The second lecture of the current IPH series (2021-2022) was dedicated to a highly prevalent, public health threat  of the 21^st century; Childhood obesity and type 2 diabetes mellitus.

Professor of Pediatric and Adolescents Endocrinology of National & Kapodistrian University of Athens, Mrs Evangelia Charmandari presented the increased prevalence of both conditions, amongst both children and adolescents. According to recent international data, obesity causes more deaths than malnutrition and obese children run a far greater risk for cardio-vascular diseases during their adulthood.

In Greece, 30-35% of children and adolescents are overweight and obese, the higher rate observed in the rest European countries and the United States of America.

Professor Charmandari presented the benefits of using high information technology and big data aggregation as essential tools aiming to tackle the problem and develop preventive health policies.

During the 4-year project BigO, useful information was collected through smartwatches and smartphones, regarding behavior, physical activities, nutritional habits and the living environment of the participating children. Preliminary observations showed that children who participated in the program were more likely to understand the added value of a healthy lifestyle, which they adopted ever since.

Long-COVID and COVID-19 implications, in all age groups including in asymptomatic COVID-19 patients, can only be prevented with worldwide mass vaccination; That was the unanimous message delivered by all three speakers of the October 6 online Round Table Discussion entitled “Important post COVID19 implications,” which opened the 7th Lecture Series of the Institute of Public Health, ACG.

Professor of Pulmonology Mr. Nikos Tzanakis, Professor of Neurology and President of the Hellenic Neurological Society Mr. Georgios Tsivgoulis and Professor Emeritus of Psychiatry Mr. Pavlos Sakkas approached the COVID-19 symptomatology, risks and implications from their specialty’s perspective. According to the current data, 1 in 4 patients will present respiratory impairment and while the majority of patients will improve, 5% will eventually progress to pulmonary fibrosis.

One-third of the patients presents neurological disorders that are considered reversible and are expected to improve in the course of the 6 months following the disease.

Furthermore, patients may also experience anxiety, irritability, depression, sleep disorders, psychosis and post-traumatic stress disorder. Referring specifically to children’s reactions, Prof. Sakkas seemed to be reassuring about their adaptive skills towards any kind of challenge, even though they, too, have been affected by the changes brought to their life by the pandemic measures.

The Institute of Public Health of the American College of Greece has released their 2021-2022 program for the 7th Series of Lectures on Public Health.

Every month, scientists and academics will share the most up-to-date information on current and emerging health topics. The lectures are of interest to healthcare professionals but also to the public who will benefit from information on how to prevent disease through healthy practices.

The 7th series of Lectures will open on Wednesday October 6th at 18:30, with an online Round Table Discussion entitled “Important Post COVID-19 Implications”.

• Post COVID-19 Lung Injury: Complications & Prognosis
  Nikos Tzanakis
  Professor of Pulmonology, School of Medicine, University of Crete

• Post COVID-19 Neurological Disorders
  Georgios Tsivgoulis
  Professor & Chairman of Second Department of Neurology, School of Medicine, National & Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece

• Post COVID-19 Effect on Mental Health of Patients & Society
  Pavlos Sakkas
  Professor Emeritus, Psychiatry, School of Medicine, National & Kapodistrian University of Athens

Moderator: Prof.Panagiotis Behrakis
Pulmonologist – Intensivist
Director, Institute of Public Health, The American College of Greece

The Round Table Discussion will be broadcasted live in the Institute of Public Health, The American College of Greece Facebook page and Youtube https://youtu.be/2REqjCaC02c

All Lectures, delivered in greek, are open to public and free of charge. Each lecture includes a discussion period at the end of the session, where guests are encouraged to ask their most pressing questions on the specific health topic.

Lectures are credited by the Pan-Hellenic Medical Association for continuing medical education (CME-CPD credits) and by the Hellenic Regulatory Body of Nurses (Ε.Ν.Ε)for Continuing Nursing Education.

Υou may attend the lecture on schedule, without any charge, live or later on, at your own convenience through the Institute of Public Health, The American College of Greece Facebook page and the Institute of Public Health – ACG Youtube channel. Once the lecture is completed, the video will also be uploaded and available on the IPH Youtube channel. All IPH lectures are held in Greek.

If you are a physician or a registered nurse, you can claim the CME credits by responding the online questionnaire (), after the completion of the lecture. The certification of attendance including the CME credits will be sent to your e-mail, as soon as possible.

All other attendees can claim the certification of attendance by simply e-mailing their request (including their full name) to iph@acg.edu.

