Παιδιατρική | Τόμος 71 • Τεύχος 5 • Σεπτέμβριος - Οκτώβριος 2008 by E-chlld

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∆ﬁÌÔ˜ 71 ñ ∆Â‡¯Ô˜ 5 ñ ™ÂÙ¤Ì‚ÚÈÔ˜-√ÎÙÒ‚ÚÈÔ˜ 2008

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331æ˘¯ÔÏÔÁ›·

345A quadrivalent human papillomavirus (HPV) vaccine to prevent cervical cancer and other HPV related anogenital diseases X. Castellsagué, G. Trimis, D. Florakis

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413 ™˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV A. ∫ˆÓÛÙ·ÓÙﬁÔ˘ÏÔ˜

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Paediatriki

REVIEW ARTICLES

331Psychology of embryos, neonates and infants: current developmental research

G. Kugiumutzakis

345A quadrivalent human papillomavirus (HPV) vaccine to prevent cervical cancer and other HPV related anogenital diseases

X. Castellsagué, G. Trimis, D. Florakis

355Phimosis and circumcision in children

G. Sakellaris, I. Bouloukaki, A. Dimopoulou, G. Charissis

ORIGINAL ARTICLES

361Adherence to the Mediterranean diet by children and adolescents in Greece

N. Vidra, A-E. Farmaki, S. Koinaki, K. Belogianni, S. Sofrona, F. Magkanari, M. Kontogianni, M. Yannakoulia

368The relation of body mass index with selected behavioural parameters in 11 year-old children

A. Christodoulos, H. Douda, D. Tousoulis, S. Tokmakidis

376The prevalence and epidemiology of obesity in children of southeastern Attica. The modern lifestyle and the role of the primary care paediatrician

O. Filippou, M. Dolianiti, K. ∫aranasiou, V. Tasiopoulou, M. Ziva-Petropoulou, S. Papadakou-Lagogianni

383Ethical dilemmas due to prenatal diagnostics: preliminary results of the multicentre research programme EDIG S. Kitsiou-Tzeli, S. Christogiorgos, V. Vassilopoulou, Eug. Soumaki, G. Kolaitis, V. Lagari, K. Kostakou, V. Velissariou, N. Strintzis, D. Botsis, E. Kanavakis, J. Tsiantis, EDIG consortium

PRACTICAL ISSUE

390Diagnostic approach to lymphadenopathy in children

N. Chaliasos, A. Vlahos, A. Makis

CASE REPORT

399Thrombocytopenic purpura in a child with brucellosis: case report and literature review ∞. ªanola, ∞. ªakis, C. ∆saousi, ¡. Chaliasos, ∞. Siamopoulou-Mavridou

CLINICAL QUIZ

403“Innocent” heart murmur in a child

N. Anagnostatou, I. Germanakis, M. Kalmanti

PAEDIATRIC NEWS IN BRIEF

404 Algorithms, Recommendations, Guidelines and Scientific Statements 2008 E. Galanakis

NEWS FROM THE INTERNET

407 An algorithm for Developmental Surveillance and Screening

L. Thomaidis

OBITUARY

409 Victor A. McKusick

Ch. Sp. Bartsokas

LETTER TO THE EDITORIAL BOARD

413 Prescription of the HPV vaccine

A. Constantopoulos

¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

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Michael Anthracopoulos, Pneumonology, Patras

Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki

George Varlamis, Cardiology, Thessaloniki

Emmanouil Galanakis, Ethics and Deontology, Heraklion

Loretta Thomaidou, Developmental Pediatrics, Athens

Maria Kanariou, Immunology, Athens

Antonis Kattamis, Haematology - √ncology, Athens

Sophia Kitsiou-Tzeli, Genetics, Athens

Alexandra Papadopoulou, Gastroenterology - Nutrition, Athens

Vassiliki Papaevagelou, Infectious Diseases, Athens

Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina

Antigone Syrigou-Papavasiliou, Neurology, Athens

Evangelia Charmandari, Endocrinology, Athens

ª¤ÏË ÙË˜ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈÎ‹˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board

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Adenike Grange, Lagos, Nigeria

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Jan Janda, Prague, Czech Republic

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Manuel Moya, Alicante, Spain

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·Ó·Ù˘ÍÈ·Î‹ ¤ÚÂ˘Ó·*

°. ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿ÎË˜

¶ÂÚ›ÏË„Ë: ™ÙÔ ·ÚfiÓ ÎÂ›ÌÂÓÔ ÂÚÈÁÚ¿ÊÔÓÙ·È Â˘Ú‹Ì·Ù· ÙË˜ Û‡Á¯ÚÔÓË˜ ∞Ó·Ù˘ÍÈ·Î‹˜ æ˘¯ÔÏÔÁ›·˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÈÎ·ÓfiÙËÙÂ˜ ÙˆÓ ÂÌ‚Ú‡ˆÓ, ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ, Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ 21 Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜ (ÂÁÎ˘ÌÔÛ‡ÓË Î·È ÚÒÙÔ ¤ÙÔ˜). √È ·Ó·ÙÚÔ¤˜ Ô˘ Â¤ÊÂÚÂ ÛÙÈ˜ „˘¯ÔÏÔÁÈÎ¤˜ ıÂˆÚ›Â˜ Ë ¤ÚÂ˘Ó· ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÓÔ˘ ‹Ù·Ó ÌÂÁ¿ÏÂ˜, Ë ÚfiÔ‰Ô˜ ÙË˜ ÁÓÒÛË˜ Û·Ê‹˜, Ù· ÛËÌÂ›· ÎÔÈÓÒÓ ÂÓ‰È·ÊÂÚfiÓÙˆÓ

ÌÂÙ·Í‡ ·È‰È¿ÙÚˆÓ Î·È ·Ó·Ù˘ÍÈ·ÎÒÓ „˘¯ÔÏﬁÁˆÓ ÔÏÏ¿ Î·È Ô ‰ÈÂÈÛÙËÌÔÓÈÎﬁ˜ ‰È¿ÏÔÁÔ˜ ÂÎÎÚÂÌÂ›.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: æ˘¯ÔÏÔÁÈÎ‹ Á¤ÓÓËÛË, ‰È-˘ÔÎÂÈÌÂÓÈÎﬁ˜ ÓÔ˘˜, ¤Ì‚Ú˘·, ÓÂÔÁÓ¿, ‚Ú¤ÊË.

Psychology of embryos, neonates and infants: current developmental research**

G. Kugiumutzakis

Abstract: The aim of this paper is to describe the current developmental psychological research findings on the abilities of human embryos, neonates and infants during pregnancy and first year. These research findings have led to many reversals of the psychological theories about the origin of the human mind, and provide clear progress of knowledge. Although the common points of interest of paediatricians and developmental psychologists are many, the relevant interdisciplinary dialogue has yet to begin.

Key words: Psychological birth, intersubjective mind, embryo, neonate, infant.

√ ÓÂÔÁÓÈÎﬁ˜ ÓÔ˘˜: ·Ï·ÈﬁÙÂÚ· Î·È Û‹ÌÂÚ·

∆· Â˘Ú‹Ì·Ù· ÙˆÓ „˘¯ÔÏÔÁÈÎÒÓ ÂÚÂ˘ÓÒÓ Ù·

ÙÂÏÂ˘Ù·›· 40 ¯ÚﬁÓÈ· ¿ÏÏ·Í·Ó ÙÈ˜ ·ﬁ„ÂÈ˜ ÙˆÓ

ÂÈ‰ÈÎÒÓ ˆ˜ ÚÔ˜ ÙÈ˜ ÈÎ·ÓﬁÙËÙÂ˜ ÙˆÓ ÂÌ‚Ú‡ˆÓ, ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ. ÃˆÚ›˜ Ó· ··-

ÍÈÒÓÂÙ·È Ë ÙÂÚ¿ÛÙÈ· ÚÔÛÊÔÚ¿ ÙˆÓ ÚˆÙÔfiÚˆÓ ÂÚÂ˘ÓËÙÒÓ (fiˆ˜ ÙÔ˘ Freud, ÙÔ˘ Piaget, ÙÔ˘ Vygotsky Î.¿.), Û‹ÌÂÚ· ÁÓˆÚ›˙Ô˘ÌÂ fiÙÈ ÔÈ

ÂÚÈÁÚ·Ê¤˜ ÙÔ˘˜ ˘ÔÙ›ÌËÛ·Ó ÙÈ˜ ‰˘Ó·ÙﬁÙËÙÂ˜ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÓÔ˘ (1,2,3,4,5,6). ™ÙÔÓ ¶›Ó·Î· 1, Û˘ÓÔ„›˙ÔÓÙ·È

ÛÂ 10 ÛËÌÂ›· ÔÈ ÚÈ˙ÈÎ¤˜ ·Ó·ÙÚÔ¤˜ Ô˘ Â¤ÊÂÚ·Ó ÔÈ Û‡Á¯ÚÔÓÂ˜ ¤ÚÂ˘ÓÂ˜ ˆ˜ ÚÔ˜ ÙËÓ “·Ú¯ÈÎ‹

Î·Ù¿ÛÙ·ÛË” ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ÓÔ˘.

∞ÓÙÈÚÔÛˆÂ˘ÙÈÎ¿ ÂÚÂ˘ÓËÙÈÎ¿ Â˘Ú‹Ì·Ù·

ÚÔÛˆÂ˘ÙÈÎ¿ Â˘Ú‹Ì·Ù· ·ﬁ ÙË Û‡Á¯ÚÔÓË ‚ÚÂÊÈÎ‹ ¤ÚÂ˘Ó·, ÂÓ‰ÂÈÎÙÈÎ¿ ÙË˜ ·Ó·ÙÚÔ‹˜. ∂Ó‰ÔÌ‹ÙÚÈ· „˘¯ÔÏÔÁÈÎ‹ ÏÂÈÙÔ˘ÚÁÈÎﬁÙËÙ· Î·È ÌÂÙ·ÁÂÓÓËÙÈÎ‹ Û˘Ó¤¯ÂÈ· ™Ù· ¤Ì‚Ú˘· ·Ú·ÙËÚÔ‡ÓÙ·È ÔÚÁ·ÓˆÌ¤ÓÂ˜ Û˘ÌÂÚÈÊÔÚ¤˜,

Í˘ÁÎ·˜, ÌÔÚÊ·ÛÌÔ› ÚÔÛÒÔ˘, ÎÏˆÙÛÈ¤˜, ·Ó·‰›ÏˆÛË, ·ÓÙ›‰Ú·ÛË ÛÂ ÂÍˆÙÂÚÈÎÔ‡˜ ÂÚÂıÈÛÌÔ‡˜ Î.¿. ∏ ÁÂ‡ÛË Î·È Ë ÔÛÌ‹ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ Ô‰ËÁÂ› Ù· ¤Ì‚Ú˘· Ó· Ì¿ıÔ˘Ó ÙËÓ ÂÈ‰ÈÎ‹

Ì˘Úˆ‰È¿ ÙÔ˘ ÌËÙÚÈÎÔ‡ ÛÒÌ·ÙÔ˜ Î·È, ﬁÙ·Ó ÁÂÓÓËıÔ‡Ó, Ó· ÙËÓ ÚÔÙÈÌÔ‡Ó ·ﬁ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë

ÌÈ·˜ Í¤ÓË˜ Á˘Ó·›Î·˜. ∏ ›‰È· ÚÔÙ›ÌËÛË ÈÛ¯‡ÂÈ

ˆ˜ ÚÔ˜ ÙË ÁÂ‡ÛË Î·È ÙËÓ ÔÛÌ‹ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, ÚÔÙÈÌ‹ÛÂÈ˜ ÂÓ‰ÂÈÎÙÈÎ¤˜ ÙˆÓ ÂÌ‚Ú˘˚-

ÎÒÓ Û˘Ó-ÏÂÈÙÔ˘ÚÁÈÒÓ ·ÓÙ›ÏË„Ë˜, Ì¿ıËÛË˜ Î·È

ÌÓ‹ÌË˜ (7,8).

™Â Û¯ÂÙÈÎ¿ ÂÈÚ¿Ì·Ù·, Ô DeCasper Î·È ÔÈ

Û˘ÓÂÚÁ¿ÙÂ˜ ÙÔ˘ ÂÍ¤Ù·Û·Ó ·Ó ÓÂÔÁÓ¿ ËÏÈÎ›·˜ 3

ËÌÂÚÒÓ ÚÔÙÈÌÔ‡Ó Ó· ·ÎÔ‡Ó ÙË Ì·ÁÓËÙÔÊˆÓË-

Ì¤ÓË ÊˆÓ‹ ÙË˜ ÌËÙ¤Ú·˜ ÙÔ˘˜ Ó· ÙÔ˘˜ Ï¤ÂÈ ¤Ó· ·Ú·Ì‡ıÈ ‹ ÙË Ì·ÁÓËÙÔÊˆÓËÌ¤ÓË ÊˆÓ‹ ÌÈ·˜ Í¤ÓË˜ Á˘Ó·›Î·˜ Ó· ·ÊËÁÂ›Ù·È ÙÔ ›‰ÈÔ ·Ú·Ì‡ıÈ. ∂Í¤Ù·Û·Ó, Â›ÛË˜, ·Ó Ù· ÓÂÔÁÓ¿ ÚÔÙÈÌÔ‡Ó Ó·

∆Ì‹Ì· ºÈÏÔÛÔÊÈÎÒÓ Î·È ∫ÔÈÓˆÓÈÎÒÓ ™Ô˘‰ÒÓ, ºÈÏÔÛÔÊÈÎ‹ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜

AÏÏËÏÔÁÚ·Ê›·: °È¿ÓÓË˜ ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿ÎË˜ gkugium@phl.uoc.gr ∆Ì‹Ì· ºÈÏÔÛÔÊÈÎÒÓ Î·È ∫ÔÈÓˆÓÈÎÒÓ ™Ô˘‰ÒÓ, ºÈÏÔÛÔÊÈÎ‹ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜, ¶·ÓÂÈÛÙËÌÈÔ‡ÔÏË, 74 100, ƒ¤ı˘ÌÓÔ, ∫Ú‹ÙË

Department of Philosophy and Social Studies School of Philosophy, University of Crete

Correspondence: Giannis Kugiumutzakis gkugium@phl.uoc.gr Department of Philosophy and Social Studies, School of Philosophy, University of Crete, 74 100 Rethymno, Crete

¶·Ï·ÈﬁÙÂÚÂ˜ „˘¯ÔÏÔÁÈÎ¤˜ ıÂˆÚ›Â˜ ™‡Á¯ÚÔÓÂ˜ „˘¯ÔÏÔÁÈÎ¤˜ ıÂˆÚ›Â˜

1 ∞-ÎÔÈÓˆÓÈÎﬁ˜ ∫ÔÈÓˆÓÈÎﬁ˜

2 ∞Û˘ÓÂ›‰ËÙÔ˜ ∞Û˘ÓÂ›‰ËÙÔ˜ Î·È Û˘ÓÂÈ‰ËÙﬁ˜

3 ÕÁÚ·ÊÔ˜ ¯¿ÚÙË˜ (tabula rasa) ŒÌÊ˘ÙÂ˜ ÈÎ·ÓﬁÙËÙÂ˜

4 ∞ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿∞ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿ Î·È ÈÎ·ÓﬁÙËÙ· ÂÌÚﬁıÂÙË˜ ‰Ú¿ÛË˜ Î·È ÛÎ¤„Ë˜

5 ∞Û˘ÓÙfiÓÈÛÙÂ˜ ÌÂÙ·Í‡ ÙÔ˘˜ ·ÈÛı‹ÛÂÈ˜™˘ÓÙÔÓÈÛÌ¤ÓÂ˜ ÌÂÙ·Í‡ ÙÔ˘˜ ·ÈÛı‹ÛÂÈ˜ ∞ÓÙÈÏËÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜

6 ∞ÚÓËÙÈÎ¤˜ Û˘ÁÎÈÓ‹ÛÂÈ˜£ÂÙÈÎ¤˜ Î·È ·ÚÓËÙÈÎ¤˜ Û˘ÁÎÈÓ‹ÛÂÈ˜

7 ∞Ô˘Û›· ·›ÛıËÛË˜ ÙÔ˘ 3‰È¿ÛÙ·ÙÔ˘ ¶·ÚÔ˘Û›· ·›ÛıËÛË˜ ÙÔ˘ 3‰È¿ÛÙ·ÙÔ˘ ¯ÒÚÔ˘, ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ¯ÒÚÔ˘, ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ÙË˜ ·ÈÙÈfiÙËÙ·˜ÙË˜ ·ÈÙÈfiÙËÙ·˜

8 ªÂÏ¤ÙË ‚ÚÂÊÒÓ ˆ˜ ·ÙfiÌˆÓªÂÏ¤ÙË ‚ÚÂÊÒÓ ˆ˜ ·ÙfiÌˆÓ Î·È ˆ˜ ÂÈÎÔÈÓˆÓÈ·ÎÒÓ Û˘ÓÙÚfiÊˆÓ

9∏ ·Ó¿Ù˘ÍË ˆ˜ ÌÈ· ÌÔÓ·¯ÈÎ‹ ‰ÈÂÚÁ·Û›·∞Ó¿Ù˘ÍË ÛÂ Ï·›ÛÈ· Û˘Ó-·Ó¿Ù˘ÍË˜. µÚ¤ÊÔ˜ Î·È ÁÔÓ¤·˜ ·˘ÙÔ-‰ÔÌÔ‡ÓÙ·È Î·È

10∆· ‚Ú¤ÊË

ÂÈÚ·Ì·ÙÈÎ‹ Û˘Óı‹ÎË) ÁÈ· Ó· ·ÎÔ‡Ó ÙË Ì·ÁÓËÙÔÊˆ-

ÓËÌ¤ÓË ÊˆÓ‹ ÙË˜ ÌËÙ¤Ú·˜ ·Ú¿ ÙË˜ Í¤ÓË˜ Á˘Ó·›Î·˜, ÁÈ· Ó· ·ÎÔ‡Ó ÙÔ ·Ï·Èﬁ ÔÈÎÂ›Ô ·Ú·Ì‡ıÈ ·Ú¿ ÙÔ

Ó¤Ô ·Ú·Ì‡ıÈ, ÂÓÒ ‰ÂÓ ÚÔÙÈÌÔ‡Û·Ó ÙË ÊˆÓ‹ ÙÔ˘

·ﬁ ÙË ÊˆÓ‹ ¿ÏÏˆÓ ·Ó‰ÚÒÓ (∂ÈÎﬁÓ· 1). √È

ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ ‰Â›¯ÓÔ˘Ó ﬁÙÈ ·ﬁ ÙÔÓ 7Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ

Ì‹Ó· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜ Û˘Ó-ÏÂÈÙÔ˘ÚÁÔ‡Ó Ë ·ÎÔ‹, Ë

Ì¿ıËÛË Î·È Ë ÌÓ‹ÌË Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙﬁ Ë ·ÎÔ˘ÛÙÈ-

Î‹ ÚÔÙ›ÌËÛË (9,10,6).

∏ Piontelli (11,12) ÌÂÏ¤ÙËÛÂ ÛÙÔ˘˜ ˘ÂÚ‹¯Ô˘˜ Ù·

ÎÈÓËÙÈÎ¿ ÚﬁÙ˘· ‰›‰˘ÌˆÓ ÂÌ‚Ú‡ˆÓ, Ù· ÔÔ›·,

·ÊÔ‡ ÁÂÓÓ‹ıËÎ·Ó, Û˘Ó¤¯ÈÛÂ Ó· Ù· ÌÂÏÂÙ¿ Ì¤¯ÚÈ Ù· 4

¯ÚﬁÓÈ· ÙÔ˘˜. ∆· ‰›‰˘Ì· ¤Ì‚Ú˘· ‰È·ÌÔÚÊÒÓÔ˘Ó Ì¤Û·

ÛÙË Ì‹ÙÚ· ‰È·ÎÚÈÙ¿ ·ÙÔÌÈÎ¿ ÎÈÓËÙÈÎ¿ ÚﬁÙ˘· -

ÁÚ‹ÁÔÚÂ˜ ‹ ·ÚÁ¤˜ ÎÈÓ‹ÛÂÈ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ‹ ÙˆÓ ÌÂ-

ÏÒÓ, ÎÏˆÙÛÈ¤˜ Î.Ù.Ï. ∂ÈÏ¤ÔÓ, ÛÙË Ì‹ÙÚ· ‰È·ÌÔÚ-

ÊÒÓÔ˘Ó ÌÂÙ·Í‡ ÙÔ˘˜ Û·Ê‹ ÚﬁÙ˘· ·ÏÏËÏÂÈ‰Ú·-

ÛÙÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ (.¯. ÂÈıÂÙÈÎﬁÙËÙ·, ÙÚ˘ÊÂÚﬁÙËÙ·, ·ÔÌ¿ÎÚ˘ÓÛË, ¯·˝‰ÂÌ· ÎÂÊ·ÏÒÓ Î.¿.), Ù·

ÔÔ›· ·Ú·ÙËÚÔ‡ÓÙ·È Î·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∫¿ÔÈ· ‰›‰˘Ì· ¤Ì‚Ú˘· ‰ÂÓ ·ÓÙÈ‰ÚÔ‡Ó ÛÙÈ˜ ÎÏˆÙÛÈ¤˜ ÙÔ˘ ‰›-

‰˘ÌÔ˘ Û˘ÓÙÚﬁÊÔ˘ ÙÔ˘˜, ÔÚÈÛÌ¤Ó· ÌﬁÏÈ˜ ÓÈÒÛÔ˘Ó ÙÔ

¿ÁÁÈÁÌ· ÙÔ˘ ‰È‰‡ÌÔ˘ ÙÔ˘˜ ·ÔÛ‡ÚÔÓÙ·È Û·Ó Ó· Ù·

¯Ù‡ËÛÂ ËÏÂÎÙÚÈÎﬁ ÚÂ‡Ì· Î·È Î¿ÔÈ· ¿ÏÏ· „¿¯ÓÔ˘Ó ÙË ÛˆÌ·ÙÈÎ‹ Â·Ê‹, Â›ÙÂ ÁÈ· Ó· ·Ú¯›ÛÔ˘Ó ·ÌÔÈ‚·›Â˜

ÎÏˆÙÛÈ¤˜ Â›ÙÂ ÁÈ· Ó· ·ÓÙÈ‰Ú¿ÛÔ˘Ó ÊÈÏÈÎ¿ ÌÂ Î¿ÙÈ Û·Ó ¯¿‰È (Ì¿ÁÔ˘ÏÔ ÌÂ Ì¿ÁÔ˘ÏÔ Â·Ê‹). ¶·Ú·‰Â›ÁÌ·ÙÔ˜ ¯¿ÚÈÓ, ÛÙË Ì‹ÙÚ·, ÔÈ ‰È˙˘ÁˆÙÈÎÔ› ‰›‰˘ÌÔÈ Alice Î·È

fiˆ˜ Î·È ÔÈ ÂÓ‹ÏÈÎÂ˜, Ï‹ÙÙÔ˘Ó ÁÚ‹ÁÔÚ· ÛÙ· Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÔÙÈÎ¿ Î·È ·ÎÔ˘ÛÙÈÎ¿ ÂÚÂı›ÛÌ·Ù· Î·È ·‡Ô˘Ó Ó· Ù· ÚÔÛ¤¯Ô˘Ó. ∆Ô ÂÓ‰È·Ê¤ÚÔÓ ÙÔ˘˜ Í˘Ó¿ ·Ì¤Ûˆ˜ ÛÙÈ˜ ·Ú·ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÙÔ˘ ·Ï·ÈÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜. ∫ÔÈÙ¿˙Ô˘Ó ‹ ·ÎÔ‡Ó ÂÈÏÂÎÙÈÎ¿ Ù· Û‡ÓıÂÙ· ·Ú¿ Ù· ·Ï¿ ÂÚÂı›ÛÌ·Ù·. √È ·ÈÛı‹ÛÂÈ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Â›Ó·È ÏÂÈÙÔ˘ÚÁÈÎ¤˜ Î·È Û˘ÓÙÔÓÈÛÌ¤ÓÂ˜ ÌÂÙ·Í‡ ÙÔ˘˜. ∂›Ó·È, Â›ÛË˜, Û˘ÓÙÔÓÈÛÌ¤ÓÂ˜ ÌÂ ÙÔ ÎÈÓËÙÈÎfi Û‡ÛÙËÌ·. √È Û˘ÓÙÔÓÈÛÌÔ› ·˘ÙÔ› ·Ó·Ù‡ÛÛÔÓÙ·È Î·È ÂÎÏÂÙ‡ÓÔÓÙ·È ÛÙÔÓ ¯ÚfiÓÔ Î·È ‰Â›¯ÓÔ˘Ó fiÙÈ ÌÂÙ·Í‡ ÙÔ˘˜ ÔÈ ·ÈÛı‹ÛÂÈ˜ “ÌÈÏÔ‡Ó”

1 ¡ÂÔÁÓﬁ ËÏÈÎ›·˜

∆· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË ÂÎÊÚ¿˙Ô˘Ó, Â›ÛË˜, ¤Î-

ÏËÍË ÛÙ· Ì·ıËÌ·ÙÈÎÒ˜ ·‰‡Ó·Ù· Û˘Ì‚¿ÓÙ· Î·È,

ÂÈÏ¤ÔÓ, ÌÂ ÙÔÓ ÙÚﬁÔ ÙÔ˘˜ (.¯. ¤ÎÏËÍË, ·Ú·-

ÙÂÙ·Ì¤ÓÔ ÎÔ›Ù·ÁÌ· Î.¿.), ÚÔÛı¤ÙÔ˘Ó Î·È ·Ê·ÈÚÔ‡Ó

Ì¤¯ÚÈ ÙÔ 3 ‹ ÙÔ 4. ™Ù· ÂÈÚ¿Ì·Ù· ÙË˜ Wynn (18,19)

ÙÔ 5ÌËÓÔ ‚Ú¤ÊÔ˜ ‚Ï¤ÂÈ ÙÔ ¯¤ÚÈ ÌÈ·˜ ÂÚÂ˘Ó‹ÙÚÈ·˜ Ó·

ÎÚ·Ù¿ 1 ÎÔ‡ÎÏ· Î·È Ó· ÙËÓ ·Ê‹ÓÂÈ ÛÙËÓ ·ÓÔÈÎÙ‹

ÛÎËÓ‹ ÂÓﬁ˜ ÎÔ˘ÎÏÔı¤·ÙÚÔ˘. ªÂÙ¿, Ë ÎÔ˘ÚÙ›Ó· ÙË˜

ÛÎËÓ‹˜ ÙÚ·‚È¤Ù·È. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔ ‚Ú¤ÊÔ˜ ‚Ï¤ÂÈ

ÙÔ ¯¤ÚÈ ÙË˜ ÂÚÂ˘Ó‹ÙÚÈ·˜ Ó· ‚¿˙ÂÈ ›Ûˆ ·ﬁ ÙÔ Î¿-

Ï˘ÌÌ· ÙË˜ ÎÔ˘ÚÙ›Ó·˜ 1 ‰Â‡ÙÂÚË ÎÔ‡ÎÏ·. µÏ¤ÂÈ Î·-

ı·Ú¿ ÙÔ ¯¤ÚÈ ÙË˜ ÂÚÂ˘Ó‹ÙÚÈ·˜ Ó· ·ÔÌ·ÎÚ‡ÓÂÙ·È

¿‰ÂÈÔ. ªÂÙ¿ ·ÓÔ›ÁÂÈ Ë ·˘Ï·›· Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Â›-

ÙÂ ÙÔ Ì·ıËÌ·ÙÈÎÒ˜ ÔÚıﬁ ·ÔÙ¤ÏÂÛÌ· (1+1=2 ÎÔ‡-

ÎÏÂ˜ - Ù· ‚Ú¤ÊË ÎÔÈÙ¿˙Ô˘Ó ÙÈ˜ 2 ÎÔ‡ÎÏÂ˜ ¯ˆÚ›˜ ¤Î-

ÏËÍË) Â›ÙÂ ÙÔ Ì·ıËÌ·ÙÈÎÒ˜ ·‰‡Ó·ÙÔ ·ÔÙ¤ÏÂÛÌ·

(1+1=1 ÎÔ‡ÎÏ·, Ë ‰Â‡ÙÂÚË Â›¯Â ·Ê·ÈÚÂıÂ› ÎÚ˘Ê¿

·ﬁ ÙËÓ ÂÚÂ˘Ó‹ÙÚÈ·). ∆· ÓÂ·Ú¿ ‚Ú¤ÊË ÂÎÏ‹ÙÙÔ-

ÓÙ·È, Û·ÛÙ›˙Ô˘Ó, ·ÔÚÔ‡Ó, ·ÓÔ›ÁÔ˘Ó ÙÔ ÛÙﬁÌ· ÛÙÔ

1+1=1 ‹ ÛÙËÓ ·Ú·ÏÏ·Á‹ 2+1=2, ·ÏÏ¿ Î·È ÛÙËÓ

·Ê·›ÚÂÛË 2-1=2 ‹ 3-1=3 - ¤ÎÏËÍË Ô˘ ÙË ‚Ï¤Ô˘-

ÌÂ ÛÙÔ ÚfiÛˆfi ÙÔ˘˜, ÚÔÎ‡ÙÂÈ ·fi ÌÂÙÚ‹ÛÂÈ˜

ÙˆÓ ·ÏÏ·ÁÒÓ ÙÔ˘ Î·Ú‰È·ÎÔ‡ ÙÔ˘˜ ·ÏÌÔ‡ Î·È

ÙÔÓ ·Ú·ÙÂÙ·Ì¤ÓÔ ¯ÚﬁÓÔ Ô˘ Û·ÛÙÈÛÌ¤Ó· ÎÔÈÙ¿-

˙Ô˘Ó ÙÔ “Ï¿ıÔ˜”, ÙËÓ ·Ú·‚›·ÛË ÙË˜ ‚ÚÂÊÈÎ‹˜

ÚÔÛ‰ÔÎ›·˜ ﬁÙÈ 1+1 ‰ÂÓ Î¿ÓÂÈ Ô‡ÙÂ 1 Ô‡ÙÂ 3, ·ÏÏ¿

·ÎÚÈ‚Ò˜ 2. ∆· ›‰È· Â˘Ú‹Ì·Ù· ˘‹ÚÍ·Ó ÛÂ ·Ú·ÏÏ·-

Á¤˜ ÙÔ˘ ·Ú¯ÈÎÔ‡ ÂÈÚ¿Ì·ÙÔ˜ ÛÂ ·ÓıÚÒÈÓ· ÓÂÔÁÓ¿

ËÏÈÎ›·˜ 4 ËÌÂÚÒÓ, Ù· ÔÔ›· ‰È¤ÎÚÈÓ·Ó ÙÈ˜ ‰ÈÛ‡ÏÏ·-

‚Â˜ ·ﬁ ÙÈ˜ ÙÚÈÛ‡ÏÏ·‚Â˜ Ï¤ÍÂÈ˜ (·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙˆÓ

ÔÙÈÎÒÓ ÌÂ ·ÎÔ˘ÛÙÈÎ¿ ÂÚÂı›ÛÌ·Ù·) Î·È ÛÂ ÓÂ·Ú¿

‚Ú¤ÊË Ô˘ ·Ó›¯ÓÂ˘Û·Ó ÙË ‰È·ÊÔÚ¿ 1/4 ˘ÁÚÔ‡ ·ﬁ

3/4 ˘ÁÚÔ‡ ÛÂ ¤Ó· ‰Ô¯Â›Ô, Î·È, ÙÔ ÈÔ ‰‡ÛÎÔÏÔ, ﬁÙ·Ó

¯ÚÂÈ¿ÛÙËÎÂ Ó· ·ÓÈ¯ÓÂ‡ÛÔ˘Ó ·ÚÈıÌÔ‡˜ ‰È-·ÈÛıËÙË-

ÚÈ·Î¿, ‰ËÏ·‰‹ Ó· ÚÔÛı¤ÛÔ˘Ó 1 ·ÓÙÈÎÂ›ÌÂÓÔ Î·È 1 ‹¯Ô (20,21,22,23,4).

°ÓˆÚ›˙·ÌÂ ·ﬁ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980 ﬁÙÈ ÓÂÔÁÓ¿

ËÏÈÎ›·˜ 2 ¤ˆ˜ 3 ËÌÂÚÒÓ Î·È ‚Ú¤ÊË Ì¤¯ÚÈ 8 ÌËÓÒÓ (25,26) ÌÔÚÔ‡Û·Ó Ó· ·ÓÈ¯ÓÂ‡ÛÔ˘Ó ‰È-·ÈÛıËÙËÚÈ·Î¿

ÌÈÎÚÔ‡˜ ·ÚÈıÌÔ‡˜, ‰ËÏ·‰‹ Ó· ·Ú·‚Ï¤Ô˘Ó ÙÈ˜ ‰È·ÊÔÚ¤˜ ÔÙÈÎÒÓ Î·È ·ÎÔ˘ÛÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È Ó· ·ÓÈ¯ÓÂ‡Ô˘Ó ÙÔÓ ·ÚÈıÌfi ·˘ÙfiÓ Î·ı’ ·˘ÙfiÓ (·fi ÙÔ 1 ¤ˆ˜ ÙÔ 3). ™Ù· ÂÈÚ¿Ì·Ù·, ÔÈ ÂÚÂ˘ÓËÙ¤˜ ·ÚÔ˘Û›·˙·Ó 2 ÊˆÙÔÁÚ·Ê›Â˜ Ô˘ ·Ó··ÚÈÛÙÔ‡Û·Ó .¯. 1 È-

›Ï· Î·È 3 ÎÔ˘‰Ô˘Ó›ÛÙÚÂ˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·ÚÔ˘Û›·ÛË˜, ·ÎÔ‡ÁÔÓÙ·Ó .¯. 3 ‹¯ÔÈ. ªÂÙ¿ ÙÔÓ ‹¯Ô, ‚Ú¤ÊË Î¿Ùˆ ÙˆÓ 8 ÌËÓÒÓ ÎÔ›Ù·˙·Ó ÂÚÈÛÛfiÙÂÚÔ ÙÈ˜ 3 ÎÔ˘‰Ô˘Ó›ÛÙÚÂ˜ (ÔÙÈÎÔ-·ÎÔ˘ÛÙÈÎ‹ ·Ó›¯ÓÂ˘ÛË ÙÔ˘ ·ÚÈıÌÔ‡). ™ÙÔ ÂÚÁ·ÛÙ‹ÚÈfi Ì·˜ ÌÂÏÂÙ‹ıËÎÂ (23,4) Ë ·ÚÈıÌËÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÛÂ ‚Ú¤ÊË 5, 7 Î·È 9 ÌËÓÒÓ Î·È

Ù¤ıËÎÂ ÙÔ ˙‹ÙËÌ· ÙË˜ ·Ó¿Ù˘ÍË˜ ÙË˜ ‚ÚÂÊÈÎ‹˜

∂ÈÎfiÓ· 3. ∞Ó··Ú¿ÛÙ·ÛË ÙË˜ ÂÈÚ·Ì·ÙÈÎ‹˜ Û˘Óı‹ÎË˜. 1 = Ù· ÌÂÁ¿ÊˆÓ·, 2 = Ù· ÚÔ‚·ÏÏfiÌÂÓ· ÔÙÈÎ¿ ÂÚÂı›ÛÌ·Ù· (108 x 80 ÂÎ·Ù.), 3 = Ë Î¿ÌÂÚ·, Î·Ï˘ÌÌ¤ÓË ÌÂ ¤Ó· ÏÂ˘Îfi ·Ó›, ÂÎÙfi˜ ·fi ÙÔÓ Ê·Îfi, 4 = ÙÔ ‚Ú¤ÊÔ˜, 5 = Ë ÌËÙ¤Ú·, 6 = Ô ÌÔÓfi‰ÚÔÌÔ˜ Î·ıÚ¤ÙË˜ Ô˘ Â¤ÙÚÂÂ ÛÙËÓ ÂÚÂ˘Ó‹ÙÚÈ· Ó· ‚Ï¤ÂÈ Ì¤Û· ÛÙÔ ÂÈÚ·Ì·ÙÈÎfi ‰ˆÌ¿ÙÈÔ, 7 = ÚÔ‚ÔÏÂ›˜ ÙˆÓ “ÛÏ¿ÈÓÙ˜”, 8 = ·ÚÌfiÓÈÔ, 9 = Ì·ÁÓËÙfiÊˆÓÔ, 10 = ÂÚÂ˘Ó‹ÙÚÈ·, 11 = ‚ÔËıÔ› ÙË˜ ÂÚÂ˘Ó‹ÙÚÈ·˜ (23). ...Ù·Ú¿ÁÌ·Ù·Ô˘ÌÂÙÚÔ‡ÓÂÚÈÛÛfiÙÂÚÔ

·ÚÈıÌËÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ (∂ÈÎfiÓ· 3). µÚ¤ıËÎÂ fiÙÈ Ù· ‚Ú¤ÊË ‰È·ÎÚ›ÓÔ˘Ó ÙÔ 1 ·fi ÙÔ 2 Î·È ·fi ÙÔ 3, Î·ıÒ˜ Î·È ÙÔ 2 ·fi ÙÔ 3, ‰ËÏ·‰‹ Ù·

- ·˘Í¿ÓÂÙ·È

ÓˆÚ›˜

·ﬁ ÙÔ˘˜ 5 ¤ˆ˜ ÙÔ˘˜ 9

ÎÔÚ›ÙÛÈ· ·ﬁ ﬁ,ÙÈ

·ÁﬁÚÈ·. ∆· ÎÔÚ›ÙÛÈ· “Ù· ‹Á·Ó Î·Ï‡ÙÂÚ·”

·ÁfiÚÈ·, Ù· ÔÔ›· Î·Ù¿ ÙÔÓ 9Ô Ì‹Ó· Î¿Ï˘„·Ó ÙË ‰È·ÊÔÚ¿ ·fi Ù· ÎÔÚ›ÙÛÈ·. ∆¤ÏÔ˜, ‚Ú¤ıËÎÂ fiÙÈ Ù·

ﬁÌÔÈ· ÔÙÈÎ¿ ÂÚÂı›ÛÌ·Ù· (1 Ì¿Ï· Î·È 3 Ì¿ÏÂ˜)

Î·È ÙÔ ÔÈÎÂ›Ô ÎÔÈÓˆÓÈÎﬁ ÂÚ¤ıÈÛÌ· ÙÔ˘ ÚÔÛÒÔ˘ ÙË˜

ÌËÙ¤Ú·˜ ‰ÈÂ˘ÎfiÏ˘Ó·Ó ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙÔ˘ ·ÚÈıÌÔ‡, ÂÓÒ ÙË ‰˘ÛÎfiÏÂ„·Ó Ù· ·ÓfiÌÔÈ· ÔÙÈÎ¿ ÂÚÂı›ÛÌ·Ù· (2 È›ÏÂ˜ Î·È 3 Ì¿ÏÂ˜) Î·È ÙÔ ÚfiÛˆÔ ÌÈ·˜ Í¤ÓË˜ Á˘Ó·›Î·˜ (23,4).

