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Sökning: WFRF:(Petridou Eleni Th.)

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2.
  • Georgakis, Marios K., et al. (författare)
  • Age at menopause and duration of reproductive period in association with dementia and cognitive function : A systematic review and meta-analysis
  • 2016
  • Ingår i: Psychoneuroendocrinology. - 0306-4530 .- 1873-3360. ; 73, s. 224-243
  • Forskningsöversikt (refereegranskat)abstract
    • <p>Introduction: The preponderance of dementia among postmenopausal women compared with same-age men and the female sex hormones neuroprotective properties support a tentative role of their deficiency in the dementia pathogenesis. Methods: Pairs of independent reviewers screened 12,323 publications derived from a search strategy for MEDLINE to identify articles investigating the association of age at menopause/reproductive period with (i) dementia and (ii) cognitive function; a snowball of eligible articles and reviews was conducted and authors were contacted for additional information. Random-effect models were used for the meta analysis. Results: Age at menopause (13 studies; 19,449 participants) and reproductive period (4 studies; 9916 participants) in the highest categories were not associated with odds of dementia (effect size [ES]: 0.97 [0.78-1.21]) and Alzheimer's disease (ES: 1.06 [0.71-1.58]). Significant heterogeneity was however noted in both analyses (12: 63.3%, p = 0.003 and 12: 72.6%, p = 0.01, respectively). Subgroup analyses by outcome assessment, study design, level of adjustment and study quality did not materially change the findings. In 9/13 studies assessing cognitive function, advanced age at menopause/longer reproductive period was significantly associated with better cognitive performance/lower decline. Due to statistical differences, no meta-analysis was possible for cognitive function. Conclusions: Existing evidence does not support an association between indices of prolonged exposure to female hormones and lower dementia risk. There are indications, however, for better cognitive performance and delayed cognitive decline, supporting a link between female hormone deficiency and cognitive aging. Current literature limitations, indicated by the heterogeneous study-set, point towards research priorities in this clinically relevant area.</p>
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3.
  • Georgakis, Marios K, et al. (författare)
  • Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause : A Systematic Review and Meta-analysis
  • 2016
  • Ingår i: JAMA psychiatry. - 2168-6238 .- 2168-622X. ; 73:2, s. 139-149
  • Forskningsöversikt (refereegranskat)abstract
    • <p><strong>Importance:</strong> Estrogens have neuroprotective and antidepressive effects; however, associations between indices of reduced endogenous estrogens and risk for postmenopausal depression have not been systematically explored.</p><p><strong>Objective:</strong> To investigate the association of age at menopause and the duration of the reproductive period with the risk for depression among postmenopausal women with naturally occurring menopause.</p><p><strong>Data Sources:</strong> A search strategy for use of MEDLINE was developed (through January 1, 2015) using the key terms menopause, climacteric, reproductive period, depression, and mood disorders. References of included studies and reviews were also screened; authors were contacted to maximize synthesized evidence.</p><p><strong>Study Selection:</strong> A total of 12 323 articles, without language restriction, were screened by pairs of reviewers to identify observational studies related to the study hypothesis; 14 studies were eligible for meta-analysis.</p><p><strong>Data Extraction and Synthesis:</strong> Pairs of reviewers independently extracted information on study design and type of analysis by participants' characteristics and methods of depression ascertainment. Study quality was assessed using the Newcastle-Ottawa Scale, and fixed- or random-effects models were implemented.</p><p><strong>Main Outcomes and Measures:</strong> Pooled-effect estimates for depression, defined by psychiatric evaluation or validated instruments, by age at menopause and duration of the reproductive period.</p><p><strong>Results:</strong> The 14 studies included in the meta-analysis represented 67 714 women. An inverse association (reported as odds ratio [OR]; 95% CI of 2-year increments) with depression in postmenopausal women was shown for increasing age at menopause (0.98; 0.96-0.99 [67 434 unique participants; 13 studies]) and duration of the reproductive period (0.98; 0.96-0.99 [54 715 unique participants; 5 studies]). Menopause at age 40 or more years compared with premature menopause was associated with a 50% decreased risk for depression (3033 unique participants; 4 studies). Pooling of studies examining severe depression showed a 5% decrease in risk of severe depression with increasing (2-year increment) age at menopause (52 736 unique participants; 3 studies); sensitivity analysis of studies controlling for past depression revealed similar results for age at menopause (0.98; 0.96-1.00 [48 894 unique participants; 3 studies). No heterogeneity or publication bias was evident in the main analyses.</p><p><strong>Conclusions and Relevance:</strong> Longer exposure to endogenous estrogens, expressed as older age at menopause and longer reproductive period, is associated with a lower risk of depression in later life. Identifying women at higher risk for depression due to early menopause who could benefit from psychiatric intervention or estrogen-based therapies could be useful in the clinical setting.</p>
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4.