If you wish to subscribe to our contact list for notifications about future lectures and other activities, please send us your request including your consent and information (Name-Surname-Occupation-Telephone number [optional]) to iph@acg.edu.

Click here for the final program for 2021-2022
Click here for more information of each lecture of the 7th Series of Lectures (updated after their implementation)
Click here to watch videos of past lectures in the IPH YouTube channel

“I choose NOT to smoke” was the simple but strong message addressed to the Greek society during the event organized by the Hellenic Ministry of Health, in the context of the World No Tobacco Day on Monday, May 31, 2021.  The event was broadcasted live from the Acropolis Museum while a few, distinguished, honorary guests were physically present, due to the ongoing pandemic restrictions.

H.E. the President of the Hellenic Republic, Mrs Katerina Sakellaropoulou addressed the audience with a short greeting honoring the World No Tobacco Day. The Minister of Education & Religious Affairs, Mrs Niki Kerameus, the Minister of Health, Mr Vassilis Kikilias, the Deputy Minister of Health, Mrs Zoi Rapti, The General Secretary of the Ministry of Health, Mr Panagiotis Prezerakos, the President of the Hellenic National Public Health Organization, Mr. Panagiotis Arkoumaneas and representatives of opposition political parties presented their viewpoints, concerns and vision on tobacco control in Greece.

Prof. Panagiotis Behrakis, Director of the Institute of Public Health, The American College of Greece and Chair of the Committee of Experts on Tobacco of the Greek Ministry of Health, coordinated the entire event. During his opening speech, Prof. Behrakis underlined the remarkable decline of smoking prevalence in Greece during 2009-2019 (24,5%). According to the data of the Hellenic Statistical Authorities, the decline is even more exceptional (52,4%) for the population group aged 16-24 years old. During the second part of the event, acclaimed guest speakers delivered lectures on tobacco prevention and cessation, tobacco control policies and the major public health risk due to tobacco use. Prof. Behrakis presented detailed national data on the smoking prevalence decline achieved over the last decade, the profile characteristics of the Greek smoker, as well as the most recent data about smoking attitude of the Greek population during the pandemic. As he mentioned, the pandemic had a negative but, fortunately, small impact on the smoking prevalence decline in Greece.

The President of the American College of Greece, Dr. David G. Horner, honorary guest of the Ministry of Health, addressed the audience with a short message, during which he paid tribute to the pioneering pillars of the College, ever since its establishment in Asia Minor, as an economic, cultural and social impact to the Greek society. Dr. Horner acknowledged the vision of the Greek-American entrepreneur and philanthropist George D. Behrakis, materialized by the establishment and documented work of the ACG Institute of Public Health (IPH), which is fully funded by the Behrakis Foundation in Boston. Mentioning the recent smoking prevalence decline in Greece, he congratulated Prof. Behrakis and the IPH team for “making a positive difference for the people in Greece”.

The event was held in greek:

World Immunization Week 2021 bears a special importance and particular significance as the world navigates through the waves of SARS-CoV-2 pandemic.

Looking back in the emergence of COVID-19 in the early rise of 2020, the global community, and especially so biomedical engineers and health scientists, wishing we already had a vaccine, raced against time to develop one. A unique, challenging race, and a first ever wide collaboration took place between biotechnological, pharmaceutical, medical and artificial intelligence experts with health and state authorities worldwide. The results justified the efforts. In less than a year research has led to the development and manufacture of several vaccines that are currently available and administered according to the vaccination schedule of each country.

COVID-19 Vaccines Global Access (COVAX), led by the World Health Organization (WHO) in collaboration with the Global Vaccine Alliance (Gavi), the Coalition for Epidemic Preparedness Innovations (CEPI) and UNICEF, aims to ensure equal access for all countries worldwide¹. “A global pandemic requires a world effort to end it – none of us will be safe until everyone is safe”².

As of April 22, 2021³ 929,000,000 doses have been given globally, 213 million individuals are fully vaccinated representing 2,7% of the world population. In Greece, 2.6 million doses have been given, 774.000 individuals are fully vaccinated representing 7.2% of the Greek population.

Currently available vaccines against COVID-19 have been developed based on three different technologies; using a different vehicle, vaccines present the human organism the information to create the characteristic spike protein and train the immune system to fight SARS-CoV-2:

• Viral vector-based vaccines use a non-pathogenic (innocent) adenovirus to bring the information for the spike protein production: Astra Zeneca, Johnson & Johnson Janssen, Sputnik V
• mRNA based use the part of SARS-CoV-2 mRNA that contains the code for spike protein synthesis: Moderna, Pfizer-BioNTech
• Protein-based use directly the spike protein: Novavax (pending authorisation)

Most vaccinations lead to none or mild, self -limited symptoms (sore arm, fever, chills, myalgias), or less frequently allergic reactions.