√ ÎÔÈÓˆÓÈÎfi˜ ÓÔ˘˜ ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ °È· ÏfiÁÔ˘˜ ¯ÒÚÔ˘, ·fi ÙÈ˜ ÂÈÚ·Ì·ÙÈÎ¤˜ ·ÏÏ¿ Î˘Ú›ˆ˜ ·fi ÙÈ˜ ÔÏÏ¤˜ Ó·ÙÔ˘Ú·ÏÈÛÙÈÎ¤˜, ‰È·¯ÚÔÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÌÈÎÚÔ-·Ó¿Ï˘ÛË˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ô˘ Ì·ÚÙ˘ÚÔ‡Ó ÙËÓ ¤ÌÊ˘ÙË ÎÔÈÓˆÓÈÎfiÙËÙ· ÙˆÓ ‚ÚÂÊÒÓ, ·Ó·Ê¤ÚÔ˘ÌÂ ·Ú·Î¿Ùˆ ÌÂÚÈÎ¿ ÌfiÓÔ Â˘Ú‹Ì·Ù·

ÁÈ· ÙÔ˘˜ ÚÒÙÔ˘˜ 12 Ì‹ÓÂ˜. ∏ ‰È¿ÎÚÈÛË ÙˆÓ Ê¿ÛÂˆÓ ·Ó¿Ù˘ÍË˜ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜, Ì¤Û· ÛÙÈ˜ ÔÔ›Â˜

·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â˘Ú‹Ì·Ù·, ‚·Û›˙ÂÙ·È ÛÙË ıÂˆÚ›·

ÙÔ˘ Trevarthen (5,6,8) ÁÈ· ÙËÓ ¤ÌÊ˘ÙË Î·Ù·ÁˆÁ‹ Î·È

ÙËÓ ÔÓÙÔÁÂÓÂÙÈÎ‹ ÔÚÂ›· ÙÔ˘ Û˘ÓÙÚÔÊÈÎÔ‡ ‹ ‰È˘ÔÎÂÈÌÂÓÈÎÔ‡ ÓÔ˘ ÙˆÓ ·ÓıÚÒˆÓ - Ì›· ·ﬁ ÙÈ˜ Ï¤ÔÓ ÚÔˆıËÌ¤ÓÂ˜ „˘¯Ô-‚ÈÔÏÔÁÈÎ¤˜ ıÂˆÚ›Â˜ ÙË˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ·È‰ÈÔ‡ Ì¤Û· ÛÙËÓ ÎÔ˘ÏÙÔ‡Ú· ·Ó·ÙÚÔÊ‹˜ ÙÔ˘ (27). √È ÚÒÙÂ˜ 4 Â‚‰ÔÌ¿‰Â˜ (ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô˜)

ÂÚ›Ô‰Ô ·˘Ù‹, ·Ó·‰‡ÂÙ·È ÌÈ· ÈÎ·ÓﬁÙËÙ· Â˘·›ÛıËÙË˜ ·¿ÓÙËÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙËÓ

ÙË˜ ÌËÙ¤Ú·˜ Î·È ÌÈ· ÂÙÔÈÌﬁÙËÙ· ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË

1 3

ºˆÙÔÁÚ·Ê›· 1. √ ÂÚÂ˘ÓËÙ‹˜ ·ÓÔ›ÁÂÈ ÙÔ ÛÙﬁÌ·

ÙÔ˘ ÁÈ· ÚÒÙË ÊÔÚ¿. ∆Ô ÂÓ‰È·Ê¤ÚÔÓ ÙÔ˘

ÓÂÔÁÓÔ‡ Â›Ó·È ÂÌÊ·Ó¤˜ ÛÙÔ ÚﬁÛˆﬁ ÙÔ˘.

ºˆÙÔÁÚ·Ê›· 3. √ ÂÚÂ˘ÓËÙ‹˜ ·ÓÔ›ÁÂÈ ÙÔ ÛÙﬁÌ· ÙÔ˘ ÁÈ· ¤ÌÙË ÊÔÚ¿. ∆Ô ÓÂÔÁÓﬁ ÙÔÓ ÌÈÌÂ›Ù·È Ì›· ÊÔÚ¿...

Î·È ÔÈ Â˘Î·ÈÚ›Â˜ ÌÔ˘ÛÈÎÒÓ ÂÌÂÈÚÈÒÓ ı· Î·ıÔÚ›ÛÔ˘Ó

ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜ ÛÂ Î¿ıÂ ·È‰› (33,4).

∏ ÈÎ·ÓﬁÙËÙ· ÙË˜ ÓÂÔÁÓÈÎ‹˜ Ì›ÌËÛË˜

∆Ë ‰ÂÎ·ÂÙ›· ÙÔ˘ 1970, Í¤Û·ÛÂ ÌÈ· ‰È·Ì¿¯Ë ·Ó

Ù· ÓÂÔÁÓ¿ Î·Ù¿ ÙÔÓ 1Ô Ì‹Ó· (12Ë-30‹ ËÌ¤Ú·) ÌÈÌÔ‡-

ÓÙ·È (34) ‹ ‰ÂÓ ÌÈÌÔ‡ÓÙ·È. ™Â 4 ÂÈÚ·Ì·ÙÈÎ¤˜ ÌÂÏ¤-

ÙÂ˜, ÂÚÂ‡ÓËÛ· ÙË ÓÂÔÁÓÈÎ‹ Ì›ÌËÛË ÛÂ ÌÈ· Ì·ÈÂ˘ÙÈÎ‹

ÎÏÈÓÈÎ‹, Ù· ÚÒÙ· 45 ÏÂÙ¿ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙﬁ. ™ÙËÓ

ÂÈÚ·Ì·ÙÈÎ‹ Û˘Óı‹ÎË, ·ÚÔ˘Û›·˙· ÛÂ ÓÂÔÁÓ¿ ÔÙÈ-

Î¿ ÚﬁÙ˘· (ÚÔ‚ÔÏ‹ ÙË˜ ÁÏÒÛÛ·˜, ¿ÓÔÈÁÌ· ÙÔ˘

ÛÙﬁÌ·ÙÔ˜, ÎÏÂ›ÛÈÌÔ ÙˆÓ Ì·ÙÈÒÓ) Î·È ·ÎÔ˘ÛÙÈÎ¿ Úﬁ-

Ù˘· (ÙÔ˘˜ ‹¯Ô˘˜ ‘·’, ‘Ì’ Î·È ‘·ÁÎÔ‡’). √È ÌÈÎÚÔ-·Ó·-

Ï‡ÛÂÈ˜ Î·È ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ ÙˆÓ ·ÓÙÈ‰Ú¿ÛÂ-

ˆÓ 170 ÓÂÔÁÓÒÓ, ËÏÈÎ›·˜ 10 ¤ˆ˜ 45 ÏÂÙÒÓ, Î·Ù¤‰ÂÈÍ·Ó Ì›ÌËÛË ÙˆÓ ÔÙÈÎÒÓ ÚÔÙ‡ˆÓ Î·È ÙÔ˘ ÊˆÓ‹Â-

ÓÙÔ˜ ‘·’. ™ÙËÓ ∂ÈÎﬁÓ· 4, Ê·›ÓÔÓÙ·È Ï›Á· ‰Â˘ÙÂÚﬁÏÂ-

Ù· ·ﬁ ÙË ÌÈÎÚÔ-·Ó¿Ï˘ÛË ÙË˜ Ì›ÌËÛË˜ ÂÓﬁ˜ ÓÂÔ-

ÁÓÔ‡, ÎÔÚÈÙÛÈÔ‡, ËÏÈÎ›·˜ 20 ÏÂÙÒÓ, ÛÙÔ ÚﬁÙ˘Ô

ÙÔ˘ ·ÓÔ›ÁÌ·ÙÔ˜ ÙÔ˘ ÛÙﬁÌ·ÙÔ˜ (29,2,4).

™ÙË ‚¿ÛË ÙˆÓ ·Ú·¿Óˆ 4 Î·È ÛÙË Û˘Ó¤¯ÂÈ· ¿ÏÏˆÓ 10 ‰È·¯ÚÔÓÈÎÒÓ Ó·ÙÔ˘Ú·ÏÈÛÙÈÎÒÓ ÌÂÏÂÙÒÓ, Ô˘ ÂÎÔÓ‹Û·ÌÂ ÌÂ Û˘ÓÂÚÁ¿ÙÂ˜, Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·Ó¿Ù˘ÍË ÙË˜ Ì›ÌËÛË˜ Î·È ÙÔ Û˘ÁÎÈÓËÛÈ·Îfi ÙË˜ Ï·›ÛÈÔ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜ (‚Ï. ÏÂÙ. 4), ÚÔ¯ˆÚ‹Û·ÌÂ ÛÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ÎÏ·ÛÈÎÔ‡ ÔÚÈÛÌÔ‡ ÙË˜ Ì›ÌËÛË˜ (·Ó··Ú·ÁˆÁ‹ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ¿ÏÏÔ˘, Piaget) (35), ‰ÈfiÙÈ ‰ÂÓ ÂÚÈÁÚ¿ÊÂÈ ÌÂ ·ÎÚ›‚ÂÈ·, ·ÓÙ›ıÂÙ· Û˘ÚÚÈÎÓÒÓÂÈ ·‰ÈÎ·ÈÔÏfiÁËÙ· ÙÔÓ ÏÔ‡ÙÔ ÙˆÓ Ê·ÈÓÔÌ¤ÓˆÓ ÙË˜ ·ÓıÚÒÈÓË˜ Ì›ÌËÛË˜. ∞ÓÙÈÎ·Ù·ÛÙ‹Û·ÌÂ ÙË Ï¤ÍË “·Ó··Ú·ÁˆÁ‹” ÌÂ ÙË Ï¤ÍË “ÌÔ›Ú·ÛÌ·”. √Ú›Û·ÌÂ ÙË Ì›ÌËÛË, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ ÙÔÓ

ÚÒÙÔ ¯ÚﬁÓÔ ÙË˜ ˙ˆ‹˜, ˆ˜ ÙÔ ÌÔ›Ú·ÛÌ· Ï›ÁÔ ÔÏ‡ ÙË˜ ›‰È·˜ Ú¿ÍË˜, ÙˆÓ ›‰ÈˆÓ Û˘ÁÎÈÓ‹ÛÂˆÓ (ÎÈÓ‹ÙÚˆÓ) Î·È ÙˆÓ ›‰ÈˆÓ ÚÔı¤ÛÂˆÓ ÂÈÎÔÈÓˆÓ›·˜ ·Ó¿ÌÂÛ· ÛÂ ‰‡Ô ˘ÔÎÂ›ÌÂÓ· (36:176). ∆· ÙÂÏÂ˘Ù·›· 10

¯ÚﬁÓÈ·, ÔÈ ÓÂ˘ÚÔÂÈÛÙ‹ÌÔÓÂ˜ ¿Ú¯ÈÛ·Ó Ó· ·ÓÈ¯ÓÂ‡Ô˘Ó

ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ ·ÓıÚÒˆÓ Î·È Èı‹ÎˆÓ (macaques) Ù· ÌÔÈÚ¿ÛÌ·Ù· Ô˘ Û˘Ì‚·›ÓÔ˘Ó Î·Ù¿ ÙË Ì›ÌËÛË. ∞ÓÈ¯ÓÂ‡Ô˘Ó ÙÔ˘˜ Î·ıÚÂÙÈÎÔ‡˜ ÓÂ˘ÚÒÓÂ˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó (Î·È) ÛÙÈ˜ ‰È·‰ÈÎ·Û›Â˜ ÙË˜ Ì›ÌËÛË˜ Î·È ‰Ë

ÙË˜ ·ÓıÚÒÈÓË˜ ÓÂÔÁÓÈÎ‹˜ Ì›ÌËÛË˜ (37:77-82) - ·Ó

Î·È ·ﬁ ÌﬁÓÔÈ ÙÔ˘˜ ÔÈ Î·ıÚÂÙÈÎÔ› ÓÂ˘ÚÒÓÂ˜ ‰ÂÓ ÂÚÌËÓÂ‡Ô˘Ó ÙÔÓ ÏÔ‡ÙÔ ÙˆÓ ÌÈÌËÙÈÎÒÓ Ê·ÈÓÔÌ¤ÓˆÓ.

™ÙÔÓ ÎﬁÌ‚Ô ÙˆÓ ÎÔÈÓÒÓ ÂÓ‰È·ÊÂÚﬁÓÙˆÓ

·È‰È¿ÙÚˆÓ Î·È ·Ó·Ù˘ÍÈ·ÎÒÓ „˘¯ÔÏﬁÁˆÓ ∞Ó Î·È ˘¿Ú¯Ô˘Ó ÔÏÏ¤˜ ÂÚÈÔ¯¤˜ ¤ÚÂ˘Ó·˜ ÎÔÈÓÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ ÁÈ· ·È‰›·ÙÚÔ˘˜ Î·È ·Ó·Ù˘ÍÈ·ÎÔ‡˜ „˘¯ÔÏﬁÁÔ˘˜, ·Ú·Î¿Ùˆ ÂÚÈÁÚ¿ÊÔ˘ÌÂ ÙËÓ ÙÚ¤¯Ô˘Û· ¤ÚÂ˘Ó· ÙÚÈÒÓ Â‰›ˆÓ, Ô˘ Ì·ÚÙ˘ÚÂ› ÙÈ˜ ÚÔÎÏ‹ÛÂÈ˜, Ù· ÎÂÓ¿ ÁÓÒÛË˜ Î·È ÙËÓ ·Ó¿ÁÎË ÁÈ· ‰ÈÂÈÛÙËÌÔÓÈÎ‹ Û˘ÓÂÚÁ·Û›·.

¢‡ÛÎÔÏÂ˜ ÂÚ›Ô‰ÔÈ ∫·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜, ¤¯Ô˘Ó ‚ÚÂıÂ› 8 “‰‡ÛÎÔÏÂ˜”, ÌÂÙ·‚·ÙÈÎ¤˜ ÂÚ›Ô‰ÔÈ Û˘ÁÎÈÓËÛÈ·Î‹˜ ·ÛÙ¿ıÂÈ·˜, ÎÚ›ÛË˜ Î·È Û‡ÁÎÚÔ˘ÛË˜ ÛÙÈ˜ Û¯¤ÛÂÈ˜ ‚Ú¤ÊÔ˘˜-ÌËÙ¤Ú·˜. √È van de Rijt-Plooij & Plooij (38,39) ·Ú·Ù‹ÚËÛ·Ó ÙÔ Ê·ÈÓfiÌÂÓÔ ÙˆÓ “‰‡ÛÎÔÏˆÓ” ÂÚÈfi‰ˆÓ, ÚÒÙ· ÛÙÈ˜ Û¯¤ÛÂÈ˜ ÌËÙ¤ÚˆÓ-‚ÚÂÊÒÓ ¯ÈÌ·ÓÙ˙‹‰ˆÓ Î·È ÌÂÙ¿ ÛÙÈ˜ Û¯¤ÛÂÈ˜ ÌËÙ¤ÚˆÓ-‚ÚÂÊÒÓ ÙÔ˘ Â›‰Ô˘˜ Ì·˜. ™ÙÔ˘˜ ¯ÈÌ·ÓÙ˙‹‰Â˜, Ë “‰˘ÛÎÔÏ›·” ÂÎÊÚ·˙fiÙ·Ó ·fi ÙËÓ ÂÈı˘Ì›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ó· ‚Ú›ÛÎÂÙ·È Û˘ÓÂ¯Ò˜ ÎÔ-

·Ó¿ÁÎË ÁÈ· ÊÚÔÓÙ›‰·, Û˘ÓÙÚÔÊÈ¿ Î·È ·ÚËÁÔÚÈ¿. ∏

Î¿ıÂ ÂÚ›Ô‰Ô˜ “‰˘ÛÎÔÏÈÒÓ” ıÂˆÚÂ›Ù·È ﬁÙÈ ·Ó·ÎÏ¿

ÎÚ›ÛÈÌÂ˜ ·ÏÏ·Á¤˜ Î·È ·Ó·‰ÈÔÚÁ·ÓÒÛÂÈ˜ ÛÙÔÓ ‚ÚÂÊÈÎﬁ

ÂÁÎ¤Ê·ÏÔ, ·ÏÏ¿ Î·È ÛÙÔÓ ÙÚﬁÔ Ô˘ Ë ÌËÙ¤Ú· ¯ÂÈÚ›-

˙ÂÙ·È ÙÈ˜ ·ÏÏ·Á¤˜ ·˘Ù¤˜. ∆· Ê·ÈÓﬁÌÂÓ· ·˘Ù¿ Û˘Ì‚·›-

ÓÔ˘Ó ÚÈÓ ·ﬁ Û·Ê‹ ‚ÚÂÊÈÎ¿ ¿ÏÌ·Ù· ·ÓÂÍ·ÚÙËÛ›·˜

ÙÔ˘ ‚Ú¤ÊÔ˘˜ ·fi ÙÔ˘˜ ÁÔÓÂ›˜. ¶ÔÏ‡ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ÙÚˆÙfiÙËÙ·, Î¿ÙÈ Û·Ó Ê·ÈÓÔÌÂÓÈÎ‹ ·ÏÈÓ‰Úfi-

ÌËÛË ÛÙËÓ ·Ó¿Ù˘ÍË, Ì·˙› ÌÂ ·˘ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ·, ‰ËÏ·‰‹ Û˘¯ÓfiÙÂÚÂ˜ ·ÚÚÒÛÙÈÂ˜ ÙˆÓ ‚ÚÂÊÒÓ, ·ÚÚÒÛÙÈÂ˜ ÔÔÈ·Û‰‹ÔÙÂ ·ÈÙÈÔÏÔÁ›·˜. À¿Ú¯ÂÈ ÂÎÓÂ˘ÚÈÛÌfi˜ Î·È ·fi ÙÈ˜ ‰‡Ô ÏÂ˘Ú¤˜. √È ÁÔÓÂ›˜ Î·È Ù·

‚Ú¤ÊË Ú¤ÂÈ Ó· ‰È·Ú·ÁÌ·ÙÂ˘ÙÔ‡Ó Í·Ó¿ ÙÈ˜ Û˘Ó‹-

ıÂÈÂ˜ Î·È ÙÔ˘˜ ÙÚﬁÔ˘˜ ·ÏÏËÏÂ›‰Ú·Û‹˜ ÙÔ˘˜, Î·-

ıÒ˜ ÔÈ ·ÏÏ·Á¤˜ ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ¤¯Ô˘Ó

·ÏÏ¿ÍÂÈ Ù· ÂÓ‰È·Ê¤ÚÔÓÙ· Î·È ÙÈ˜ ÈÎ·ÓﬁÙËÙ¤˜ ÙÔ˘, ·ÓÔ›ÁÔÓÙ·˜ Ó¤Ô˘˜ ‰ÚﬁÌÔ˘˜ ÁÓˆÛÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜, Ì¿ıËÛË˜ Î·È ÂÈÎÔÈÓˆÓ›·˜. √È “‰‡ÛÎÔÏÂ˜” ÂÚ›Ô‰ÔÈ

‹ ÂÚ›Ô‰ÔÈ “·ÏÈÓ‰ÚﬁÌËÛË˜” ıÂˆÚÔ‡ÓÙ·È Û‹ÌÂÚ·

Ì¤ÚÔ˜ ÙË˜ ÔÌ·Ï‹˜ ·Ó¿Ù˘ÍË˜. ™Ù· ÌÂÛÔ‰È·ÛÙ‹Ì·Ù·

ÌÂÙ·Í‡ ÙˆÓ “‰‡ÛÎÔÏˆÓ” ÂÚÈﬁ‰ˆÓ ·Ú·ÙËÚÔ‡ÓÙ·È

ÔÏ‡ “Â‡ÎÔÏÂ˜” Â‚‰ÔÌ¿‰Â˜ (“sunny” weeks), ﬁÔ˘ ÙÔ ‚Ú¤ÊÔ˜ ‰ÂÓ Â›Ó·È “‰‡ÛÎÔÏÔ” ÛÙÔÓ Í‡ÓÈÔ, ÛÙÔÓ

‡ÓÔ Î·È ÛÙÔÓ ıËÏ·ÛÌfi, ·ÏÏ¿ ¯·ÚÔ‡ÌÂÓÔ, ÙÔÏÌËÚfi, ÌÂ ÈÔ ÛÙ·ıÂÚ‹ ‰È¿ıÂÛË Î·È ÌÂ ÏÈÁfiÙÂÚÂ˜ ·Ó¿ÁÎÂ˜

ÊÚÔÓÙ›‰·˜, ·ÚËÁÔÚÈ¿˜ Î·È Û˘ÓÙÚÔÊÈ¿˜ - Â‚‰ÔÌ¿‰Â˜

Î·Ù¿ ÙÈ˜ ÔÔ›Â˜ ·ÛÎÂ› ÙÈ˜ Ó¤Â˜ ÙÔ˘ ‰ÂÍÈﬁÙËÙÂ˜. ™ÙËÓ

∂ÈÎﬁÓ· 5 Ê·›ÓÔÓÙ·È ÔÈ 8 “‰‡ÛÎÔÏÂ˜” Î·È ÔÈ 8 “Â‡ÎÔÏÂ˜” ÂÚ›Ô‰ÔÈ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜.

√È ·Ú·¿Óˆ “‰‡ÛÎÔÏÂ˜” ÂÚ›Ô‰ÔÈ ‰ÂÓ Ú¤ÂÈ Ó·

Û˘Á¯¤ÔÓÙ·È ÌÂ ÂÚÈÙÒÛÂÈ˜ fiÔ˘ ÙÔ ÓÂ·Úfi ‚Ú¤ÊÔ˜ ÓÔÛÂ› ‹ ÔÓ¿ÂÈ Î.Ï., ‰ËÏ·‰‹ ÌÂ ÁÂÁÔÓfiÙ· Ù· ÔÔ›·

¡ÂÔÁÓÈÎfi Î·È ‚ÚÂÊÈÎfi ÎÏ¿Ì· °ÂÓÈÎ¿ ÛÙ· ıËÏ·ÛÙÈÎ¿ Î·È ÂÈ‰ÈÎ¿ ÛÙÔÓ ¿ÓıÚˆÔ, Ù· ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈÎ‹ ÌÂ ÙË Á¤ÓÂÛË, ÙËÓ ·Ó¿Ù˘ÍË, ÙÈ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ÂÓÙÔÈÛÌfi ÙˆÓ ÌË¯·ÓÈÛÌÒÓ ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ Î·È ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÎÏ¿Ì·ÙÔ˜, Î·ıÒ˜ Î·È ÌÂ ÙÈ˜ Û¯ÂÙÈÎ¤˜ ÚÔ˜ ÙÔ ÎÏ¿Ì· ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÙˆÓ ÁÔÓ¤ˆÓ, ‰ÂÓ ¤¯Ô˘Ó Ì¤¯ÚÈ Û‹ÌÂÚ· ‚ÚÂÈ ÈÎ·ÓÔÔÈËÙÈÎ¤˜ ··ÓÙ‹ÛÂÈ˜. ∂›Ó·È ¿Ú·ÁÂ ÙÔ ÎÏ¿Ì· ÌfiÓÔ ¤Ó·˜ ‰Â›ÎÙË˜ Â›Ó·˜, ‰›„·˜, Ó‡ÛÙ·˜ Î.¿.; ∂›Ó·È ÌfiÓÔ ¤Ó· Û‡ÌÙˆÌ· ÎÏÈÓÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜, .¯. fiÓÔ˜ ˆ˜ Û‡ÌÙˆÌ· ÓfiÛÔ˘; ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ·Ó·Ù˘ÍÈ·Îfi ÛÈÓÈ¿ÏÔ, ‰ËÏ·‰‹ ÛËÌ·ÙÔ‰ÔÙÂ› ÌÈ· ÏÂÈÙÔ˘ÚÁ›· ÛÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÓÔ˘; ◊ Ì‹ˆ˜ Â›Ó·È Î·È Ù· 3 Ì·˙›; ŸÙ·Ó ÂÚÂ˘ÓËÙ¤˜ ·È‰›·ÙÚÔÈ Î·È ·Ó·Ù˘ÍÈ·ÎÔ› „˘¯ÔÏfiÁÔÈ (43) ıÂÒÚËÛ·Ó ÙÔ ÓÂÔÁÓÈÎfi Î·È ÙÔ ‚ÚÂÊÈÎfi ÎÏ¿Ì· ˆ˜ ‰Â›ÎÙË Î·È ˆ˜ Û‡ÌÙˆÌ· Ì¤Û· ·fi ÌÈ· ·Ó·Ù˘ÍÈ·Î‹ ÚÔÔÙÈÎ‹, Ô‰ËÁ‹ıËÎ·Ó Ó· ÔÚ›ÛÔ˘Ó ÛÂ ˘ÁÈ‹ ‚Ú¤ÊË ÙÔÓ ‚ÚÂÊÈÎfi ÎÔÏÈÎfi, fi¯È ˆ˜ Á·ÛÙÚÂÓÙÂÚÈÎfi fiÓÔ, ·ÏÏ¿ ˆ˜ ÌÈ· ÂÎ‰‹ÏˆÛË

·ÙÔÌÈÎÒÓ ‰È·ÊÔÚÒÓ ÛÙÔ Ù·ÌÂÚ·Ì¤ÓÙÔ Î·È ÛÙË Û˘ÁÎÈÓËÛÈ·Î‹ Ú‡ıÌÈÛË. ŒÙÛÈ, Ë Î‡ÚÈ· ÂÛÙ›· ÙË˜ ¤ÚÂ˘Ó·˜ Î·È Ë Î‡ÚÈ· ·ÈÙ›· ÙÔ˘ ÎÔÏÈÎÔ‡ ÌÂÙ·ÙÔ›ÛÙËÎÂ

·ﬁ ÙË Á·ÛÙÚÂÓÙÂÚÈÎ‹ ÂÚÈÔ¯‹ ÛÙÔ ∫¡™. ∞Ó Î·È Î¿-

ÔÈÂ˜ ÔÚÁ·ÓÈÎ¤˜ ÓﬁÛÔÈ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ¤Ó·Ó

ÔÈÔÓÂ› ÎÔÏÈÎfi, ÔÈ ÓfiÛÔÈ ·˘Ù¤˜ Â›Ó·È ÏÈÁfiÙÂÚÂ˜ ·fi

ﬁÛÔ ÔÈ ÂÚÂ˘ÓËÙ¤˜ ÚÔÛ‰ÔÎÔ‡Û·Ó. µ¤‚·È·, ÙÔ ·›ÓÈÁÌ·

ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÎÔÏÈÎÔ‡ - ·Ú¿ Ù· ÂÚÂ˘ÓËÙÈÎ¿ ‚‹Ì·Ù·

(44,45,46). ™ÙÔ ‚ÚÂÊÈÎﬁ ÎÏ¿Ì· ˘¿Ú¯Ô˘Ó ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ

∏ ·˘ÍËÌ¤ÓË ‚ÚÂÊÈÎ‹ ÓÔÛËÚfiÙËÙ· Î·Ù¿ ÙÈ˜ 8 “‰‡ÛÎÔÏÂ˜” ÂÚÈfi‰Ô˘˜ Û›ÁÔ˘Ú· ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ¤ÚÂ˘Ó·˜ Î·È Î·Ù·ÓfiËÛË˜ (40,41,42).

5 6810 1213172126313639444951525358

∂ÈÎﬁÓ· 5 «¢‡ÛÎÔÏÂ˜» ÂÚ›Ô‰ÔÈ (Ì·‡ÚÂ˜ ÛÙ‹ÏÂ˜) Î·È «Â‡ÎÔÏÂ˜» ÂÚ›Ô‰ÔÈ (ÏÂ˘Î¤˜ ÛÙ‹ÏÂ˜), ÛÂ Â‚‰ÔÌ¿‰Â˜, Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ (38,39).

ÁÚ‹ÁÔÚ·ÙÔ ÚÔÛ¤¯ÂÈ Î·È ·ÓÙÈ‰Ú¿ Ô ÁÔÓ¤·˜. ŸÌˆ˜, ÙÔ

ÎÏ¿Ì· Û˘¯Ó¿ ÚÔÎ·ÏÂ› ÛÙÔÓ ÁÔÓ¤· Û˘Ó·ÈÛı‹Ì·Ù·

·ÔÙ˘¯›·˜, ¿Á¯Ô˘˜, Ì·Ù·›ˆÛË˜, ·ÎﬁÌ· Î·È ÙËÓ È‰¤·

ﬁÙÈ ÙÔ ‚Ú¤ÊÔ˜ ‰ÂÓ ÙÔÓ ·Á·¿. ŒÓ· ‚ÚÂÊÈÎﬁ ÎÏ¿Ì·

ÂÎÓÂ˘ÚÈÛÌﬁ ÛÙË ÌËÙ¤Ú· ‹ ÙÔÓ ·Ù¤Ú· Î·È Ó· ÌËÓ ·ÓÙÈ‰Ú¿ÛÔ˘Ó „‡¯Ú·ÈÌ·, ˘ÔÓÔÌÂ‡ÔÓÙ·˜ ÙË Û¯¤ÛË

ÙÔ˘˜ ÌÂ ÙÔ ‚Ú¤ÊÔ˜, ‰Â‰ÔÌ¤ÓÔ˘ ﬁÙÈ ÙÔ ‚Ú¤ÊÔ˜ ÎÏ·›ÂÈ

ÚÔÛ‰ÔÎÒÓÙ·˜ ·Ó·ÎÔ‡ÊÈÛË. ∆Ô ÓÂÔÁÓÈÎﬁ Î·È ÙÔ ‚ÚÂ-

ÊÈÎﬁ ÎÏ¿Ì· Â›Ó·È ¤Ó·˜ ÙÚﬁÔ˜ ÂÈÎÔÈÓˆÓ›·˜ ÙÔ˘ ·È-

‰ÈÔ‡ - ÌËÓ¿ Î·È ÚÔÛ‰ÔÎ¿ ‚Ô‹ıÂÈ· (47,48,49,50,51).

∏ ÙÚ¤¯Ô˘Û· ¤ÚÂ˘Ó· ‰Â›¯ÓÂÈ ÙÔÓ ÚﬁÏÔ ÙÔ˘ ¿ÏÏÔ˘

(ÌËÙ¤Ú·, ·Ù¤Ú·˜ Î.¿), ·ÏÏ¿ Î·È ÙˆÓ “ÙÂ¯ÓÈÎÒÓ”

ÙÔ˘, ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÎÏ·›ÓÂ. ¡Â-

ÔÁÓ¿ ËÏÈÎ›·˜ 4 ¤ˆ˜ 7 ˆÚÒÓ Ù· ÔÔ›· ¤ÎÏ·ÈÁ·Ó, ‰ÂÓ

ËÚÂÌÔ‡Û·Ó ÌÂ ÙË Û˘ÓÂ¯‹ ·ÙÈÎ‹ Â·Ê‹, ·ÏÏ¿ ÌÂ ÙËÓ

·Û˘ÓÂ¯‹ ·ÙÈÎ‹ Â·Ê‹ - ﬁ¯È Û˘ÓÂ¯¤˜, ·ÏÏ¿ ·Û˘ÓÂ-

¯¤˜ ¯¿‰È (52). ∂ÈÏ¤ÔÓ, ÙÔ ›‰ÈÔ ÙÔ ÓÂÔÁÓﬁ ÌÂ ÙÔ ÎÏ¿-

Ì· ÙÔ˘ ÌÔÚÂ› Ó· ÂÎÊÚ¿ÛÂÈ Ì¤Ûˆ Ì›ÌËÛË˜ ‰È˘ÔÎÂÈ-

ÌÂÓÈÎ‹ Û˘Ì¿ıÂÈ· - ÓÂÔÁÓ¿ ËÏÈÎ›·˜ 18 ¤ˆ˜ 34 ˆÚÒÓ

‰ÂÓ ÌÈÌÔ‡ÓÙ·È ÙÔ Ì·ÁÓËÙÔÊˆÓËÌ¤ÓÔ ÎÏ¿Ì· ÙÔ˘˜,

·ÏÏ¿ ÙÔ Ì·ÁÓËÙÔÊˆÓËÌ¤ÓÔ ÎÏ¿Ì· ¿ÏÏˆÓ ÓÂÔÁÓÒÓ.

∫Ï¿Ì· ÛÙÔ ÎÏ¿Ì· ÙÔ˘ ¿ÏÏÔ˘ Ì·ÚÙ˘ÚÂ› Û˘ÁÎÈÓËÛÈ·Î‹

Â˘·ÈÛıËÛ›· Î·È ÂÓÛ˘Ó·›ÛıËÛË (53).

∂›Ó·È Û·Ê¤˜ ﬁÙÈ Ì¤¯ÚÈ Ó· ÂÚÂ˘Ó‹ÛÔ˘ÌÂ Î·È Ó· Î·-

Ù·ÓÔ‹ÛÔ˘ÌÂ ÂÚÈÛÛfiÙÂÚÔ ÙÔ ÎÏ¿Ì·, Ô Û˘Ì‚Ô˘ÏÂ˘ÙÈÎfi˜ Ì·˜ ÏfiÁÔ˜ ÚÔ˜ ÙÔ˘˜ ÂÍ·ÓÙÏËÌ¤ÓÔ˘˜ ·fi ÙÔ ÓÂ-

ÔÁÓÈÎfi Î·È ÙÔ ‚ÚÂÊÈÎfi ÎÏ¿Ì· ÁÔÓÂ›˜ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ÚÔÛÂÎÙÈÎfi˜. ¡˘¯ÙÂÚÈÓfi

fiÛÔ ı· ÂÈı˘ÌÔ‡Û·ÌÂ Î·Ù·ÓÔËÙfi˜, ¤ÛÙˆ Î·È ·Ó ÓˆÚ›˜ Ô ¶Ï¿ÙˆÓ (56) Î·È ·ÚÁfiÙÂÚ· ÈÔ Û˘ÛÙËÌ·ÙÈÎ¿ Ô Freud (57) ¿ÓÔÈÍ·Ó Ï›ÁÔ ÙËÓ ÎÂÚÎfiÔÚÙ· ÙË˜ ÛÎÔÙÂÈÓ‹˜ ÙÔ˘ ÏÂ˘Ú¿˜ (58,59). ∏ Û˘˙‹ÙËÛË ·Ó Ù· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË ‰ÂÓ ÔÓÂÈÚÂ‡ÔÓÙ·È (60) ‹ ÔÓÂÈÚÂ‡ÔÓÙ·È (61) Û˘ÓÂ¯›˙ÂÙ·È Î·È ÙÔ

„˘¯ÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ‚ÚÂÊÒÓ, ¿ÏÏÔÈ ÛÙÈ˜ ‰˘ÛÎÔÏ›Â˜ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË Î·È ÙÔÓ ÙÔÎÂÙﬁ, ÔÚÈÛÌ¤ÓÔÈ ÛÙÈ˜ Ú·ÎÙÈÎ¤˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÛÙÈ˜ Û¯¤ÛÂÈ˜ ÙÔ˘˜ ÌÂ Ù· ‚Ú¤ÊË, ¿ÏÏÔÈ ÛÙË ‰È·‰ÈÎ·Û›· ıËÏ·ÛÌÔ‡-·ÔıËÏ·ÛÌÔ‡ Î·È Î¿ÔÈÔÈ ¿ÏÏÔÈ ÛÙÔ ¿Á¯Ô˜, ÛÙ· ÛÙÚÂÛÔÁﬁÓ· ‚ÈÒÌ·Ù· Î·È ÛÙË ÌËÙÚÈÎ‹ Î·Ù¿ıÏÈ„Ë

ÚÈÓ Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙﬁ. ø˜ ÚÔ˜ ÙËÓ ·Ô˘Û›· ‹ ÙËÓ

·ÚÔ˘Û›· Û¯¤ÛË˜ ÌÂÙ·Í‡ ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ Í˘Ó‹Ì·ÙÔ˜ ÙˆÓ ‚ÚÂÊÒÓ Î·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, ¤¯ÂÈ ‚ÚÂıÂ›: ·) ·Ô˘Û›· Û¯¤ÛË˜ ÌÂ ÙËÓ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ÙÔÓ ÚfiˆÚÔ ÙÔÎÂÙfi, ÙÔ Ê‡ÏÔ Î·È ÙË ÛÂÈÚ¿ Á¤ÓÓËÛË˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜, Î·È ‚) ·ÚÔ˘Û›· Û¯¤ÛË˜ ÌÂ: 1. ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ - ·Ó ˘¿Ú¯ÂÈ ‚Ú¤ÊÔ˜

Ô˘ Í˘Ó¿ ·Ú·¿Óˆ ·fi 4 ÊÔÚ¤˜ ÙË Ó‡¯Ù· Î¿ıÂ Â‚‰ÔÌ¿‰· Î·È ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ ·‰ÂÚÊfi ‹ ·‰ÂÚÊ‹, ·˘Ùfi˜ ‹ ·˘Ù‹ Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· Â›¯Â ‹ Ó· ¤¯ÂÈ ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ 2. ÂÚÈÁÂÓÓËÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· - Û˘¯Ó¿, ·ÏÏ¿ fi¯È ¿ÓÙ·, ¤¯Ô˘Ó ÚÔ‚Ï‹Ì·Ù· Ù· ÓÂÔÁÓ¿ Ô˘ Â›¯·Ó ¯·ÌËÏ¤˜ ÙÈÌ¤˜ Apgar ÛÙÔ 1Ô Î·È ÛÙÔ 5Ô ÏÂÙfi ÌÂÙ¿ ÙÔÓ

ÚÔ‚Ï‹Ì·Ù· ·ÛÊ˘Í›·˜ Î.Ï.

3. ÙÔ ‚ÚÂÊÈÎﬁ Ù·ÌÂÚ·Ì¤ÓÙÔ Î·È ÙË Û˘ÌÂÚÈÊÔ-

ÔÚÁ¿ÓˆÛË - Ù· ‚Ú¤ÊË ÌÂ Î·Î‹ ‰È¿ıÂÛË, ÌÈÎÚfiÙÂÚË ÚÔÛ·ÚÌÔÛÙÈÎfiÙËÙ· Î·È Ú˘ıÌÈÎfiÙËÙ·, Î·ıÒ˜ Î·È ÌÂ ‰˘ÛÎÔÏ›Â˜ ÛÙËÓ ÚÔÛ¤ÁÁÈÛË/·fiÛ˘ÚÛË Â›¯·Ó ÂÚÈÛÛfiÙÂÚÂ˜ ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘

10. DeCasper AJ. ∞ÎÔ‡ÓÂ Ù· ¤Ì‚Ú˘· Ì¤Û· ÛÙË Ì‹ÙÚ·; ™ÙÔ: ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿ÎË˜ °, Â. ¤Î‰. ¶ÚfiÔ‰Ô˜ ÛÙËÓ ∞Ó·Ù˘ÍÈ·Î‹ æ˘¯ÔÏÔÁ›· ÙˆÓ ¶ÚÒÙˆÓ ÃÚfiÓˆÓ. ∏Ú¿ÎÏÂÈÔ: ¶·ÓÂÈÛÙËÌÈ·Î¤˜ ∂Î‰fiÛÂÈ˜ ∫Ú‹ÙË˜; 1992. Û. 49-63.

11. Piontelli A. Twin pregnancies. In: Piontelli A, editor. Twins. From Fetus to Child. London: Routledge; 1992. p. 115-116.

12. Piontelli A. Twins. From Fetus to Child. London: Routledge; 2002.

13. Butterworth G, Harris M. Principles of Developmental Psychology. Hove: Lawrence Erlbaum; 1994.

14. Berk LE. Child Development. Boston: Allyn & Bacon; 1989.

15. Gibson EJ, Walk RD. The “visual cliff”. Scientific American 1960;202:64-71.

16. Bower TGR. The object in the world of the infant. Scientific American 1971;225:31-38.

17. Bower TGR. Development in Infancy. 2nd edition. San Francisco: Freeman; 1982.

18. Wynn K. Children’s understanding of counting. Cognition 1990;36:155-193.

19. Wynn K, Bloom P, Chiang WC. Enumeration of collective entities by 5-month-old infants. Cognition 2002;83:B55-62.

20. Bijeljac-Babic R, Bertoncini J, Mehler J. How do 4-day-old infants categorize multisyllabic utterances? Developmental Psychology 1993;29:711-721.

21. Gao F, Levine SC, Huttenlocher J. What do infants know about continuous quantity? J Exp Child Psychol 2000;77:20-29.

22. Kobayashi T, Hiraki K, Mugitani R, Hasegawa T. Baby arithmetic: one object plus one tone. Cognition 2004;91: B23-34.

23. ∆ÛÔ‡ÚÙÔ˘ µ, ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿ÎË˜ °. ∞Ó·Ù˘ÍÈ·Î¤˜ Ù¿ÛÂÈ˜ ÛÙËÓ ÚÒÈÌË ‚ÚÂÊÈÎ‹ ·ÚÈıÌËÙÈÎ‹ ÈÎ·ÓﬁÙËÙ·. æ˘¯ÔÏÔÁÈÎ¿ £¤Ì·Ù· 2003;9:24-54.

24. Hauser MD, MacNeilage P, Ware M. Numerical representations in primates. Proc Nat Acad Sci, USA 1996;93:15141517.

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A quadrivalent human papillomavirus (HPV) vaccine to prevent cervical cancer and other HPV related anogenital diseases

X. Castellsagué1, G. Trimis2, D. Florakis2

Abstract: The quadrivalent (HPV types 6, 11, 16, 18) vaccine has been formulated to protect against the most common disease causing human papillomavirus (HPV) types and is expected to reduce substantially the morbidity, mortality, and cost burden of HPV infection. The quadrivalent vaccine has demonstrated high efficacy in women not exposed to HPV against anogenital cancers by preventing premalignant genital lesions (cervical, vulvar, vaginal), as well as genital warts, caused by HPV types 6, 11, 16 and 18. In adolescent males and females and young women, the quadrivalent HPV vaccine has been found to be immunogenic and safe, with a tolerability profile comparable to that of a placebo. Long-term follow up of young women has provided no evidence of diminished immunity through five years, as evidenced by high efficacy for prevention of persistent infection and disease caused by HPV 6, 11, 16 or 18.