  • Georgakis, Marios K, et al. (författare)
  • Comorbidity of Cognitive Impairment and Late-Life Depression Increase Mortality : Results From a Cohort of Community-Dwelling Elderly Individuals in Rural Greece
  • 2016
  • Ingår i: Journal of Geriatric Psychiatry and Neurology. - 0891-9887 .- 1552-5708. ; 29:4, s. 195-204
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>OBJECTIVE:</strong> To investigate the association of cognitive impairment (COGI) and depression with all-cause mortality and cardiovascular-specific mortality among community-dwelling elderly individuals in rural Greece.</p><p><strong>METHODS:</strong> Cognition and depressive symptomatology of 676 Velestino town residents aged ≥60 years were assessed using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Eight-year all-cause mortality and cardiovascular mortality were explored by multivariate Cox regression models controlling for major confounders.</p><p><strong>RESULTS:</strong> Two hundred and one patients died during follow-up. Cognitive impairment (MMSE ≤ 23) was independently associated with all-cause mortality (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.13-2.18) and cardiovascular mortality (HR: 1.57, 95%CI: 1.03-2.41). Moderate to severe depression (GDS &gt; 10) was significantly associated only with a 51% increase in all-cause mortality. A male-specific association was noted for moderate to severe depression, whereas the effect of COGI was limited to females. Noteworthy, COGI and depression comorbidity, rather than their sole presence, increased all-cause mortality and cardiovascular mortality by 66% and 72%, respectively. The mortality effect of COGI was augmented among patients with depression and of depression among patients with COGI.</p><p><strong>CONCLUSION:</strong> COGI and depression, 2 entities often coexisting among elderly individuals, appear to increase all-cause mortality and cardiovascular mortality. Gender-specific modes may prevail but their comorbidity should be carefully assessed, as it seems to represent an independent index of increased frailty, which eventually shortens life expectancy.</p>
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5.
  • Cook, Michael B, et al. (författare)
  • Tobacco and Alcohol in Relation to Male Breast Cancer: An Analysis of the Male Breast Cancer Pooling Project Consortium.
  • 2015
  • Ingår i: Cancer Epidemiology Biomarkers & Prevention. - American Association for Cancer Research. - 1538-7755. ; 24:3, s. 520-531
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The etiology of male breast cancer is poorly understood, partly due to its relative rarity. Although tobacco and alcohol exposures are known carcinogens, their association with male breast cancer risk remains ill-defined. Methods: The Male Breast Cancer Pooling Project consortium provided 2,378 cases and 51,959 controls for analysis from 10 case-control and 10 cohort studies. Individual participant data were harmonized and pooled. Unconditional logistic regression was used to estimate study design-specific (case-control/cohort) odds ratios (OR) and 95% confidence intervals (CI), which were then combined using fixed effects meta-analysis. Results: Cigarette smoking status, smoking pack-years, duration, intensity, and age at initiation were not associated with male breast cancer risk. Relations with cigar and pipe smoking, tobacco chewing, and snuff use were also null. Recent alcohol consumption and average grams of alcohol consumed per day were also not associated with risk; only one sub-analysis of very high recent alcohol consumption (>60 grams/day) was tentatively associated with male breast cancer (ORunexposed referent=1.29, 95%CI:0.97-1.71; OR>0-<7 g/day referent=1.36, 95%CI:1.04-1.77). Specific alcoholic beverage types were not associated with male breast cancer. Relations were not altered when stratified by age or body mass index. Conclusions: In this analysis of the Male Breast Cancer Pooling Project we found little evidence that tobacco and alcohol exposures were associated with risk of male breast cancer. Impact: Tobacco and alcohol do not appear to be carcinogenic for male breast cancer. Future studies should aim to assess these exposures in relation to subtypes of male breast cancer.