However, a very rare type of adverse reaction has been recently observed, following millions of viral vector vaccine doses administered. The reaction involves a thrombosis with thrombocytopenia syndrome (TTS), in unusual sites, such as the cerebral venous sinus (CVST) and splanchnic vein thrombosis⁴. The syndrome is considered to be caused by the activation of an autoimmune mechanism, similar to the HIT (Heparin Induced Thrombocytopenia- observed in some individuals treated with heparin), thus termed VIIT (Vaccine Induced Immune Thrombosis with Thrombocytopenia)⁵.

Symptoms that might be linked to VIIT include breathlessness, chest pain, leg swelling, abdominal pain, persistent headache, blurred vision and petechiae (blood spots under the skin)⁶.

As per the 4^th April 2021 data, in a total of 34 million individuals having been vaccinated, 169 cases of CVST and 53 cases of splanchnic vein thrombosis including 18 fatalities, had been reported to EU drug safety database (EudraVigilance).

All cases were extensively reviewed by (PRAC) the EMA safety Committee, who stated that the syndrome is very rare and the benefits of vaccination outweigh the risk⁷.

To put things in perspective, the risk for VIIT is 1 case in 250.000 vaccinated people, while the risk for thrombosis by the contraceptive pill is 1 in 2000 and that of long air travel 1 in 1000/year⁸.

Furthermore, COVID-19 patients are at increased risk of developing thromboembolic disease. Specifically, the risk is estimated as 11.2% for deep vein thrombosis ,7.8% for pulmonary embolism, and 30% for thrombocytopenia, while 23% of those admitted in the intensive care unit will develop venous thromboembolism⁹.

Taking into consideration all facts and numbers it becomes evident that indeed the benefits outweigh the risks. Vaccination is the only effective way to prevent COVID-19, preserve our health and resume normalcy.

It happened so many times before for diseases unbeknown to the younger among us. 200 years of vaccination history and experience prove the benefits:

• Eradicate transmissible diseases and prevent future outbreaks
• Improve morbidity and mortality at an individual and population level
• Prevent disease, reduce disease severity and prolong life expectancy
• Create herd immunity protecting those who cannot be vaccinated (i.e infants)
• In preventing infectious diseases, vaccines also protect from certain types of cancer related to the initial infection (i.e HPV virus/cervical cancers among women)
• Prevent antibiotic resistance
• Reduce the financial burden on health care systems
• Vaccines are safer than disease and respective medical treatment

It is noteworthy that the current pandemic as difficult and challenging as it is, has given us some positive opportunities:

• The fast exchange and dissemination of medical knowledge as the disease was unfolding
• The fast development of tests, therapeutic protocols and vaccines
• The pharmacovigilance and safety protocols in real time function
• The vast, big data size of information collected, analysed and interpreted in no time
• The advanced technological abilities of our era and the fast forward boost to embrace new technologies in short time
• The amazing results of selflessness and volunteerism especially among healthcare workers
• The worldwide collaborative potential exhibited by countries, industries, scientific and technologic communities and philanthropists

In this global effort everybody has a role to protect their own health and the health of their fellow citizens, family and friends. When facing a transmittable disease, our best option and the most effective one is to get vaccinated.

“Prevention is better than cure” as Hippocrates said

References

¹ https://www.who.int/initiatives/act-accelerator/covax

² https://www.who.int/news-room/commentaries/detail/a-global-pandemic-requires-a-world-effort-to-end-it-none-of-us-will-be-safe-until-everyone-is-safe

³ https://www.google.com/search?q=who+covid+vaccination+statistics&rlz=1C5CHFA_enGR800GR800&oq=who+covid+vaccination+statistics&aqs=chrome..69i57j0i390l2j69i64.1570j0j15&sourceid=chrome&ie=UTF-8%20%E2%80%A6..

⁴ https://www.who.int/news/item/16-04-2021-global-advisory-committee-on-vaccine-safety-(gacvs)-review-of-latest-evidence-of-rare-adverse-blood-coagulation-events-with-astrazeneca-covid-19-vaccine-(vaxzevria-and-covishield)

⁵ Schultz NH, IH Sørvoll, AE Michelsen, LA Munthe, F Lund-Johansen, MT Ahlen, M Wiedmann, et al. 2021. “Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination”. The New England Journal of Medicine.