Key words: HPV, quadrivalent vaccine, CIN 2/3, AIS, VIN 2/3, VaIN 2/3, genital warts.

Abbreviations

AAHS:amorphous aluminium hydroxide sulphate

AIS:adenocarcinoma in situ

CIN:cervical intraepithelial neoplasia

GMTs:geometric mean titres

HPV:human papillomavirus

VaIN:vaginal intraepithelial neoplasia

VIN:vulvar intraepithelial neoplasia

VLPs:virus-like particles

Introduction

Human papillomavirus (HPV) related morbidity and mortality from cytologic abnormalities of the cervix and surrounding genitalia and cervical cancer develop with high frequency. Cervical cancer has been shown to be caused by HPV infection in over 99% of cases (1). Most sexually active women will become infected with HPV in their lifetime, and over 50% of girls will acquire HPV within 48 months of becoming sexually active (2). However, up to 80% and 90%, respectively, of the women infected in the first and second years will spontaneously become clear of the infection.

HPV-associated precancerous changes in the cervix may either resolve spontaneously or be identified through screening surveillance and treated, but in some cases (1-12%) progression to cervical cancer may occur (1-3). There are over 100 HPV types, with 30-40 types associated with anogenital disease. Approximately two thirds of these are considered “high-risk” for oncogenic progression while the remaining one third are considered “low-risk” (4). Approxi-

mately 500,000 women develop cervical cancer annually, resulting in an annual mortality of about 200,000 (1). Cervical cancer is the second most common cancer among young women in the 15-44 year age group in Europe, with estimated rates of 33,000 new cases, and 15,000 deaths per year (1,5). The low-risk HPV types are primarily associated with genital warts, but they may be associated rarely with anogenital and oral cancers (4). The morbidity associated with the low-risk HPV types results in physical and emotional discomfort, which, although treated by ablation or cryotherapy, is often followed by recurrence of lesions. Thus, there is a significant medical need to address HPV-related disease (3,4).

Immunization of women using a vaccine directed against the most common high-oncogenic risk HPV types (HPV 16 and 18) and most common low risk HPV types (HPV 6 and 11) represents a logical primary prevention strategy for reducing the occurrence of HPV related diseases. The purpose of this article is to review the clinical development, efficacy, immunogenicity and safety results of the recombinant quadrivalent HPV vaccine.

Rationale for development and composition of a quadrivalent HPV L1 VLP vaccine

As is already known, most HPV-related disease can be attributed to HPV types 6, 11, 16, and 18. HPV types 6 and 11 are linked to the development

1 Unit of Infections and Cancer, Cancer Epidemiology Research Program (CERP), Institut Català d’Oncologia (ICO) CIBERESP, Hospitalet de Llobregat, Barcelona, Spain 2 Medical Department, Vaccine Unit (Sanofi Pasteur MSD), VIANEX S.A., Athens, Greece

Correspondence: Xavier Castellsagué xcastellsague@iconcologia.net Unit of Infections and Cancer, Institut Català d’Oncologia (ICO) CIBERESP, Hospitalet de Llobregat, Barcelona, Spain

Phase II proof-of-principle

HPV 16 vaccine

Women 16-23 years of age

Phase II Women 16-23 years of age

Phase III efficacy FUTURE 1&2

Women 15-26 years of age

Year-5 immune memory evaluation

Phase III adolescent immunogenicity, both genders, 9-15 years of age

Duration of effectiveness registry study Nordic region

Adolescent follow-up extension

Efficacy study in mid-adult women

Male efficacy study

efficacy beyond the planned end of the primary efficacy trial is being extended in a subset of women enrolled in the Nordic region (15). A key aspect of the clinical efficacy studies of prophylactic HPV vaccines in women has been the utilization of high grade cervical intraepithelial neoplasia (CIN 2/3) as a surrogate marker for cervical cancer. CIN 2/3 is an obligate precursor for, and is closely temporally associated with the development of cervical cancer; it is a clinically im-

Approved in >60 countries, including US and EU

portant syndrome requiring treatment and its reduction implies a reduced risk of cervical cancer (25,26).

The combined data presented in this review are based on an analysis conducted at follow up at a mean of three years post-vaccination. These values differ slightly from the final combined analyses of the fouryear data, which have not yet been published. The primary analysis involved the per-protocol population, that is, subjects who had no serum antibodies to HPV

Table 2. Primary analysis of efficacy against human papillomavirus (HPV)16/18-related cervical intraepithelial neoplasia (CIN)2/3 adenocarcinoma-in-situ (AIS) (adapted from Ault KA - ref. 27)

Vaccine (N=10,291)

Per-protocol susceptible population †

Placebo (N=10,292)

n Cases Rate* N Cases Rate* Efficacy (95% CI)

HPV 16/18-related CIN2/3 or AIS85791<0.18550850.499% (93 to 100)

By lesion type

CIN28579008550560.3100% (93 to 100)

CIN385791<0.18550510.298% (89 to 100)

AIS85790085507<0.1100% (31 to 100)

By HPV type

HPV 16-related 74551<0.17265730.499% (92 to 100)

HPV 18-related 7450007381180.1100% (78 to 100)

Each woman counted only once in each applicable row. N=number randomised to group; n=number in specified population.

*Cases per 100 person-years at risk.

† Numbers with at least one follow-up visit post-dose 3: 8492 vaccine vs 8462 placebo for analysis of HPV16/18 endpoints; 7401 vs 7203 for analysis of HPV16 endpoints; 7381 vs 7314 for analysis of HPV18 endpoints.

Figure 2. Quadrivalent Human papillomavirus (HPV) vaccine clinical programme.

Table 3. Vaccine efficacy in preventing high-grade vulval and vaginal lesions associated with human papillomavirus (HPV)16 or HPV18 and genital warts associated with HPV 6/11/16 and 18 (adapted from Joura EA, et al - ref. 28 and Barr E, et al - ref. 29) Vaccine (n=9087)

Per-protocol susceptible population # HPV

By lesion type HPV

HPV 6/11/16/18 related genital warts789920.0079001600.8999% (95.4 to 99.9)

# Includes individuals who were HPV DNA negative by PCR and seronegative to the relevant vaccine-HPV-type at enrolment, remained PCR negative to the same vaccine-HPV-type through 1 month after dose three, received three doses of vaccine or placebo within 1 year, and did not violate the protocol. Among those in the per-protocol population, the following had at least one follow-up visit after dose three: vaccine=7771 vs placebo=7742 for the analysis of HPV 16/18 endpoints; vaccine=6653 vs placebo=6465 for the analysis of HPV 16 endpoints; and vaccine=7413 vs placebo=7341 for the analysis of HPV 18 endpoints.

*Cases per 100 person-years at risk

†Of the 15 cases in the placebo group, seven were from protocol 013 and eight were from protocol 015.

6, 11, 16 or 18 at day 1, who had no HPV 6, 11, 16 or 18 DNA in their swabs at day 1 through month 7, and who had completed three vaccinations. Overall, on day 1, 73% of enrolled women tested negative for HPV types 6, 11, 16, 18 and 27% tested positive to at least one HPV type either by PCR and/or serology (27,28). At the three-year follow up, the combined Phase II/Phase III per-protocol analysis demonstrated that prophylactic quadrivalent HPV vaccination was 99% efficacious against CIN 2/3 or adenocarcinoma in situ (AIS) related to HPV 16 and 18; see Table 2 (27). This analysis also showed that the quadrivalent vaccine prevented 100% of HPV 16- and HPV 18-related cases of high grade vulvar intraepithelial neoplasia (VIN 2/3) and high grade vaginal intraepithelial neoplasia (VaIN 2/3) and 99% of HPV 6, 11, 16, or 18-related cases of genital warts; see Table 3 (28,29). The quadrivalent vaccine was up to 100% effective in reducing the incidence of HPV 6/11/16/18-related disease in HPV-naïve women (i.e., seronegative and HPV DNA negative by PCR), as well as in women who had been previously exposed to at least one vaccine HPV type at enrollment, but had no ongoing HPV infection (i.e., seropositive but HPV DNA negative by PCR) (30).

Immunogenicity – Duration of Protection

The immunoassay used in the trials of the quadrivalent vaccine is a competition assay measuring one neutralising antibody species only. VLPs are highly

immunogenic and, in VLP-immunised individuals, the peak anti-VLP antibody responses are substantially greater (at least 1-3 logs) than those made at seroconversion in natural infections (31). What is the duration, however, of the protection induced by the vaccines? The data from the trials are very encouraging, with serum antibody levels falling from the peak levels achieved after the third immunization to a lower concentration that persists at the same level (at least 1020 times that of natural infection for HPV 16) for at least 60 months post-vaccination; see Figure 3 (31). The quadrivalent vaccine was 100% efficacious in preven-ting HPV 6, 11, 16, or 18-related cases of CIN 2/3, VIN 2/3, VaIN 2/3 and genital warts at five year follow up (31). Antibody responses in women entering the quadrivalent Phase II study, who were already sero-positive and DNA-negative for vaccine-type HPV, had about twice the response as women who were naïve to the respective HPV types, suggesting an anamnestic response to infection (32). Results from a challenge study of 241 women, in which vaccinated women were given a booster dose five years after enrolment, showed rapid and enhanced antibody response after the fourth immunisation characteristic of an anamnestic response, so it is probable that quadrivalent vaccine will confer protection for a very long period and a booster dose may not be needed, as the vaccine induces good immune memory (31).

While the major part of the clinical development programme for quadrivalent vaccine was conducted

Table 4. Human papillomavirus (HPV) quadrivalent vaccine-related injection site and systemic adverse events*

Percentage of subjects

5088) (n=3470) (n=320) (n=3790)

Injection site (occurring 1-5 days after vaccination)

Systemic (occurring 1-15 days after vaccination)

* Vaccine-related adverse experiences include only those occurring at a frequency of ≥1% among recipients of quadrivalent vaccine and also at a greater frequency compared with placebo recipients.

Data from Gardasil, quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine. EPAR, 16-8-07. www.emea.europa.eu/humandocs/Humans/EPAR/gardasil/gardasil.htm

in female subjects aged 16-26 years, Phase III immunogenicity studies have also been performed in more than 6,000 female and male adolescents aged 915 years. The quadrivalent vaccine has been shown to be well tolerated and immunogenic in subjects aged 9-15 years. The results of the study showed that, by month 7, seroconversion rates were more than 99% for all four HPV types in each group (girls, boys and young women). By month 7, compared to young women, anti-HPV geometric mean titres (GMTs) in girls and boys, respectively, were 1.7 to 2.7-fold higher, thus permitting the bridging of efficacy data generated in young women to both girls and boys; see Figure 4 (24). Based on the strength of the clinical data from women aged 16-26 years and the even higher immunogenicity levels seen in male and female adolescents aged 9-15 years, bridging studies permitted the

conclusion that adolescents would also be protected from clinical disease after quadrivalent vaccine administration.

Cross protection

The humoral immunity induced by the VLP vaccines appears to be predominantly type-specific, but there is considerable amino-acid sequence homology in L1 between closely related HPV types (27). This implies that there could be cross-neutralising epitopes. The first results from a supportive per protocol analysis of two large phase III studies (FUTURE I and FUTURE II, three-year follow up) show that the quadrivalent vaccine prevented 38% (95% CI; 6,60) of pre-cancerous cervical lesions (CIN 2/3, AIS) caused by ten other cancer-causing HPV types (31/ 33/35/39/45/51/52/56/58/59), in addition to the virus

months, compared with those of natural infection (adapted from Olsson SE, et al - ref. 31).

Figure 3 Geometric mean titres (GMTs) of neutralized antibodies (HPV type 16) after quadrivalent vaccine administration for up to 60

Time since vaccination day 1, months

9-15 years of age (protocol 018) 16-23 years of age (protocol 007)

Figure 4. Anti-human papillomavirus (HPV) geometric mean titres (GMTs) in adolescent and adult recipients of quadrivalent HPV types 6, 11, 16, and 18 vaccine. Bars indicate 95% CIs. (Adapted from Block SL, et al - ref. 24.)

types directly targeted by the vaccine (mean follow up of three years) (33). These ten additional virus types cause around 16% of cervical cancer in Europe and up to 22% of cervical cancer around the world (34).

Safety

The combined quadrivalent HPV vaccine safety database indicates that the quadrivalent vaccine was generally well tolerated in both young women and adolescents, as assessed by using a vaccination-report card (VRC)-aided surveillance for 14 days following each vaccine injection. The most common vaccineand placebo-related systemic adverse experiences were fever (10.3% vs 8.6%), nausea (4.2% vs 4.1%), and dizziness (2.8% vs 2.6%), respectively. Adverse vaccine-related injection site experiences included pain, swelling, erythema and pruritus, all of which occurred at a somewhat higher frequency than in subjects receiving aluminum-containing placebo; see Table 4 (24,35). At the time of licensure, a total of 2,266 subjects became pregnant during clinical trials (vaccine = 1115, placebo = 1151). Of these pregnancies, the percentage of subjects experiencing an adverse outcome was similar in the vaccine and placebo groups. The rates of congenital abnormalities were comparable to those in the general population, with no difference between the quadrivalent HPV vaccine (15 cases) and the placebo group (16 cases). However,

it is recommended that pregnancy be avoided during the course of vaccination (16).

The quadrivalent HPV vaccine is approved to be safe, and post licensure, as more than 30 million doses of quadrivalent vaccine have been distributed worldwide and no serious adverse events have been associated with the vaccine, according to the Adverse Report System of the Centers for Disease Control (CDC) and the European Medicine Agency (EMEA) (36). Moreover, through the central Nordic registry, longterm efficacy and safety is continuing to be evaluated on a population basis in real time (15).

Ongoing studies with quadrivalent HPV vaccine

An ongoing Phase III study is being conducted in mid-adult women, aged 24-45 years. This placebo controlled, triple-blind study is following a total of 2,800 subjects over a three-year period in order to evaluate the safety profile of the quadrivalent vaccine and its efficacy in preventing HPV type 6-, 11-, 16-, and 18-related infections and disease. The interim analysis showed that the quadrivalent vaccine was as safe in this group as it is in younger women and prevented 92% of combined HPV 6, 11, 16, or 18-related cases of CIN 2/3 or AIS, VIN 2/3 and VaIN 2/3 and genital warts after a follow up of 1.65 years. More extensive results will be available in the near future (37).

An additional study in the Phase III clinical development programme for the quadrivalent HPV vaccine is aimed at evaluating the immunogenicity and tolerability of the vaccine, together with the clinical efficacy in preventing genital warts and anal cancer in men aged 16-23 years; results are expected towards the end of 2008 (15). Genital warts occur in both men and women who are sexually active, and a majority (85%) of anal cancer cases worldwide can be attributed to HPV infection (38). Thus, it is appropriate to investigate the potential impact and benefits of administering a quadrivalent HPV vaccine to males (39). This is particularly important in the light of the lack of success of other vaccination programmess that targeted females only, e.g. Measles, Mumps, Rubella vaccine (MMR) (40).

Cost-Effectiveness Studies

Economic analyses using population-dynamic models of HPV infection, transmission, and disease for the US have demonstrated that universal vaccination of girls and women at the age of 12-24 years is cost-effective, compared with other currently accepted US health care practices, costing $4,666 per qualityadjusted life-year. This strategy was shown to yield substantially larger and more rapid health benefits than vaccinating girls at the age of 12 years only, without catch-up vaccination, and it was shown to be costef fective ($10,362 per quality-adjusted life-year), compared with a more limited female catch-up vaccination strategy for girls and women at the age of 1219 years (41). Similar results have been obtained from health-economic studies of quadrivalent vaccine conducted in other countries (42,43).

Implementation Issues

Genital HPV infections are acquired rapidly after initiation of sexual activity (44), and VLP vaccines are unlikely to induce regression of established lesions (20). Therefore, there is general agreement that vaccination of preadolescent or early adolescent girls, as well as older girls and women who have not yet become sexually active, would be the most cost-effective use of the vaccine. However, sexually active women may also benefit from vaccination. It is unlikely that these women have been exposed to more than 1 or 2 of the 4 vaccine types, so the quadrivalent vaccine could protect them against infections from the remaining types. In women with prevalent or breakthrough infections, the vaccine-induced neutralizing antibodies might also inhibit transmission of the virus to a new partner (45).

More than 100 countries, including the USA and the EU countries, have approved the quadrivalent

vaccine for clinical use and most of the health authorities of these countries have also issued recommendations and approved funding. In the USA only quadrivalent vaccine is licensed and the recommended age for vaccination of females is 11-12 years. Catch-up vaccination is recommended for females aged 13-26 years who have not been previously vaccinated (46). Most European countries have introduced HPV vaccines as routine vaccination in females aged 12-15 years, and a number of them have adopted catch up programmes for older females of up to 26 years. Many health authorities and physicians stress the importance of genital warts prevention, as genital warts have an increasing incidence worldwide (47,48,49). On the other hand, screening recommendations (Pap test) are unlikely to change in the short term, and it will be important for vaccinated women to comply with the recommendations, given that the current vaccines are not expected to protect against some other infections that can lead to cervical cancer (50,51).

In summary, quadrivalent HPV vaccine is expected to reduce substantially the morbidity, mortality, and cost burden of HPV infection, as it has been demonstrated to be of high efficacy in HPV-naive women against cervical precancerous lesions, cervical cancer, vulvar and vaginal precancerous lesions, vulvar cancer and genital warts related to the four more common HPV types.

Xavier Castellsaqué is principal investigator of HPV vaccine clinical trials conducted in Spain

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28. Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM, Perez G, Koutsky LA, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet 2007;369:1693-1702.

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31. Olsson SE, Villa LL, Costa RL, Petta CA, Andrade RP, Malm C, et al. Induction of immune memory following administration of a prophylactic quadrivalent human papillomavirus (HPV) types 6/11/16/18 L1 virus-like particle (VLP) vaccine. Vaccine 2007;25:4931-4939.

32. Giuliano AR, Lazcano-Ponce E, Villa LL, Nolan T, Marchant C, Radley D, et al. Impact of baseline covariates on the immunogenicity of a quadrivalent (Types 6, 11, 16, and 18) human papillomavirus virus-like-particle vaccine. JID 2007; 196:1153-1162.

33. Brown D, for the FUTURE Study Group. HPV type 6/11/16/18 vaccine: First analysis of cross-protection against persistent infection, cervical intraepithelial neoplasia (CIN), and adenocarcinoma in situ (AIS) caused by oncogenic HPV types in addition to 16/18. In: Proceedings of the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); 2007 September 17-20; Chicago: ICAAC 2007. p. 1720.

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36. Summary of the Vaccine Adverse Event Reporting System (VAERS) / Gardasil Vaccine Reports [Webpage, Internet]. Centers for Disease Control and Prevention; 2008: http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm

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38. Frisch M, Glimelius B, van den Brule AJ, Wohlfahrt J, Meijer CJ, Walboomers JM, et al. Sexually transmitted infection as a cause of anal cancer. N Engl J Med 1997;337:1350-1358.

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40. Bottiger M, Forsgren M. Twenty years’ experience of rubella vaccination in Sweden: 10 years of selective vaccination (of 12-year-old girls and of women postpartum) and 13 years of a general two-dose vaccination. Vaccine 1997;15:15381544.

41. Elbasha EH, Dasbach EJ, Insinga RP. Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis 2007;13:28-41.

42. Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER. Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A costeffectiveness analysis. Cost Eff Resour Alloc 2008;6:1-29 [Epub ahead of print].

43. Bergeron C, Largeron N, McAllister R, Mathevet P, Remy V. Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France. Int J Technol Assess Health Care 2008;24:10-19.

44. Winer RL, Feng Q, Hughes JP, O’Reilly S, Kiviat NB, Koutsky LA. Risk of female human papillomavirus acquisition associated with first male sex partner. J Infect Dis 2008;197:279-282.

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46. Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER, et al. Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007;56:1-24.

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48. Kjaer SK, Tran TN, Sparen P, Tryggvadottir L, Munk C, Dasbach E, et al. The burden of genital warts: a study of nearly 70,000 women from the General Female Population in the 4 Nordic countries. J Infect Dis 2007;196:1447-1454.

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Quiz

1. Cervical cancer is the _______ most common cancer among women _______ in Europe.

a. first / 45-74 years old

b. second / 15-44 years old

c. first / 15-44 years old

d. second / 45-74 years old

2.Cervical cancer has been shown to be caused by HPV infection in over _______ of cases.

a. 99%

b. 89%

c. 79%

d. 69%

3. Over _______ of girls will acquire HPV within 48 months of becoming sexually active.

a. 10%

b. 30%

c. 50%

d. 70%

4. Up to _______ of HPV-associated precancerous changes might progress to cervical cancer.

a. 3%

b. 6%

c. 12%

d. 20%

5. HPV types 16 and 18 account for _______ of cervical cancer and HPV types 6 and 11 for _______ of genital warts in Europe.

a. 60% / 50%

b. 90% / 75%

c. 50% / 90%

d. 75% / 90%

6. Amorphous Aluminium Hydroxide Sulphate (AAHS):

a. has the greatest capacity to bind HPV VLPs and generate substantially higher antibody titres than ALOH

b. has limited capacity to bind HPV VLPs and generate substantially lower antibody titres than ALOH

c. has no clinical experience as it has not been used as an adjuvant in other licensed vaccines

d. It is used as an adjuvant only in conjugated vaccines

7. The quadrivalent HPV vaccine has demonstrated high efficacy against the following 6, 11, 16, 18 HPV related diseases:

a. cervical cancer, high grade cervical intraepithelial neoplasia

b. cervical cancer, high grade cervical, vulvar and vaginal intraepithelial neoplasias

c. cervical cancer, high grade cervical intraepithelial neoplasia and genital warts

d. cervical cancer, high grade cervical, vulvar, vaginal intraepithelial neoplasias and genital warts

8. In 9-15 year old adolescents, the quadrivalent HPV vaccine has demonstrated:

a. high efficacy against 6, 11, 16, 18 HPV related anogenital diseases

b. low efficacy against 6, 11, 16, 18 HPV related anogenital diseases

c. higher immunogenicity than in women 15-26 years old

d. lower immunogenicity than in women 15-26 years old

9. The most effective practice to reduce cervical cancer worldwide is:

a. systematic implementation of screening programmes (Pap test) in sexually active women

b. routine HPV vaccination of women aged 12-26 years

c. combined implementation of screening programs (Pap test) in sexually active women and routine vaccination in women aged 12-26 years

d. there is no effective practice to reduce cervical cancer

The correct answers at page 416

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Phimosis and circumcision in children

G. Sakellaris, I. Bouloukaki, A. Dimopoulou, G. Charissis

Abstract: Male circumcision is a surgical technique that has been practiced since ancient times. However, there has been concern over the last few years that many operations for circumcision are performed unnecessarily. The most common medical indication for circumcision is pathological phimosis, but there is confusion about the interpretation of the term phimosis, as the pathological form is not always distinguished from physiological phimosis, which is a normal part of penile development. Surgical excision of the prepuce should be restricted to lesions that are unresponsive to alternative forms of treatment, such as topical steroid application, adhesiolysis and preputioplasty. Improved knowledge of foreskin development and disorders on the part of the paediatrician could reduce many referrals to the paediatric surgery outpatient department.

Key words: Phimosis, circumcision, prepuce, alternative treatments.

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Department of Paediatric Surgery, University General Hospital of Heraklion, Medical School of the University of Crete

Correspondence: Georgios Sakellaris gsakell@mycosmos.gr Department of Paediatric Surgery, University General Hospital of Heraklion, Medical School of the University of Crete

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Ï›·ÓÛË ÙË˜ ‚·Ï¿ÓÔ˘ Î·È ÙË ‰ÈÂ˘ÎﬁÏ˘ÓÛË ÙË˜ ÔÏ›-

ÛıËÛ‹˜ ÙË˜ Î·Ù¿ ÙË ÛÂÍÔ˘·ÏÈÎ‹ Â·Ê‹. ∏ ÌÔÓ·‰ÈÎ‹

ÙË˜ ÓÂ‡ÚˆÛË Û˘Ì‚¿ÏÏÂÈ ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙË˜ ˆ˜ ÂÚˆ-

ÙÔÁÂÓÔ‡˜ ˙ÒÓË˜.

∏ ·Ó¿Ù˘ÍË ÙË˜ ·ÎÚÔÔÛı›·˜ Â›Ó·È ·ÙÂÏ‹˜ ÛÙ·

ÓÂÔÁ¤ÓÓËÙ· ·ÁﬁÚÈ·. ∆È˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ˙ˆ‹˜

Û˘ÌÊ‡ÂÙ·È ÛÂ ‹ÈÔ ‚·ıÌﬁ ÌÂ ÙË ‚¿Ï·ÓÔ, ˆÛÙﬁÛÔ Ë

Û‡ÌÊ˘ÛË ·˘Ù‹ Á›ÓÂÙ·È ÈÛ¯˘ÚﬁÙÂÚË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÚÒÙÔ˘ ¤ÙÔ˘˜.

·˘Ù‹ Î·È ÙÔ Ê·ÈÓﬁÌÂÓÔ ·˘Ùﬁ ‰ÂÓ ıÂˆÚÂ›Ù·È Ê›-

ÌˆÛË ÌÂ ÙËÓ ·ıÔÏÔÁÈÎ‹ ¤ÓÓÔÈ·, ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ·Ó·Ê¤ÚÂÙ·È ˆ˜ “Ê˘ÛÈÔÏÔÁÈÎ‹ Ê›ÌˆÛË” ‹ ·Ï¿ ˆ˜ “ÌË Î·Ù·ÛÒÌÂÓË ·ÎÚÔÔÛı›·” (3). √ ‰È·¯ˆÚÈÛÌfi˜ ·fi ÙË ‚¿Ï·ÓÔ Î·È Ë ·Ó¿Û·ÛË ÙË˜ ·ÎÚÔÔÛı›·˜

Û˘Ì‚·›ÓÂÈ ÛÂ ‰È¿ÊÔÚÂ˜ ËÏÈÎ›Â˜. √È Û˘ÌÊ‡ÛÂÈ˜ ‰È·-

¯ˆÚ›˙ÔÓÙ·È ·˘ÙﬁÌ·Ù·, Û˘Ó‹ıˆ˜ Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹

ËÏÈÎ›·, Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÈ‰ÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜. ∏

Ê˘ÛÈÔÏÔÁÈÎ‹ Ê›ÌˆÛË ÌÂÈÒÓÂÙ·È ÌÂ ÙËÓ ËÏÈÎ›·, ﬁˆ˜

Ê·›ÓÂÙ·È ·ﬁ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ (4). ™‡ÌÊˆÓ· ÌÂ

ÙÔÓ Gairdner, Ë ¤ÏÍË ÙË˜ ·ÎÚÔÔÛı›·˜ ÚÔ˜ Ù· ›Ûˆ

ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤¯ÚÈ ÙÔ 1Ô ¤ÙÔ˜ ÛÙÔ 50% ÙˆÓ ·ÁÔ-

ÚÈÒÓ, ¤ˆ˜ ÙÔ 2Ô ¤ÙÔ˜ ÛÙÔ 75% Î·È ¤ˆ˜ ÙËÓ ËÏÈÎ›· ÙˆÓ

3 ÂÙÒÓ ÛÙÔ 90% ÙˆÓ ·ÁÔÚÈÒÓ. ∏ ·Ó¿Ù˘ÍË ÙË˜ ·ÎÚÔ-

ÔÛı›·˜ ÂÚÈÁÚ¿ÊËÎÂ Â›ÛË˜ ·ﬁ ÙÔÓ Oster, Û‡Ì-

ÊˆÓ· ÌÂ ÙÔÓ ÔÔ›Ô ‚Ú¤ıËÎÂ ﬁÙÈ ÔÈ ÂÈÙÒÛÂÈ˜ ÙˆÓ

Û˘ÌÊ‡ÛÂˆÓ ÙË˜ ·ÎÚÔÔÛı›·˜ ÌÂÈÒıËÎ·Ó ·ﬁ 70%

ÛÙËÓ ËÏÈÎ›· ÙˆÓ 6-7 ÂÙÒÓ ÛÂ 5% ÛÙËÓ ËÏÈÎ›· ÙˆÓ

16-17 ÂÙÒÓ. ¢ÂÓ ˘¿Ú¯ÂÈ, ÂÔÌ¤Óˆ˜, ÚÔıÂÛÌ›· ÁÈ’

·˘Ùfi Î·È ÛÂ ÌÈÎÚfi ÔÛÔÛÙfi ·ÁÔÚÈÒÓ Ë ·ÎÚÔÔÛı›·

‰ÂÓ ¤¯ÂÈ Î·Ù·Û·ÛÙÂ› Ï‹Úˆ˜ Ì¤¯ÚÈ ÙËÓ ÂÊË‚Â›·.

∂ÔÌ¤Óˆ˜, ÌÈ· ÌË Î·Ù·ÛÒÌÂÓË ·ÎÚÔÔÛı›· ÛÂ ·È‰› ÚÈÓ ·ﬁ ÙËÓ ÂÊË‚Â›· ‰ÂÓ ıÂˆÚÂ›Ù·È ÓﬁÛÔ˜ Î·È

¯ÚÂÈ¿˙ÂÙ·È ıÂÚ·Â›·.

‰›ÎËÓ Ì·ÏÔÓÈÔ‡ (ballooning) Î·Ù¿ ÙËÓ Ô‡ÚËÛË. ∆Ô Ê·ÈÓﬁÌÂÓÔ ·˘Ùﬁ

·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓÔ Î·È ˘Ô¯ˆÚÂ› fiÙ·Ó Ë ·ÎÚÔÔÛı›· ÌÔÚÂ› Ó· Î·Ù·Û·ÛÙÂ› Ê˘ÛÈÔÏÔÁÈÎ¿. ™Â ·Ô˘Û›· ·ıÔÏÔÁÈÎ‹˜ Ê›ÌˆÛË˜, ÙÔ ballooning ‰ÂÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi ·fiÊÚ·ÍË˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ (3). ∏ ·Ú·ÁˆÁ‹ ÛÌ‹ÁÌ·ÙÔ˜ ·fi ÙËÓ ÂÛˆÙÂÚÈÎ‹ ÂÈÊ¿ÓÂÈ· ÙË˜ ·ÎÚÔÔÛı›·˜, Ô˘ Û˘Ì‚¿ÏÏÂÈ ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙË˜ ·ÎÚÔÔÛı›·˜ ·fi ÙË ‚¿Ï·ÓÔ, Î·È Ë ·Ô‚ÔÏ‹ ·˘ÙÔ‡ ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜ Û˘¯Ó¿ ÂÎÏ·Ì‚¿ÓÔÓÙ·È ÂÛÊ·ÏÌ¤Ó· ˆ˜ ÏÔ›ÌˆÍË. ∏ ¿ıÚÔÈÛË ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜

Â›Ó·È ‰˘Ó·Ùﬁ Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÌÈ·˜ ÎÈÙÚÈÓˆ‹˜ ‰ÈﬁÁÎˆÛË˜ ÛÙÔ ‰¤ÚÌ· ÙË˜ ·ÎÚÔÔÛı›·˜, Ô˘

ÂÛÊ·ÏÌ¤Ó· ÌÔÚÂ› Ó· ÂÎÏËÊıÂ› ˆ˜ ÛÌËÁÌ·ÙÔÁﬁÓÔ˜

Î‡ÛÙË ‹ ·ÎfiÌË Î·È ˆ˜ fiÁÎÔ˜. ªÂÙ¿ ÙËÓ ÂÊË‚Â›·, Ë ·ÎÚÔÔÛı›· Ú¤ÂÈ Ó· ¤ÏÎÂÙ·È Î·È Ó· Î·ı·Ú›˙ÂÙ·È, ÏfiÁˆ ÙË˜ ÔÚÌÔÓÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙËÓ ÂÚÈÔ¯‹.

º›ÌˆÛË

∏ Ê›ÌˆÛË ÚÔÎ·ÏÂ›Ù·È ·ﬁ ¤Ó· ÛÊÈÎÙﬁ ‰·ÎÙ‡ÏÈÔ ÈÓÒ‰Ô˘˜ ÈÛÙÔ‡ ÛÙËÓ ·ÎÚÔÔÛı›·, Ô˘ ‰ÂÓ ÂÈÙÚ¤ÂÈ

ÙËÓ ¤ÏÍË ÙË˜ ·ÎÚÔÔÛı›·˜ ÚÔ˜ Ù· ›Ûˆ, ÒÛÙÂ Ó· Á›ÓÂÈ ÔÚ·Ù‹ Ë ‚¿Ï·ÓÔ˜ (∂ÈÎﬁÓ· 1). ªÔÚÂ› Ó· ÚÔÎ‡„ÂÈ ·ﬁ ÚÔÛ¿ıÂÈÂ˜ ‚›·ÈË˜ ¤ÏÍË˜ ÙË˜ ·ÎÚÔÔÛı›·˜

ÚÔ˜ Ù· ›Ûˆ, Û˘ÓÂÂ›· Ï·Óı·ÛÌ¤ÓË˜ Û˘Ì‚Ô˘Ï‹˜,

ÛÂ ÔÏÏ¿ ·ÁﬁÚÈ· (Ê˘ÛÈÔÏÔÁÈÎ‹ Ê›ÌˆÛË) (5).

¶›Ó·Î·˜ 1. ∞ﬁÏ˘ÙÂ˜ ÂÓ‰Â›ÍÂÈ˜ ÂÚÈÙÔÌ‹˜

ñ ¶·ıÔÏÔÁÈÎ‹ Ê›ÌˆÛË: ∏ ÌﬁÓË ·ﬁÏ˘ÙË ¤Ó‰ÂÈÍË ÁÈ· ÂÚÈÙÔÌ‹

ıÂˆÚÂ›Ù·È Ë ‰ËÌÈÔ˘ÚÁ›· Ô˘ÏÒ‰Ô˘˜ ‰·ÎÙ˘Ï›Ô˘ ÛÙÔ ¿ÓÔÈÁÌ·

ÙË˜ ·ÎÚÔÔÛı›·˜, Î·ıÈÛÙÒÓÙ·˜ ÙË ÌË Î·Ù·ÛÒÌÂÓË. ¢ÂÓ Â›-

Ó·È Û˘ÓËıÈÛÌ¤ÓÔ ·›ÙÈÔ ÚÈÓ ·ﬁ ÙËÓ ËÏÈÎ›· ÙˆÓ 5 ÂÙÒÓ. ñ ÀÔÙÚÔÈ¿˙Ô˘Û· ‚·Ï·Ó›ÙÈ‰·/‚·Ï·ÓÔÔÛı›ÙÈ‰·.

ñ ™·ÓÈﬁÙÂÚÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜.

ÊÔÚ¤˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ‰È·ÎÚÈıÔ‡Ó Î·È Ë Ê›ÌˆÛË

ÌÔÚÂ› Ó· ‰È·ÁÓˆÛÙÂ› ÌﬁÓÔ ·Ó·‰ÚÔÌÈÎ¿, ÛÙËÓ ÂÚ›-

ÙˆÛË Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Î·ıﬁÏÔ˘ ‚ÂÏÙ›ˆÛË ÛÙË ‰˘-

Ó·ÙﬁÙËÙ· ¤ÏÍË˜ ÙË˜ ﬁÛıË˜.

∏ Ê›ÌˆÛË ÂÌÔ‰›˙ÂÈ ÙËÓ ·ÚÔ¯¤ÙÂ˘ÛË ÙÔ˘ ¯ÒÚÔ˘

ÌÂÙ·Í‡ ÙË˜ ·ÎÚÔÔÛı›·˜ Î·È ÙË˜ ‚·Ï¿ÓÔ˘, ÌÂ ·ÔÙ¤-

ÏÂÛÌ· ÙË Û˘ÛÛÒÚÂ˘ÛË Ô‡ÚˆÓ Î·È ÛÌ‹ÁÌ·ÙÔ˜. ∂·-

ÎfiÏÔ˘ıÔ Â›Ó·È ÌÈ· ‹È· ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹, Ô˘ ÂÈ‰ÂÈÓÒÓÂÈ ÙË Ê›ÌˆÛË. ∏ ‰ÈfiÁÎˆÛË ‰›ÎËÓ Ì·ÏÔÓÈÔ‡ ÙË˜ ·ÎÚÔÔÛı›·˜ Î·Ù¿ ÙËÓ Ô‡ÚËÛË ·ÔÙÂÏÂ› ÛËÌÂ›Ô

ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ÛÙËÓ Î·Ù¿ÛÙ·ÛË ·˘Ù‹. ™˘Ó‹ıË Û˘ÌÙÒÌ·Ù· Â›Ó·È Ë ÌË Î·Ù·ÛÒÌÂÓË ·ÎÚÔÔÛı›·, Ô ÂÚÂıÈÛÌﬁ˜ ‹ Ë ·ÈÌÔÚÚ·Á›· ·ﬁ ÙÔ

¿ÓÔÈÁÌ· ÙË˜ ·ÎÚÔÔÛı›·˜, Ë ¯ÚﬁÓÈ· Â›Û¯ÂÛË Ô‡-

ÚˆÓ, Ô˘ ÌÔÚÂ› Ó· ÂÈÏ·ÎÂ› ÌÂ ‰Â˘ÙÂÚÔ·ı‹

ÂÓÔ‡ÚËÛË, ‹ ·ÔÊÚ·ÎÙÈÎ¿ Ê·ÈÓﬁÌÂÓ· ÛÙÔ ·ÓÒÙÂÚÔ

Ô˘ÚÔÔÈËÙÈÎﬁ Û‡ÛÙËÌ· (2).

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› ﬁÙÈ Ë Â›ÙˆÛË ÙË˜ ·ıÔÏÔÁÈÎ‹˜

Ê›ÌˆÛË˜ ÛÙ· ·ÁﬁÚÈ· Â›Ó·È 0,4 ÂÚÈÙÒÛÂÈ˜/1000

·ÁfiÚÈ· ÙÔÓ ¯ÚfiÓÔ ‹ fiÙÈ 0,6% ÙˆÓ ·ÁÔÚÈÒÓ ÚÔÛ‚¿Ï-

ÏÔÓÙ·È Ì¤¯ÚÈ ÙÔ 15Ô ¤ÙÔ˜ ÙË˜ ËÏÈÎ›·˜ ÙÔ˘˜. ∆Ô ÔÛÔÛÙﬁ, ﬁÌˆ˜, ÙˆÓ ·ÁÔÚÈÒÓ Ô˘ ˘Ê›ÛÙ·Ù·È ÂÚÈÙÔÌ‹

ÛÙËÓ ∞ÁÁÏ›· Â›Ó·È 8 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ ·ﬁ ÙÔ ÔÛÔÛÙﬁ ÙˆÓ ·ÁÔÚÈÒÓ ÌÂ ·ıÔÏÔÁÈÎ‹ Ê›ÌˆÛË (6).

£ÂÚ·Â›· ÙË˜ Ê›ÌˆÛË˜ ∏ Ê›ÌˆÛË Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ıÂÚ·Â˘ÙÈÎ¿ ﬁÙ·Ó Û˘ÓÔ‰Â‡ÂÙ·È ·ﬁ ÙËÓ ·ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ

Û˘ÌÙˆÌ¿ÙˆÓ ·ﬁÊÚ·ÍË˜ ÙË˜ Ô˘ÚÔÊﬁÚÔ˘ Ô‰Ô‡ ‹

ÏÔ›ÌˆÍË. ∞Ó ¤Ó· ·È‰› ·ÊÂıÂ› ÌÂ Ê›ÌˆÛË, ı· ÂÌÊ·-

Ó›˙ÂÈ ¿ÏÁÔ˜ Î·Ù¿ ÙËÓ ÂÚˆÙÈÎ‹ Â·Ê‹ ÛÙËÓ ÂÓ‹ÏÈÎË

˙ˆ‹, ÏﬁÁˆ ‚Ï¿‚Ë˜ ÙË˜ ·ÎÚÔÔÛı›·˜. ∫¿Ùˆ ·ﬁ ÙËÓ

·ÎÚÔÔÛı›· ı· ÂÌÊ·ÓÈÛÙÂ› ‹È· ¯ÚﬁÓÈ· ÊÏÂÁÌÔÓ‹

Î·È, ·Ó ·˘Ù‹ Ë ÊÏÂÁÌÔÓ‹ ÂÈÌÂ›ÓÂÈ ÁÈ· ‰ÂÎ·ÂÙ›Â˜, Â›Ó·È ‰˘Ó·Ùﬁ Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ

∂ÈÎﬁÓ· 2 ∏ ÙÂ¯ÓÈÎ‹ ÙË˜ Ï·ÛÙÈÎ‹˜ ÙË˜ ·ÎÚÔÔÛı›·˜.

