prostate cancer death (HR = 1.35, 1.09-1.68). The results for waist circumference were generally similar to those for BMI, but the associations were slightly stronger for high-grade (HR = 1.43, 1.07-1.92) and fatal prostate cancer (HR = 1.55, 1.23-1.96)., Conclusions: The findings from this large prospective study show that men who are taller and who have greater adiposity have an elevated risk of high-grade prostate cancer and prostate cancer death.

In vitro and animal studies suggest that bioactive constituents of coffee and tea may have anticarcinogenic effects against cutaneous melanoma; however, epidemiological evidence is limited to date. We examined the relationships between coffee (total, caffeinated or decaffeinated) and tea consumption and risk of melanoma in the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a multicentre prospective study that enrolled over 500,000 participants aged 25-70 years from ten European countries in 1992-2000. Information on coffee and tea drinking was collected at baseline using validated country-specific dietary questionnaires. We used adjusted Cox proportional hazards regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the associations between coffee and tea consumption and melanoma risk. Overall, 2,712 melanoma cases were identified during a median follow-up of 14.9 years among 476,160 study participants. Consumption of caffeinated coffee was inversely associated with melanoma risk among men (HR for highest quartile of consumption vs. non-consumers 0.31, 95% CI 0.14-0.69) but not among women (HR 0.96, 95% CI 0.62-1.47). There were no statistically significant associations between consumption of decaffeinated coffee or tea and the risk of melanoma among both men and women. The consumption of caffeinated coffee was inversely associated with melanoma risk among men in this large cohort study. Further investigations are warranted to confirm our findings and clarify the possible role of caffeine and other coffee compounds in reducing the risk of melanoma., (© 2017 UICC.)

Flavonoids have been shown to inhibit colon cancer cell proliferation in vitro and protect against colorectal carcinogenesis in animal models. However, epidemiological evidence on the potential role of flavonoid intake in colorectal cancer (CRC) development remains sparse and inconsistent. We evaluated the association between dietary intakes of total flavonoids and their subclasses and risk of development of CRC, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cohort of 477,312 adult men and women were recruited in 10 European countries. At baseline, dietary intakes of total flavonoids and individual subclasses were estimated using centre-specific validated dietary questionnaires and composition data from the Phenol-Explorer database. During an average of 11 years of follow-up, 4,517 new cases of primary CRC were identified, of which 2,869 were colon (proximal = 1,298 and distal = 1,266) and 1,648 rectal tumours. No association was found between total flavonoid intake and the risk of overall CRC (HR for comparison of extreme quintiles 1.05, 95% CI 0.93-1.18; p-trend = 0.58) or any CRC subtype. No association was also observed with any intake of individual flavonoid subclasses. Similar results were observed for flavonoid intake expressed as glycosides or aglycone equivalents. Intake of total flavonoids and flavonoid subclasses, as estimated from dietary questionnaires, did not show any association with risk of CRC development., (© 2016 UIC.)

Background: Adherence to a Mediterranean diet (MD) has been quantified through various indexes that rely on full-length questionnaires, but their application in data collected with brief questionnaires has not been systematically investigated. Objective: We aimed to evaluate the ability of the commonly used MD score (MDS) to classify individuals according to their adherence to an MD when applied to data collected with brief questionnaires. Methods: We assessed the diet of 200 participants from a Greek national health survey with the use of 2 instruments: 1 ) a validated, detailed food-frequency questionnaire (FFQ) estimating grams per day of intake of individual foods and 2 ) a selection of 19 questions from the Baseline Nutrition Credits4Health (BNC4H) electronic platform questionnaire that assessed servings with subjective serving sizes. We calculated the MDS&#95;FFQ (referent) and MDS&#95;BNC4H indexes from each questionnaire and estimated their correlation and the percentage of study participants who were ranked in an identical tertile in both indexes. We repeated the analyses for 2 additional indexes defined with criteria different from the MDS [Mediterranean Diet Index (MDI)&#95;BNC4H and Mediterranean Diet Assessment Score (MEDAS)&#95; BNC4H]. Results: Spearman correlation coefficients for the MDS&#95;FFQ were 0.31 with the MDS&#95;BNC4H, 0.24 with the MDI&#95;BNC4H, and 0.23 with the MEDAS&#95;BNC4H. The proportion of participants ranked into the same adherence level as the referent MDS&#95;FFQ was 50% for the MDS&#95;BNC4H (weighted κ = 0.27) and lower for the other indexes. The use of medians as cutoffs (as in the MDS&#95;FFQ) had low discriminative ability when applied to servings per day (MDS&#95;BNC4H) in some MDS components, leading to comparability problems in the range of values between the 2 indexes. Conclusions: Our findings highlight certain issues that need to be considered when applying pre-existing MD indexes in settings with different dietary assessments. Given the widespread use of electronic platforms for dietary assessment, our results may offer further insight into designing brief, simplified questionnaires that aim to estimate MD adherence with easily quantifiable scores.