⁶ https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood

⁷ https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood

⁸ Mahase, Elisabeth. 2021. “AstraZeneca vaccine: Blood clots are “extremely rare” and benefits outweigh risks, regulators conclude”. BMJ. 373.

⁹ Tan BK, S Mainbourg, A Friggeri, L Bertoletti, M Douplat, Y Dargaud, C Grange, H Lobbes, S Provencher, and JC Lega. 2021. “Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis”. Thorax

The Institute of Public Health (IPH), The American College of Greece, organized an online event about the Blood safety and quality of blood in emergencies on Wednesday, March 17, 2021. The event featured a presentation by Constantina Politis, Associate Professor of Medicine, National and Kapodistrian University of Athens, Haematologist, Scientific Advisor of the Hellenic National Public Health Organization (EODY) and the Coordinating Haemovigilance Centre and Surveillance of Transfusion (SKAEM).

Prof. Politis strengthened the importance of healthy individuals donating blood, especially during the COVID-19 pandemic, since a significant reduction in blood collection was recorded, ranging from 10 to 35%. To cover increased needs, blood donations are organized outside the hospitals, in designated areas, under special precautionary measures and according to the strict instructions of the National Blood Donation Center and SKAEM, EODY.

Given the importance of blood transfusion as a therapeutic means for the treatment of many diseases and for medical interventions, Greece has implemented measures to ensure the effective utilization of blood resources.

Despite new concerns about emerging infectious diseases, resulting from climate change, global mobility and high population movements, the blood transfusion continues to be a safe procedure.

Find the program of the 6th Series of Lectures, 2020-2021 here

The event’s video (in greek):

The socio-economic impact of reduced birth rates in Greece, along with their causes, challenges and solutions were at the center of the panel discussion organized by the ACG – Institute of Public Health in collaboration with the NGO HOPEgenesis and with the support of the ACG Office of Public Affairs, on Thursday, February 25, 2021.

The event featured Deputy Minister for Health, Zoe Rapti, UNESCO Goodwill Ambassador and Founder/President of “ELPIDA Friends’ Association of Children with cancer” and “Marianna V. Vardinoyannis Foundation”, Marianna Vardinoyannis, Founder/President NGO HOPEgenesis, Stephanos Chandakas and the Dean of the School of Business & Economics of The American College of Greece Dr. Annie Triantafyllou. The discussion was moderated by Professor Panagiotis Behrakis, Director of the Institute of Public Health of The American College of Greece.

The panel speakers agreed that the demographic problem undermines the future of Greece, has serious consequences for economic development and endangers prosperity. Further, the current health crisis exacerbates the problem, as it increases insecurity and makes starting a family even more challenging. Economic hardship acts as a deterrent to childbearing plans for a large portion of the population, while it has also led to the migration of many couples of reproductive age. Deputy Minister Zoe Rapti mentioned that by 2050 the country’s population will have decreased to about 9 million, projecting that 35% of the population will be aged 65 and over, and by 2080 to 7.8 million, burdening significantly the social security system. Zoe Rapti elaborated on the government’s incentives to reverse the trend.

Women have taken on multiple roles to adapt to changes in society today, as explained by Mrs Vardinogiannis, whereas the lack of support in their work environment and limited access to health services for people living in remote areas, all contribute to low birth rates.

Stefanos Chandakas noted that the family should be approached by society as a pole of growth and development and in the absence of measures the future cost for the country will be much higher.

Dr. Triantafyllou stressed that social stability enhances financial security and vice versa and highlighted the role of partnerships between the public and private sectors in securing an innovative and flexible framework of support to young families.

You can watch the event in the following video (the event was held in greek):

Smoking is associated with COVID-19, by enabling the spreading of the virus and making the human organism more susceptible to the virus.

Use of tobacco and novel tobacco products increases:

• hand – mouth contact by 200 times/day
• hand contact with potentially infectious objects (cigarette packet, lighter, ash trays, vaping devices…)
• makes the use of face mask problematic
• impairs the respiratory system defence mechanisms
• leads to frequent bronchial and lung infections (ex: influenza and common cold viruses)
• increases micro-particulate environmental pollution and facilitates virus’ ability to travel longer

Increased SARS CoV-2 spreading from asymptomatic and pro-symptomatic smokers can be
due to:

• chronic cough and expectoration (COPD)
• environmental pollution by cigarette butts, ashtrays, passive smoking
• frequent smoking at home due to quarantine, leading to increased passive exposure of non-smokers and children