ÂÓÔ¯Ï‹Ì·Ù· ·ﬁ Û˘ÁÎ¤ÓÙÚˆÛË Î˘ÙÙ¿ÚˆÓ Ô˘ ·Ô-

Ó·

ÚÔËÁÔ‡ÓÙ·È ÙË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ Â¤Ì‚·ÛË˜ ÌfiÓÔ fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ·fiÏ˘ÙË ¤Ó‰ÂÈÍË ¿ÌÂÛË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ Î·È ‰ÂÓ ·ÔÙÂÏÔ‡Ó Î·ıÈÂÚˆÌ¤ÓÂ˜ Ù·ÎÙÈÎ¤˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ Ê›ÌˆÛË˜.

·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ê›ÌˆÛË˜ ÌÂ ÙÔÈÎ¿ ÛÙÂÚÔÂÈ‰‹ ˘ÔÛÙËÚ›˙ÂÙ·È ·ﬁ ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜, ÌÂ ÔÛÔÛÙﬁ ·ÔÎ·Ù¿ÛÙ·ÛË˜ 80% ÙˆÓ ÂÚÈÙÒ-

ÛÂˆÓ (3). °›ÓÂÙ·È ÙÔÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÛÙÂÚÔÂÈ‰Ô‡˜

ÎÚ¤Ì·˜ (0,05% betamethasone) ‰‡Ô ÊÔÚ¤˜ ÙËÓ ËÌ¤Ú·, ÁÈ· Ì›·, ‰‡Ô ‹ Ù¤ÛÛÂÚÈ˜ Â‚‰ÔÌ¿‰Â˜, Ë ÔÔ›· Â›Ó·È ÌÈ· ·ÛÊ·Ï‹˜, ·Ï‹ Î·È ÊıËÓ‹ Ï‡ÛË. °›ÓÂÙ·È ··Ï‹

¤ÏÍË ÙË˜ ·ÎÚÔÔÛı›·˜, ¯ˆÚ›˜ Ó· ÚÔÎÏËıÂ› fiÓÔ˜, Î·È ÂÊ·ÚÌÔÁ‹ ÂÓfi˜ ÈÎ·ÓÔ‡ ¿¯Ô˘˜ ÛÙÚÒÌ·ÙÔ˜ ÎÚ¤Ì·˜ ÛÙÔ ÈÔ ÛÙÂÓfi Ì¤ÚÔ˜ ÙË˜ ·ÎÚÔÔÛı›·˜. ∞Ó ÌÂÙ¿ ·fi 3 Ì‹ÓÂ˜ ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· Á›ÓÂÈ ¤ÏÍË ÙË˜

·ÎÚÔÔÛı›·˜, Ë ıÂÚ·Â›· ÛÙ·Ì·Ù¿ÂÈ.

™Â ÂÚÈÙÒÛÂÈ˜ Ô˘ ˘¿Ú¯Ô˘Ó ·Û‡ÌÌÂÙÚÂ˜ ‹ ÂÌÊ·ÓÂ›˜ Û˘ÌÊ‡ÛÂÈ˜ ÌÂÙ·Í‡ ÙË˜ ·ÎÚÔÔÛı›·˜ Î·È ÙË˜

‚·Ï¿ÓÔ˘, ÌÔÚÂ› Ó· ÂÊ·ÚÌÔÛÙÂ› Ë Û˘ÌÊ˘ÛÈﬁÏ˘ÛË, ÌÈ· ·Ï‹ Â¤Ì‚·ÛË Ô˘ ÌÔÚÂ› Ó· Á›ÓÂÈ ˘ﬁ ÙÔÈÎ‹

·Ó·ÈÛıËÛ›· (7). ŸÌˆ˜, Â›Ó·È ÛËÌ·ÓÙÈÎﬁ Ó· ·Ó·ÊÂÚıÂ› ﬁÙÈ Ë ÚÔÛ¿ıÂÈ· ‰È¿ÓÔÈÍË˜ ÙË˜ ·ÎÚÔÔÛı›·˜

Ú¤ÂÈ Ó· Á›ÓÂÈ ·ﬁ ¤ÌÂÈÚÔ ¯ÂÈÚÔ˘ÚÁﬁ, ÁÈ· Ó· ·ÔÊ‡ÁÔ˘ÌÂ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ÛÙÔ ¯Â›ÏÔ˜ ÙË˜ ·ÎÚÔÔÛı›·˜, ÔÈ ÔÔ›ÔÈ ÌÔÚÔ‡Ó Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó Ô˘Ï‹

Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ Ê›ÌˆÛË.

ªÈ· ¿ÏÏË ÂÓ·ÏÏ·ÎÙÈÎ‹ Ì¤ıÔ‰Ô˜ ıÂÚ·Â›·˜ ÙË˜

Ê›ÌˆÛË˜, Ë Ï·ÛÙÈÎ‹ ÙË˜ ·ÎÚÔÔÛı›·˜, ·ÔÙÂÏÂ›

ÈÔ Â‡ÎÔÏË, ÁÚ‹ÁÔÚË Î·È ·ÛÊ·Ï‹ Â¤Ì‚·ÛË ·ﬁ ÙËÓ

ÂÚÈÙÔÌ‹ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÈÌ‹ÎË ÙÔÌ‹ ÙÔ˘

ÊÈÌˆÙÈÎÔ‡ ‰·ÎÙ˘Ï›Ô˘ ÌÂ ÂÁÎ¿ÚÛÈ· Û˘ÚÚ·Ê‹, ¯ˆÚ›˜ ·Ê·›ÚÂÛË ÈÛÙÔ‡ (∂ÈÎﬁÓ· 2) (8). Œ¯Ô˘Ó ÚÔÙ·ıÂ› ·ÚÎÂÙ¤˜ ÂÓ·ÏÏ·ÎÙÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜, ÌÂ ÏÈÁﬁÙÂÚÂ˜ ÂÈÏÔÎ¤˜, Ô˘ ÛÙÔ¯Â‡Ô˘Ó ÛÙË ‰ÈÂ‡Ú˘ÓÛË ÙË˜ ·ÎÚÔÔÛı›·˜, ÒÛÙÂ Ó· Î·Ù·Û¿Ù·È ÈÔ Â‡ÎÔÏ· Î·È Ó· ¤¯ÂÈ

∫ÔÈÓˆÓÈÎÔ›/„˘¯ÔÏÔÁÈÎÔ›

ÏﬁÁÔÈ

π·ÙÚÈÎÔ›

∂Ï·ÙÙˆÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ ÙË˜ Ì‹ÙÚ·˜∞ÈÌÔÚÚ·Á›·

∂Ï·ÙÙˆÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ Ô˘ÚÔÏÔ›ÌˆÍË˜§Ô›ÌˆÍË

∂Ï·ÙÙˆÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ ÌÂÙ¿‰ÔÛË˜ ÙˆÓ ÛÂÍÔ˘·ÏÈÎ¿ ∆Ú·˘Ì·ÙÈÛÌﬁ˜ ÙË˜ ‚·Ï¿ÓÔ˘

ÌÂÙ·‰È‰ﬁÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ¶ÂÚ›ÛÛÂÈ· ·ÎÚÔÔÛı›·˜

∫·Ï‡ÙÂÚË ˘ÁÈÂÈÓ‹™˘ÌÊ‡ÛÂÈ˜ ÙË˜ ‚·Ï¿ÓÔ˘

∂ÊfiÛÔÓ ·ÔÙ‡¯Ô˘Ó ÔÈ ÚÔËÁÔ‡ÌÂÓÂ˜ Ì¤ıÔ‰ÔÈ, ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Ë ÂÚÈÙÔÌ‹, Ë ÔÔ›·, fiˆ˜ Î¿ıÂ Â¤Ì‚·ÛË, ıÂˆÚÂ›Ù·È ÙÚ·˘Ì·ÙÈÎ‹ ÁÈ· ÙÔ

·È‰›, ÂÓÒ Â›Ó·È ÌË ·Ó·ÛÙÚ¤„ÈÌË Î·È ı· Ú¤ÂÈ Ó· ·ÔÙÂÏÂ› ÙÂÏÂ˘Ù·›· Ï‡ÛË. √È ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ÂÚÈÙÔÌ‹, Û‡ÌÊˆÓ· ÌÂ ÙÔ The Royal College of Surgeons of England (9), Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∏ ÍËÚˆÙÈÎ‹ ·ÔÊÚ·ÎÙÈÎ‹ ‚·Ï·Ó›ÙÈ‰· ‰ÂÓ ıÂˆÚÂ›Ù·È Ï¤ÔÓ ÌÔÚÊ‹ Ê›ÌˆÛË˜ Ô˘ ··ÈÙÂ› ¯ÂÈÚÔ˘ÚÁÈÎ‹ ıÂÚ·Â›· (7). ªÂ ÙÈ˜ ÓÂﬁÙÂÚÂ˜ ıÂÚ·Â›Â˜ Ô˘ ÚÔ·Ó·Ê¤ÚıËÎ·Ó, ÙÔ ÔÛÔÛÙﬁ ÙË˜ ÂÚÈÙÔÌ‹˜ ÌÂÈÒÓÂÙ·È ·Ó·ÁÎ·-

ÛÙÈÎ¿ (10).

™˘˙‹ÙËÛË

Œ¯ÂÈ ·Ú·ÙËÚËıÂ› ﬁÙÈ ÔÏÏ¤˜ ÊÔÚ¤˜ Ë ÂÚÈÙÔÌ‹

Á›ÓÂÙ·È ¿ÛÎÔ·. ∏ ÂÚÈÙÔÌ‹ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È

ÌfiÓÔÓ fiÙ·Ó ˘¿Ú¯Ô˘Ó ·fiÏ˘Ù· Û·Ê‹ ÎÏÈÓÈÎ¿ ‰Â‰Ô-

Ì¤Ó·, ÂÂÈ‰‹ ÔÏÏ¤˜ ÊÔÚ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÔ‚·-

Ú¤˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¤˜ ÂÈÏÔÎ¤˜, ﬁˆ˜ Û˘ÌÊ‡ÛÂÈ˜

ÙË˜ ‚·Ï¿ÓÔ˘, ÛÙ¤ÓˆÛË ÙË˜ Ô˘Ú‹ıÚ·˜, Ô˘ÚËıÚÈÎﬁ

Û˘Ú›ÁÁÈÔ, ·ÈÌÔÚÚ·Á›· ‹ ÏÔ›ÌˆÍË, ÔÈ ÔÔ›Â˜ ÌÔÚÂ›

Ó· ¯ÚÂÈ·ÛÙÔ‡Ó ¯ÂÈÚÔ˘ÚÁÈÎ‹ ıÂÚ·Â›· (11). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÂÈÏÔÎÒÓ ÔÈÎ›ÏÏÂÈ ·fi 0,06% ¤ˆ˜ 55% (12) Î·È ÔÏÏÔ› ÂÈÛÙ‹ÌÔÓÂ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ·‰ÈÎ·ÈÔÏfiÁËÙÂ˜ ÂÚÈÙÔÌ¤˜ ·ÔÙÂÏÔ‡Ó ÌÈ· ÌÔÚÊ‹

Î·ÎÔÔ›ËÛË˜ ÙÔ˘ ·È‰ÈÔ‡, Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ÙÔ˘ ·Ê‹ÛÂÈ „˘¯ÔÏÔÁÈÎ¿ ÙÚ·‡Ì·Ù·.

™‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ ∞Î·‰ËÌ›·˜ ¶·È‰È·ÙÚÈÎ‹˜ ÙÔ˘ 1999 (13), Ô˘ Â·Ó·‰È·Ù˘ÒıËÎ·Ó ÙÔ 2005 (14), Ë ÂÚÈÙÔÌ‹, ÂÈ‰ÈÎ¿ ﬁÙ·Ó

ÂÎÙÂÏÂ›Ù·È ÚÈÓ ·ﬁ ÙËÓ ËÏÈÎ›· ÙÔ˘ ÂÓﬁ˜ ¤ÙÔ˘˜, ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, È‰È·›ÙÂÚ· ÛÂ ÓÂÔÁÓ¿ ÌÂ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜

(13,14,15).

ÂÓËÌ¤ÚˆÛË, Î·ıÒ˜ Î·È Ó· ¤¯Ô˘Ó ÙËÓ Â˘Î·ÈÚ›· Ó· Û˘˙ËÙ‹ÛÔ˘Ó ÙËÓ ·fiÊ·Û‹ ÙÔ˘˜. ™ÙËÓ ∞ÁÁÏ›·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÚÈÙÔÌÒÓ ÌÂÈÒıËÎÂ ·fi 35%, ÛÙÈ˜ ·Ú¯¤˜ ÙÔ˘ 1930, ÛÙÔ 6,5% ÛÙ· Ì¤Û· ÙÔ˘ 1980. ¶·Ú’ fiÏ· ·˘Ù¿, fiÌˆ˜, ıÂˆÚÂ›Ù·È fiÙÈ Ù· 2/3 ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ‹Ù·Ó ¿ÛÎÔÂ˜, ÂÊfiÛÔÓ ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÔÌ¤˜ ¤ÁÈÓ·Ó ÛÂ ËÏÈÎ›· Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ, fiÔ˘ Ë ·ıÔÏÔÁÈÎ‹ Ê›ÌˆÛË ıÂˆÚÂ›Ù·È Û¿ÓÈ· (16). °ÂÓÈÎfiÙÂÚ·, ˘¿Ú¯ÂÈ ÌÈ· Û‡Á¯˘ÛË fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ fiÚÔ Ê›ÌˆÛË Î·È ÔÏÏ¿ ·È‰È¿ ıÂˆÚÂ›Ù·È

ﬁÙÈ ¤¯Ô˘Ó ·ıÔÏÔÁÈÎ‹ Ê›ÌˆÛË Î·È Ô‰ËÁÔ‡ÓÙ·È ¿ÛÎÔ· ÛÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô. ™¯ÂÙÈÎ‹ ÌÂÏ¤ÙË ‰Â›¯ÓÂÈ ﬁÙÈ

˘¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ÎÏÈÓÈÎ‹ ¿Ô„Ë, ÌÂÙ·Í‡ ·È‰È¿ÙÚˆÓ Î·È ¯ÂÈÚÔ˘ÚÁÒÓ, fiÛÔÓ ·ÊÔÚ¿ ÙÈ˜ ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ÂÚÈÙÔÌ‹. √È ¯ÂÈÚÔ˘ÚÁÔ› ÚfiÙÂÈÓ·Ó ÂÚÈÛÛfiÙÂÚÔ ÙËÓ ÂÚÈÙÔÌ‹ ˆ˜ Ï‡ÛË, Èı·ÓfiÙ·Ù· Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙÔÓ ·˘ÍËÌ¤ÓÔ ·ÚÈıÌfi ¿ÛÎÔˆÓ ÂÚÈÙÔÌÒÓ (17). ™ÙË ™Î·Ó‰ÈÓ·‚›·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÚÈÙÔÌÒÓ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi 2% (16). ∏ ÂÚÈÙÔÌ‹, fiÌˆ˜, ·Ú·Ì¤ÓÂÈ ·ÚÎÂÙ¿ ‰ËÌÔÊÈÏ‹˜ ÛÙÈ˜ ∏ÓˆÌ¤ÓÂ˜ ¶ÔÏÈÙÂ›Â˜ ∞ÌÂÚÈÎ‹˜, ÌÂ ÔÛÔÛÙfi 60% (ÙÒÛË ·fi ÙÔ 80% ÙÔ 1970), ÂÓÒ ÙÔ 80% ÙˆÓ ∞ÌÂÚÈÎ·ÓÒÓ ·Ó‰ÚÒÓ ¤¯ÂÈ ˘ÔÛÙÂ› ÂÚÈÙÔÌ‹ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, ÁÂÁÔÓfi˜

Ô˘ ÂËÚÂ¿˙ÂÈ Î·Ù¿ ÚÔÛ¤ÁÁÈÛË 100 ÂÎ·ÙÔÌÌ‡ÚÈ· ÂÓ‹ÏÈÎÂ˜, ÛÂ ÔÈÎ›ÏÔ ‚·ıÌﬁ (18).

∏ Â›‰Ú·ÛË ÙË˜ ÂÚÈÙÔÌ‹˜ ÛÙËÓ ÂÚˆÙÈÎ‹ Â˘¯·Ú›ÛÙËÛË Î·È ÙÔ˘ ¿ÓÙÚ· Î·È ÙË˜ Á˘Ó·›Î·˜ ‰ÂÓ ¤¯ÂÈ Â·ÚÎÒ˜ ÌÂÏÂÙËıÂ›. ªÂÏ¤ÙË ‚·ÛÈÛÌ¤ÓË ÛÂ ÂÚˆÙËÌ·ÙÔÏﬁÁÈ·

(19), ÂÓÒ ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ Ù·

∏ÏÈÎ›·>6 ÂÙ.

∞Û˘ÌÙˆÌ·ÙÈÎﬁ

∞ÔÊÚ·ÎÙÈÎ‹

§‡ÛË ÙˆÓ Û˘ÌÊ‡ÛÂˆÓ

∂ÈÙ˘¯›· ¶Ï·ÛÙÈÎ‹ ÙË˜ ·ÎÚÔÔÛı›·˜

∞ÓÂ·ÚÎ‹˜ Ï·ÛÙÈÎ‹

•ËÚˆÙÈÎ‹ ·ÔÊÚ·ÎÙÈÎ‹ ‚·Ï·Ó›ÙÈ‰·

¶˘ÔÁﬁÓÔ ÎÔÎÎ›ˆÌ·

∂ÈÎﬁÓ· 3. ∞ÏÁﬁÚÈıÌÔ˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ Ê›ÌˆÛË˜.

ÔÔ›Â˜ Â›¯·Ó ÂÌÂÈÚ›Â˜ ÌÂ Û˘ÓÙÚﬁÊÔ˘˜ Ô˘ Â›¯·Ó

˘ÔÛÙÂ› ÂÚÈÙÔÌ‹ Î·È ÌÂ Û˘ÓÙÚfiÊÔ˘˜ ¯ˆÚ›˜ ÂÚÈÙÔÌ‹, Ê·›ÓÂÙ·È fiÙÈ ÔÈ Á˘Ó·›ÎÂ˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÚˆÙÈÎ‹ Û˘ÓÂ‡ÚÂÛ‹ ÙÔ˘˜, Â›¯·Ó ÚÔÙ›ÌËÛË ÛÙÔ ÌË ÂÚÈÙÂÙÌËÌ¤ÓÔ ¤Ô˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ ÂÚÈÙÂÙÌËÌ¤ÓÔ (24). ∂ÎÙfi˜, fiÌˆ˜, ·fi ÙÈ˜ Ì·ÎÚÔÚfiıÂÛÌÂ˜ Û˘Ó¤ÂÈÂ˜

ÛÙËÓ ÂÚˆÙÈÎ‹ ‰È¤ÁÂÚÛË, ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› „˘¯ÔÏÔÁÈÎ¤˜ Î·È ÎÔÈÓˆÓÈÎ¤˜ ÂÈÙÒÛÂÈ˜. ∏ ·ÒÏÂÈ· ÂÓfi˜ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ¿Á¯Ô˜, Î·Ù¿ıÏÈ„Ë, ·ÏÏ·Á‹ ÛÙÔÓ ÙÚfiÔ ·ÓÙ›ÏË„Ë˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, ·›ÛıËÌ· ·ÎÚˆÙËÚÈ·ÛÌÔ‡, ·ÎfiÌË Î·È

ÔÚÁ‹ ‹ ·ÈÛı‹Ì·Ù· ·˘ÙÔÎÙÔÓ›·˜ (18). ™ÙÔÓ ¶›Ó·Î· 2, Û˘ÓÔ„›˙ÔÓÙ·È Ù· ˘¤Ú Î·È Ù· Î·Ù¿ ÙË˜ ÂÚÈÙÔÌ‹˜ ·ﬁ È·ÙÚÈÎ‹˜ Î·È ÎÔÈÓˆÓÈÎÔ„˘¯ÔÏÔÁÈÎ‹˜ ÏÂ˘Ú¿˜.

‰ÂÓ ¤¯Ô˘Ó Î·ıÈÂÚˆıÂ›, ˘¿Ú¯Ô˘Ó

ÌÂÏ¤ÙÂ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È ‰ÂÓ ˘¿Ú¯ÂÈ

ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤¯Ô˘Ó

ÛÂ Ù¤ÙÔÈÔ˘ Â›‰Ô˘˜ ıÂÚ·Â›Â˜. ™˘ÓÔ„›˙ÔÓÙ·˜, Û‡ÌÊˆÓ· ÌÂ ÙÔ˘˜ Bréaud et al (25), ·Í›˙ÂÈ Ó· ı˘Ì¿Ù·È Î·ÓÂ›˜ ÙÔÓ ·Ú·¿Óˆ ·ÏÁﬁ-

ÁÈ·

·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ê›ÌˆÛË˜ (∂ÈÎﬁÓ· 3).

ÔÈ ÂÚÈÛÛﬁÙÂÚÂ˜ ¿ÛÎÔÂ˜ ÂÚÈÙÔÌ¤˜ ÂÎÙÂÏÔ‡ÓÙ·È ÛÂ

ÙËÓ ËÏÈÎÈ·Î‹ ÔÌ¿‰·. √È ÁÔÓÂ›˜ Ú¤ÂÈ Ó· Î·ıËÛ˘¯·ÛÙÔ‡Ó ﬁÙÈ Ë Î·Ù¿ÛÙ·ÛË ·˘Ù‹ Û¯Â‰ﬁÓ ¿ÓÙÔÙÂ

ÂÚÓ¿ ÌÂ ÙÔ ¯ÚﬁÓÔ. ∂›ÛË˜, ‰ÂÓ ı· Ú¤ÂÈ ÛÂ Î·Ì›·

ÂÚ›ÙˆÛË Ó· ÚÔÛ·ı‹ÛÔ˘Ó Ó· ¤ÏÍÔ˘Ó ‚›·È· ÚÔ˜

Ù· ›Ûˆ ÙËÓ ·ÎÚÔÔÛı›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. ∏ Î·Ï‡-

ÙÂÚË ÁÓÒÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·ÎÚÔÔÛı›·˜ ·ﬁ

ÙÔÓ ÁÂÓÈÎﬁ È·ÙÚﬁ Î·È ÙÔÓ ·È‰›·ÙÚÔ ı· ÌÔÚÔ‡ÛÂ Ó·

Ô‰ËÁ‹ÛÂÈ ÛÂ ÌÂ›ˆÛË ÙˆÓ ·Ú·ÔÌÒÓ Ù¤ÙÔÈˆÓ Â-

ÚÈÛÙ·ÙÈÎÒÓ ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÙË˜ ·È‰Ô¯ÂÈ-

ÚÔ˘ÚÁÈÎ‹˜. ∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·

·Ó·ÁÓˆÚ›˙ÂÈ ﬁÙÈ Ë ÂÚÈÙÔÌ‹ ÛÂ ÓÂÔÁ¤ÓÓËÙ· ¤¯ÂÈ ÎÈÓ-

‰‡ÓÔ˘˜ ·ÏÏ¿ Î·È ÔÊ¤ÏË Î·È ﬁÙÈ Ë ·ﬁÊ·ÛË ÁÈ· ÙËÓ

ÂÎÙ¤ÏÂÛ‹ ÙË˜ Ú¤ÂÈ Ó· Â›Ó·È ı¤Ì· ÂÈÏÔÁ‹˜ ÙË˜ ÔÈ-

ÎÔÁ¤ÓÂÈ·˜ Î·È ÙÔ˘ ÁÈ·ÙÚÔ‡ ÙË˜. ∏ ÂÚÈÙÔÌ‹, ÏÔÈﬁÓ, ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È, ·ÏÏ¿ ı·

10. Quaba O, MacKinlay GA. Changing trends in a decade of circumcision in Scotland. J Pediatr Surg 2004;39:1037-1039.

11. Ceylan K, Burhan K, Yilmaz Y, Can S, Kus A, Mustafa G. Severe complications of circumcision: an analysis of 48 cases. J Ped Urol 2007;3: 32-35.

12. Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE. Trends in paediatric circumcision and its complications in England between 1997 and 2003. B J Surg 2006;93:885-890.

13. American Academy of Pediatrics, Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999;103: 686-693.

14. American Academy of Pediatrics. AAP publications retired and reaffirmed. Pediatrics 2005;116:796.

15. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomized trials and observational studies. Arch Dis Child 2005;90:853-858.

16. Rickwood AM, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys: survey of trends in practice. BMJ 2000;321:792-793.

17. Farshi Z, Atkinson KR, Squire R. A study of clinical opinion and practice regarding circumcision. Arch Dis Child 2000; 83:393-396.

1. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 (Suppl 1): 34-44.

2. Brandes SB, McAninch JW. Surgical methods of restoring the prepuce: a critical review. BJU Int 1999;83 (Suppl 1): 109-113.

3. Rickwood AM. Medical indications for circumcision. BJU Int 1999;83 (Suppl 1):45-51.

4. Hsieh TF, Chang CH, Chang SS. Foreskin development before adolescence in 2149 schoolboys. Int J Urol 2006;13: 968-970.

5. Dewan PA. Treating phimosis. Med J Aust 2003;178:148-150.

6. Shankar KR, Rickwood AM. The incidence of phimosis in boys. BJU Int 1999;84:101-102.

7. Huntley JS, Bourne MC, Munro FD, Wilson-Storey D. Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons. J R Soc Med 2003;96:449-451.

8. Cuckow PM, Rix G, Mouriquand PD. Preputial plasty: a good alternative to circumcision. J Pediatr Surg 1994;29: 561-563.

9. The Royal College of Surgeons of England. Statement on Male Circumcision, 6 March 2001. Webpage: http://www.rcseng.ac. uk/media/medianews/index.html#2001.

18. Hammond T. A preliminary poll of men circumcised in infancy or childhood. BJU Int 1999;83 (Suppl 1):85-92.

19. DaiSik K, Myung-Geol P. The effect of male circumcision on sexuality. BJU Int 2007;99:619-622.

20. Masood S, Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK. Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? Urol Int 2005; 75:62-66.

21. Aydur E, Gungor S, Ceylan ST, Taiimaz L, Baser I. Effects of childhood circumcision age on adult male sexual functions. Int J Impot Res 2007;19:424-431.

22. Fink KS, Carson CC, DeVellis RF. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol 2002;167:2113-2116.

23. Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P. Effects of circumcision on male sexual function: debunking a myth. J Urol 2002;167:2111-2112.

24. O’Hara K, O’Hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int 1999;83 (Suppl 1):79-84.

25. Bréaud J, Guys JM. Phimosis: medical treatment or circumcision? Arch Pediatr 2005;12:1424-1432.

ÀÈÔı¤ÙËÛË ÙË˜ ÌÂÛÔÁÂÈ·Î‹˜ ‰›·ÈÙ·˜ ·ﬁ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

ÛÙËÓ ∂ÏÏ¿‰·

¡. µ›‰Ú·1, ∞-∂. º·ÚÌ¿ÎË1, ™. ∫Ô˚Ó¿ÎË1, ∫. ªÂÏÔÁÈ¿ÓÓË1, ™. ™ˆÊÚÔÓ¿2, º. ª·ÁÎ·Ó¿ÚË2, ª. ∫ÔÓÙÔÁÈ¿ÓÓË1, ª. °È·ÓÓ·ÎÔ‡ÏÈ·1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÔÓ ‚·ıÌfi ˘ÈÔı¤ÙËÛË˜ ÙË˜ ÌÂÛÔÁÂÈ·Î‹˜ ‰›·ÈÙ·˜ ·fi Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÛÙËÓ ∂ÏÏ¿‰·, ÌÂ ¯Ú‹ÛË ÙÔ˘ ÔÈÔÙÈÎÔ‡ ‰Â›ÎÙË KIDMED, Î·ıÒ˜

Î·È ÙÈ˜ Èı·Ó¤˜ Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂ ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: √ ˘fi ÌÂÏ¤ÙË ÏËı˘ÛÌfi˜ ÂÚÈÂÏ¿Ì‚·ÓÂ 1305 ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 3-18

ÂÙÒÓ. ∆Ô ‰Â›ÁÌ· ‹Ù·Ó ·ÓÙÈÚÔÛˆÂ˘ÙÈÎﬁ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›·, Î·Ï‡-

ÙÔÓÙ·˜ fiÏÂ˜ ÙÈ˜ ÁÂˆÁÚ·ÊÈÎ¤˜ ÂÚÈÔ¯¤˜, ÂÎÙfi˜ ·fi Ù· ÓËÛÈ¿ ÙÔ˘ πÔÓ›Ô˘ Î·È ÙÔ˘ ∞ÈÁ·›Ô˘. ∞fi ÙÔ˘˜ ÁÔÓÂ›˜

ÙˆÓ ·È‰ÈÒÓ Î·È ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ¤ÊË‚Ô˘˜ Û˘ÏÏ¤¯ıËÎ·Ó, Ì¤Ûˆ ÙËÏÂÊˆÓÈÎ‹˜ Û˘Ó¤ÓÙÂ˘ÍË˜, ÏËÚÔÊÔÚ›Â˜

ÁÈ· Ù· ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ, Ù· ·ÓıÚˆÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, ÙË ‰È·ÈÙËÙÈÎ‹ ÚfiÛÏË„Ë, ÙÔÓ ‰Â›ÎÙË KIDMED, ÙË ÛˆÌ·ÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ‰È¿ÊÔÚÂ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙË˜ ‰È·ÈÙËÙÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙˆÓ Û˘ÌÌÂÙÂ¯fiÓÙˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆Ô 10% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·ÚÔ˘Û›·˙Â ˘„ËÏ‹

·ÚÓËÙÈÎ¿ ÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡/ÂÊ‹‚Ô˘ Î·È ÙÈ˜

™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÌÂÏ¤ÙË˜ ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÌÈ· È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎ‹ Ù¿ÛË ·ÔÌ¿ÎÚ˘ÓÛË˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ·ﬁ Ù·

ÎÏÂÈ‰È¿:

Adherence to the Mediterranean diet in children and adolescents in Greece

N. Vidra1, A-E. Farmaki1, S. Koinaki1, K. Belogianni1, S. Sofrona2, F. Magkanari2, M. Kontogianni1, M. Yannakoulia1

Abstract

Background: The aim of this study was to evaluate the adherence to the Mediterranean dietary pattern among children and adolescents in Greece, based on the KIDMED index, and its association with sociodemographic parameters.

Methods: The sample consisted of 1,305 boys and girls, aged 3-18 years; it was representative of the Greek population in terms of age and gender, and covered all geographical areas apart from the Aegean and Ionian islands. Information on the subjects’ socio-demographic, dietary, anthropometric and physical activity characteristics were collected by telephone interview. For the participants aged 3-12 years, parents were asked to respond on behalf of their children.

Results: Of the total sample, 10% had a high KIDMED score, indicating optimal Mediterranean diet. No differences were observed between girls and boys with regards to the KIDMED score; however, adolescents reported lower values than younger children. The percentage of children and adolescents with high KIDMED score was statistically greater among individuals with a high parental educational level. Multivariate analysis revealed that the KIDMED score was associated positively with physical activity and maternal educational level and negatively with age and sedentary activities.

Conclusion: The findings of this study indicate that Greek children and adolescents exhibit a low degree of adherence to the traditional Mediterranean dietary pattern.

Key words: Nutrition, Mediterranean diet, children, adolescents.

1 Department of Nutrition –Dietetics, Harokopio University, Athens

2 “Aristidis Daskalopoulos” Foundation, Athens

Correspondence: Mary Yannakoulia myiannak@hua.gr Department of Nutrition –Dietetics, Harokopio University 70, El. Venizelos St. 17671, Kallithea

Î·È Ê‡ÏÔ ¶·È‰È¿ (3-12 ÂÙÒÓ) ŒÊË‚ÔÈ (13-18 ÂÙÒÓ)

∫ÔÚ›ÙÛÈ· ∞ÁﬁÚÈ· ∫ÔÚ›ÙÛÈ· ∞ÁﬁÚÈ·

µ¿ÚÔ˜ (kg)31,0 ± 12,230,6 ± 12,755,8 ± 9,4‰ 65,3 ± 13,5‚,‰

⁄„Ô˜ (cm)130 ± 20128 ± 20164 ± 7‰ 172 ± 11‚,‰

¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (kg/m2) 17,9 ± 4,118,0 ± 3,620,6 ± 3,0‰ 21,9 ± 3,6‚,‰

∫·ÙËÁÔÚ›Â˜ ˘¤Ú‚·ÚÔ˘ (%)

À¤Ú‚·ÚÔÈ18,018,58,7‰ 19,8‚,‰ ¶·¯‡Û·ÚÎÔÈ13,112,81,9‰ 3,7‚,‰

∂ÓÂÚÁÂÈ·Î‹ ÚﬁÛÏË„Ë (kcal/ËÌ¤Ú·)1727 ± 5551762 ± 5681534 ± 557‰ 2095 ± 823‚,‰

¶ÚﬁÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ (% ÂÓÂÚÁ. ÚﬁÛÏË„Ë˜)42,8 ± 9,442,9 ± 8,443,5 ± 10,642,2 ± 8,4

¶ÚﬁÛÏË„Ë ÚˆÙÂ˚ÓÒÓ (% ÂÓÂÚÁ. ÚﬁÛÏË„Ë˜)15,8 ± 4,116,2 ± 3,715,8 ± 4,715,8 ± 4,1

¶ÚﬁÛÏË„Ë ÏÈÈ‰›ˆÓ (% ÂÓÂÚÁ. ÚﬁÛÏË„Ë˜)42,3 ± 8,141,8 ± 7,441,7 ± 8,843,0 ± 8,1

∫ÔÚÂÛÌ¤ÓˆÓ ÏÈÈ‰›ˆÓ15,4 ± 4,215,2 ± 3,514,2 ± 4,514,9 ± 3,8·

ªÔÓÔ·ÎﬁÚÂÛÙˆÓ ÏÈÈ‰›ˆÓ18,5 ± 5,518,4 ± 5,319,0 ± 5,819,5 ± 5,5Á

∫·ıÈÛÙÈÎ¤˜ ‰Ú·ÛÙËÚÈﬁÙËÙÂ˜ (min/ËÌ¤Ú·)62 ± 5869 ± 6186 ± 8592 ± 85‰

¶ÂÚ¿ÙËÌ· (min/ËÌ¤Ú·)25 ± 3726 ± 4134 ± 39Á 31 ± 39

¶·È¯Ó›‰È ÌÂ Ê›ÏÔ˘˜ (min/ËÌ¤Ú·)63 ± 8373 ± 8417 ± 40‰ 36 ± 59‚,‰

√ÚÁ·ÓˆÌ¤ÓË ¿ÛÎËÛË (min/ËÌ¤Ú·)18 ± 4214 ± 3217 ± 4432 ± 61‚,‰

KIDMED (0-12)5,4 ± 1,75,4 ± 1,94,9 ± 2,1‰ 4,6 ± 2,0‰

· p≤0,05 ÛÂ Û¯¤ÛË ÌÂ Ù· ÎÔÚ›ÙÛÈ· ÙË˜ ·ÓÙ›ÛÙÔÈ¯Ë˜ ËÏÈÎÈ·Î‹˜ ÔÌ¿‰·˜

‚ p<0,001 ÛÂ Û¯¤ÛË ÌÂ Ù· ÎÔÚ›ÙÛÈ· ÙË˜ ·ÓÙ›ÛÙÔÈ¯Ë˜ ËÏÈÎÈ·Î‹˜ ÔÌ¿‰·˜

Á p≤0,05 ÛÂ Û¯¤ÛË ÌÂ Ù· ¿ÙÔÌ· ÙÔ˘ ›‰ÈÔ˘ Ê‡ÏÔ˘ ÙË˜ ÌÈÎÚﬁÙÂÚË˜ ËÏÈÎÈ·Î‹˜ ÔÌ¿‰·˜ ‰ p<0,001 ÛÂ Û¯¤ÛË ÌÂ Ù· ¿ÙÔÌ· ÙÔ˘ ›‰ÈÔ˘ Ê‡ÏÔ˘ ÙË˜ ÌÈÎÚﬁÙÂÚË˜ ËÏÈÎÈ·Î‹˜ ÔÌ¿‰·˜

68±54 min/ËÌ¤Ú·, p<0,001), ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ÛÙÔ ÂÚ¿ÙËÌ· (33±39 min/ËÌ¤Ú· ¤Ó·ÓÙÈ 26±39 min/ËÌ¤Ú·, p=0,001), ÛÙËÓ ÔÚÁ·ÓˆÌ¤ÓË ¿ÛÎËÛË (23±53 min/ËÌ¤Ú· ¤Ó·ÓÙÈ 16±38 min/ËÌ¤Ú·, p=0,01) Î·È ÛÙÈ˜ Î·ıÈÛÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ (88±84 min/ËÌ¤Ú· ¤Ó·ÓÙÈ 66±60 min/ËÌ¤Ú·, p<0,001). ∂›ÛË˜, ÔÈ ¤ÊË‚ÔÈ Â›¯·Ó ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ˘¤Ú‚·ÚÔ˘ Î·È ·¯˘Û·ÚÎ›·˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È‰È¿ (p<0,001).

ŸÙ·Ó ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙÂ˜ ÛÙË ÌÂÏ¤ÙË Î·ÙËÁÔÚÈÔÔÈ‹ıËÎ·Ó, ·Ó¿ÏÔÁ· ÌÂ ÙË ‚·ıÌÔÏÔÁ›· ÙÔ˘˜ ÛÙÔ KIDMED, ÛÂ ·˘ÙÔ‡˜ Ô˘ Â›¯·Ó ¯·ÌËÏ‹, ÌÂÛ·›· Î·È

˘„ËÏ‹ ‚·ıÌÔÏÔÁ›·, ÚÔ¤Î˘„Â ﬁÙÈ ˘„ËÏ‹ ‚·ıÌÔÏÔ-

Á›·, ‰ËÏ·‰‹ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌﬁ ˘ÈÔı¤ÙËÛË˜ ÙˆÓ ‚·-

ÛÈÎÒÓ ·Ú¯ÒÓ ÙË˜ ÌÂÛÔÁÂÈ·Î‹˜ ‰›·ÈÙ·˜, Â›¯Â ÙÔ 10%

ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ (11,3% ÙˆÓ ·È‰ÈÒÓ Î·È 8,3% ÙˆÓ

ÂÊ‹‚ˆÓ, p<0,001). ∂›ÛË˜, ÙÔ ÔÛÔÛÙﬁ ÌÂ ˘„ËÏﬁ

KIDMED ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ¿ÙÔÌ·

ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· Â›¯Â ·ÓÒÙÂÚË ‹ ·ÓÒÙ·ÙË ÂÎ-

·›‰Â˘ÛË, ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· Â›¯Â Ï¿‚ÂÈ Ì¤¯ÚÈ Î·È ‰Â˘ÙÂÚÔ‚¿ıÌÈ· ÂÎ·›‰Â˘ÛË (14,3% Î·È 7,7% ·ÓÙ›ÛÙÔÈ¯·, p<0,001). ∞ÓÙ›ÛÙÔÈ¯·, ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜, ·Ó¿ÏÔÁ· ÌÂ ÙË ÌfiÚÊˆÛË ÙÔ˘ ·Ù¤Ú·, ‚Ú¤ıËÎ·Ó ÛÙ· ÔÛÔÛÙ¿ ÙˆÓ ·ÙfiÌˆÓ ÌÂ ˘„ËÏfi KIDMED. √È ·Ú¿ÌÂÙÚÔÈ Ô˘ ‰˘ÓËÙÈÎ¿

ÁÈ· Èı·ÓÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ÙÔ ˘„ËÏfiÙÂÚÔ KIDMED Û¯ÂÙ›˙ÂÙ·È ıÂÙÈÎ¿ ÌÂ ÙË Û˘ÓÔÏÈÎ‹ ÛˆÌ·ÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· (‚=0,079, p=0,005) Î·È ÙÔ Â›Â‰Ô ÌfiÚÊˆÛË˜ ÙË˜ ÌËÙ¤Ú·˜ (‚=0,097, p=0,003)

Î·È ·ÚÓËÙÈÎ¿ ÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡ (‚=0,115, p<0,001) Î·È ÙÈ˜ Î·ıÈÛÙÈÎ¤˜ ‰Ú·ÛÙËÚÈﬁÙËÙÂ˜ (‚=0,134, p<0,001). ∂›ÛË˜, Ë ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED ÂÌÊ¿ÓÈÛÂ ÌÈ· Ù¿ÛË Ó· Û˘Û¯ÂÙ›˙ÂÙ·È ıÂÙÈÎ¿ ÌÂ ÙÔ Â›Â‰Ô ÌﬁÚÊˆÛË˜ ÙÔ˘ ·Ù¤Ú· (‚=0,057, p=0,075) Î·È ·ÚÓËÙÈÎ¿ ÌÂ ÙÔÓ ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (‚=0,052, p=0,103).