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7.
  • Georgakis, Marios K., et al. (författare)
  • Surgical menopause in association with cognitive function and risk of dementia : A systematic review and meta-analysis
  • 2019
  • Ingår i: Psychoneuroendocrinology. - PERGAMON-ELSEVIER SCIENCE LTD. - 0306-4530 .- 1873-3360. ; 106, s. 9-19
  • Forskningsöversikt (refereegranskat)abstract
    • <p>Introduction: Experimental and epidemiological studies suggest female sex hormones to have long-lasting neuroprotective and anti-ageing properties. Surgically-induced menopause leads to a premature cessation of exposure to female sex hormones and could thus impact late-life cognitive function. Yet, evidence remains controversial. Methods: We systematically reviewed literature for articles investigating the association of surgical menopause (defined as bilateral oophorectomy before the onset of menopause) with risk of dementia, cognitive performance, cognitive decline, and Alzheimer's disease neuropathological indices later in life. We evaluated study quality with the Newcastle-Ottawa scale and performed random-effects meta-analyses. Results: We identified 11 eligible studies (N = 18,867). Although surgical menopause at any age was not associated with risk of dementia (4 studies; HR: 1.16, 95%CI: 0.96-1.43), early surgical menopause (&lt;= 45 years of age) was associated with a statistically significantly higher risk (2 studies; HR: 1.70, 95%CI: 1.07-2.69). Surgical menopause at any age was associated with faster decline in verbal memory, semantic memory, and processing speed, whereas early surgical menopause was further associated with faster global cognitive decline. No heterogeneity was noted. Among women undergoing surgical menopause, a younger age at surgery was associated with faster decline in global cognition, semantic and episodic memory, worse performance in verbal fluency and executive function, and accumulation of Alzheimer's neuropathology. Conclusions: Current evidence is limited, but suggests surgical menopause induced by bilateral oophorectomy at &lt;= 45 years of age to be associated with higher risk of dementia and cognitive decline. Additional large-scale cohort studies are necessary to replicate these findings.</p>
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8.
  • Georgakis, Marios K., et al. (författare)
  • Validation of TICS for detection of dementia and mild cognitive impairment among individuals characterized by low levels of education or illiteracy : a population-based study in rural Greece
  • 2017
  • Ingår i: Clinical Neuropsychologist (Neuropsychology, Development and Cognition : Section D). - 1385-4046 .- 1744-4144. ; 31, s. 61-71
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective: The efficacy of the most widely used tests for dementia screening is limited in populations characterized by low levels of education. This study aimed to validate the face-to-face administered Telephone Interview for Cognitive Status (TICS) for detection of dementia and mild cognitive impairment (MCI) in a population-based sample of community dwelling individuals characterized by low levels of education or illiteracy in rural Greece. Methods: The translated Greek version of TICS was administered through face-to-face interview in 133 elderly residents of Velestino of low educational level (&lt;12years). We assessed its internal consistency and test-retest reliability, its correlation with sociodemographic parameters, and its discriminant ability for cognitive impairment and dementia, as defined by a brief neurological evaluation, including assessment of cognitive status and level of independence. Results: TICS was characterized by adequate internal consistency (Cronbach's : .72) and very high test-retest reliability (intra-class correlation coefficient: .93); it was positively correlated with age and educational years. MCI and dementia were diagnosed in 18 and 10.5% of the population, respectively. Its discriminant ability for detection of dementia was high (Area under the curve, AUC: .85), with a sensitivity and specificity of 86 and 82%, respectively, at a cut-off point of 24/25. TICS did not perform well in differentiating MCI from cognitively normal individuals though (AUC: .67). Conclusion: The directly administered TICS questionnaire provides an easily applicable and brief option for detection of dementia in populations of low educational level and might be useful in the context of both clinical and research purposes.</p>
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9.