A study by Yuying et al¹. showed how smokers help the spread of SARS-CoV-2

A study by Gaiha et al.² showed the association between smoking and COVID-19

WHO sums all the information on the graph below³

References

¹ Sun, Yuying, Tai Hing Lam, Yee Tak Derek Cheung, Man Ping Wang, Yongda Wu, Jianjiu Chen, Xiaoyu Zhang, William H. C. Li, and Sai Yin Ho. 2021. “First Report on Smoking and Infection Control Behaviours at Outdoor Hotspots during the COVID-19 Pandemic: An Unobtrusive Observational Study”. International Journal of Environmental Research and Public Health. 18 (3): 1031.

² Gaiha S.M., Halpern-Felsher B., and Cheng J. 2020. “Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19”. Journal of Adolescent Health. 67 (4): 519-523.

³ https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/resources-for-tobacco-use-control-as-part-of-covid-19-response/infographic-coronavirus-covid-19-and-tobacco-use

Press Release of the Experts Committee of the Ministry of Health for Tobacco Control

According to the Hellenic Statistical Authority data*, an impressive smoking decrease has been documented in Greece during the decade 2009-2019. More specifically, in September 2019 smoking prevalence among adult population was 24.9% for daily smokers (more than one cigarette per day) and 3.7% for occasional smokers (less than 7 cigarettes per week). A comparison of three surveys conducted by the Hellenic Statistical Authority in 8500 households in 2009, 2014 and 2019, shows a decrease of daily smokers by 24.5% and occasional smokers by 38.3% (diagram 1).

Even more impressive are the results among individuals younger than 24 years old. As it is depicted in diagram 2, the overall decrease in this age group was 52,4%, a finding positively related to the ten-year implementation of the SMOKEFREEGREECE initiative, funded by the George D. Behrakis Foundation for smoking prevention in school age children.

The Experts Committee of the Ministry of Health for Tobacco Control express their sincere congratulations to the educational community and to the successful cooperation between the Ministries of Health and Education and Religion in the field of smoking prevention. The aforementioned effort, if continued as such, will be considered the most successful in Europe and will rank Greece among the countries of the European Union that essentially pursue the goal of a total smoking prevalence less than 5% by 2040.

*the data of 2019 were announced by Hellenic Statistical Authority on December 18^th , 2020

The President: Panagiotis Behrakis

 The members:
Athena Kalokairinou
Anna Kokkevi
George Balafoutis
Eleana Stoufi
Panagiotis Tsanakas
George Chrousos

The President of the Experts Committee of the Ministry of Health for Tobacco Control and Director of the Institute of Public Health -The American College of Greece, Professor Panagiotis Behrakis referring to the Hellenic Statistical Authority’s (ELSTAT) Health survey, stated that the results:

• confirm the findings of recent surveys conducted by the Institute of Public Health-ACG that show a significant decline of smoking prevalence in Greece, as well as those of respective European surveys
• raise questions in regards to the World Health Organization’s sources reliability, since a recent WHO publication depicts Greece as a nation of smokers with a smoking prevalence over 42%

Closing, Professor Behrakis affirmed that Greece meets the European Union goal for smoking prevalence reduction with great success and will intensively continue the SMOKEFREEGREECE initiative implementation towards this mission.

The Institute of Public Health (IPH), The American College of Greece, organized an online event about the education and preventive measures to avoid severe accidents in children and adolescents on Wednesday, January 20, 2021. The event featured a presentation by Anastassios Hatzis, Pediatric Intensivist, Former PICU Director “Agia Sofia” Children’s Hospital, Athens, Greece.

Did you know that accident-related injuries are the leading cause of children’s death in developed countries, including Greece and that 80% of serious household accidents occur at the inside of the home, mostly in the living room and the bedroom?

Dr Hatzis pointed out that suffocation, drowning, poisoning, burns, falls and violence can endanger the life of children and adolescents or even cause them permanent disabilities. Statistic data on serious accidents show that the majority of accidents (63%) happen while children play, especially at home and less outside i.e. in schools, playgrounds or other venues.

Adopting precautionary and protection measures, such as educate adults both parents and teachers to learn how to give first aid and apply the Heimlich maneuver, create safe spaces, increase targeted supervision of teachers both in the classroom and during breaks, could lead to a significant decrease in accidents. Concerning health services, Greece needs additional pediatric intensive care units, in order to accommodate proper and immediate treatment.

Find the program of the 6th Series of Lectures, 2020-2021 here

The event’s video (in greek):