™˘˙‹ÙËÛË √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ Î·È ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‹Ù·Ó 16,2% Î·È 8,6%, ·ÓÙ›ÛÙÔÈ¯·. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È ÛÂ Û˘ÌÊˆÓ›· ÌÂ Ù· ·ÓÙ›ÛÙÔÈ¯· Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ› ÁÈ· ·ÓÂÏÏ‹ÓÈ· ·ÓÙÈÚÔÛˆÂ˘ÙÈÎ¿ ‰Â›ÁÌ·Ù· Î·È ‚·Û›˙ÔÓÙ·È ÙfiÛÔ ÛÂ ÌÂÙÚÔ‡ÌÂÓÂ˜ (22) fiÛÔ Î·È ÛÂ ·˘ÙÔ‰ËÏÔ‡ÌÂÓÂ˜ ÙÈÌ¤˜ (23).

ŸÛÔÓ ·ÊÔÚ¿ ÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜, ÔÈ ·ÏÏ·Á¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂÎ·ÂÙ›Â˜ ÛÂ ‰È¿ÊÔÚÔ˘˜ ÏËı˘ÛÌÔ‡˜ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÌÈ· ÛÂÈÚ¿ ·ﬁ ·ÏÏ·Á¤˜ ÛÂ

¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È

ÂÊ‹‚Ô˘˜ (39-42). √È Goodman Î·È Û˘Ó. (43) ¤‰ÂÈÍ·Ó

ﬁÙÈ ÙÔ 96% ÙˆÓ ÂÊ‹‚ˆÓ Î·ÙËÁÔÚÈÔÔÈÔ‡Ó ÔÚı¿ ÙÔÓ

Â·˘Ùﬁ ÙÔ˘˜ ÌÂ ‚¿ÛË Ù· ·˘ÙÔ‰ËÏÔ‡ÌÂÓ· ÛÙÔÈ¯Â›·

ÛÙÈ˜ Î·ÙËÁÔÚ›Â˜ ˘¤Ú‚·ÚÔ˘/·¯‡Û·ÚÎÔ˘ Î·È Î·Ù·-

Ï‹ÁÔ˘Ó ﬁÙÈ ÔÈ ·˘ÙÔ‰ËÏÔ‡ÌÂÓÂ˜ ÙÈÌ¤˜ ‚¿ÚÔ˘˜ Î·È

‡„Ô˘˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·ÍÈﬁÈÛÙ· ÛÂ

ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙËÓ ·ÍÈÔÏﬁÁËÛË ÙÔ˘

ÎÈÓ‰‡ÓÔ˘ ÙË˜ ·¯˘Û·ÚÎ›·˜. ∆¤ÏÔ˜, Ô Û˘Á¯ÚÔÓÈÎﬁ˜

Û¯Â‰È·ÛÌﬁ˜ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜, ·ÏÏ¿ Î·È Ë ¤ÏÏÂÈ„Ë

‚ÈÔÏÔÁÈÎÒÓ ‰ÂÈÎÙÒÓ, ‰ÂÓ Ì·˜ ÂÈÙÚ¤Ô˘Ó Ó· Ô‰ËÁË-

ıÔ‡ÌÂ ÛÂ Û˘ÌÂÚ¿ÛÌ·Ù· ÁÈ· ÔÔÈÂÛ‰‹ÔÙÂ ·ÈÙÈÔÏÔ-

ÁÈÎ¤˜ Û˘Û¯ÂÙ›ÛÂÈ˜ ‹ Èı·Ó¿ ÔÊ¤ÏË ÁÈ· ÙËÓ ˘ÁÂ›· ·ﬁ

ÙËÓ ˘ÈÔı¤ÙËÛË ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ‰È·ÙÚÔÊÈÎÔ‡

ÚÔÙ‡Ô˘.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ô ‰Â›ÎÙË˜ KIDMED Â›Ó·È ÙÔ

ÌfiÓÔ ‰È·ı¤ÛÈÌÔ ÂÚÁ·ÏÂ›Ô, ·fi fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ÁÈ·

ÙËÓ ·ÍÈÔÏﬁÁËÛË ÙË˜ ˘ÈÔı¤ÙËÛË˜ ÙË˜ ÌÂÛÔÁÂÈ·Î‹˜ ‰›·ÈÙ·˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜. ∏ ˘„ËÏﬁÙÂÚË

In: Matalas A-L, Zampelas A, Stavrinos V, Wolinsky I, editors. The Mediterranean Diet: Constituents and Health Promotion. 1st ed. Boca Raton: CRC Press; 2001. p. 53-73.

5. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Eng J Med 2003;348:2599-2608.

6. Fitﬁ M, Guxens M, Corella D, Saãez G, Estruch R, de la Torre R, et al. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med 2007;167:1195-1203.

7. Estruch R, Mart›nez-Gonzaãlez MA, Corella D, Salas-Salvadﬁ J, Ruiz-Gutiérrez V, Covas MI, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006;145:1-11.

8. Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, et al. The association between adherence to the Mediterranean diet and fasting indices of glucose homoeostasis: the ATTICA Study. J Am Coll Nutr 2007;26:32-38.

9. Esposito K, Ciotola M, Giugliano D. Mediterranean diet, endothelial function and vascular inflammatory markers. Public Health Nutr 2006;9:1073-1076.

10. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 2004;80:1012-1018.

ÙË˜, Ë ÔÔ›· Â›Ó·È Ë ÚÒÙË Ô˘ ‰ÈÂÚÂ‡ÓËÛÂ ÙÔ ı¤Ì· ·˘Ùfi ÛÂ ¤Ó· ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÛÙËÓ ∂ÏÏ¿‰·, ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ˘¿Ú¯ÂÈ

ÌÈ· È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎ‹ Ù¿ÛË ·ÔÌ¿ÎÚ˘ÓÛË˜ ·ﬁ

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Ô, ı· ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ Î·È ÛÙÔ Ì¤ÏÏÔÓ (45-47),

·ÏÏ¿ Î·È ÔÈÂ˜ ı· Â›Ó·È ÔÈ Èı·Ó¤˜ ÌÂÏÏÔÓÙÈÎ¤˜ Û˘-

Ó¤ÂÈÂ˜ ÙË˜ ·ÏÏ·Á‹˜ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ

ÛÙË Û˘¯ÓﬁÙËÙ· ÂÌÊ¿ÓÈÛË˜ ·ÛıÂÓÂÈÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ‰È·ÙÚÔÊ‹.

¶ËÁ‹ ¯ÚËÌ·ÙÔ‰ﬁÙËÛË˜ ∏ ÌÂÏ¤ÙË ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËÎÂ ·ﬁ ÙÔ “ÿ‰Ú˘Ì·

∞ÚÈÛÙÂ›‰Ë˜ ¢·ÛÎ·ÏﬁÔ˘ÏÔ˜”.

µÈ‚ÏÈÔÁÚ·Ê›·

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44. Guerra A, Feldl F, Koletzko B. Fatty acid composition of plasma lipids in healthy Portuguese children: is the Mediterranean diet disappearing? Ann Nutr Metab 2001; 45:78-81.

45. Greco L, Musmarra F, Franzese C, Auricchio S. Early childhood feeding practices in southern Italy: is the Mediterranean diet becoming obsolete? Study of 450 children aged 6-32 months in Campania, Italy. Cultural Paediatric Association. Acta Paediatr 1998;87:250-256.

46. Cruz JA. Dietary habits and nutritional status in adolescents over Europe-Southern Europe. Eur J Clin Nutr 2000;54 (1 Suppl):S29-S35.

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1 ∆Ì‹Ì· ∂ÈÛÙ‹ÌË˜ º˘ÛÈÎ‹˜

∞ÁˆÁ‹˜ & ∞ıÏËÙÈÛÌÔ‡,

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AÏÏËÏÔÁÚ·Ê›·:

™¿‚‚·˜ ∆ÔÎÌ·Î›‰Ë˜

stokmaki@phyed.duth.gr

∆.∂.º.∞.∞. ∫ÔÌÔÙËÓ‹˜

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∞. ÃÚÈÛÙﬁ‰Ô˘ÏÔ˜1, ∂. ¢Ô‡‰·1, ¢. ∆Ô‡ÛÔ˘ÏË˜2, ™. ∆ÔÎÌ·Î›‰Ë˜1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ‰ÈÂÚÂ˘Ó‹ÛÂÈ ÙË Û¯¤ÛË ÙÔ˘ ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) ÌÂ ÂÈÏÂÁÌ¤ÓÂ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÛÂ ·È‰È¿ ÙË˜ ™∆’ Ù¿ÍË˜ ÙÔ˘ ¢ËÌÔÙÈÎÔ‡. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∆Ô ‰Â›ÁÌ· ·ÔÙ¤ÏÂÛ·Ó 181 ·ÁfiÚÈ· Î·È 197 ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 11,40±0,39 ÂÙÒÓ, ·fi ÙË µÔÚÂÈÔ·Ó·ÙÔÏÈÎ‹ ∞ÙÙÈÎ‹. ∞ÍÈÔÏÔÁ‹ıËÎ·Ó Ù· ·ÓıÚˆÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·È‰ÈÒÓ, Ë ‰È·ÙÚÔÊ‹, Ë Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· (º¢) Î·È ÂÈÏÂÁÌ¤ÓÂ˜ ·Ú¿ÌÂÙÚÔÈ ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜. ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ˘ÂÚ‚ÔÏÈÎÔ‡ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ÙË˜ ·¯˘Û·ÚÎ›·˜ ¤ÁÈÓÂ ÌÂ ‚¿ÛË ‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ·. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∆Ô 37,3% ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó ˘¤Ú‚·ÚÔ/·¯‡Û·ÚÎÔ (˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜: 28,6%, ·¯˘Û·ÚÎ›·: 8,7%), ¯ˆÚ›˜ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (χ2=0,03, p=0,986). T· ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ·Ó¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ (p=0,009 Î·È p=0,0001, ·ÓÙ›ÛÙÔÈ¯·) Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ Ï›Ô˘˜ (p=0,045 Î·È p=0,005, ·ÓÙ›ÛÙÔÈ¯·) Î·È ÚˆÙÂ˚ÓÒÓ (p=0,028 Î·È p=0,0001, ·ÓÙ›ÛÙÔÈ¯·) ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, ÛÂ Û¯¤ÛË ÌÂ Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ¢ª™. ∏ ÂÓÂÚÁÂÈ·Î‹ ‰·¿ÓË ·fi º¢ ˘„ËÏ‹˜ ¤ÓÙ·ÛË˜ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ˘¤Ú‚·Ú· ·È‰È¿ (·ÁfiÚÈ·: p=0,05, ÎÔÚ›ÙÛÈ·: p=0,011), ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ‰È·ÈÛÙÒıËÎ·Ó ÂÈÏ¤ÔÓ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÙË Û˘ÓÔÏÈÎ‹ º¢ (p=0,024). ∆· ˘¤Ú‚·Ú· ·È‰È¿ ÛËÌÂ›ˆÛ·Ó ¯·ÌËÏfiÙÂÚÂ˜ ÂÈ‰fiÛÂÈ˜ ÛÙËÓ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÙÔ¯‹ Î·È ÙË Ì˘˚Î‹ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡ (p≤0,001). ªÂ ‚¿ÛË ÙÈ˜ ·Ó·Ï‡ÛÂÈ˜ ÔÏÏ·Ï‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜, Ë º¢ ÛÙ· ‰‡Ô Ê‡Ï· (·ÁfiÚÈ·: ‚=-0,18, SE=0,01, p=0,05, ÎÔÚ›ÙÛÈ·: ‚=-0,17, SE=0,31, p=0,05)

Î·È Ë ‰È·ÙÚÔÊÈÎ‹ ÚfiÛÏË„Ë Ï›Ô˘˜ ÛÙ· ÎÔÚ›ÙÛÈ· (‚=0,17, SE=0,04, p=0,05) ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎ‹ ·ÓÂÍ¿ÚÙËÙË Û˘Û¯¤ÙÈÛË ÌÂ ÙÔÓ ¢ª™. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ¤ÚÂ˘Ó·˜ ÂÈ‚Â‚·ÈÒÓÔ˘Ó ÙËÓ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, ÂÈÛËÌ·›ÓÔÓÙ·˜ ÙËÓ ·Ó¿ÁÎË ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏË„Ë˜, ÌÂ ÛÙfi¯Ô ÙËÓ ·‡ÍËÛË ÙË˜ º¢, ÙË ‚ÂÏÙ›ˆÛË ÙË˜ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÙÔ¯‹˜ Î·È ÙËÓ ˘ÈÔı¤ÙËÛË ˘ÁÈÂÈÓÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÚÔÙ‡ˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ·È‰ÈÎ‹ ·¯˘Û·ÚÎ›·, Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ·, Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË, Ì·ÎÚÔıÚÂÙÈÎ¿ ÛÙÔÈ¯Â›·.

The relation of body mass index with selected behavioural parameters in 11 year-old children

1 Department of Sports and Exercise Science, Democritus University of Thrace, Greece

2 1st Cardiology Unit, Athens University Medical School, Greece

Correspondence: Savvas Tokmakidis

stokmaki@phyed.duth.gr

Department of Physical Education and Sports Science

Democritus University of Thrace 69100 Komotini, Greece

A. Christodoulos1, H. Douda1, D. Tousoulis2, S. Tokmakidis1

Abstract

Background: The aim of this study was to investigate the possible relationship of body mass index (BMI) with selected behavioural parameters in 11 year-old Greek children.

Methods: The sample consisted of 181 boys and 197 girls, aged 11.40±0.39 years, from northeastern Attica, Greece. Data were collected on the children’s anthropometry, dietary patterns, physical activity (PA), and selected physical fitness components. The participants were classified into normal weight and overweight/obese according to international age- and gender-specific BMI cut-off points.

Results: The prevalence of overweight/obesity was 37.3% (overweight: 28.6%, obese: 8.7%), without a significant gender difference (χ2=0.03, p=0.986). Compared with their normal-weight peers, overweight boys and girls reported lower energy intake derived from carbohydrates (p=0.009 and p=0.0001, respectively) and a higher intake of fat (p=0.045 and p=0.005, respectively) and protein (p=0.028 and p=0.0001, respectively). Energy expenditure from vigorous PA was lower in overweight children (boys: p=0.05, girls: p=0.011), while for girls, statistically significant differences were also observed in total PA (p=0.024). Finally, the overweight children had lower cardiovascular fitness and abdominal endurance than their normal-weight peers (p≤0.001). In multiple regression analysis, PA for both genders (boys: ‚=-0.18, SE=0.01, p=0.05, girls: ‚=-0.17, SE=0.31, p=0.05) and dietary fat intake for girls (‚=0.17, SE=0.04, p=0.05) remained significantly and independently related to BMI.

Conclusions: These findings confirm the rising prevalence of obesity in Greek children and suggest that

future intervention strategies for counteracting and/or preventing obesity in children should aim primarily at promotion of physical activity, improvement of cardiorespiratory fitness and adoption of healthy dietary patterns.

Key words: Body mass index, childhood obesity, physical activity, physical fitness, macronutrients.

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Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ

˘„ËÏ¤˜ ÙÈÌ¤˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, ‰˘ÛÌÂÓ¤˜

ÚÔÊ›Ï ÏÈÈ‰›ˆÓ Î·È ˘„ËÏ¤˜ ÙÈÌ¤˜ ÁÏ˘Îﬁ˙Ë˜

Î·È ÈÓÛÔ˘Ï›ÓË˜ ÛÙÔ ·›Ì· (1-3). ∂ÈÏ¤ÔÓ, Ë ·È-

‰ÈÎ‹ ·¯˘Û·ÚÎ›· ÂÈ‰Ú¿ ‚Ï·ÙÈÎ¿ ÛÙË ‰ÔÌ‹

Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÁÁÂ›ˆÓ Ì·ÎÚÔÚﬁıÂÛÌ·, Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙË ÌÂÏÏÔÓÙÈÎ‹ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Î·È ÌÂÙ·‚ÔÏÈÎÒÓ ·ı‹ÛÂˆÓ, ﬁˆ˜

ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Î·ÚˆÙÈ‰ÈÎ‹˜ ÓfiÛÔ˘, ‰È·‚‹ÙË Ù‡Ô˘ ππ Î·È ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (4-6).

∞ÚÎÂÙ¤˜ ¤ÚÂ˘ÓÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙfiÛÔ Ë ·¯˘Û·ÚÎ›· Î·È ÔÈ ÂÈÏÔÎ¤˜ ÙË˜ (5-7) fiÛÔ Î·È ÔÈ Û˘ÌÂÚÈÊÔÚ¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·˘Ù‹Ó (8,9) ¤¯Ô˘Ó ÙÈ˜ Ú›˙Â˜ ÙÔ˘˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

Î·È ÙÂ›ÓÔ˘Ó Ó· ÌÂÙ·Ê¤ÚÔÓÙ·È ÛÙËÓ ÂÓ‹ÏÈÎË

˙ˆ‹. ∆· ·È‰È¿ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ÙÔ˘

Ì¤ÏÏÔÓÙÔ˜Ø Û˘ÓÂÒ˜ Ë ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ·Ú·-

ÁﬁÓÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ·‡ÍËÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙÈ˜ ÌÈÎÚ¤˜ ËÏÈÎ›Â˜ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏ¤ÛÂÈ ÛËÌ·ÓÙÈÎ‹ ÚÔÙÂÚ·ÈﬁÙËÙ· ÁÈ· ÙÔ˘˜

ÊÔÚÂ›˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ˘ÁÂ›·, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·Ó·Ù˘¯ıÔ‡Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¤˜ ÛÙÚ·-

ÙËÁÈÎ¤˜ ÚﬁÏË„Ë˜ Î·È ÚÒÈÌË˜ ·Ú¤Ì‚·ÛË˜. ∏ Û˘¯ÓﬁÙËÙ· ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜

ÛÙËÓ ∂ÏÏ¿‰· ¤¯ÂÈ ˘ÂÚ‰ÈÏ·ÛÈ·ÛÙÂ› ÙËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· (10). ∆· ‰Â‰ÔÌ¤Ó· Ô˘ ·ÊÔÚÔ‡Ó ÙË

Û·ÚÎ›·˜ Â›Ó·È Èı·ÓﬁÓ Ó· ‰È·ÊÔÚÔÔÈÂ›Ù·È ·ﬁ

ÂÚÈÔ¯‹ ÛÂ ÂÚÈÔ¯‹. ¢Â‰ÔÌ¤ÓË˜ ÙË˜ ·Ó¿ÁÎË˜

ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ı¤Ì·ÙÔ˜, ÛÙËÓ

·ÚÔ‡Û· ÌÂÏ¤ÙË ÂÍÂÙ¿˙ÂÙ·È Ë Û¯¤ÛË ÙË˜ ·¯˘-

ÌÂ ÙË ‰È·ÙÚÔÊ‹, ÙË Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ· (º¢) Î·È ÙË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË ÛÂ ¤Ó· ‰Â›ÁÌ· Ì·ıËÙÒÓ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡.

ÀÏÈÎﬁ Î·È ª¤ıÔ‰ÔÈ

ÙË˜ ÌÂÏ¤ÙË˜

ÌÂÏ¤ÙË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÙÔ Û¯ÔÏÈÎﬁ ¤ÙÔ˜ 2005-2006 (√ÎÙÒ‚ÚÈÔ˜ 2005 - π·ÓÔ˘¿ÚÈÔ˜ 2006) ÛÙË

µÔÚÂÈÔ·Ó·ÙÔÏÈÎ‹ ∞ÙÙÈÎ‹, ÌÂ ÙËÓ ¤ÁÎÚÈÛË ÙÔ˘ ¶·È‰·ÁˆÁÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘, Î·È ·ÔÙÂÏÂ› ÙÌ‹Ì· Â˘Ú‡ÙÂÚË˜ ¤ÚÂ˘Ó·˜ ÌÂ ÛÎÔfi ÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û¯¤ÛË˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ ÌÂ ÙÔ˘˜ ‰Â›ÎÙÂ˜ ˘ÁÂ›·˜ Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙˆÓ Ì·ıËÙÒÓ. °È· ÙÔ˘˜ ÛÎÔÔ‡˜ ÙË˜ ¤ÚÂ˘Ó·˜ ÂÈÏ¤¯ıËÎ·Ó, ÌÂ ÙË Ì¤ıÔ‰Ô ÙˆÓ Ù˘¯·›ˆÓ ·ÚÈıÌÒÓ, 15 ·fi Ù· 25 ‰ËÌfiÛÈ· ‰ËÌÔÙÈÎ¿ Û¯ÔÏÂ›· ÙË˜ ÂÚÈÔ¯‹˜, ÛÙ· ÔÔ›· ÊÔÈÙÔ‡Û·Ó 393 Ì·ıËÙ¤˜ ÙË˜ ™∆ã Ù¿ÍË˜ (205 ÎÔÚ›ÙÛÈ·, 188 ·ÁfiÚÈ·). ∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó ÙÂÏÈÎ¿ 378 Ì·ıËÙ¤˜ ËÏÈÎ›·˜ 11,4±0,4 ÂÙÒÓ (197 ÎÔÚ›ÙÛÈ·, 181 ·ÁfiÚÈ·, ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ 96,2%), ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÔÔ›ˆÓ ˙ËÙ‹ıËÎÂ ¤ÁÁÚ·ÊË ¿‰ÂÈ· ÙˆÓ ÁÔÓ¤ˆÓ, Î·ÙfiÈÓ ÏÂÙÔÌÂÚÔ‡˜ ÂÓËÌ¤ÚˆÛ‹˜ ÙÔ˘˜ Ì¤Ûˆ ÂÈÛÙÔÏ‹˜.

∆· ‰Â‰ÔÌ¤Ó· Û˘ÏÏ¤¯ıËÎ·Ó Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ ÒÚÂ˜ ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ Û¯ÔÏÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ì·ı‹Ì·ÙÔ˜ Ê˘ÛÈÎ‹˜ ·ÁˆÁ‹˜. ∞ÊÔ‡ ÚÔËÁÔ˘Ì¤Óˆ˜ ‰fiıËÎ·Ó ÔÈ ··Ú·›ÙËÙÂ˜ Ô‰ËÁ›Â˜ Î·È ‰ÈÂ˘ÎÚÈÓ›ÛÂÈ˜ ÁÈ· ÙÔÓ ÙÚfiÔ ‰ÈÂÍ·ÁˆÁ‹˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ, ÔÈ Ì·ıËÙ¤˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ÚÔ˜ ÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›ÎÙÂ˜, ÙË ‰È·ÙÚÔÊ‹, ÙË º¢ Î·È ÙË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÎÙ¤ÏÂÛË˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜, ÔÈ Ì·ıËÙ¤˜ ·Ú·ÎÈÓÔ‡ÓÙ·Ó ·fi ÙÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Ó· Î·Ù·‚¿ÏÔ˘Ó ÙÔ Ì¤ÁÈÛÙÔ ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘˜.

∞ÓıÚˆÔÌÂÙÚÈÎÔ› ‰Â›ÎÙÂ˜

ÌÂ ÙÔ˘˜ Ì·ıËÙ¤˜ ÓÙ˘Ì¤ÓÔ˘˜ ÂÏ·ÊÚ¿ Î·È ¯ˆÚ›˜ ˘Ô‰‹Ì·Ù·. ∆Ô

ÌÂÙÚ‹ıËÎÂ ÌÂ „ËÊÈ·Î‹ ˙˘Á·ÚÈ¿ ·ÎÚÈ‚Â›·˜, ÌÂ ÚÔÛ¤ÁÁÈÛË ±0,1 kg. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËÎÂ ÌÂ ÙËÓ Ï¿ÙË ›ÛÈ· Î·È ·ÎÔ˘ÌÈÛÌ¤ÓË ÛÂ ·Ó·ÛÙËÌﬁÌÂÙÚÔ ÙÔ›¯Ô˘, ÌÂ

ÚÔÛ¤ÁÁÈÛË ±0,5 cm. √ ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜

(¢ª™) ˘ÔÏÔÁ›ÛÙËÎÂ ˆ˜ ÙÔ ËÏ›ÎÔ ÙÔ˘ ‚¿ÚÔ˘˜ ‰È· ÙÔ˘

ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m 2). ªÂ ‚¿ÛË ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›·, ÔÈ ÙÈÌ¤˜ ÙÔ˘ ¢ª™ Î¿ıÂ ·È‰ÈÔ‡ ÌÂÙ·ÙÚ¿ËÎ·Ó ÛÂ z-score Î·È ÂÎÙÈÌ‹ıËÎÂ Ë Û˘¯ÓﬁÙËÙ· ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚÎ›·˜, Û‡ÌÊˆÓ· ÌÂ Ù· ÎÚÈÙ‹ÚÈ·

Û¯¤ÛË ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ ÌÂ ÙÈ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È, ˆÛÙfiÛÔ, ÏÈÁÔÛÙ¿ Î·È ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ·ÓÙÈÎÚÔ˘fiÌÂÓ· (11-14). ∂ÈÏ¤ÔÓ, Ù· Û˘ÌÂÚ¿ÛÌ·Ù¿ ÙÔ˘˜ ‰ÂÓ Â›Ó·È ÁÂÓÈÎÂ‡ÛÈÌ·, Î·ıÒ˜ Ë Û˘ÓÂÚÁÈÛÙÈÎ‹ Â›‰Ú·ÛË ÙˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ·¯˘-

-3,00-2,00-1,00-0,001,002,003,004,00

¢ª™ z-score

Î·ÓÔÓÈÎ‹˜ Î·Ù·ÓÔÌ‹˜.

ÙË˜ ¢ÈÂıÓÔ‡˜ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ÁÈ· ÙËÓ ¶·¯˘Û·ÚÎ›·, Ù·

ÔÔ›· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÈ˜ ÙÈÌ¤˜ ·Ó·ÊÔÚ¿˜ ÙÔ˘ ¢ª™ ÂÓËÏ›ÎˆÓ, ‰ËÏ·‰‹ ÛÂ 25.01≤¢ª™≥29.99 kg/m2 ÁÈ· ÙÔ ˘ÂÚ‚ÔÏÈÎﬁ ‚¿-

ÚÔ˜ Î·È ÛÂ ¢ª™≥30.0 kg/m2 ÁÈ· ÙËÓ ·¯˘Û·ÚÎ›· (15,16).

∞ÍÈÔÏﬁÁËÛË ‰È·ÙÚÔÊ‹˜ ∏ ‰È·ÙÚÔÊ‹ ·ÍÈÔÏÔÁ‹ıËÎÂ ÌÂ ¤Ó· ÂÚˆÙËÌ·ÙÔÏﬁÁÈÔ

24ˆÚË˜ ·Ó¿ÎÏËÛË˜ (17). √È Û˘ÌÌÂÙ¤¯ÔÓÙÂ˜ ÎÏ‹ıËÎ·Ó Ó· Î·-

Ù·ÁÚ¿„Ô˘Ó ÌÂ ·ÎÚ›‚ÂÈ· ÙÔ Â›‰Ô˜ Î·È ÙËÓ ÔÛﬁÙËÙ· ﬁÏˆÓ ÙˆÓ

ÁÂ˘Ì¿ÙˆÓ, ˘ÁÚÒÓ Î·È Ù˘¯ﬁÓ Û˘ÌÏËÚˆÌ¿ÙˆÓ Ô˘ Î·Ù·Ó¿Ïˆ-

Û·Ó ÙËÓ ÚÔËÁÔ‡ÌÂÓË ËÌ¤Ú·, ÌÂ ÙÔÓ ﬁÚÔ ﬁÙÈ ‹Ù·Ó ÌÈ· Û˘ÓË-

ıÈÛÌ¤ÓË ËÌ¤Ú·. °È· ÙËÓ ·ÎÚÈ‚‹ ÂÎÙ›ÌËÛË ÙˆÓ ÔÛÔÙ‹ÙˆÓ Î·È

ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÌÈ·˜ Î·ÓÔÓÈÎ‹˜ ÌÂÚ›‰·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ¤Á-

¯ÚˆÌÂ˜ ÊˆÙÔÁÚ·Ê›Â˜ ÙÚÔÊ›ÌˆÓ. ªÂ ‚¿ÛË ÙÔ˘˜ “¶›Ó·ÎÂ˜

Û‡ÓıÂÛË˜ ÙÚÔÊ›ÌˆÓ Î·È ÂÏÏËÓÈÎÒÓ Ê·ÁËÙÒÓ” (18), Î·ıÒ˜ Î·È

ÙÈ˜ ÂÙÈÎ¤ÙÂ˜ Û˘ÛÎÂ˘·ÛÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ Î˘ÎÏÔÊÔÚÔ‡Ó

ÛÙËÓ ÂÏÏËÓÈÎ‹ ·ÁÔÚ¿, ÂÎÙÈÌ‹ıËÎ·Ó Ë Û˘ÓÔÏÈÎ‹ ÂÓÂÚÁÂÈ·Î‹

ÚﬁÛÏË„Ë (kcal/ËÌ¤Ú·) Î·È Ë ÚﬁÛÏË„Ë Ì·ÎÚÔıÚÂÙÈÎÒÓ

ÛÙÔÈ¯Â›ˆÓ ˆ˜ ÔÛÔÛÙﬁ ÙË˜ Û˘ÓÔÏÈÎ‹˜ ÂÓ¤ÚÁÂÈ·˜.

∂ÎÙ›ÌËÛË Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜

∏ º¢ ·ÔÙÈÌ‹ıËÎÂ ÌÂ ÙÔ ∂ÚˆÙËÌ·ÙÔÏﬁÁÈÔ º˘ÛÈÎ‹˜ ¢Ú·-

ÛÙËÚÈfiÙËÙ·˜ Î·È ∆ÚfiÔ˘ ∑ˆ‹˜ (∂º¢∆∑), ¤Ó· ·ÍÈfiÈÛÙÔ Î·È

¤ÁÎ˘ÚÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙËÓ ·ÍÈÔÏﬁÁËÛË ÙË˜ Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙˆÓ ∂ÏÏËÓÔ·›‰ˆÓ (19). √È Ì·ıËÙ¤˜ ÎÏ‹ıËÎ·Ó Ó· Î·Ù·-

ÁÚ¿„Ô˘Ó fiÏÂ˜ ÙÈ˜ º¢ ÛÙÈ˜ ÔÔ›Â˜ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ Ù˘ÈÎ‹˜ Â‚‰ÔÌ¿‰·˜ Î·È, ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó·, ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ 7 ËÌ¤ÚÂ˜. °È· fiÏÂ˜ ÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜, ÔÈ Ì·ıËÙ¤˜ ¤ÚÂÂ Ó· ‰ÒÛÔ˘Ó ·Ó·Ï˘ÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ‰È¿ÚÎÂÈ· Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘˜ ÛÂ ·˘Ù¤˜. ªÂ ‚¿ÛË Ù· ÛÙÔÈ¯Â›· ·˘Ù¿ Î·È ÙÔ ÂÓÂÚÁÂÈ·Îfi ÎfiÛÙÔ˜ Î¿ıÂ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÂ

ÌÂÙ·‚ÔÏÈÎ¿ ÈÛÔ‰‡Ó·Ì· (ª∂∆) (20), ˘ÔÏÔÁ›ÛÙËÎÂ Ë ÂÓÂÚÁÂÈ·Î‹ ‰·¿ÓË (ÛÂ MET-ÒÚÂ˜/Â‚‰ÔÌ¿‰·) ·ﬁ ‰Ú·ÛÙËÚÈﬁÙËÙÂ˜

Ì¤ÙÚÈ·˜ (3-5,9 ª∂∆) Î·È ˘„ËÏ‹˜ ¤ÓÙ·ÛË˜ (≥6 ª∂∆), Î·ıÒ˜

Î·È Ë Û˘ÓÔÏÈÎ‹ Â‚‰ÔÌ·‰È·›· ÂÓÂÚÁÂÈ·Î‹ ‰·¿ÓË. ŒÏÂÁ¯Ô˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜

ÙˆÓ ·Ó·‰ÈÏÒÛÂˆÓ ·fi ÙËÓ Î·Ù¿ÎÏÈÛË ÛÂ 30 sec (Ì˘˚Î‹ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡) Î·È ÙË˜ ‰›ÏˆÛË˜ ·fi Î·ıÈÛÙ‹ ı¤ÛË (Â˘Ï˘ÁÈÛ›·). √È ‰ÔÎÈÌ·Û›Â˜ ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙËÓ ∂˘Úˆ·˚Î‹ ¢¤ÛÌË ¢ÔÎÈÌ·ÛÈÒÓ EUROFIT, ÂÓÒ Ô ÙÚfiÔ˜ ‰ÈÂÍ·ÁˆÁ‹˜ ÙÔ˘˜ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ Û¯ÂÙÈÎfi ÂÁ¯ÂÈÚ›‰ÈÔ (21).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

°È· fiÏÂ˜ ÙÈ˜ ÛÙ·ÙÈÛÙÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ÚfiÁÚ·ÌÌ· SPSS 13,0. √È Û˘ÓÂ¯Â›˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ Ì¤ÛÂ˜ ÙÈÌ¤˜ ± Ù˘ÈÎ‹ ·fiÎÏÈÛË. √È Î·ÙËÁÔÚÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ˆ˜ Û¯ÂÙÈÎ¤˜ Û˘¯ÓfiÙËÙÂ˜. ¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÍÂÙ·ÛÙÔ‡Ó ÔÈ Èı·Ó¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ÛÙ· ÔÛÔÛÙ¿ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚÎ›·˜ ¤ÁÈÓÂ ¯Ú‹ÛË ÙÔ˘ ÙÂÛÙ χ2. ∏ ·Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛË˜ ÌÂ Ú‡ıÌÈÛË ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎ›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ‰È·ÊÔÚÒÓ ÛÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›ÎÙÂ˜, ÙË ‰È·ÙÚÔÊ‹, ÙË º¢ Î·È ÙË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË, ÛÂ Û¯¤ÛË ÌÂ ÙÔ Ê‡ÏÔ Î·È ÙÔÓ ¢ª™. ™ÙË Û˘Ó¤¯ÂÈ· ÂÊ·ÚÌfiÛÙËÎ·Ó ·Ó·Ï‡ÛÂÈ˜ ÔÏÏ·Ï‹˜ ÁÚ·ÌÌÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ÍÂ¯ˆÚÈÛÙ¿ ÁÈ· Ù· ‰‡Ô Ê‡Ï·, ÁÈ· Ó· ÂÍÂÙ·ÛÙÂ› Ë ·ÓÂÍ¿ÚÙËÙË Â›‰Ú·ÛË ÙË˜ º¢ Î·È ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÛÙÔÓ ¢ª™. ∆Ô Â›Â‰Ô ÛÙ·ÙÈÛÙÈÎ‹˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙËÎÂ ÛÂ p<0,05.

∞ÔÙÂÏ¤ÛÌ·Ù·

™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ÂÓÒ ÛÙËÓ ∂ÈÎﬁÓ· 1 ·ÂÈÎÔÓ›˙ÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ z-score ÙÔ˘ ¢ª™ ÛÙ· ‰‡Ô Ê‡Ï·, ÛÂ

Û¯¤ÛË ÌÂ ÙËÓ Î·Ì‡ÏË Î·ÓÔÓÈÎ‹˜ Î·Ù·ÓÔÌ‹˜. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ ÛÙÔ ‡„Ô˜, ÙÔ ‚¿ÚÔ˜ ‹ ÙÔÓ ¢ª™. ∞ﬁ ÙËÓ ¿ÏÏË ÌÂÚÈ¿, Ë Î‡ÚÈ· Â›‰Ú·ÛË ÙÔ˘

·Ú¿ÁÔÓÙ· «Î·ÙËÁÔÚ›· ¢ª™» ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÛÂ ﬁÏÔ˘˜ ÙÔ˘˜ ÂÍÂÙ·˙ﬁÌÂÓÔ˘˜ ‰Â›ÎÙÂ˜. ∞Ó·-

¶·Ú¿ÌÂÙÚÔÈ ∫·ÙËÁÔÚ›Â˜ ¢ª™ ∫ÔÚ›ÙÛÈ· ∞ÁﬁÚÈ· n=197 n=181

⁄„Ô˜ (cm)º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™150,28±7,15149,87±6,91

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·153,00±6,64‡ 151,97±5,85* F(1, 373)=8,18F(1, 373)= 4,44

µ¿ÚÔ˜ (kg)º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™39,45±6,4139,89±6,43

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·56,61±9,52# 55,28±7,41# F(1, 373)=272,11F(1, 373)=198,01

¢ª™ (kg/m2)º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™17,36±1,8117,69±1,79

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·24,11±3,03# 23,89±2,80# F(1, 373)=429,65F(1, 373)=328,71

¢ª™ (z-score)º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™-0,26±0,840,17±0,87

™˘¯ÓﬁÙËÙ·

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·1,89±0,55# 2,15±0,47# F(1, 373)=386,45F(1, 373)=293,45

À¶/¶™ÀÂÚ‚ÔÏÈÎﬁ ‚¿ÚÔ˜, % (95% ¢∂)28,9 (22,6-35,2)28,2 (21,6-34,8)

¶·¯˘Û·ÚÎ›·, % (95% ¢∂)8,6 (4,7-12,5)8,8 (4,7-12,9)

¢ª™ = ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, À¶/¶™ = ˘ÂÚ‚ÔÏÈÎﬁ ‚¿ÚÔ˜/·¯˘Û·ÚÎ›·, ¢∂ = ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜. √È ÙÈÌ¤˜ ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ·ÊÔÚÔ‡Ó Ì¤ÛË ÙÈÌ‹±Ù˘ÈÎ‹

ÌÂ ‚¿ÛË ÙÈ˜ ‰ÈÂıÓÂ›˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÁÈ·

·ÍÈÔÏﬁÁËÛË ÙÔ˘ ˘ÂÚ‚ÔÏÈÎÔ‡ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÂ ·È‰È¿ 2-18 ÂÙÒÓ (15). ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜

ÌÂÙ·Í‡ ÙˆÓ Î·ÙËÁÔÚÈÒÓ ÙÔ˘ ¢ª™ ÁÈ·: *p≤0,05, ‡p≤0,005, #p≤0,0001.

‚¿ÚÔ˘˜ (¶›Ó·Î·˜ 1). ªÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ô˘ Ù¤ıË-

Î·Ó (15,16), 37,3% ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó ˘¤Ú‚·ÚÔÈ

(˘ÂÚ‚ÔÏÈÎﬁ ‚¿ÚÔ˜: 28,6%, ·¯˘Û·ÚÎ›·: 8,7%), ¯ˆ-

Ú›˜ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ

(χ2=0,03, df=2, p=0,986).

∆· ‰È·ÙÚÔÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È Ë º¢ ÙÔ˘

‰Â›ÁÌ·ÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∏ Ì¤ÛË

ËÌÂÚ‹ÛÈ· ıÂÚÌÈ‰ÈÎ‹ ÚﬁÛÏË„Ë ‰ÂÓ ·ÚÔ˘Û›·ÛÂ

ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ·È‰ÈÒÓ

Ê˘ÛÈÔÏÔÁÈÎÔ‡ ¢ª™ Î·È ˘¤Ú‚·ÚˆÓ/·¯‡Û·ÚÎˆÓ

·È‰ÈÒÓ, ÌÂ ÂÍ·›ÚÂÛË ÌÈ· ÔÚÈ·Î‹ ÛÙ·ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈÎfiÙËÙ· ÛÙ· ·ÁfiÚÈ· (p=0,058). ™ËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ‚Ú¤ıËÎ·Ó ÛÙ· ÂÈÌ¤ÚÔ˘˜ Ì·ÎÚÔıÚÂÙÈÎ¿ ÛÙÔÈ¯Â›·, ÌÂ Ù· ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Ó· ·Ó·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ (p=0,009 Î·È p=0,0001, ·ÓÙ›ÛÙÔÈ¯·) Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ Ï›Ô˘˜ (p=0,045 Î·È p=0,005, ·ÓÙ›ÛÙÔÈ¯·) Î·È ÚˆÙÂ˚ÓÒÓ (p=0,028 Î·È p=0,0001, ·ÓÙ›ÛÙÔÈ¯·) ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, ÛÂ Û¯¤ÛË ÌÂ Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ¢ª™. ∏ ÂÓÂÚÁÂÈ·Î‹ ‰·¿ÓË ·fi º¢ ˘„ËÏ‹˜ ¤ÓÙ·ÛË˜ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (p=0,05 Î·È p=0,011, ·ÓÙ›ÛÙÔÈ¯·), ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ‰È·ÈÛÙÒıËÎ·Ó ÂÈÏ¤ÔÓ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÙË Û˘ÓÔÏÈÎ‹ Â‚‰ÔÌ·‰È·›· ÂÓÂÚÁÂÈ·Î‹ ‰·¿ÓË (p=0,024). ∆¤ÏÔ˜, Ù· ˘¤Ú‚·Ú· ·È‰È¿ ÛËÌÂ›ˆÛ·Ó ¯·ÌËÏfiÙÂÚÂ˜ ÂÈ‰fiÛÂÈ˜ ÛÙËÓ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÙÔ¯‹ Î·È ÙË Ì˘˚Î‹ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡ (∂ÈÎfiÓ· 2·-‚), ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ Â˘Ï˘ÁÈÛ›· (∂ÈÎfiÓ· 2Á).