This study examined the association between physical fitness and a technical execution score in rhythmic gymnasts varying in the performance level. Forty-six young rhythmic gymnasts (age: 9.9 ±1.3 years) were divided into two groups (qualifiers, n=24 and non-qualifiers, n=22) based on the results of the National Championships. Gymnasts underwent a series of physical fitness tests and technical execution was evaluated in a routine without apparatus. There were significant differences between qualifiers and non-qualifiers in the technical execution score (p=0.01, d=1.0), shoulder flexion (p=0.01, d=0.8), straight leg raise (p=0.004, d=0.9), sideways leg extension (p=0.002, d=0.9) and body fat (p=.021, d=0.7), but no differences were found in muscular endurance and jumping performance. The technical execution score for the non-qualifiers was significantly correlated with shoulder extension (r=0.423, p<0.05), sideways leg extension (r=0.687, p<0.01), push ups (r=0.437, p<0.05) and body fat (r=0.642, p<0.01), while there was only one significant correlation with sideways leg extension (r=0.467, p<0.05) for the qualifiers. Multiple regression analysis revealed that sideways leg extension, body fat, and push ups accounted for a large part (62.9%) of the variance in the technical execution score for the non-qualifiers, while for the qualifiers, only 37.3% of the variance in the technical execution score was accounted for by sideways leg extension and spine flexibility. In conclusion, flexibility and body composition can effectively discriminate between qualifiers and non-qualifiers in youth rhythmic gymnastics. At the lower level of performance (non-qualifiers), physical fitness seems to have a greater effect on the technical execution score.

Background: Chronic inflammation and oxidative stress are thought to be involved in colorectal cancer development. These processes may contribute to leakage of bacterial products, such as lipopolysaccharide (LPS) and flagellin, across the gut barrier. The objective of this study, nested within a prospective cohort, was to examine associations between circulating LPS and flagellin serum antibody levels and colorectal cancer risk., Methods: A total of 1,065 incident colorectal cancer cases (colon, n = 667; rectal, n = 398) were matched (1:1) to control subjects. Serum flagellin- and LPS-specific IgA and IgG levels were quantitated by ELISA. Multivariable conditional logistic regression models were used to calculate ORs and 95% confidence intervals (CI), adjusting for multiple relevant confouding factors., Results: Overall, elevated anti-LPS and anti-flagellin biomarker levels were not associated with colorectal cancer risk. After testing potential interactions by various factors relevant for colorectal cancer risk and anti-LPS and anti-flagellin, sex was identified as a statistically significant interaction factor (Pinteraction < 0.05 for all the biomarkers). Analyses stratified by sex showed a statistically significant positive colorectal cancer risk association for men (fully-adjusted OR for highest vs. lowest quartile for total anti-LPS + flagellin, 1.66; 95% CI, 1.10-2.51; Ptrend, 0.049), whereas a borderline statistically significant inverse association was observed for women (fully-adjusted OR, 0.70; 95% CI, 0.47-1.02; Ptrend, 0.18)., Conclusion: In this prospective study on European populations, we found bacterial exposure levels to be positively associated to colorectal cancer risk among men, whereas in women, a possible inverse association may exist., Impact: Further studies are warranted to better clarify these preliminary observations., (©2016 American Association for Cancer Research.)

The role of amount and type of dietary fat consumption in the etiology of hepatocellular carcinoma (HCC) is poorly understood, despite suggestive biological plausibility. The associations of total fat, fat subtypes and fat sources with HCC incidence were investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which includes 191 incident HCC cases diagnosed between 1992 and 2010. Diet was assessed by country-specific, validated dietary questionnaires. A single 24-hr diet recall from a cohort subsample was used for measurement error calibration. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated from Cox proportional hazard models. Hepatitis B and C viruses (HBV/HCV) status and biomarkers of liver function were assessed separately in a nested case-control subset with available blood samples (HCC = 122). In multivariable calibrated models, there was a statistically significant inverse association between total fat intake and risk of HCC (per 10 g/day, HR = 0.80, 95% CI: 0.65-0.99), which was mainly driven by monounsaturated fats (per 5 g/day, HR = 0.71, 95% CI: 0.55-0.92) rather than polyunsaturated fats (per 5 g/day, HR = 0.92, 95% CI: 0.68-1.25). There was no association between saturated fats (HR = 1.08, 95% CI: 0.88-1.34) and HCC risk. The ratio of polyunsaturated/monounsaturated fats to saturated fats was not significantly associated with HCC risk (per 0.2 point, HR = 0.86, 95% CI: 0.73-1.01). Restriction of analyses to HBV/HCV free participants or adjustment for liver function did not substantially alter the findings. In this large prospective European cohort, higher consumption of monounsaturated fats is associated with lower HCC risk., (© 2015 UICC.)