  • Mavromatis, Ioannis D., et al. (författare)
  • Validity of intraoperative gross examination of myometrial invasion in patients with endometrial cancer : a meta-analysis
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 91:7, s. 779-793
  • Forskningsöversikt (refereegranskat)abstract
    • <p>Objective. The current recommended endometrial cancer surgical treatment is abdominal extrafascial total hysterectomy with bilateral salpingo-oophorectomy followed by pelvic lymphadenectomy if &gt;50% myometrial invasion is estimated by intraoperative gross examination (IGE). This meta-analysis aims to quantify evidence regarding the validity/predictive value of IGE staging compared with final histology. Design. Meta-analysis of studies published until October 2011. Setting. Systematic search, according to PRISMA guidelines, of the six major medical literature databases Medline, Scopus, EMBASE, Google Scholar, Ovid, Cochrane. Population. Sixteen eligible studies including 2567 endometrial cancer patients. Methods. Pooled sensitivity/specificity, accuracy, negative/positive predictive value (NPV/PPV) and diagnostic odds ratio (DOR) of IGE were calculated and the summary receiver operator characteristic (sROC) curve was constructed. A meta-regression analysis was used to explore the role of potential modifiers of sensitivity and specificity. Main outcome measures. Pooled diagnostic measures of IGE indices. Results. Sixteen studies (15 retrospective, one prospective) meeting the inclusion criteria were qualitatively analyzed. Pooled IGE estimates were: sensitivity = 0.75 (95%CI: 0.720.78), specificity = 0.92 (95%CI 0.900.94), accuracy = 0.87 (95%CI 0.860.88), NPV = 0.89 (95%CI 0.870.92), PPV = 0.80 (95%CI 0.760.84) and DOR = 36.9 (95%CI 28.747.4). No significant modifiers were identified for sensitivity or specificity. Conclusions. The synthesized measures presented here for the first time showed that accuracy, sensitivity and specificity of IGE were 87, 75 and 92%, respectively, which indicates that IGE is useful for estimating depth of myometrial invasion and staging of endometrial cancer in clinical practice. The degree to which the relatively low values of some of its performance indicators could be improved remains to be elucidated in order for the values to be comparable with those from frozen section biopsies.</p>
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10.
  • Michelakos, Theodoros, et al. (författare)
  • Serum Folate and B12 Levels in Association With Cognitive Impairment Among Seniors : Results From the VELESTINO Study in Greece and Meta-Analysis
  • 2013
  • Ingår i: Journal of Aging and Health. - 0898-2643 .- 1552-6887. ; 25:4, s. 589-616
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective: To summarize existing evidence on the effect of serum folate and vitamin B12 levels on cognitive impairment among elders via a meta-analysis, also including unpublished data from a cross-sectional study of seniors ( &gt; 65 years) residing in Velestino, Greece. Method: Serum measurements and Mini-Mental State Examination (MMSE) assessments were available for 593 Velestinians. In addition, 12 studies availing data on folate blood levels (N = 9,747) and 9 on B12 (N = 8,122) were identified following a search algorithm; pooled effect estimates were derived. Results: Cognitive impairment (MMSE &lt; 24) among Velestenians was associated with lower education level in both genders; decreased social activity, depressive symptoms and low folate levels in males; older age in females. Meta-analyses showed an adverse effect of low-folate levels on cognition (OR: 1.66, 95% CI: 1.40-1.96); B12 was nonsignificantly associated (OR: 1.11, 95% CI: 0.88-1.40). Discussion: Low folate levels are associated with cognitive impairment of seniors; underlying pathophysiological mechanisms should be further explored.</p>
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