ÁÚ·ÌÌÈ-

Î‹˜ ·ÏÈÓ‰ÚﬁÌËÛË˜ ‚Ú¤ıËÎÂ ﬁÙÈ ÛÙ· ÎÔÚ›ÙÛÈ· Ë Û˘-

ÓÔÏÈÎ‹ º¢ (p=0,017) Î·È Ë ‰È·ÙÚÔÊÈÎ‹ ÚﬁÛÏË„Ë

Ï›Ô˘˜ (p=0,019) Û˘Ó¤‚·Ï·Ó ÛËÌ·ÓÙÈÎ¿ Î·È ·ÓÂÍ¿ÚÙËÙ· Ë Î¿ıÂ Ì›· ·fi ÙËÓ ¿ÏÏË ÛÙËÓ Úfi‚ÏÂ„Ë ÙÔ˘ ¢ª™ (¶›Ó·Î·˜ 3). ™Ù· ·ÁfiÚÈ·, Ë Û˘ÓÔÏÈÎ‹ º¢ ‹Ù·Ó

ÛËÌ·ÓÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Ú¿ÌÂÙÚÔ˜ ÙÔ˘ ¢ª™ (p=0,018), ÂÓÒ Ë Û˘Ì‚ÔÏ‹ ÙË˜ Ì¤ÛË˜ ËÌÂÚ‹ÛÈ·˜

ıÂÚÌÈ‰ÈÎ‹˜ ÚﬁÛÏË„Ë˜ Î·È ÙË˜ ÚﬁÛÏË„Ë˜ Ï›Ô˘˜

‹Ù·Ó ÔÚÈ·Î¿ ÛËÌ·ÓÙÈÎ‹ (p=0,067 Î·È p=0,089, ·ÓÙ›ÛÙÔÈ¯·). √È ÂÍÈÛÒÛÂÈ˜ ·ÏÈÓ‰ÚﬁÌËÛË˜ ÂÚÌ‹ÓÂ˘Û·Ó

Î·È ÛÙ· ‰‡Ô Ê‡Ï· ¤Ó· ÌÈÎÚﬁ ÔÛÔÛÙﬁ ÙË˜ ‰È·Î‡Ì·ÓÛË˜ ÙÔ˘ ¢ª™ (7%).

™˘˙‹ÙËÛË

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÂÍÂÙ¿ÛÙËÎÂ Ë Û¯¤ÛË ÙÔ˘

¢ª™ ÌÂ ÙË º¢, ÙË ‰È·ÙÚÔÊ‹ Î·È ÙË Ê˘ÛÈÎ‹ Î·Ù¿-

ÛÙ·ÛË ÛÂ 11¯ÚÔÓÔ˘˜ Ì·ıËÙ¤˜. ¢È·ÈÛÙÒıËÎÂ ¤Ó·

˘„ËÏfi ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ/·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ, Ù· ÔÔ›·, ÛÂ Û¯¤ÛË ÌÂ Ù· ·È‰È¿ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜, ·ÚÔ˘Û›·Û·Ó ÌÂÈˆÌ¤ÓË º¢, ‰È·ÊÔÚÂÙÈÎ¿ ‰È·ÙÚÔÊÈÎ¿ ÚfiÙ˘· Î·È ¯·ÌËÏfiÙÂÚÂ˜ ÂÈ‰fiÛÂÈ˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜. ∞fi ÙÈ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ë º¢ ÛÙ· ‰‡Ô Ê‡Ï· Î·È Ë

n=197 n=181

∂ÓÂÚÁÂÈ·Î‹ ÚﬁÛÏË„Ë (kcal/ËÌ¤Ú·)º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™1682,89±477,151575,14±467,97

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·1632,19±468,161718,67±420,85 F(1, 354)=0,54F(1, 354)=3,63

∂Ó¤ÚÁÂÈ· (%) ·ﬁ:

À‰·Ù¿ÓıÚ·ÎÂ˜º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™55,75±8,6753,15±9,86

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·49,28±11,05# 48,73±13,72† F(1, 354)= 16,95F(1, 354)= 6,94

¶ÚˆÙÂ˝ÓÂ˜º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™19,03±4,1821,10±5,70

§›Ë

∂ÓÂÚÁÂÈ·Î‹ ‰·¿ÓË ·ﬁ:

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·22,42±5,64# 23,19±8,75* F(1, 354)=14,70F(1, 354)=4,88

º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™25,23±6,4125,75±6,55

À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·28,31±7,15‡ 28,08±9,82*

F(1, 354)=7,99F(1, 354)=4,03

ª¤ÙÚÈ· º¢º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™27,12±22,8824,61±18,84 (ª∂∆-ÒÚÂ˜/Â‚‰ÔÌ¿‰·)À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·24,89±24,2423,51±22,88 F(1, 373)=0,48F(1, 373)=0,11

ŒÓÙÔÓË º¢

º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™16,68±20,6122,61±22,18 (ª∂∆-ÒÚÂ˜/Â‚‰ÔÌ¿‰·)À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·9,00±17,01† 16,37±21,54* F(1, 373)=6,45F(1, 373)=3,85

™˘ÓÔÏÈÎ‹ º¢

º˘ÛÈÔÏÔÁÈÎﬁ˜ ¢ª™43,79±32,1547,01±25,78 (ª∂∆-ÒÚÂ˜/Â‚‰ÔÌ¿‰·)À¤Ú‚·Ú·/ ¶·¯‡Û·ÚÎ·33,87±32,23*39,91±29,34 F(1, 373)=5,14F(1, 373)=2,38

¢ª™ = ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜, º¢ = Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ·, MET = ÌÂÙ·‚ÔÏÈÎﬁ ÈÛÔ‰‡Ó·ÌÔ. ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ Î·ÙËÁÔÚÈÒÓ ÙÔ˘ ¢ª™ ÁÈ·: *p≤0,05, †p≤0,01, ‡p≤0,005, #p≤0,0001.

·È‰ÈÒÓ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ·¯˘Û·Ú-

Î›·˜) ÛÙÔ ·ÚﬁÓ ‰Â›ÁÌ· ÂÌÊ·Ó›˙ÔÓÙ·È ˘„ËÏﬁÙÂÚ· ÛÂ

Û¯¤ÛË ÌÂ ÙÈ˜ ¯ÒÚÂ˜ ÙË˜ µﬁÚÂÈ·˜ ∂˘ÚÒË˜ (10,227,4%) Î·È ·ÚﬁÌÔÈ· ÌÂ ÂÎÂ›Ó· ÙˆÓ ÌÂÛÔÁÂÈ·ÎÒÓ

¯ˆÚÒÓ (29,8-36,0%), ÌÂ ÂÍ·›ÚÂÛË ÙËÓ ∆Ô˘ÚÎ›· (14,0%) (1,24-26).

∏ ÈÛ¯˘Ú‹ ·ÓÙ›ÛÙÚÔÊË Û¯¤ÛË ÙÔ˘ ¢ª™ ÌÂ ÙË º¢, Ë ÔÔ›· ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·ﬁ ÙËÓ Â›‰Ú·ÛË ¿ÏÏˆÓ

·Ú·ÁﬁÓÙˆÓ, Â›Ó·È Û‡ÌÊˆÓË ÌÂ Ù· Û˘ÌÂÚ¿ÛÌ·Ù·

ÚÔËÁÔ‡ÌÂÓˆÓ ÂÚÂ˘ÓÒÓ ÛÙË ¯ÒÚ· Ì·˜ (12) Î·È ·Ï-

ÏÔ‡ (27), ÔÈ ÔÔ›Â˜ ·Ó·Ê¤ÚÔ˘Ó ﬁÙÈ Ë º¢ ·ÔÙÂÏÂ›

·ÓÂÍ¿ÚÙËÙÔ ÚÔÁÓˆÛÙÈÎﬁ ‰Â›ÎÙË ÙË˜ ·¯˘Û·ÚÎ›·˜

ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. À¿Ú¯Ô˘Ó ˆÛÙﬁÛÔ Î·È ¤ÚÂ˘-

ÓÂ˜ Ô˘ Î·Ù¤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· ﬁÙÈ Ë º¢ ‰ÂÓ

Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ·¯˘Û·ÚÎ›· (11,28).

Â›Ó·È Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÂÚÂ˘ÓÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÙË Û¯¤ÛË ÙÔ˘ ¢ª™ ÌÂ ÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ¤ÚÂ˘Ó·, Ë

·È‰È¿ 11-12 ÂÙÒÓ. ∞ÚÎÂÙÔ› ÂÚÂ˘ÓËÙ¤˜, ˆÛÙfiÛÔ, ‰ÂÓ ÌfiÚÂÛ·Ó Ó· ‰È·ÈÛÙÒÛÔ˘Ó ·ÚfiÌÔÈÂ˜ Û˘Û¯ÂÙ›ÛÂÈ˜ (30,31). ™ÙË ¯ÒÚ· Ì·˜, ÌÂÏ¤ÙÂ˜ ÛÙËÓ ¶ÈÂÚ›· (12) Î·È ÙË ª·ÁÓËÛ›· (13) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ÂÓÂÚÁÂÈ·Î‹ ÚfiÛÏË„Ë Î·È Ë Î·Ù·Ó¿ÏˆÛË Ï›Ô˘˜ ÛÙË ‰È·ÙÚÔÊ‹ ‰ÂÓ Û¯ÂÙ›ÛÙËÎ·Ó ÌÂ ÙÔ ÛˆÌ·ÙÈÎfi Ï›Ô˜ ‹ ÙÔÓ ¢ª™. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÌÈ· ÚfiÛÊ·ÙË ¤ÚÂ˘Ó· ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ πˆ·ÓÓ›ÓˆÓ (14) Î·Ù¤ÏËÍÂ ÛÂ ·ÓÙ›ıÂÙ· Û˘ÌÂÚ¿ÛÌ·Ù·. ∫ÔÈÓfi Â‡ÚËÌ·, ˆÛÙfiÛÔ, ÛÙÈ˜ ÙÚÂÈ˜ ·˘Ù¤˜

¶›Ó·Î·˜ 3 ∞ÔÙÂÏ¤ÛÌ·Ù· ·Ó¿Ï˘ÛË˜ ·ÏÈÓ‰ÚﬁÌËÛË˜ ÁÈ· ÙÔÓ ¢ª™ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ËÏÈÎ›·, ÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜ Î·È ÙË º¢

∫ÔÚ›ÙÛÈ· ∞ÁﬁÚÈ·

¶·Ú¿ÌÂÙÚÔÈ ‚ (SE) ‚ (SE)

∏ÏÈÎ›· (¤ÙË)0,01 (0,94)0,04 (0,60)

∂ÓÂÚÁÂÈ·Î‹ ÚﬁÛÏË„Ë 0,01 (0,00)0,14 (0,00) (kcal/ËÌ¤Ú·)

∂Ó¤ÚÁÂÈ· ·ﬁ Ï›Ë (%)0,17 (0,04)*0,13 (0,04)

™˘ÓÔÏÈÎ‹ º¢ -0,17 (0,31)*-0,18 (0,01)*

(ª∂∆-ÒÚÂ˜/Â‚‰ÔÌ¿‰·) R 0,257*0,261*

¢ª™ = ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜, º¢ = Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·, MET = ÌÂÙ·‚ÔÏÈÎfi ÈÛÔ‰‡Ó·ÌÔ, SE = Ù˘ÈÎfi ÛÊ¿ÏÌ·. * p≤0,05.

ÙÔ

ÔÔ›Ô Û’ ·˘Ù‹ ÙËÓ ËÏÈÎ›· ÌÔÚÂ› Ó· ·Ó¤ÏıÂÈ ¤ˆ˜ ~1/3 ÙË˜ Û˘ÓÔÏÈÎ‹˜ ËÌÂÚ‹ÛÈ·˜ ÂÓÂÚÁÂÈ·Î‹˜ ÚﬁÛÏË„Ë˜ (32) Î·È Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ˘¤Ú‚·Ú· Î·È

·¯‡Û·ÚÎ· ·È‰È¿, ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ¢ª™ (33). §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÈ˜ ˘„ËÏ¤˜ ÙÈÌ¤˜ ÙÔ˘ ¢ª™ ÛÙÔ ·ÚfiÓ ‰Â›ÁÌ·, ı· ÌÔÚÔ‡ÛÂ

Ó· ˘Ôı¤ÛÂÈ Î¿ÔÈÔ˜ ﬁÙÈ Ë Û˘ÓÔÏÈÎ‹ ÂÓÂÚÁÂÈ·Î‹

ÚﬁÛÏË„Ë ÙˆÓ ·È‰ÈÒÓ, ﬁˆ˜ ·˘Ù‹ Î·Ù·ÁÚ¿ÊËÎÂ

ÌÂ ÙÔ ∂º¢∆∑, ‹Ù·Ó Èı·ÓÒ˜ ¯·ÌËÏﬁÙÂÚË ÛÂ Û¯¤ÛË ÌÂ ÙËÓ Ú·ÁÌ·ÙÈÎ‹. ∂Í¿ÏÏÔ˘, Ë ·¯˘Û·ÚÎ›· Â›Ó·È ÙÔ Ì·ÎÚÔÚﬁıÂÛÌÔ

ÙÔ ÔÔ›Ô ÌÔÚÂ› ¿ÏÏÔÙÂ Ó· ÔÊÂ›ÏÂÙ·È

∂ÈÎﬁÓ· 2. ¢È·ÊÔÚ¤˜ ÌÂÙ·Í‡ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î·È ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ÛÙËÓ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÙÔ¯‹, ÙË Ì˘˚Î‹ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡ Î·È ÙËÓ Â˘Ï˘ÁÈÛ›·. √È ÙÈÌ¤˜ ·ÊÔÚÔ‡Ó Ì¤ÛË ÙÈÌ‹ ± Ù˘ÈÎ‹ ·ﬁÎÏÈÛË. ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ Î·ÙËÁÔÚÈÒÓ ÙÔ˘ ¢ª™ ÁÈ·: # p≤0,001.

Î·ıÒ˜ Î·È ÌÂÙ·Í‡ ‰È·ÊÔÚÂÙÈÎÒÓ ÏËı˘ÛÌÒÓ (34). ∆¤ÏÔ˜, ˘¿Ú¯Ô˘Ó ÛÙÔÈ¯Â›· Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ÙË˜ ¿Ô„Ë˜ ﬁÙÈ Ë ÌÂÙ·‚ÔÏÈÎ‹ ·¿ÓÙËÛË

ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÂ ÌÈ· ‰È·Ù·Ú·¯‹ ÙË˜ ÂÓÂÚÁÂÈ·Î‹˜

ÈÛÔÚÚÔ›·˜ ÂËÚÂ¿˙ÂÙ·È ÛËÌ·ÓÙÈÎ¿ ·fi ÙÔÓ ÁÔÓfiÙ˘Ô Î¿ıÂ ·ÙfiÌÔ˘ (35,36). ∂ÔÌ¤Óˆ˜, Ù· ¿ÙÔÌ· ÌÂ ÁÂÓÂÙÈÎ‹ ÚÔ‰È¿ıÂÛË ÂÓ‰Â¯ÔÌ¤Óˆ˜ Ó· ÌËÓ Â›Ó·È ÛÂ ı¤ÛË Ó· ·ÓÙÈÛÙ·ıÌ›ÛÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÙÈ˜ ÂÚÈÔ‰ÈÎ¤˜ ‰È·Î˘Ì¿ÓÛÂÈ˜ ÛÙËÓ ÂÓÂÚÁÂÈ·Î‹ ‰·¿ÓË ‹ ÙËÓ ÂÓÂÚÁÂÈ·Î‹ ÚfiÛÏË„Ë. ∏ ·Ú·ÙÂÙ·Ì¤ÓË ·‰˘Ó·Ì›·

·ÓÙÈÛÙ¿ıÌÈÛË˜ ÌÈ·˜ Ù¤ÙÔÈ·˜ ‰È·Ù·Ú·¯‹˜ ÛÙËÓ ÂÓÂÚÁÂÈ·Î‹ ÈÛÔÚÚÔ›· Ì·ÎÚÔÚﬁıÂÛÌ· ÂÎ‰ËÏÒÓÂÙ·È ˆ˜

·‡ÍËÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ Ï›Ô˘˜ ÛÙÔ ÛÒÌ· (28).

∞Ó Î·È ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÓÂÚÁÂÈ·Î‹

‰·¿ÓË ·ﬁ º¢ Ì¤ÙÚÈ·˜ ¤ÓÙ·ÛË˜, Ù· ˘¤Ú‚·Ú· ·È-

‰È¿ ·Ó¤ÊÂÚ·Ó ÌÈÎÚﬁÙÂÚË Û˘ÌÌÂÙÔ¯‹ ÛÂ º¢ ˘„ËÏ‹˜

¤ÓÙ·ÛË˜. ™Â ·ÚÎÂÙ¤˜ ¤ÚÂ˘ÓÂ˜ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› ﬁÙÈ

Ù· ˘¤Ú‚·Ú· ·È‰È¿ Û˘ÌÌÂÙ¤¯Ô˘Ó ÏÈÁﬁÙÂÚÔ ÛÂ ‰Ú·ÛÙËÚÈﬁÙËÙÂ˜ Ô˘ ··ÈÙÔ‡Ó ·˘ÍËÌ¤ÓË ÂÓÂÚÁÂÈ·Î‹

·Ú¤Ì‚·ÛË˜ Ô˘ ·Â˘ı‡ÓÔ-

ÙÔ˘ ÛÒÌ·ÙÔ˜, ÙË Û˘Ó·ÎﬁÏÔ˘ıË ·‡ÍËÛË ÙÔ˘ ‚·ÛÈÎÔ‡

ÌÂÙ·‚ÔÏÈÛÌÔ‡ Î·È ÙËÓ ÚÔÔ‰Â˘ÙÈÎ‹ ·‡ÍËÛË ÙË˜

Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙËÓ ·Ú·ÁˆÁ‹

ÂÓ¤ÚÁÂÈ·˜ (39).

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙË Û¯¤ÛË ·¯˘Û·ÚÎ›·˜ Î·È Ê˘ÛÈ-

Î‹˜ Î·Ù¿ÛÙ·ÛË˜, ‰È·ÈÛÙÒıËÎÂ ﬁÙÈ Ù· ˘¤Ú‚·Ú·

·È‰È¿ ·ÚÔ˘Û›·Û·Ó ¯·ÌËÏﬁÙÂÚÂ˜ ÂÈ‰ﬁÛÂÈ˜ ÛÂ

Û¯¤ÛË ÌÂ Ù· ·È‰È¿ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜ ÛÙÈ˜ ‰Ô-

ÎÈÌ·Û›Â˜ Ô˘ ··ÈÙÔ‡Û·Ó Î¿ıÂÙË ‹ ÔÚÈ˙ﬁÓÙÈ· ÌÂ-

Ù·ÙﬁÈÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Î¿ÙÈ Ô˘ ·ÔÙÂ-

ÏÂ› ÎÔÈÓﬁ Â‡ÚËÌ· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (13,23,37). √È

¯·ÌËÏﬁÙÂÚÂ˜ ÂÈ‰ﬁÛÂÈ˜ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ

ÔÊÂ›ÏÔÓÙ·È ÚÔÊ·ÓÒ˜ ÛÙ· ·˘ÍËÌ¤Ó· ÔÛÔÛÙ¿ Ï›-

Ô˘˜ ÛÙÔ ÛÒÌ· ÙÔ˘˜, Ô˘ ·ÔÙÂÏÔ‡Ó ¤Ó· ÂÈÏ¤ÔÓ

ÊÔÚÙ›Ô ÛÙË ‰È¿ÚÎÂÈ· ÂÎÙ¤ÏÂÛË˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ

(40). £· Ú¤ÂÈ ÛÙÔ ÛËÌÂ›Ô ·˘Ùﬁ Ó· ÙÔÓÈÛÙÂ› È‰È·›-

ÙÂÚ· Ë ÛËÌ·Û›· ÙË˜ ÌÂÈˆÌ¤ÓË˜ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÙÔ¯‹˜, Î·ıÒ˜ Ê·›ÓÂÙ·È ﬁÙÈ ·ÔÙÂÏÂ› ·ÓÂÍ¿ÚÙËÙÔ ÚÔ‰È·ıÂÛÈÎﬁ ·Ú¿ÁÔÓÙ· ÁÈ·

·ÓÙÈÎ·ÙÔ-

ÙÚ›˙Ô˘Ó ÙËÓ ÂÚÈÔÚÈÛÌ¤ÓË ÈÎ·ÓﬁÙËÙ· ÔÍÂ›‰ˆÛË˜

ÙˆÓ ÂÓ‰ÔÌ˘˚ÎÒÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ (42), ÁÂÁÔÓﬁ˜ Ô˘

¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ Â›ÛË˜ ÂÚÈÔÚÈÛÌ¤ÓË ·ÓÔ¯‹

ÛÙ· Ï›Ë ÙˆÓ ÙÚÔÊÒÓ Î·È, ÙÂÏÈÎ¿, ÙËÓ ·‡ÍËÛË ÙÔ˘

ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È Ï›Ô˘˜ (12). ∞˘Ùﬁ Û˘Ì‚·‰›˙ÂÈ ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ¤ÚÂ˘Ó·˜:

·ÚﬁÏÔ Ô˘ ÙÔ ÔÛÔÛÙﬁ Ï›Ô˘˜ ÛÙË ‰È·ÙÚÔÊ‹ ‹Ù·Ó

·ÚfiÌÔÈÔ ÁÈ· Ù· ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (~28%), ¯ˆÚ›˜ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÔ Û˘ÓÈÛÙÒÌÂÓÔ fiÚÈÔ

ÙÔ˘ 30% ÙË˜ Û˘ÓÔÏÈÎ‹˜ ÂÓ¤ÚÁÂÈ·˜, Ë ‰È·ÙÚÔÊÈÎ‹

ÚﬁÛÏË„Ë Ï›Ô˘˜ ·ÔÙ¤ÏÂÛÂ ÛËÌ·ÓÙÈÎﬁ ÚÔÁÓˆ-

ÛÙÈÎﬁ ‰Â›ÎÙË ÙÔ˘ ¢ª™ ÌﬁÓÔ ÛÙ· ÎÔÚ›ÙÛÈ·, ÂÍ·ÈÙ›·˜

ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÙË˜ ¯·ÌËÏﬁÙÂÚË˜ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈ-

Î‹˜ ÙÔ˘˜ ·ÓÙÔ¯‹˜ ÛÂ Û¯¤ÛË ÌÂ Ù· ·ÁﬁÚÈ·.

√ ÔÌﬁ¯ÚÔÓÔ˜ Û¯Â‰È·ÛÌﬁ˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜

‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÁÈ· ·È-

ÙÈÒ‰Ë Û¯¤ÛË ÙË˜ º¢ Î·È ÙË˜ ‰È·ÙÚÔÊ‹˜ ÌÂ ÙËÓ ·¯˘Û·ÚÎ›·. ŒÓ·˜ ¿ÏÏÔ˜ ÂÚÈÔÚÈÛÌﬁ˜ ÙË˜ ¤ÚÂ˘Ó·˜ Â›Ó·È Ë

¤ÏÏÂÈ„Ë ÛÙÔÈ¯Â›ˆÓ ·Ó·ÊÔÚÈÎ¿ ÌÂ ÙÔ ÛÙ¿‰ÈÔ ˆÚ›Ì·Ó-

ÙËÓ ·Ó·ÁÎ·ÈﬁÙËÙ·

ÚÈˆÌ¤ÓˆÓ ÔÏÈÙÈÎÒÓ ˘ÁÂ›·˜ Î·È ÂÊ·ÚÌÔÁ‹˜ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚﬁÏË„Ë˜ ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜, Ô˘ Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙÈ˜ ·Ó¿ÁÎÂ˜ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Î·È Ó· ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ ·‡ÍËÛË ÙË˜ º¢, ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ Î·È ÛÙËÓ ˘ÈÔı¤ÙËÛË ˘ÁÈÂÈÓÒÓ ‰È·ÙÚÔÊÈÎÒÓ

ÚÔÙ‡ˆÓ. ∏ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘ ··ÈÙÂ› ·ÚÂÌ‚¿ÛÂÈ˜ Â˘ÚÂ›·˜ ÎÏ›Ì·Î·˜ Î·È ÎÈÓËÙÔÔ›ËÛË fiÏˆÓ ÙˆÓ ÂÌÏÂÎfiÌÂÓˆÓ ÎÔÈÓˆÓÈÎÒÓ

‰ÔÌÒÓ (ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔÈÎ‹˜ ÎÔÈÓˆÓ›·˜, È·ÙÚÈÎ‹˜ ÎÔÈÓﬁÙËÙ·˜, ÊÔÚ¤ˆÓ ˘ÁÂ›·˜), ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÌÂÈ-

ˆıÂ› Ë Û˘¯ÓﬁÙËÙ· ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ Î·È Ó· ÚÔÏËÊıÔ‡Ó ÔÈ ÂÈÏÔÎ¤˜ ÙË˜ ÛÙË ÌÂÏÏÔÓÙÈÎ‹ ˘ÁÂ›· ÙˆÓ ÛËÌÂÚÈÓÒÓ ·È‰ÈÒÓ. ∂˘¯·ÚÈÛÙ›Â˜ √È Û˘ÁÁÚ·ÊÂ›˜ ıÂˆÚÔ‡Ó ˘Ô¯Ú¤ˆÛ‹

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18. ∆ÚÈ¯ÔÔ‡ÏÔ˘ ∞. ¶›Ó·ÎÂ˜ ™‡ÓıÂÛË˜ ∆ÚÔÊ›ÌˆÓ Î·È ∂ÏÏËÓÈÎÒÓ º·ÁËÙÒÓ. ∞ı‹Ó·: ∂ÈÛÙËÌÔÓÈÎ¤˜ ∂Î‰ﬁÛÂÈ˜ ¶·ÚÈÛÈ¿ÓÔ˜; 2004

19. ∞rgiropoulou EC, Michalopoulou M, Aggeloussis N, Avgerinos A. Validity and reliability of physical activity measures in Greek high school age children. J Sports Sci Med 2004;3:147-159.

20. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32 (9 Suppl):498-516.

21. ™˘Ì‚Ô‡ÏÈÔ ÙË˜ ∂˘ÚÒË˜ - ∂ÈÙÚÔ‹ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÛÔÚ. Eurofit. ∂˘ÚˆÙ¤ÛÙ ÁÈ· ÙËÓ ·ÍÈÔÏﬁÁËÛË ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜. £ÂÛÛ·ÏÔÓ›ÎË: ∂Î‰ﬁÛÂÈ˜ ™¿ÏÙÔ; 1992.

22. Krassas GE, Tzotzas T, Tsametis C, Konstantinidis T. Prevalence and trends in overweight and obesity among children and adolescents in Thessaloniki, Greece. J Pediatr Endocrinol Metab 2001;14(5 Suppl):1319-1326.

23. Tokmakidis SP, Kasambalis A, Christodoulos A. Fitness levels of Greek primary schoolchildren in relationship to overweight and obesity. Eur J Pediatr 2006;165:867-874.

24. De Vito E, La Torre G, Lanfianno E, Berandi D, Ricciardi G. Overweight and obesity among secondary school children in Central Italy. Eur J Epidemiol 1999;15:649-654.

25. Padez C, Fernandes T, Moura~o I, Moreira P, Rosado V. Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from 19702002. Am J Hum Biol 2004;16:670-678.

26. Sur H, Kolotourou M, Dimitriou M, Kocaoglu B, Keskin Y, Hayran O, et al. Biochemical and behavioral indices related to BMI in schoolchildren in urban Turkey. Prev Med 2005;41:614-621.

27. Maffeis C, Talamini G, Tato L. Influence of diet, physical activity and parents’ obesity on children’s adiposity: a fouryear longitudinal study. Int J Obes Relat Metab Disord 1998;22:758-764.

28. Goran MI, Shewchuk R, Gower BA, Nagy TR, Carpenter WH, Johnson RK. Longitudinal changes in fatness in white children: no effect of childhood energy expenditure. Am J Clin Nutr 1998;67:309-316.

29. Perry AC, Tremblay LM, Signorile JF, Kaplan TA, Miller PC. Fitness, diet and coronary risk factors in a sample of southeastern U.S. children. Appl Human Sci 1997;16: 133-141.

30. Burniat W. Child and adolescent obesity: causes and consequences, prevention and management. 1st ed. New York: Cambridge University Press; 2002.

31. Twisk JW, Van Mechelen W, Kemper HC, Post GB. The relation between “long-term exposure” to lifestyle during youth and young adulthood and risk factors for cardiovascular disease at adult age. J Adolesc Health 1997;20: 309-319.

32. Champagne CM, Baker NB, DeLany JP, Harsha DW, Bray GA. Assessment of energy intake underreporting by doubly labeled water and observations on reported nutrient intakes in children. J Am Diet Assoc 1998;98:426-433.

33. Maffeis C, Schutz Y, Zaffanello M, Piccoli R, Pinelli L. Elevated energy expenditure and reduced energy intake in obese prepubertal children: paradox of poor dietary reliability in obesity? J Pediatr 1994;124:348-354.

34. Goran MI, Sun M. Total energy expenditure and physical activity in prepubertal children: recent advances based on the application of the doubly labeled water method. Am J Clin Nutr 1998;68:944-999.

35. Bouchard C. Individual differences in the response to regular exercise. Int J Obes 1995;19:5-8.

36. Bouchard C, Tremblay A, Despres JP, Nadeau A, Lupien PJ, Thériault G, et al. The response to long-term overfeeding in identical twins. N Engl J Med 1990;322:1477-1482.

37. Deforche B, Lefevre J, De Bourdeaudhuij I, Hills A, Duquet W, Bouckaert J. Physical fitness and physical activity in obese and non-obese Flemish youth. Obes Res 2003;11:434-441.

38. Poehlman ET. A review: exercise and its influence on resting energy metabolism in man. Med Sci Sports Exerc 1989;21: 515-525.

39. Goldberg GR, Prentice AM, Davies HL, Murgatroyd PR. Residual effect of graded levels of exercise on metabolic rate. Eur J Clin Nutr 1990;44:99-105.

40. Astrand PO, Rodahl K. Physiological bases of exercise. In: Textbook of work physiology. Physiological bases of exercise. 3rd ed. New York: McGraw-Hill Book Company; 1986, p. 295-353.

41. Johnson MS, Figueroa-Colon R, Herd SL, Fields DA, Sun M, Hunter GR, et al. Aerobic fitness, not energy expenditure, influences subsequent increase in adiposity in black and white children. Pediatrics 2000;106:e50.

42. König D, Väisänen SB, Bouchard C, Halle M, Lakka TA, Baumstark MW, et al. Cardiorespiratory fitness modifies the association between dietary fat intake and plasma fatty acids. Eur J Clin Nutr 2003;57:810-815.

43. Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics 2002;110:903-910.

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,

°ÂÓÈÎﬁ ¡ÔÛÔÎÔÌÂ›Ô

“∞ÛÎÏËÈÂ›Ô µÔ‡Ï·˜”

AÏÏËÏÔÁÚ·Ê›·:

ŸÏÁ· ºÈÏ›Ô˘ filiolga@hotmail.com

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,

°ÂÓÈÎﬁ ¡ÔÛÔÎÔÌÂ›Ô

“∞ÛÎÏËÈÂ›Ô µÔ‡Ï·˜”

√. ºÈÏ›Ô˘, ª. ¢ÔÏÈ·Ó›ÙË, ∫. ∫·Ú·Ó¿ÛÈÔ˘, µ. ∆·ÛÈÔÔ‡ÏÔ˘, ª. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘, ™. ¶··‰¿ÎÔ˘-§·ÁÔÁÈ¿ÓÓË

¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔﬁ˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó: 1) Ë Î·Ù·ÁÚ·Ê‹ ÙË˜ Û˘¯ÓﬁÙËÙ·˜ Î·È ÙˆÓ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ Î·È ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÓÔÛÔÎÔÌÂ›Ô˘ ÙË˜ ¡ÔÙÈÔ·Ó·ÙÔÏÈÎ‹˜ ∞ÙÙÈÎ‹˜, 2) Ë ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ÛËÌ·Û›·˜

ÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ

Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜.

Î·È Ì¤ıÔ‰ÔÈ: ™ÙËÓ ÚÔÔÙÈÎ‹ ·˘Ù‹ ÌÂÏ¤ÙË Û˘ÌÌÂÙÂ›¯·Ó 167 ·È‰È¿ (103 ·ÁfiÚÈ·), ËÏÈÎ›·˜ 2-14 ÂÙÒÓ, ÌÂ ¢ª™ ≥85Ë ∂£. ∫·Ù·ÁÚ·ÊfiÙ·Ó Ë ËÏÈÎ›·, ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ‡„Ô˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÁÔÓÈÒÓ Î·È ÙˆÓ ·‰ÂÏÊÒÓ ÙÔ˘˜, Î·ıÒ˜ Î·È o ÙÚfiÔ˜ ˙ˆ‹˜ ÙÔ˘˜ (‰È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜, Ê˘ÛÈÎ‹ ¿ÛÎËÛË, ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·ÛË˜). °È· Ù· ·È‰È¿ ÌÂ

Department of Paediatrics, “Asklipeio Voulas” General Hospital

Correspondence: Olga Filippou filiolga@hotmail.com

Department of Paediatrics, “Asklipeio Voulas” General Hospital

ÙËÓ ·‡ÍËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜.

ÙÔ˘ ·˘ÍËÌ¤ÓÔ˘ ¢ª™ ÛÙÔ 55,6% ÙˆÓ ÂÚÈÙÒÛÂˆÓ, ÂÓÒ ÔÈ Ô‰ËÁ›Â˜

ÁÂÓÈÎﬁÏÔÁÂ˜ Î·È ·Û·ÊÂ›˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Û˘ÓÂ¯‹˜ ÂÓËÌ¤ÚˆÛË Î·È

ÎÏÂÈ‰È¿: ¶·È‰ÈÎ‹

The prevalence and epidemiology of obesity in children of southeastern Attica. The modern lifestyle and the role of the primary care paediatrician

O. Filippou, M. Dolianiti, K. ∫aranasiou, V. Tasiopoulou, M. Ziva-Petropoulou, S. Papadakou-Lagogianni

Abstract

Background: The aims of this study were: 1) to provide epidemiological and demographic data on the prevalence of overweight and obese children from the outpatient clinic of a hospital in southeastern Attica, 2) to study possible correlations between obesity in these children and various parameters of the modern lifestyle, and 3) to evaluate the abilities of primary care paediatricians in the recognition and therapeutic intervention of childhood obesity.

Methods: The prospective study included 167 children (103 boys), aged 2-14 years, with Body Mass Index (BMI) ≥85th percentile for age and gender. Information was obtained regarding the age, body weight and height of the subjects and of their parents and siblings, and lifestyle parameters of the overweight patients (physical activity, dietary habits and TV watching hours). ∆he instructions that had been given by paediatricians concerning the increased BMI problem of the children were also recorded.

Results: During a two-year period, 9.7% of children attending for well child visits had a BMI ≥85th percentile. Obesity prevalence tended to be higher for children in the 2-5 years age group. Most of the overweight children (93.2%) had a familial form of obesity. A positive correlation was demonstrated between the children’s BMI and their consumption of commercial juices and chips, reduced physical activity and increased TV watching hours. The children’s paediatricians had failed to identify the obesity problem in 55.6% of all cases, while the instructions that had been given about its management were often generalized and unclear.

Conclusions: As the role of primary care paediatricians in early recognition and prevention of the longterm sequelae of obesity is crucial, their awareness and provision of interventions are necessary, in order to face this problem from its beginning.

Key words: Childhood obesity, obesity management, interventions, dietary recommendations, Body Mass Index.

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¢ª™:‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜

∂£: ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË ∂π: ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›·

∂ÈÛ·ÁˆÁ‹

∆Ô 1997, Ô ¶·ÁÎﬁÛÌÈÔ˜ √ÚÁ·ÓÈÛÌﬁ˜ ÀÁÂ›·˜

¯·Ú·ÎÙ‹ÚÈÛÂ ÙËÓ ·¯˘Û·ÚÎ›· ˆ˜ ·ÁÎﬁÛÌÈ· ÂÈ-

‰ËÌ›·. ∏ ÓﬁÛÔ˜ ¤Ï·‚Â ·˘Í·ÓﬁÌÂÓÂ˜ ‰È·ÛÙ¿ÛÂÈ˜

ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›·, È‰È·›ÙÂÚ· ÛÙÔÓ ·È‰ÈÎﬁ

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‰›·ÙÚÔ˘˜ ·Ú·Ì¤ÓÂÈ ÙÔ ÎÚ›ÛÈÌÔ ·Ú¯ÈÎﬁ ‚‹Ì·.

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Û˘¯ÓﬁÙËÙ·˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ Î·È ÙˆÓ ÂÈ‰Ë-

ÌÈÔÏÔÁÈÎÒÓ Î·È ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈ-

ÎÒÓ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ

Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· ∂ÍˆÙÂÚÈÎ¿ π·ÙÚÂ›· (∂π) ÙÔ˘

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·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ Î·È ÙÔ˘ ÙÚﬁÔ˘ ˙ˆ‹˜ ÙˆÓ

·È‰ÈÒÓ ·˘ÙÒÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚÎ›·˜

Î·È, Ù¤ÏÔ˜, Ë ÌÂÏ¤ÙË ÙÔ˘ ÚﬁÏÔ˘ ÙÔ˘ ·È‰È¿ÙÚÔ˘

ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Î·È

·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜.

ÀÏÈÎﬁ - ª¤ıÔ‰Ô˜

∫·Ù¿ ÙË ‰ÈÂÙ›· ∞‡ÁÔ˘ÛÙÔ˜ 2005 - ™ÂÙ¤Ì‚ÚÈÔ˜ 2007, 180 ·È‰È¿ Î·È ¤ÊË‚ÔÈ ÌÂ µªπ ≥85Ë ∂£ ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘˜ (‰ËÏ·‰‹ ·¯‡Û·ÚÎ· ‹ ˘¤Ú‚·Ú·) ÚÔÛ‹Ïı·Ó ÛÙ· ∂π ÙÔ˘ ÙÌ‹Ì·ÙÔ˜. ∆ÂÏÈÎ¿, 167 ·fi ·˘Ù¿ Û˘ÌÌÂÙÂ›¯·Ó ÛÙËÓ ·ÚÔ‡Û· ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË, Î·ÙfiÈÓ Û˘Ó·›ÓÂÛË˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. ∆· ÛÙÔÈ¯Â›· ·ÓÙÏ‹ıËÎ·Ó ·fi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Û˘ÌÏ‹ÚˆÓ·Ó

ÔÈ ÁÈ·ÙÚÔ› ÙË˜ ÎÏÈÓÈÎ‹˜ (¶›Ó·Î·˜ 1). ™ˆÌ·ÙÔÌÂÙÚÈÎ¿ ‰Â‰ÔÌ¤Ó·

∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËÎÂ ÌÂ ˙˘Á·ÚÈ¿ Ù‡Ô˘

Seca ·ÎÚÈ‚Â›·˜ ±0,5 kg, ÌÂ Ù· ·È‰È¿ ÓÙ˘Ì¤Ó· ÂÏ·ÊÚ¿. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËÎÂ ÛÂ ﬁÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·, ÌÂ ÙÔ ·Ó·ÛÙËÌﬁÌÂÙÚÔ Ô˘ ‚Ú›ÛÎÂÙ·È ÂÓÛˆÌ·ÙˆÌ¤ÓÔ

˘¤Ú‚·ÚˆÓ Î·È

Î·ıÔÚ›ÛÙËÎ·Ó ÌÂ ‚¿ÛË ÙÈ˜ Î·-

Ì‡ÏÂ˜ ¢ª™ ÙˆÓ ∂ÏÏ‹ÓˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, ÂÓÒ ÁÈ· ÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹Û·ÌÂ Ù· ‰ÈÂıÓÒ˜ Î·ıÔÚÈÛÌ¤Ó· ﬁÚÈ· (≤25, 25,1-29,9 Î·È ≥30 kg/m 2, ·ÓÙ›ÛÙÔÈ¯·) (1,2).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

√È ÔÈÔÙÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ ÙË

Û¯ÂÙÈÎ‹ Û˘¯ÓﬁÙËÙ·. °È· ÙË Û‡ÁÎÚÈÛË ·Ó·ÏÔÁÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙÔ˘ χ2 Î·È ÙÔ Fisher’s exact test.

‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ÚﬁÁÚ·ÌÌ· stata 8,0. √È ÙÈÌ¤˜ p Ô˘ ·Ó·-

Î·È Ë ÛÙ·ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈ-

Ù¤ıËÎÂ ÛÙÔ 0.05.

¶›Ó·Î·˜ 1. ∂ÚˆÙËÌ·ÙÔÏﬁÁÈÔ ÌÂÏ¤ÙË˜

1. ¢ËÌÔÁÚ·ÊÈÎ¿ Î·È ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘˜ Î·È ÙˆÓ ·‰ÂÏÊÒÓ ÙÔ˘˜ (ËÏÈÎ›·, Ê‡ÏÔ, ‚¿ÚÔ˜ Î·È ‡„Ô˜ ÛÒÌ·ÙÔ˜).

2. ¢È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜:

∫·Ù·Ó¿ÏˆÛË ·Ó·„˘ÎÙÈÎÒÓ ‹/Î·È ¤ÙÔÈÌˆÓ ¯˘ÌÒÓ.

∫·Ù·Ó¿ÏˆÛË “snacks” (·Ù·Ù¿ÎÈ·, Á·ÚÈ‰¿ÎÈ·, ÛÔÎÔ-

Ï¿ÙÂ˜, ÌÈÛÎﬁÙ·).

∫·Ù·Ó¿ÏˆÛË ¤ÙÔÈÌˆÓ Ê·ÁËÙÒÓ ·ﬁ ÂÛÙÈ·ÙﬁÚÈ·, Ù·-

¯˘Ê·ÁÂ›· Î.Ï.

∏ Û˘¯ÓﬁÙËÙ· Î·Ù·ÁÚ·ÊﬁÙ·Ó ˆ˜ 0-1-2-3-4-5-6-7 ‹

ÂÚÈÛÛﬁÙÂÚÂ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.

3. º˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ·:

™˘ÛÙËÌ·ÙÈÎ‹ ÂÓ·Û¯ﬁÏËÛË ÌÂ Î¿ÔÈÔ ¿ıÏËÌ·.

¶·È¯Ó›‰È ÛÙÔ Û¯ÔÏÂ›Ô, ÛÙÔÓ ‰ÚﬁÌÔ ‹ ÛÙËÓ ·˘Ï‹ ÙÔ˘

ÛÈÙÈÔ‡.

¶ÂÚ¿ÙËÌ· ¤ˆ˜ ÙÔ Û¯ÔÏÂ›Ô/ ÙÔ ÊÚÔÓÙÈÛÙ‹ÚÈÔ/ ÙË

ÛÙ¿ÛË ÏÂˆÊÔÚÂ›Ô˘.

∏ Û˘¯ÓﬁÙËÙ· Î·Ù·ÁÚ·ÊﬁÙ·Ó ˆ˜ 0-1-2-3-4-5-6-7 ‹

ÂÚÈÛÛﬁÙÂÚÂ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.

4. ¶·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂﬁÚ·ÛË˜:

¶·ÚÔ˘Û›· Û˘ÛÎÂ˘‹˜ ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡.

ﬂÚÂ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙËÏÂﬁÚ·ÛË˜.

∏ Û˘¯ÓﬁÙËÙ· Î·Ù·ÁÚ·ÊﬁÙ·Ó ˆ˜ 0-1-2-3-4-5-6-7 ‹

∞ÔÙÂÏ¤ÛÌ·Ù·

∞ﬁ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÈÛÎ¤ÊÙËÎ·Ó

Ù· ∂π, 9,7% (180 ·È‰È¿) Â›¯·Ó ¢ª™ ≥ 85Ë ∂£ ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ (‰ËÏ·‰‹ ‹Ù·Ó ·¯‡Û·ÚÎ· ‹ ˘¤Ú‚·Ú·). ∞fi ·˘Ù¿ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË (167 ·È‰È¿), 103 (61,7%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 64 (38,3%) ÎÔÚ›ÙÛÈ·. ∏ ‰È¿ÌÂÛË ËÏÈÎ›· ‹Ù·Ó 9,7 ¤ÙË (2-14 ÂÙÒÓ). ∆Ô 54,5% ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, 57 ·ÁfiÚÈ· Î·È 34 ÎÔÚ›ÙÛÈ· ‹Ù·Ó ·¯‡Û·ÚÎ· (µªπ ≥95Ë ∂£).

ªÂ ‰È·¯ˆÚÈÛÌﬁ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÙˆÓ ·¯‡Û·ÚÎˆÓ/˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ÛÂ 3 ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜ (2-5 ÂÙÒÓ, 6-10 ÂÙÒÓ Î·È 11-14 ÂÙÒÓ), ‰È·ÈÛÙÒıËÎÂ ﬁÙÈ

Ù· Ó‹È· ¤ÙÂÈÓ·Ó Ó· Â›Ó·È ÛÂ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙﬁ

·¯‡Û·ÚÎ·, Û˘ÁÎÚÈÓﬁÌÂÓ· ÌÂ Ù· ˘ﬁÏÔÈ· ·È‰È¿.

∆Ô ÔÛÔÛÙﬁ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‹Ù·Ó 70,4%

ÛÙËÓ ÔÌ¿‰· ÙˆÓ 2-5 ÂÙÒÓ, 53,2% ÛÙËÓ ÔÌ¿‰· ÙˆÓ 6-

10 ÂÙÒÓ Î·È 49,2% ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜. ¢ÂÓ ‚Ú¤ıËÎÂ ‰È·-

ÊÔÚ¿ ÛÙÔÓ ‚·ıÌﬁ ÙË˜ ·¯˘Û·ÚÎ›·˜ ·Ó¿ÌÂÛ· ÛÙ·

·ÁﬁÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ·.

‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÂÈ‚Â‚·›ˆÛÂ ÙËÓ ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·Î‹ ‰È·ÛÔÚ¿ ÙË˜

ÓﬁÛÔ˘, Î·ıÒ˜ ÛÙÔ 93,2% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÓÙÔ›-

ÛÙËÎÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¿ÏÏÔ ¤Ó· ˘¤Ú‚·ÚÔ ¿ÙÔÌÔ ÛÙËÓ

ÔÈÎÔÁ¤ÓÂÈ·. ∆Ô 37,8% ÙˆÓ ·Ù¤ÚˆÓ Î·È ÙÔ 36,1% ÙˆÓ

ÌËÙ¤ÚˆÓ ÙˆÓ ·ÙﬁÌˆÓ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË

‹Ù·Ó ·¯‡Û·ÚÎÔÈ (¢ª™ ≥30), ÂÓÒ 1 ÛÙ· 4 ·¯‡Û·ÚÎ· ·È‰È¿ Â›¯Â Î·È ÙÔ˘˜ ‰‡Ô ÁÔÓÂ›˜ ·¯‡Û·ÚÎÔ˘˜.

∞ÎﬁÌ·, ·ﬁ Ù· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ Ô˘ Â›¯·Ó ·‰¤Ú-

ÊÈ·, ‚Ú¤ıËÎÂ ﬁÙÈ ÙÔ 40% Â›¯Â ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ·‰ÂÚ-

Êﬁ ˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ. ∏ ‡·ÚÍË Î·È ¿ÏÏˆÓ

ÌÂÏÒÓ ÌÂ ·˘ÍËÌ¤ÓÔ ¢ª™ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÂËÚ¤·˙Â

ÛËÌ·ÓÙÈÎ¿ ÙÔÓ ‚·ıÌﬁ ÙË˜ ·¯˘Û·ÚÎ›·˜ ÙˆÓ ·È‰ÈÒÓ (p=0,006) (∂ÈÎﬁÓ· 1).

ŸÛÔÓ ·ÊÔÚ¿ ÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜, ÙÔ 59,3% ÙˆÓ ·È‰ÈÒÓ Î·Ù·Ó¿ÏˆÓÂ ¤ÙÔÈÌÔ˘˜ ¯˘ÌÔ‡˜ ≥3 ÊÔÚ¤˜/Â‚‰ÔÌ¿‰·, ÁÂÁÔÓﬁ˜ Ô˘ Û˘Ó‰¤ıËÎÂ ÌÂ ÙËÓ ·‡ÍËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ (p=0,028). OÈ

¤ÊË‚ÔÈ Î·Ù·Ó¿ÏˆÓ·Ó Û˘¯ÓﬁÙÂÚ· ·ÂÚÈÔ‡¯· ÔÙ¿ Û˘-

ÁÎÚÈÙÈÎ¿ ÌÂ Ù· Ó‹È· Î·È Ù· ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ (p=0,027), ÂÓÒ ÛÙÈ˜ ÌÈÎÚ¤˜ ËÏÈÎ›Â˜ (2-5 ÂÙÒÓ) ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË Î·Ù·Ó¿ÏˆÛË ÌÈ-

ÛÎﬁÙˆÓ Î·È ‚Ô˘ÙËÌ¿ÙˆÓ, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (p=0,006). ∆Ô 34,1% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Î·Ù·Ó¿ÏˆÓÂ ¤ÙÔÈÌÔ Ê·ÁËÙﬁ >2 ÊÔÚ¤˜/Â‚‰ÔÌ¿‰·, ÂÓÒ

ÙÔ 39,5% Ï¿Ì‚·ÓÂ ˘„ËÏ‹˜ ıÂÚÌÈ‰ÈÎ‹˜ ·Í›·˜ “snacks” ≥3 ÊÔÚ¤˜/Â‚‰ÔÌ¿‰·. ∂›ÛË˜, Ë ·¯˘Û·ÚÎ›· ‹Ù·Ó ÛÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎﬁ

ÙÔ˘ ¯ÚﬁÓÔ˘ ÛÙÔÈ¯ÂÈÒ‰Ô˘˜ Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜.

ÙÔ 86,2%

ÙËÏÂfiÚ·ÛË >2 ÒÚÂ˜ ÙËÓ ËÌ¤Ú·, ÂÓÒ ÙÔ 41,8% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ ÙËÏÂfiÚ·ÛË Î·ıËÌÂÚÈÓ¿ >4 ÒÚÂ˜. ∆Ô 46,7% Â›¯Â Û˘ÛÎÂ˘‹ ÙËÏÂfiÚ·ÛË˜ ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘,

ÙË˜ ¤ÚÂ˘Ó·˜ ‰ÂÓ ·ıÏÔ‡ÓÙ·Ó Î·ıﬁÏÔ˘ Î·È ‰ÂÓ ÂÚ·ÙÔ‡Û·Ó Î·ıËÌÂÚÈÓ¿, ·ÎﬁÌ·

ÌÈÎÚ¤˜ ·ÔÛÙ¿ÛÂÈ˜ fiˆ˜ Ë ‰È·‰ÚÔÌ‹ Û›ÙÈ-Û¯ÔÏÂ›Ô (48% Î·È 49,6% ·ÓÙ›ÛÙÔÈ¯·). ∆Ô ·È¯Ó›‰È ÛÙËÓ ·˘Ï‹ Â›¯Â ÂÚÈÔÚÈÛÙÂ› ÔÏ‡, ·ÊÔ‡ Û¯Â‰fiÓ 1 ÛÙ· 3 ·È‰È¿ (30,2%) ‰ÂÓ ¤·È˙Â Î·ıfiÏÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Â‚‰ÔÌ¿‰·˜. ∏ ·Ô˘Û›· ÙË˜ Î·ıËÌÂÚÈÓ‹˜ Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È Û˘ÛÙËÌ·ÙÈÎ‹˜ ÂÓ·Û¯fiÏËÛË˜ ÌÂ

Î¿ÔÈÔ ¿ıÏËÌ· Û¯ÂÙ›ÛÙËÎÂ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ÌÂ ·˘ÍËÌ¤ÓÔ ¢ª™ (p=0,017).

™Â fiÙÈ ·ÊÔÚ¿ ÛÙÈ˜ Ô‰ËÁ›Â˜ Ô˘ Â›¯·Ó ‰ÔıÂ› ·fi ÙÔÓ ·È‰›·ÙÚÔ Ô˘ Ù· ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ, ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ·È‰È¿ (55,6%) ‰ÂÓ ¤Ï·‚·Ó Î·Ì›· Ô‰ËÁ›· Û¯ÂÙÈÎ¿ ÌÂ ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·˘ÍËÌ¤ÓÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÙÔ˘˜. √È ·È‰›·ÙÚÔÈ ¤‰ÈÓ·Ó Û˘¯ÓfiÙÂÚ· Ô‰ËÁ›Â˜ ÛÙ· Ó‹È· (64%), Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ·È‰È¿ ËÏÈÎ›·˜ 6-10 ÂÙÒÓ (48,7%) Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (31,1%) (p=0,012), ·ÔÙ¤ÏÂÛÌ· Ô˘ Èı·ÓfiÓ ÔÊÂ›ÏÂÙ·È Î·È ÛÙËÓ ÏËÌÌÂÏ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ. §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÔÓ ¢ª™ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÛÙÔ 33,8% ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È

ÛÙÔ 52,7% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ¤ÁÈÓ·Ó Î¿ÔÈÂ˜

Û˘ÛÙ¿ÛÂÈ˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘ ·˘ÍËÌ¤ÓÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (p=0,016). ¶·ÚﬁÌÔÈ·, ÔÈ ·¯‡Û·ÚÎÔÈ Ï¿Ì‚·Ó·Ó Û˘¯ÓﬁÙÂÚ· Ô‰ËÁ›Â˜ Î·È ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÔÌ¿‰Â˜ Ô‰ËÁÈÒÓ (¶›Ó·Î·˜ 2).

∞fi Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó Î¿ÔÈÂ˜ Ô‰ËÁ›Â˜, ÙÔ 91,7% ¤Ï·‚Â ‰È·ÙÚÔÊÈÎ¤˜ Û˘ÛÙ¿ÛÂÈ˜, ÙÔ 59,7% Ô‰ËÁ›Â˜ ÁÈ· ·‡ÍËÛË ÙË˜ Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ÙÔ 50% Ô‰ËÁ›Â˜ ÁÈ· ÂÚÁ·ÛÙËÚÈ·Îfi

√‰ËÁ›Â˜ ¢ª™ (85Ë-94Ë ∂£) ¢ª™ ( ≥95Ë ∂£) N%N%P

√‰ËÁ›Â˜ Ÿ¯È4766,24347,30,016 ¡·È2433,84852,7

√‰ËÁ›Â˜ ‰È·ÙÚÔÊ‹˜Ÿ¯È4969,04751,60,026 ¡·È2231,04448,4

√‰ËÁ›Â˜ ÁÈ· ¿ÛÎËÛËŸ¯È5881,76167,00,036 ¡·È1318,33033,0

√‰ËÁ›Â˜ ÁÈ· ÂÚÁ·ÛÙËÚÈ·Îﬁ ¤ÏÂÁ¯ÔŸ¯È6388,76369,20,003 ¡·È811,32830,8

√‰ËÁ›Â˜ ÁÈ· ÂÏ¿ÙÙˆÛË ÙË˜ ÙËÏÂı¤·ÛË˜Ÿ¯È6794,47582,40,022 ¡·È45,61617,6

Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Â›¯·Ó Á›ÓÂÈ Î¿ÔÈÂ˜ Û˘ÛÙ¿-

ÛÂÈ˜ ·ﬁ ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜, ·˘Ù¤˜ ‹Ù·Ó ÁÂÓÈÎﬁÏÔÁÂ˜

Î·È ·Û·ÊÂ›˜. ∂È‰ÈÎﬁÙÂÚ· ÁÈ· ÙË ‰È·ÙÚÔÊ‹, Ë ÚÔÙÚÔ-

‹Ù·Ó ·Ï¿ “ÙÚÒÙÂ ÏÈÁﬁÙÂÚÔ”, ¯ˆÚ›˜ Û˘ÁÎÂÎÚÈÌ¤-

ÓË ·Ó·ÊÔÚ¿ ÛÙËÓ ·ÔÊ˘Á‹ ‹ ÛÙËÓ ÚÔÛı‹ÎË ÂÈ‰ÈÎÒÓ ÙÚÔÊ›ÌˆÓ ÛÙÔ ‰È·ÈÙÔÏﬁÁÈÔ. °È· ÙË Ê˘ÛÈÎ‹ ¿ÛÎË-

ÛË, Î·Ó¤Ó·˜ ·È‰›·ÙÚÔ˜ ‰ÂÓ Â›¯Â ÚÔÙÂ›ÓÂÈ ÛÙÔÓ ˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ ·ÛıÂÓ‹ ÙÔ˘ Û˘ÌÌÂÙÔ¯‹ ÛÂ

Î¿ÔÈÔ ÔÚÁ·ÓˆÌ¤ÓÔ ¿ıÏËÌ·, Ô‡ÙÂ Â›¯Â ÂÈÛËÌ¿ÓÂÈ

ÙËÓ ·Ó¿ÁÎË ÁÈ· ·‡ÍËÛË ÙË˜ Î·ıËÌÂÚÈÓ‹˜ Ê˘ÛÈÎ‹˜

‰Ú·ÛÙËÚÈﬁÙËÙ¿˜ ÙÔ˘, ÂÈÏ¤ÁÔÓÙ·˜, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ÙÔ ÂÚ¿ÙËÌ· ˆ˜ ÙÔ Û¯ÔÏÂ›Ô ‹ ÙÔ ·È¯Ó›‰È ÛÙËÓ ·˘Ï‹. √È Ô‰ËÁ›Â˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘, ﬁÔ˘ ˘‹Ú-

¯·Ó, ·ÊÔÚÔ‡Û·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙÔ ÏÈÈ‰ÈﬁÁÚ·ÌÌ·, ¯ˆÚ›˜ Ó· ˘¿Ú¯Ô˘Ó Û˘ÛÙ¿ÛÂÈ˜ ÁÈ· ÚÔÛ‰ÈÔÚÈÛÌﬁ

ÁÏ˘Îfi˙Ë˜ Ó‹ÛÙÂˆ˜, ÔÚÌÔÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·Ù¿ ÂÚ›ÙˆÛË ‹ ‰ÈÂÚÂ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘¯fiÓ Û˘Ó˘¿Ú¯Ô˘Û·˜ ÛÈ‰ËÚÔÂÓ›·˜ (Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÛÙ· ·¯‡Û·ÚÎ· ·È‰È¿) (3,4). ∞ÎfiÌË, Î·Ó¤Ó· ·È‰› ‰ÂÓ Â›¯Â Ï¿‚ÂÈ Ô‰ËÁ›· ÁÈ· Û˘ÁÎÂÎÚÈÌ¤ÓÔ ·ÚÈıÌfi ˆÚÒÓ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙËÏÂfiÚ·ÛË˜ ÙËÓ ËÌ¤Ú·.

∆ÂÏÈÎ¿, Î·Ó¤Ó·˜ ·È‰›·ÙÚÔ˜ ‰ÂÓ ·Ú¤ÂÌ„Â ÙÔÓ ˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ ·ÛıÂÓ‹ ÙÔ˘ ÁÈ· ÂÓ‰ÔÎÚÈÓÔ-

ÏÔÁÈÎﬁ ¤ÏÂÁ¯Ô, ‰È·ÈÙÔÏÔÁÈÎ‹ Û˘Ì‚Ô˘Ï‹, „˘¯ÔÏÔÁÈÎ‹

˘ÔÛÙ‹ÚÈÍË, ·ÏÏ¿ Ô‡ÙÂ Î·È ÚﬁÙÂÈÓÂ ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È Â·ÓÂÎÙ›ÌËÛË. ™˘˙‹ÙËÛË

Î·È ıÓËÙfiÙËÙ· ·fi ·ı‹ÛÂÈ˜ fiˆ˜ Ë ·ÚÙËÚÈ·Î‹ ˘¤ÚÙ·ÛË, Ô Û·Î¯·ÚÒ‰Ë˜

‰È·‚‹ÙË˜, Ù· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·, ·ÏÏ¿ Î·È ÌÂÚÈÎ¤˜ ÌÔÚÊ¤˜ Î·ÚÎ›ÓÔ˘ (8).

™ÙË ÌÂÏ¤ÙË Ì·˜ ‰È·ÈÛÙÒıËÎÂ ÛÔ‚·Ú‹ ·ÏÏ·Á‹

ÛÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ Î·È ÛÙÔÓ ÙÚﬁÔ ˙ˆ‹˜

ÙË˜ Û‡Á¯ÚÔÓË˜ ÂÏÏËÓÈÎ‹˜ ÔÈÎÔÁ¤ÓÂÈ·˜. √È ··ÈÙ‹ÛÂÈ˜ ÙË˜ Û‡Á¯ÚÔÓË˜ ˙ˆ‹˜ ·Ó·ÁÎ¿˙Ô˘Ó ÙÔ˘˜ ÁÔÓÂ›˜ Ó· ÏÂ›Ô˘Ó ·ÚÎÂÙ¤˜ ÒÚÂ˜ ·fi ÙÔ Û›ÙÈ, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ˘¿Ú¯ÂÈ ¯ÚfiÓÔ˜ Î·È ‰˘Ó·ÙfiÙËÙ· ·Ú·ÎÔÏÔ‡ıËÛË˜ Î·È ÔÚÁ¿ÓˆÛË˜ ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙˆÓ ·È‰ÈÒÓ. ◊‰Ë ·fi ÙË ÓËÈ·Î‹ ËÏÈÎ›· ‰È·ÈÛÙÒÓÔÓÙ·È ˘„ËÏ¿ ÔÛÔÛÙ¿ ·¯˘Û·ÚÎ›·˜. ∂È‰ÈÎ¿ ÛÙÈ˜ ÌÈÎÚ¤˜

ËÏÈÎ›Â˜, ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÎ·Ù·Ó¿ÏˆÛË ÚÔ˚fiÓÙˆÓ ˘„ËÏ‹˜ ıÂÚÌÈ‰ÈÎ‹˜ ·Í›·˜ (ÌÈÛÎfiÙ·, ‚Ô˘Ù‹Ì·Ù·, ·Ù·Ù¿ÎÈ·), ÂÓÒ Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·Ù·Ó·ÏÒÓÔ˘Ó ÔÏ‡ Û˘¯Ó¿ Ù·¯‡ Ê·ÁËÙfi Ô˘ Â›Ó·È ÏÔ‡ÛÈÔ ÛÂ

Î·Î‹˜ ÔÈfiÙËÙ·˜ Ï›Ë. ∆Ô ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ÓË›ˆÓ ÙË˜ ÌÂÏ¤ÙË˜ Â›Ó·È ·ÓËÛ˘¯ËÙÈÎfi, ÁÈ·Ù› Ù· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘ÛÈ¿-

˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓﬁÙËÙ· Ó· Á›ÓÔ˘Ó ·¯‡Û·ÚÎÔÈ ÂÓ‹ÏÈÎÂ˜ (9). ∂ÈÏ¤ÔÓ, ÛÙ· Ó‹È· ‰ÂÓ ¤¯Ô˘Ó ‰È·-

ÌÔÚÊˆıÂ› ·ÎﬁÌ· ‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ Î·È ¿Ú· Ë

¤ÁÎ·ÈÚË ·Ú¤Ì‚·ÛË Â›Ó·È Èı·ÓﬁÙÂÚÔ Ó· Â›Ó·È Î·È ÂÈÙ˘¯‹˜.

ÌÂ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·ÛË˜, ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÙÔ 86,2% ‚Ï¤ÂÈ ÙËÏÂfiÚ·ÛË

ËÌ¤Ú·, ÂÓÒ Ô Ì¤ÛÔ˜ ËÌÂÚ‹ÛÈÔ˜ ¯ÚﬁÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÊÙ¿ÓÂÈ ÙÈ˜ 4,2 ÒÚÂ˜, ‰È¿ÛÙËÌ· ˘ÂÚ‰ÈÏ¿ÛÈÔ ÙÔ˘ ÚÔÙÂÈÓﬁÌÂÓÔ˘

∂ÈÎﬁÓ· 2 ∞ÓÙÈÌÂÙÒÈÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ Î·Ù¿ ÔÌ¿‰Â˜ Ô‰ËÁÈÒÓ (Û‡ÓÔÏÔ ‰Â›ÁÌ·ÙÔ˜).

ÛÙÔ˘˜ ·¯‡Û·ÚÎÔ˘˜ ·ÛıÂÓÂ›˜ ÙÔ˘, ÂÓÒ ·ÚﬁÌÔÈ· ÔÈ

Barlow et al ‰È·›ÛÙˆÛ·Ó fiÙÈ ÌfiÏÈ˜ ÙÔ 42% ÙˆÓ ·È‰È¿ÙÚˆÓ ÙË˜ ÌÂÏ¤ÙË˜ ÙÔ˘˜ Û˘Ó¤ÛÙËÛÂ ÙÚfiÔ˘˜ ÚÔÒıËÛË˜ ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙ· ˘¤Ú‚·Ú· ·È‰È¿ (18,23). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ÌfiÓÔ

ÙÔ 26,5% ÙˆÓ ·È‰È¿ÙÚˆÓ ¤‰ˆÛÂ Ô‰ËÁ›Â˜ ÁÈ· ·‡ÍËÛË

ÙË˜ Ê˘ÛÈÎ‹˜ ¿ÛÎËÛË˜, ÌË ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·˜ ˆÛÙﬁÛÔ

ÌÂ Û·Ê‹ÓÂÈ· ÙÔ Â›‰Ô˜, ÙË ‰È¿ÚÎÂÈ· Î·È ÙÔ˘˜ ÙÚﬁÔ˘˜

ÙË˜.

·‡ÍËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÛÂ Î·-

ıËÌÂÚÈÓ‹ ‚¿ÛË Î·È Ë ÚÔÒıËÛË ÙË˜ Û˘ÌÌÂÙÔ¯‹˜

ÙˆÓ ·È‰ÈÒÓ ÛÂ ÔÚÁ·ÓˆÌ¤Ó· ·ıÏ‹Ì·Ù·, ·Ó¿ÏÔÁ· ÌÂ

Ù· ÂÓ‰È·Ê¤ÚÔÓÙ· Î·È ÙÈ˜ ‰ÂÍÈﬁÙËÙ¤˜ ÙÔ˘˜, Â›Ó·È ··-

Ú·›ÙËÙÔÈ ÙÚﬁÔÈ ·Ú¤Ì‚·ÛË˜ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ·È‰È¿ÙÚÔ˘, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÌÂ ÂÈÙ˘¯›·

ÙÔ Úﬁ‚ÏËÌ· ÙË˜ ·¯˘Û·ÚÎ›·˜. ∆Ô 12,3% ÙˆÓ ·È‰È¿ÙÚˆÓ Û˘Ó¤ÛÙËÛÂ ÏÈÁﬁÙÂÚÂ˜

ÒÚÂ˜ Î·ı‹ÏˆÛË˜ ÌÚÔÛÙ¿ ÛÙËÓ ÙËÏÂﬁÚ·ÛË, ÔÛÔ-

ÛÙﬁ Ô˘ ÛÙÈ˜ ‰ÈÂıÓÂ›˜ ÌÂÏ¤ÙÂ˜ Î˘Ì·›ÓÂÙ·È ·ÎﬁÌË ¯·-

ÌËÏfiÙÂÚ· (3%-5%) (18,23). ∏ ÙËÏÂfiÚ·ÛË, ÂÎÙfi˜

·ﬁ ÙË Û˘ÌÌÂÙÔ¯‹ ÙË˜ ÛÙÔÓ Û‡Á¯ÚÔÓÔ Î·ıÈÛÙÈÎﬁ

ÙÚﬁÔ ˙ˆ‹˜, ·ÛÎÂ› ﬁˆ˜ ÚÔ·Ó·Ê¤ÚıËÎÂ Î·È ÛËÌ·-

ÓÙÈÎfi ·ÚÓËÙÈÎfi ÚfiÏÔ Ì¤Ûˆ ÙË˜ ‰È·Ê‹ÌÈÛË˜ ·Óı˘ÁÈÂÈÓÒÓ ÙÚÔÊÒÓ Î·È Û˘ÓËıÂÈÒÓ. °È’ ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜, Ë Ô‰ËÁ›· ·fi ÙÔÓ ·È‰›·ÙÚÔ ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ, ÛÂ ÂÚÈÔÚÈÛÌ¤ÓÔ ¯ÚfiÓÔ, Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (∂ÈÎfiÓ· 2). ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ·È‰ÈÎ‹ ·¯˘Û·ÚÎ›· ·ÔÙÂÏÂ› ¤Ó· ÔÏ˘·Ú·ÁÔÓÙÈÎfi Úfi‚ÏËÌ· ÌÂ ÔÏÏ¤˜ Û˘ÓÈÛÙÒÛÂ˜, Ô˘ ¯Ú‹˙ÂÈ ·Ó¿ÏÔÁË˜ ÚÔÛ¤ÁÁÈÛË˜ (24,25). ∏ ·Ó·ÁÎ·ÈfiÙËÙ· ÁÈ· ÚfiÏË„Ë Â›Ó·È ÌÂÁ¿ÏË, ÂÊfiÛÔÓ ÔÈ

·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·fi ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ÙˆÓ ÔÏÔ¤Ó· ·˘Í·ÓfiÌÂÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.

µÈ‚ÏÈÔÁÚ·Ê›·

1. ÃÈÒÙË˜ ¢, ∫Ú›ÎÔ˜ •, ∆Û›ÊÙË˜ °, Ã·Ù˙ËÛ˘ÌÂÒÓ ª, ª·ÓÈ¿ÙË ª, ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞. ¢ª™ (µªπ) Î·È ÔÛÔÛÙﬁ ·¯˘Û·ÚÎ›·˜ ÛÂ ¿ÙÔÌ· ÙË˜ Â˘Ú‡ÙÂÚË˜ ÂÚÈÔ¯‹˜ ∞ıËÓÒÓ, ËÏÈÎ›·˜ 0-18 ¯ÚoÓÒÓ. ¢ÂÏÙ›Ô ∞ã ¶·È‰. ∫ÏÈÓÈÎ‹˜ 2004;51:139-154.

2. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. Geneva; 1997.

3. Pinhas-Hamiel O, Newfield RS, Koren I, Agmon A, Lilos P, Phillip M. Greater prevalence of iron deficiency in overweight children and adolescents. Int J √bes Relat Metab Disord 2003;27:416-418.

4. Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics 2004;114:104-108.

5. Troiano RP, Flegal KM, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149: 1085-1099.

6. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167-177.

7. Clarke WR, Lauer RM. Does childhood obesity track into adulthood? Crit Rev Food Sci Nutr 1993;33:423-430.

8. ∆˙ÒÙ˙· £. ∏ ÂÈ‰ËÌÈÎ‹ ‰È¿ÛÙ·ÛË Î·È Ë “·ÁÎÔÛÌÈÔÔ›ËÛË” ÙË˜ ·¯˘Û·ÚÎ›·˜. ∂ÏÏËÓÈÎ‹ π·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ¶·¯˘Û·ÚÎ›·˜ [Internet]. Webpage: http://www.eiep.gr/pages/ articles/articles0103.htm.

9. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;337:869-873.

10. Krebs NF, Jacobson MS. American Academy of Pediatrics Committee on Nutrition. Prevention of pediatric overweight and obesity. Pediatrics 2003;112:424-430.

11. Caroli M, Arfentieri L, Cardome M, Masi A. Role of television in childhood obesity prevention. Int J Obes Relat Metab Disord. 2004;28 (3 Suppl):S104-S108.

12. Pardee PE, Norman GJ, Lustig RH, Preud’homme D, Schwimmer JB. Television viewing and hypertension in obese children. Am J Prev Med 2007;33:439-443.

13. Nicholson AJ, Del Torso S, Hadjipanayis A, Van Esso D. Childhood obesity - ∞ public health crisis across the European Union. ¶·È‰È·ÙÚÈÎ‹ 2008;71:92-95.

14. Hancox RJ, Poulton R. Watching television is associated with childhood obesity: But is it clinically important? Int J Obesity (Lond) 2006;30:171-175.

15. Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA 1999; 282:1561-1567.

16. Gidding SS, Dennison BA, Birch LL, Daniess SR, Gilman MW, Lichtenstein AH, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics 2006;117:544-554.

17. Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, et al. Overweight in children and adolescents: Pathophysiology, consequences, prevention, and treatment. Circulation 2005;11:1999-2012.

18. O’Brien SH, Holubkov R, Reiss EC. Identification, evaluation, and management of obesity in our Academic Primary Care Center. Pediatrics 2004;114:154-159.

19. Price JH, Desmond SM, Ruppert ES, Stelzer CM. Pediatricians’ perceptions and practices regarding childhood obesity. Am J Prev Med 1989;5:95-103.

20. ∫·Ê¿ÙÔ˜ ∞. ¢È·ÙÚÔÊ‹ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÁÈ· ÚÔ·ÁˆÁ‹

˘ÁÂ›·˜ Î·È ·Ó¿Ù˘ÍË˜ Î·È ÚﬁÏË„Ë ÙˆÓ ¯ÚﬁÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ. ¶·È‰È·ÙÚÈÎ‹ 2008;71:157-161.

21. Watts K, Jones TW, Davis EA, Green D. Exercise training in obese children and adolescents: current concepts. Sports Med 2005; 35:375-392.

22. Council on Sports Medicine and Fitness; Council on school. Active Healthy Living. Prevention of childhood obesity through increased physical activity. Pediatrics 2006;117: 1834-1842.

23. Barlow SE, Trowbridge FL, Klish WJ, Dietz WH. Treatment of child and adolescent obesity: reports from Pediatricians, Pediatric Nurse Practitioners and Registered Dietitians. Pediatrics 2002;110:229-235.

24. Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. Pediatrics 1998; 102:e29.

25. US Preventive Services Task Force. Screening and interventions for overweight in children and adolescents: recommendation statement. Pediatrics 2005;116:205-209.

∏ıÈÎ¿ ‰ÈÏ‹ÌÌ·Ù· Î·Ù¿ ÙËÓ

ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË:

ÚÔÎ·Ù·ÚÎÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ‰È·ÎÚ·ÙÈÎÔ‡ ÂÚÂ˘ÓËÙÈÎÔ‡

ÚÔÁÚ¿ÌÌ·ÙÔ˜ EDIG

™. ∫›ÙÛÈÔ˘-∆˙¤ÏË1, ™. ÃÚÈÛÙÔÁÈÒÚÁÔ˜2, µ. µ·ÛÈÏÔÔ‡ÏÔ˘2, ∂˘Á. ™Ô˘Ì¿ÎË2, °. ∫ÔÏ·˝ÙË˜2, µ. §¿ÁÁ·ÚË2, ∫. ∫ˆÛÙ¿ÎÔ˘2, µ. µÂÏÈÛÛ·Ú›Ô˘3, ¡. ™ÙÚ›ÓÙ˙Ë˜3, ¢. ªﬁÙÛË˜4, ∂. ∫·Ó·‚¿ÎË˜1, π. ∆ÛÈ¿ÓÙË˜2, EDIG consortium*

¶ÂÚ›ÏË„Ë: °È· ÚÒÙË ÊÔÚ¿ ÛÂ Â˘Úˆ·˚Îfi Â›Â‰Ô ‰ÈÂÍ¿ÁÂÙ·È ‰È·ÎÚ·ÙÈÎ‹ ¤ÚÂ˘Ó· ÌÂ Û˘ÓÙÔÓÈÛÙÈÎfi Î¤ÓÙÚÔ ÙÔ πÓÛÙÈÙÔ‡ÙÔ Freud ÙË˜ ºÚ·ÓÎÊÔ‡ÚÙË˜, Ô˘ ÌÂÏÂÙ¿ Ù· ËıÈÎ¿ ‰ÈÏ‹ÌÌ·Ù· ÌÂÙ¿ ·fi ÙË ‰È¿ÁÓˆÛË ·-

ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÛÂ ÚÔÁÂÓÓËÙÈÎﬁ ¤ÏÂÁ¯Ô, Î·ıÒ˜ Î·È ÙÈ˜ „˘¯ÔÏÔÁÈÎ¤˜ ÂÈÙÒÛÂÈ˜ ÛÙÈ˜ Á˘Ó·›ÎÂ˜ Î·È

ÛÙÔ˘˜ Û˘ÓÙÚﬁÊÔ˘˜ ÙÔ˘˜. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ˘ÏÈÎÔ‡ Á›ÓÂÙ·È Ì¤Û· ·ﬁ ‰‡Ô ˘ÔÌÂÏ¤ÙÂ˜: ·) Î·Ù·ÁÚ¿ÊÂÙ·È Ë

ÂÌÂÈÚ›· ˙Â˘Á·ÚÈÒÓ Ô˘ ‰È¤Ú¯ÔÓÙ·È ·ﬁ ÙË ‰È·‰ÈÎ·Û›· ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘, ÌÂ ÂÚˆÙËÌ·ÙÔÏﬁÁÈ·

Î·È Û˘ÓÂÓÙÂ‡ÍÂÈ˜ Î·È ‚) Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ ÙÚﬁÔÈ ‰È·¯Â›ÚÈÛË˜ ÙˆÓ ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ Î·È ÙˆÓ ÂÈÙÒÛÂÒÓ ÙÔ˘˜ ÛÙËÓ „˘¯ÈÎ‹ ˘ÁÂ›· ÙˆÓ ·ÛıÂÓÒÓ, Ì¤Û· ·ﬁ ÙË Û˘ÓÂÚÁ·Û›· ÌÂ „˘¯ÔıÂÚ·Â˘Ù¤˜/„˘¯·Ó·Ï˘Ù¤˜ Î·È

ÚÒËÓ ·ÛıÂÓÂ›˜ ÙÔ˘˜, ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÙËÓ ÂÌÂÈÚ›· ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÛÂ ÚÔÁÂÓÓËÙÈÎﬁ ¤ÏÂÁ¯Ô. ∆·

ÚÔÎ·Ù·ÚÎÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ·ﬁ ÙËÓ ÂÚÂ˘ÓËÙÈÎ‹ ÔÌ¿‰· ÙË˜

ﬁÙÈ Á˘Ó·›ÎÂ˜ Î·È ¿Ó-

‰ÚÂ˜ ‰È·¯ÂÈÚ›˙ÔÓÙ·È ÙÔ ÁÂÁÔÓﬁ˜ ÙË˜ ·Ó·ÎÔ›ÓˆÛË˜ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÂÎÊÚ¿˙ÔÓÙ·˜ ı˘Ìﬁ ÚÔ˜

√È Á˘Ó·›ÎÂ˜ ÂÈ-

ÛÙÔ ¤Ì‚Ú˘Ô, ÂÓÒ ÚÔÎ·ÏÂ›Ù·È

¤ÓÙ·ÛË ÛÙÔ ˙Â˘Á¿ÚÈ. ∏ ‰È¿ÁÓˆÛË, ˆÛÙfiÛÔ, Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ ÚfiÏÔ ÛÙË Ï‹„Ë ·fiÊ·ÛË˜ Î·È ÛÙÔ˘˜ ÙÚfi-

Ô˘˜ ‰È·¯Â›ÚÈÛ‹˜ ÙË˜. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂ ÙÚÈÛˆÌ›· 21, Ë ‰È·ÎÔ‹ ÙË˜ Î‡ËÛË˜ Ê·›ÓÂÙ·È Â‡ÏÔÁË ·ﬁÊ·ÛË Î·È Ë ¤ÎÊÚ·ÛË ÓÙÚÔ‹˜ Î·È ÂÓÔ¯‹˜ Â›Ó·È

Î·È ÔÏÈÙÈÛÌÈÎﬁ/

Ï·›ÛÈÔ, ‰ÚÒÓÙ·˜ ÚÔÏËÙÈÎ¿ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÂÎ‰‹ÏˆÛË˜ „˘¯Ô·ıÔÏÔÁ›·˜ ÛÙÔ Ì¤ÏÏÔÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË, ‰È·‰ÈÎ·Û›·

Ethical dilemmas due to prenatal diagnostics: preliminary results of the multicentre research programme EDIG

S. Kitsiou-Tzeli1, S. Christogiorgos2, V. Vassilopoulou2, Eug. Soumaki2, G. Kolaitis2, V. Lagari2, K. Kostakou2, V. Velissariou3, N. Strintzis3, D. Botsis4, E. Kanavakis1, J. Tsiantis2, EDIG consortium**

Abstract: This multicentre study, conducted for the first time in Europe, with the coordination of the Sigmund-Freud Institute in Frankfurt, is investigating the ethical dilemmas arising from an abnormal diagnosis on prenatal testing, and its impact on the women and their partners. Data were derived from two substudies: a) Substudy A examines the behaviour of couples that have received positive prenatal diagnostic results and their dilemmas, as revealed through personal interviews and questionnaires; b) Substudy B describes the behaviour of couples receiving professional help from psychotherapists/psychoanalysts in order to deal with their ethical dilemmas and to accept therapeutic guidance to help them to handle the situation. Preliminary results obtained from the Athens research centres have shown that couples tend to express anger towards the medical personnel or God, and at the same time to use their own defenses to overcome the incident as soon as possible. The women are more likely to display narcissistic trauma, while the couples express a high degree of tension and frustration. The diagnosis appears to play an important role in decision making and coping. In cases of trisomy 21, termination of pregnancy is the usual decision, and expression of shame and guilt is milder. Psychotherapists can help the individuals to deal with their ethical dilemmas according to their personal culture or religion, in order to prevent any psychopathology in the future.

Key words: Prenatal diagnostics, decision making, ethical dilemmas, emotional reactions.

1 Laboratory of Medical Genetics, “Aghia Sophia” Children’s Hospital, University of Athens Medical School

2 Department of Child Psychiatry, “Aghia Sophia” Children’s Hospital, University of Athens Medical School

3 Department of Genetics, “Mitera” Maternity Clinic 4 2nd Department of Obstetrics and Gynaecology, “Areteio” Hospital, University of Athens Medical School

Correspondence: Sophia Kitsiou-Tzeli skitsiou@med.uoa.gr Laboratory of Medical Genetics University of Athens

·Ó¿ÁÎË˜ ÁÈ· ÁÚ‹ÁÔÚË Ï‹„Ë ·ﬁÊ·ÛË˜ (‰‡Ô ÌÂ

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ÎÔ‹˜ ÙË˜ Î‡ËÛË˜).

∏ Û˘ÓÂÚÁ·Û›· ÌÂ ÙÔ ˙Â˘Á¿ÚÈ ·Ú¯›˙ÂÈ ÌÂ ÌÈ· ÚÒ-

ÙË Û˘Ó¿ÓÙËÛË ÙË˜ Á˘Ó·›Î·˜/ÙÔ˘ ˙Â˘Á·ÚÈÔ‡ ÌÂ ÙÔÓ

ÁÂÓÂÙÈÛÙ‹ ‹ ÙÔÓ Á˘Ó·ÈÎÔÏﬁÁÔ Î·È ÙÔÓ ÂÚÂ˘ÓËÙ‹-„˘-

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ÙÔ ÂÈÛÙÚ¤„Ô˘Ó Ù·¯˘‰ÚÔÌÈÎ¿. ŒÓ· ÙÚ›ÙÔ ÂÚˆÙËÌ·-

ÙÔÏﬁÁÈÔ ·ÔÛÙ¤ÏÏÂÙ·È ÛÙË Ê¿ÛË ·ﬁÊ·ÛË˜. ∏ ›‰È·

‰È·‰ÈÎ·Û›· ·ÎÔÏÔ˘ıÂ›Ù·È ÛÙÈ˜ ÂﬁÌÂÓÂ˜ ‰‡Ô Ê¿ÛÂÈ˜

(ÂÂÍÂÚÁ·Û›·˜ Î·È Â·ÓÂÎÙ›ÌËÛË˜).

™Â

ﬁÏ· Ù· ˙Â˘Á¿ÚÈ· Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ¤ÚÂ˘-

Ó· ‰›ÓÂÙ·È Ë ‰˘Ó·ÙﬁÙËÙ· ÁÈ· „˘¯ÔÏÔÁÈÎ‹ ˘ÔÛÙ‹ÚÈÍË, ÂÊﬁÛÔÓ ÙÔ ˙ËÙ‹ÛÔ˘Ó.

∞Ú¯ÈÎ¿ Î·Ù·ÁÚ¿ÊÔÓÙ·È ‰ËÌÔÁÚ·ÊÈÎ¿ ÛÙÔÈ¯Â›·

ÙˆÓ Û˘ÌÌÂÙÂ¯ﬁÓÙˆÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ˙ËÙÂ›Ù·È ·ﬁ

ÙÈ˜ Á˘Ó·›ÎÂ˜ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ ‰ÈÂÚÂ˘ÓËÙÈÎﬁ

ÂÚˆÙËÌ·ÙÔÏﬁÁÈÔ ÌÂ ÂÚˆÙ‹ÛÂÈ˜ ÁÈ· ÙËÓ Â‚‰ÔÌ¿‰·

Î‡ËÛË˜, ÁÈ· ÚÔËÁÔ‡ÌÂÓÂ˜ ÂÁÎ˘ÌÔÛ‡ÓÂ˜ Î·È ÈÛÙÔÚÈÎﬁ ·Ô‚ÔÏÒÓ ‹/Î·È ÙÂ¯ÓËÙÒÓ ‰È·ÎÔÒÓ, ÁÈ· ·ıÔ-

ÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÂ ÚÔËÁÔ‡ÌÂÓÔ ÚÔÁÂÓÓËÙÈÎﬁ

¤ÏÂÁ¯Ô, ÁÈ· È·ÙÚÈÎ‹ ıÂÚ·Â›· ÁÈ· Ó· ÂÈÙÂ˘¯ıÂ› Ë

ÂÁÎ˘ÌÔÛ‡ÓË Î·È ÁÈ· ÙÔÓ ÏﬁÁÔ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ

ÚÔÁÂÓÓËÙÈÎﬁ ¤ÏÂÁ¯Ô.

∆· ÂÚˆÙËÌ·ÙÔÏﬁÁÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Ó·È

Ù· ÂÍ‹˜:

∂ÚˆÙËÌ·ÙÔÏﬁÁÈÔ Ê¿ÛË˜ ·Ó·ÌÔÓ‹˜

√È Û˘ÌÌÂÙ¤¯ÔÓÙÂ˜ ÂÚˆÙÒÓÙ·È ÁÈ· Ù· ÂÍ‹˜: 1) fiÛÔ ·ÈÛÈfi‰ÔÍÔÈ Â›Ó·È ÁÈ· ÙÔ Ì¤ÏÏÔÓ ÙÔ˘˜ (Life Orientation Test (LOT-R) (22), 2) ÌÂ ÔÈÔ˘˜ ÙÚfiÔ˘˜ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó „˘¯ÔÈÂÛÙÈÎ¿ ÁÂÁÔÓfiÙ· ÛÙË ˙ˆ‹ ÙÔ˘˜ (COPE Inventory) (23), 3) ÔÈ· Â›Ó·È Ë Û˘Ó·ÈÛıËÌ·ÙÈÎ‹ ÙÔ˘˜ ‰È¿ıÂÛË (Hospital Anxiety and Depression Scale (HADS) (24), 4) ÔÈÂ˜ Â›Ó·È ÔÈ ·fi„ÂÈ˜ ÙÔ˘˜ ÁÈ· ı¤Ì·Ù· ˘ÁÂ›·˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË (Fetal Health Locus of Control Scale (FHLC) (25), 5) Â¿Ó ¤¯Ô˘Ó ÌÈÏ‹ÛÂÈ ÛÂ Î¿ÔÈÔÓ ÁÈ· ÙÔ ÙÈ ı· ¤Î·Ó·Ó ÛÂ ÂÚ›ÙˆÛË ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Î·È 6) Â¿Ó Â›¯·Ó Û˘Ó·ÈÛıËÌ·ÙÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ·fi ÙÔÓ/ÙË Û‡ÓÙÚÔÊÔ. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ

·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜: Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÔÈ ·Ú·¿Óˆ ÂÚˆÙ‹ÛÂÈ˜, ÂÓÒ ÚÔÛÙ›ıÂÓÙ·È Î·È

¿ÏÏÂ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÔÈ· ·ﬁÊ·ÛË ÂÏ‹ÊıË Î·È Ò˜, Î·ıÒ˜ Î·È ÁÈ· ÙÔ˘˜ ÙÚﬁÔ˘˜ Ô˘ ·›ÚÓÔ˘Ó ·ÔÊ¿ÛÂÈ˜ (Decisional Conflict Scale (DCS) (26).

∂ÚˆÙËÌ·ÙÔÏﬁÁÈÔ Ê¿ÛË˜ ÂÂÍÂÚÁ·Û›·˜ - Â› ·ÚÓËÙÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜: ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚˆÙ‹-

ÛÂÈ˜ ÁÈ·: 1) ÙÈ˜ ÙÚ¤¯Ô˘ÛÂ˜ Û˘Óı‹ÎÂ˜ ˙ˆ‹˜ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, 2) ÙÔÓ ‚·ıÌﬁ ÈÎ·ÓÔÔ›ËÛË˜ ·ﬁ ÙËÓ È·ÙÚÈÎ‹

ÊÚÔÓÙ›‰·, 3) ÙËÓ ˘ÔÛÙ‹ÚÈÍË ·ﬁ ÙÔÓ/ÙË Û‡˙˘ÁÔ/Û‡-

ÓÙÚÔÊfi ÙÔ˘˜ (Berlin Social Suppport Scale (BSSS) (27), 4) ÙË Û˘Ó·ÈÛıËÌ·ÙÈÎ‹ ÙÔ˘˜ ‰È¿ıÂÛË (ÎÏ›Ì·Î· HADS), 5) Ùo fiÛÔ ·ÈÛÈfi‰ÔÍÔÈ Â›Ó·È ÁÈ· ÙÔ Ì¤ÏÏÔÓ

ÙÔ˘˜ (ÎÏ›Ì·Î· LOT-R) Î·È 6) ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜

ÚÔÛˆÈÎﬁÙËÙ¿˜ ÙÔ˘˜ (·ﬁ Ê˘ÛÈÔÏÔÁÈÎ¤˜ Î·Ù·ıÏÈÙÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ Ì¤¯ÚÈ ·ıÔÏÔÁÈÎ¤˜) (Depressive Experience Questionnaire (DEQ) (28). - Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜: Â·Ó·Ï·Ì‚¿ÓÔ-

Û¯ÂÙÈÎ¿ ÌÂ Ù· Û˘Ó·ÈÛı‹Ì·Ù¿ ÙÔ˘˜ ÁÈ· ÙËÓ

‚·Ó ˘fi„Ë ÛÙËÓ ·fiÊ·ÛË. ∂·Ó·¯ÔÚËÁÂ›Ù·È Ë ÎÏ›Ì·Î· DCS Î·È ÚÔÛÙ›ıÂÓÙ·È ÂÚˆÙ‹ÛÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ‰˘ÛÎÔÏ›Â˜ ÌÂÙ¿ ·fi „˘¯ÔÈÂÛÙÈÎ¿ ÁÂÁÔÓfiÙ· (Impact of Event Scale (IES-R) (29).

∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ê¿ÛË˜ Â·ÓÂÎÙ›ÌËÛË˜ - ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·Â˘ı‡ÓÂÙ·È ÛÂ Á˘Ó·›ÎÂ˜/Û˘ÓÙÚfiÊÔ˘˜ Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË: ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÚˆÙ‹ÛÂÈ˜ ÁÈ·: 1) ÙÈ˜ ÙÚ¤¯Ô˘ÛÂ˜ Û˘Óı‹ÎÂ˜ ÛÙË ˙ˆ‹ ÙÔ˘˜, 2) ÙËÓ ‡·ÚÍË ˘ÔÛÙËÚÈÎÙÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, 3) ÙÔÓ ‚·ıÌfi ÈÎ·ÓÔÔ›ËÛË˜ ·fi ÙËÓ È·ÙÚÈÎ‹ ÊÚÔÓÙ›‰·, 4) ÙÔ ıÚ‹ÛÎÂ˘Ì¿ ÙÔ˘˜ Î·È ÙË ‰‡Ó·ÌË ÙˆÓ ıÚËÛÎÂ˘ÙÈÎÒÓ ÙÔ˘˜ ÂÔÈı‹ÛÂˆÓ, 5) ÙËÓ ¿Ô„‹ ÙÔ˘˜ ÁÈ· ÙËÓ

˘ﬁÛÙ·ÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È 6) ÙË Û˘Ó·ÈÛıËÌ·ÙÈÎ‹

ÙÔ˘˜ ‰È¿ıÂÛË (ÎÏ›Ì·Î· HADS).

- ÂÚˆÙËÌ·ÙÔÏﬁÁÈÔ Ô˘ ·Â˘ı‡ÓÂÙ·È ÛÂ Á˘Ó·›-

ÎÂ˜/Û˘ÓÙÚﬁÊÔ˘˜ Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Ô˘

‰È¤ÎÔ„·Ó ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË: Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÔÈ

·Ú·¿Óˆ ÂÚˆÙ‹ÛÂÈ˜ Î·È ÚÔÛÙ›ıÂÓÙ·È ¿ÏÏÂ˜ ÁÈ·: 1) Ó¤· ÂÁÎ˘ÌÔÛ‡ÓË, 2) ‰˘ÛÎÔÏ›Â˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ÁÂÁÔÓﬁ˜ ÙË˜ ‰È·ÎÔ‹˜ (ÎÏ›Ì·Î· IES-R), 3) ÙË Û˘Ó·ÈÛıËÌ·ÙÈÎ‹ ÙÔ˘˜ ‰È¿ıÂÛË (ÎÏ›Ì·Î· HADS) Î·È 4) ﬁÛÔ Û˘ÌÊˆÓÔ‡Ó ÌÂ ‰ËÏÒÛÂÈ˜ Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÙÈ˜ ÛÎ¤„ÂÈ˜ Î·È Ù· Û˘Ó·ÈÛı‹Ì·Ù· ·ÓıÚÒˆÓ Ô˘ ¤¯Ô˘Ó

∏ ˘ÏÔÔ›ËÛË ÙË˜ ·ÚÔ‡Û·˜ ¤ÚÂ˘Ó·˜ Û˘Ó¿ÓÙËÛÂ

ÔÏÏ¤˜ ‰˘ÛÎÔÏ›Â˜, ÏﬁÁˆ ÙˆÓ ËıÈÎÒÓ Î·È Û˘Ó·ÈÛıËÌ·-

ÙÈÎÒÓ ıÂÌ¿ÙˆÓ Ô˘ ·Ó¤‰ÂÈÍÂ. ™Ù· Ï·›ÛÈ· ÙË˜ ˘ÔÌÂ-

Ï¤ÙË˜ ∞, Ë ÚÔÛ¤ÁÁÈÛË ÙˆÓ Á˘Ó·ÈÎÒÓ/˙Â˘Á·ÚÈÒÓ Ô˘

˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÚÔÁÂÓÓËÙÈÎﬁ ¤ÏÂÁ¯Ô ‹Ù·Ó ··ÈÙË-

ÙÈÎ‹. √È Á˘Ó·›ÎÂ˜ ‚Ú›ÛÎÔÓÙ·Ó Û˘Ó‹ıˆ˜ ÛÂ Î·Ù¿ÛÙ·ÛË

¿Á¯Ô˘˜ ﬁÙ·Ó ÚÔÛ¤Ú¯ÔÓÙ·Ó ÛÙÔ Î¤ÓÙÚÔ ÁÈ· ÙËÓ ÂÍ¤Ù·-

ÛË, ÂÓÒ ‰˘ÛÎÔÏ›Â˜ ÚÔ¤Î˘„·Ó ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÙË˜

Û˘ÓÂÚÁ·Û›·˜ Ì·˙› ÙÔ˘˜ ÛÙÈ˜ ÂﬁÌÂÓÂ˜ Ê¿ÛÂÈ˜ ÙË˜

¤ÚÂ˘Ó·˜ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜ ﬁÔ˘ ‰È·ÁÓÒÛÙËÎÂ

Î¿ÔÈ· ·ÓˆÌ·Ï›· ÛÙÔ ¤Ì‚Ú˘Ô.

∏ ·Ó·‰ÚÔÌÈÎ‹ Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ÛÙËÓ ˘ÔÌÂ-

Ï¤ÙË µ Û˘Ó¿ÓÙËÛÂ ‰˘ÛÎÔÏ›Â˜ ÛÙË Û˘Ó·›ÓÂÛË ÙˆÓ „˘-

¯·Ó·Ï˘ÙÒÓ/„˘¯ÔıÂÚ·Â˘ÙÒÓ Ó· ÂÈÎÔÈÓˆÓ‹ÛÔ˘Ó

ÌÂ ÚÒËÓ ıÂÚ·Â˘ﬁÌÂÓÔ‡˜ ÙÔ˘˜, ÚÔÎÂÈÌ¤ÓÔ˘ Ó·

Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙËÓ ¤ÚÂ˘Ó·. ∏ Ù‹ÚËÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ·ÔÚÚ‹ÙÔ˘, Ë ‰È·Ê‡Ï·ÍË ÚÔÛˆÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ, Ë ‰ÂÔÓÙÔÏÔÁ›· ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÚÁ·Û›·˜ ‹Ù·Ó ÌÂÚÈÎ¤˜

ÙÈ˜ ‰˘ÛÎÔÏ›Â˜ ÛÙË ‰ÈÂÍ·ÁˆÁ‹ ÙË˜ ÌÂÏ¤ÙË˜. ∏ ‰È·‰ÈÎ·Û›·, ﬁˆ˜ ÔÚÁ·ÓÒıËÎÂ ·ﬁ ÙËÓ ÂÚÂ˘ÓËÙÈÎ‹ ÔÌ¿‰· ÙË˜ ∞ı‹Ó·˜, ÂÈÎÂÓÙÚÒıËÎÂ ÛÙËÓ Î·Ù¿

ÙÔ ‰˘Ó·ÙﬁÓ ÌÂÁ·Ï‡ÙÂÚË ˘¤Ú‚·ÛË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ. ∏ ÂÈ‰›ˆÍË ÙË˜ ÚÔÛˆÈÎ‹˜ Â·Ê‹˜ ÙÔ˘ ÂÚÂ˘ÓËÙ‹

ÌÂ ÙË Á˘Ó·›Î· ‹ ÌÂ ÙÔ ˙Â˘Á¿ÚÈ, ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÙÔÓ

ÁÂÓÂÙÈÛÙ‹ ‹/Î·È ÙÔÓ Á˘Ó·ÈÎÔÏﬁÁÔ, ÚﬁÛˆ· Ô˘ Ë

Á˘Ó·›Î· ÁÓˆÚ›˙ÂÈ Î·È ÂÌÈÛÙÂ‡ÂÙ·È, ‹Ù·Ó ÌÂÁ¿ÏË˜

ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÂÁÎ·ı›‰Ú˘ÛË ÙË˜ ÌÂÙ·Í‡ ÙÔ˘˜ Û¯¤ÛË˜, Ë ÔÔ›· ‹Ù·Ó ‚ÔËıËÙÈÎ‹ ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÙË˜

Û˘ÌÌÂÙÔ¯‹˜ ÙË˜ ÛÙÈ˜ ÂﬁÌÂÓÂ˜ Ê¿ÛÂÈ˜. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë Î·Ù·ÓﬁËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ

ÙË˜ ÂÌÂÈÚ›·˜ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘, ‰ËÏ·‰‹

ÙË˜ ËıÈÎ‹˜, „˘¯ÔÏÔÁÈÎ‹˜, ÔÏÈÙÈÛÌÈÎ‹˜ Î·È È·ÙÚÈ-

Î‹˜ ÏÂ˘Ú¿˜ ÙË˜, Â›Ó·È ÛËÌ·ÓÙÈÎ‹. ™˘ÓÙÂÏÂ› ÙﬁÛÔ

ÛÙË ‰È·ÌﬁÚÊˆÛË ÂÓﬁ˜ ËıÈÎÔ‡ Ï·ÈÛ›Ô˘ ÁÈ· ÙÔÓ ¯ÂÈ-

ÚÈÛÌﬁ ÙˆÓ ﬁÛˆÓ Û˘ÓÂ¿ÁÂÙ·È Ë Û‡Á¯ÚÔÓË ÁÂÓÂÙÈÎ‹

Î·È ÙÂ¯ÓÔÏÔÁ›· ﬁÛÔ Î·È ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌﬁ ÙÔ˘ Â›-

‰Ô˘˜ ‚Ô‹ıÂÈ·˜ Ô˘ Â›Ó·È ÛÎﬁÈÌÔ Ó· ·Ú¤¯ÂÙ·È ÛÂ

Á˘Ó·›ÎÂ˜/˙Â˘Á¿ÚÈ· Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙË ‰È·‰ÈÎ·Û›·

·ﬁÊ·ÛË˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·Á¤ÓÓËÙÔ˘ ÌˆÚÔ‡. ∏ ·Ó¿-

‰ÂÈÍË ÙˆÓ ·Ú·¿Óˆ ÏÂ˘ÚÒÓ ı· ÌÔÚÔ‡ÛÂ Ó·

Ô‰ËÁ‹ÛÂÈ ÙÈ˜ Á˘Ó·›ÎÂ˜/Ù· ˙Â˘Á¿ÚÈ· Ó· Î·Ù·ÓÔ‹ÛÔ˘Ó

ﬁÙÈ Ë ‰ËÌÈÔ˘ÚÁ›· ÂÓﬁ˜ ‰ÈÏ‹ÌÌ·ÙÔ˜ Û˘ÓÙ›ıÂÙ·È

1. Alteneder RR, Kenner C, Greene D, Pohorecki S. The lived experience of women who undergo prenatal testing due to elavated maternal serum alpha-fetoprotein screening. MCN Am J Matern Child Nurs 1998;23:180-186.

2. Engels EM. Der moralische Status von Embryonen und Feten - Forschung, Diagnose, Schwangerschaftsabbruch. In: Duewell Mª, Mieth D, editors. Ethik in den Wissenhaften: Vol. 10. Ethik in der Humangenetik. Die neueren Entwicklungen der genetischen Frühdiagnostik aus ethischer Perspektive. Aufl. Tübingen: Francke Verlag; 2000. p. 271-301.

3. Hildt E. Influences of genetic testing on a person’s freedom. In: Thompson AK, Chadwick RF, editors. Genetic Information: Acquisition, Access and Control. New York: Kluwer Academic; 1999. p. 235-242.

4. Hildt E. Autonomy and Freedom of Choice in Prenatal Genetic Diagnosis. Med Health Care Philos 2002;5:65-71.

5. Hildt E. Autonomie in der Biomedizinischen Ethik: Vom klassischen therapeutischen Kontext zum nicht-therapeutischen Kontext prädiktiver genetischer Diagnostik. Habilitationsschrift. Tübingen; 2004.

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8. Leuzinger-Bohleber M. Pathogenes Leiden an der Schuld der Väter - eine Fallskizze. In: Leuzinger-Bohleber M, Lahme-Gronostaj H, Meyer-Stoll T, Michel M, editors. Psychoanalyse im Spannungsfeld zwischen Klinik und Kulturtheorie. Kassel: Institut für Psychoanalyse; 1998. p. 79-99.

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20. Green JM, Kafetsios K, Statham HE, Snowdon CM. Factor structure, validity and reliability of the Cambridge Worry Scale in a pregnant population. J Health Psychol 2003;8: 753-764.

21. Leuzinger-Bohleber M, Rﬁger B, Stuhr U, Beutel M. “Forschen und Heilen” in der Psychoanalyse. Ergebnisse und Berichte aus Forschung und Praxis. Stuttgart: Kohlhammer; 2002.

22. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol 1994;67:1063-1078.

23. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989;56:267-283.

24. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-370.

25. Labs SM & Wurtele SK. Fetal Health Locus of Control Scale: development and validation. J Consult Clin Psychol 1986; 54:814-819.

26. O’Connor AM. Validation of a decisional conflict scale. Med Decis Making 1995;15:25-30.

27. Schulz U, Schwarzer R. Long-term effects of spousal support on coping with cancer after surgery. Journal of Social and Clinical Psychology 2004;23:716-732.

28. Blatt SJ, D’Afflitti JP, Quinlan DM. Depressive Experiences Questionnaire. New Heaven, CT: Yale University Press; 1976.

29. Weiss DS, Marmar CR. The impact of Event Scale revised. In Wilson JP, Kaene TM, editors. Assessing psychological trauma and PTSD. Guilford; 1983. p. 399-411.

30. Beutel M, Will H, Völkl K, von Rad M, Weiner H. Assessment of grief exemplified pregnancy loss: development and initial results on the validity of the Munich Grief Scale. Psychother Psychosom Med Psychol 1995;45:295-302.

EDIG (Ethical Dilemmas due to Prenatal and Genetic Diagnostics) Û˘ÌÌÂÙ¤¯Ô˘Ó: 1) °ÂÚÌ·Ó›· (Sigmund Freud Institute, Û˘ÓÙÔÓÈÛÙÈÎﬁ Î¤ÓÙÚÔ ÙË˜ ¤ÚÂ˘Ó·˜, University of Kassel, University of Mainz, Eberhard Karls University of Tubingen), 2) πÛÚ·‹Ï (Hebrew University of Jerusalem), 3) ™Ô˘Ë‰›· (Linkoping University), 4) ª. µÚÂÙ·Ó›· (University of Cambridge), 5) πÙ·Ï›· (Universita Cattolica dea sacro cuora di Milano, Universita di Pavia) Î·È 6) ∂ÏÏ¿‰· (¶·ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰Ô„˘¯È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ¶·ÓÂÈÛÙËÌÈ·Î‹ æ˘¯È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¢ËÌÔÎÚ›ÙÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿ÎË˜). ™˘ÓÂÚÁ·˙ﬁÌÂÓ· Î¤ÓÙÚ·: ∂ÚÁ·ÛÙ‹ÚÈÔ

**The following centres are participating in the Ethical Dilemmas due to Prenatal and Genetic Diagnostics (EDIG) project: 1) Germany (Sigmund Freud Institute, coordination centre of the project, University of Kassel, University of Mainz, Eberhard Karls University of Tubingen), 2) Israel (Hebrew University of Jerusalem), 3) Sweden (Linkoping University), 4) United Kingdom (University of Cambridge), 5) Italy (Universita Cattolica dea sacro cuora di Milano; Universita di Pavia), and 6) Greece (Department of Child Psychiatry, University of Athens Medical School, “Aghia Sophia” Children’s Hospital; Department of Psychiatry, “Dimokritio” University of Thrace Medical School). Collaborating centres: Laboratory of Medical Genetics, University of Athens, “Aghia Sophia” Children’s Hospital; 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, “Areteio” Hospital; Department of Genetics, “Mitera” Maternity Clinic.

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,

¶·ÓÂÈÛÙËÌÈ·Îﬁ

¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

AÏÏËÏÔÁÚ·Ê›·:

¡ÈÎﬁÏ·Ô˜ Ã·ÏÈ¿ÛÔ˜ nchalias@cc.uoi.gr

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,

¶·ÓÂÈÛÙËÌÈ·Îﬁ ¡ÔÛÔÎÔÌÂ›Ô

πˆ·ÓÓ›ÓˆÓ

Department of Paediatrics, University Hospital of Ioannina

Correspondence: N. Chaliasos nchalias@cc.uoi.gr

Department of Paediatrics, University Hospital of Ioannina

¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË

¡. Ã·ÏÈ¿ÛÔ˜, ∞. µÏ¿¯Ô˜, ∞. ª¿ÎË˜

ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿

¶ÂÚ›ÏË„Ë: ∏ ‰ÈfiÁÎˆÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Â›Ó·È ÔÏ‡ Û˘¯Ó‹ ÛÙ· ·È‰È¿. ∫·Ù¿ Î·ÓfiÓ·, Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÈÔÁÂÓÒÓ Î˘Ú›ˆ˜ ÏÔÈÌÒÍÂˆÓ Î·È ÏÈÁfiÙÂÚÔ ‚·ÎÙËÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ ‹ ÏÔÈÌÒÍÂˆÓ ·fi Ì˘ÎÔ‚·ÎÙËÚ›‰È·, ÂÓÒ ·ÎfiÌË ÈÔ Û¿ÓÈ· ÔÊÂ›ÏÂÙ·È ÛÂ Î·ÎÔ‹ıÂÈÂ˜ ‹ ¿ÏÏ· ÓÔÛ‹Ì·Ù· ·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ ‹ Ê¿ÚÌ·Î·. ™‡ÌÊˆÓ· ÌÂ ÛÙ·ÙÈÛÙÈÎ¤˜, ÛÙÔ 25% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÚÔÛ¤Ú¯ÔÓÙ·È ÛÙÈ˜ ÚˆÙÔ‚¿ıÌÈÂ˜ ˘ËÚÂÛ›Â˜ ˘ÁÂ›·˜ ÁÈ· ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ·˘Ù‹ Â›Ó·È ÁÂÓÈÎÂ˘Ì¤ÓË. ∫·ÎÔ‹ıÂÈ· ·ÓÂ˘Ú›ÛÎÂÙ·È ÛÂ ÏÈÁfiÙÂÚÔ ·fi 1% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, Î˘Ú›ˆ˜ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ Î·È ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜. ™Â ÙÔÈÎ‹ ÂÓÙfiÈÛË, È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ÛÙÔ˘˜ ˘ÂÚÎÏÂ›‰ÈÔ˘˜ Î·È ÌÂÛÔıˆÚ¿ÎÈÔ˘˜ ÏÂÌÊ·‰¤ÓÂ˜. ∏ ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË Á›ÓÂÙ·È ÌÂ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi Î·È ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ÛÙ·‰È·Î‹ ¯Ú‹ÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È, ÙÂÏÈÎ¿, ·Ó ¯ÚÂÈ·ÛÙÂ›, ÌÂ ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· Î·È ·Ó¿ÏÔÁË ıÂÚ·Â›·. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ‰›‰ÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·fi ÌË ÏÂÌÊ·‰ÂÓÈÎ¤˜ Ì¿˙Â˜. ∏ ¯Ú‹ÛË ·ÏÁÔÚ›ıÌˆÓ Â›Ó·È ¯Ú‹ÛÈÌË ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ,

Diagnostic approach to lymphadenopathy in children

N. Chaliasos, A. Vlahos, A. Makis

Abstract: Lymph node enlargement is very common in children. Lymph node enlargement is caused mainly by infections, mostly viral, and less often bacterial or mycobacterial, while more rarely it is due to malignancies, immune diseases, or medication. Of all children presenting with lympadenopathy in the primary care setting, this is generalized in 25% of cases. Malignancy is identified in less than 1% of cases. Localized lympadenopathy merits special attention when the location is superclavicular or mediastinal. The diagnostic approach comprises detailed history, physical examination, targeted and stepwise use of laboratory tests, and eventually, when indicated, lymph node biopsy, in order to provide appropriate treatment. Special attention is needed to differentiate enlarged lymph nodes from other masses that are not of lymphatic origin. The use of appropriate algorithms is helpful to the paediatrician, before consultation with the paediatric haematologist/oncologist.

Key words: Lymph nodes, enlargement, childhood.

Â›Ó·È

ÔÏ‡ Û˘¯Ó‹. ™Â ˘ÁÈ‹ ·È‰È¿, Ë „ËÏ¿ÊËÛ‹ ÙÔ˘˜ Â›Ó·È Û˘ÓËıÈÛÌ¤ÓË, ÂÓÒ Û˘Ó·ÓÙÒÓÙ·È ÏÈÁﬁÙÂÚÔ Û˘¯Ó¿ ÛÙ· ÓÂÔÁÓ¿ (1). √È ÏÂÌÊ·‰¤ÓÂ˜ ˘¿ÁÔÓÙ·È, Ì·˙› ÌÂ ÙÔÓ ÛÏ‹Ó· Î·È ÙÈ˜ ·¸¤ÚÈÂ˜ Ï¿ÎÂ˜, ÛÙ· ‰Â˘ÙÂÚÔÁÂÓ‹ ÏÂÌÊÈÎ¿

·ﬁ ÙËÓ Î¿„·, ÙÔÓ

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∂ È Î ﬁ Ó · 1 . ∞ÏÁﬁÚÈıÌÔ˜ ÙÔÈÎ‹˜ ·‰ÂÓÔ¿ıÂÈ·˜.

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πÔ› ¶·Ú¿ÛÈÙ·

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2. ƒÈÓÔ˚Ô›2. ∆ÔÍﬁÎ·Ú·

3. πÔ› Coxsackie3. ∂ÏÔÓÔÛ›·

4. Parvovirus B19

5. πﬁ˜ ÈÏ·Ú¿˜

6. πﬁ˜ ÂÚ˘ıÚ¿˜

7. πﬁ˜ ·ÚˆÙ›ÙÈ‰·˜

8. πﬁ˜ ÙË˜ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

9. ∂ÚËÙÔ˚Ô›

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∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚ﬁ˜

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πﬁ˜ ·ÓÂ˘ÌÂ˘ÏÔÁÈ¿˜-¤ÚËÙ· ˙ˆÛÙ‹Ú·

∂ÚËÙÔ˚ﬁ˜ 6, 7, 8

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ÙÔ˘˜ ÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, Û˘¯ÓﬁÙÂÚÔÈ Â›Ó·È Ô

¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏﬁÎÔÎÎÔ˜, Ô ∞ ·ÈÌÔÏ˘ÙÈÎﬁ˜ ÛÙÚÂ-

ÙfiÎÔÎÎÔ˜ (ÛÙ· ÓÂÔÁÓ¿ Î·È ÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË µ ·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜), Ë ÛË„·ÈÌ›·, Ë ‚ÚÔ˘Î¤ÏÏˆÛË, Ë Û·ÏÌÔÓ¤ÏÏ· Î·È Ù· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (Ê˘Ì·Ù›ˆÛË˜-¿Ù˘·). ™Ù· ·È‰È¿, ÂÓ›ÔÙÂ ÌÔÚÔ‡Ó Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÔÈ ·Ú·ÛÈÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ (ÙÔÍfiÏ·ÛÌ·, ÙÔÍfiÎ·Ú·, Ï·ÛÌÒ‰ÈÔ ÂÏÔÓÔÛ›·˜ Î.¿.) Î·È Û¿ÓÈ· ÔÈ Ì˘ÎËÙÈ¿ÛÂÈ˜, Î˘Ú›ˆ˜ ÛÂ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ (8). ∞ÓÔÛÔ‚ÈÔÏÔÁÈÎ¤˜‰È·Ù·Ú·¯¤˜-√ÚÔÓÔÛ›·. ªÂ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÌÔÚÔ‡Ó Ó· ÂÎ‰ËÏˆıÔ‡Ó ÔÈ ÎÔÏÏ·ÁÔÓÒÛÂÈ˜ ÛÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (ÓÂ·ÓÈÎ‹ È‰ÈÔ·ı‹˜ ·ÚıÚ›ÙÈ‰·, Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·ÙÒ‰Ë˜ Ï‡ÎÔ˜ Î.¿.) Î·È ÔÚÈÛÌ¤ÓÂ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ (.¯. ¯ÚfiÓÈ· ÎÔÎÎÈˆÌ·ÙÒ‰Ë˜ ÓfiÛÔ˜), Î·ıÒ˜ Î·È ÂÌ‡ÚÂÙ· ÂÚÈÔ‰ÈÎ¿ Û‡Ó‰ÚÔÌ· (.¯. Û‡Ó‰ÚÔÌÔ PFAFA Î·È ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· D) (9) (¶›Ó·Î·˜ 3). °ÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÂ› Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÎÚ›ÛË˜ ·˘ÙÔ¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜ Î·È ˘Ô¯ˆÚÂ› ·˘ÙfiÌ·Ù· (10).

£ËÛ·˘ÚÈÛÌÒÛÂÈ˜. ¡ﬁÛÔÈ ﬁˆ˜ Gaucher Î·È ¡iemann-Pick ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ÌÂ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È Î˘ÙÙ·ÚÔÂÓ›Â˜, ·ÏÏ¿ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· (11). º¿ÚÌ·Î·. ™¿ÓÈ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È

¶›Ó·Î·˜ 2. ªÈÎÚÔ‚È·Î¿ ·›ÙÈ· Î·È ÏÂÌÊ·‰ÂÓ›ÙÈ‰Â˜

¡ÂÔÁÓ¿

ñ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏﬁÎÔÎÎÔ˜

ñ ÛÙÚÂÙﬁÎÔÎÎÔ˜ ÔÌ¿‰·˜ µ

µÚ¤ÊË Î·È Ó‹È·

ñ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏﬁÎÔÎÎÔ˜

ñ ˘ÔÁﬁÓÔ˜ ÛÙÚÂÙﬁÎÔÎÎÔ˜

¶·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Î·È ¤ÊË‚ÔÈ

ñ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏﬁÎÔÎÎÔ˜

ñ ˘ÔÁﬁÓÔ˜ ÛÙÚÂÙﬁÎÔÎÎÔ˜

ñ ·Ó·ÂÚﬁ‚È·

ñ ˘ÂÚÛ›ÓÈ· ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜

ñ ÊÚ·ÓÛÈÛ¤ÏÏ· ÙË˜ ÙÔ˘Ï·Ú·ÈÌ›·˜

ñ Ì˘ÎÔ‚·ÎÙËÚ›‰È·

Â›Ó·È Ë

Ë ÈÛÔÓÈ·˙›‰Ë, Ë ˘‰ÚÔÏ·˙›ÓË, Ë ·ÏÏÔÔ˘-

Ë Î·Ú‚·Ì·˙Â›ÓË, ÔÈ ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ Î.¿ (12,13).

Î·ÎÔ‹ıÂÈÂ˜. ªÂ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÂÎ‰ËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ë ÔÍÂ›·

ÏÂ˘¯·ÈÌ›· Î·È ÏÈÁﬁÙÂÚÔ ÔÈ ¿ÏÏÂ˜ ÏÂ˘¯·ÈÌ›Â˜ ‹ Ë ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÛË. ∏ ‰ÈﬁÁÎˆÛË Â›Ó·È

Î·È Û˘ÌÌÂÙÚÈÎ‹. ™Â ÔÍÂ›· ÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂ˘¯·ÈÌ›·, Ë ‰ÈﬁÁÎˆÛË Â›Ó·È ‰˘Ó·ÙﬁÓ Ó·

ÂÚÈÔÚ›˙ÂÙ·È ÌﬁÓÔ ÛÙÔÓ ÙÚ¿¯ËÏÔ. ™Ù· ÏÂÌÊÒÌ·Ù·, Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Â›Ó·È Î˘Ú›ˆ˜ ÌË Û˘ÌÌÂÙÚÈÎ‹ (14).

™˘Ì·ÁÂ›˜ fiÁÎÔÈ - ªÂÙ·ÛÙ¿ÛÂÈ˜. ∞fi ÙÔ˘˜ ÌÂÙ·ÛÙ·ÙÈÎÔ‡˜ fiÁÎÔ˘˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ÏÂÌÊ·‰ÂÓÈÎ¤˜ ‰ÈÔÁÎÒÛÂÈ˜ ÚÔÎ·ÏÂ› Î˘Ú›ˆ˜ ÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·. ∂›Ó·È ·Û‡ÌÌÂÙÚÂ˜, ‰È¿Û·ÚÙÂ˜ Î·È ÛÎÏËÚ¤˜ ‰ÈÔÁÎÒÛÂÈ˜ (15).

¢ÂÚÌ·ÙÔ¿ıÂÈÂ˜. ¶·ı‹ÛÂÈ˜, ﬁˆ˜ ÙÔ ÂÈÌÔÏ˘Óı¤Ó ¤Î˙ÂÌ·, ÌÔÚÔ‡Ó Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ÁÂÓÈÎÂ˘Ì¤ÓË

ÏÂÌÊ·‰ÂÓÈÎ‹ ‰ÈﬁÁÎˆÛË.

∆ÔÈÎ‹ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· – ∞›ÙÈ· πÓÈ·ÎÔ› ÏÂÌÊ·‰¤ÓÂ˜. √È ÈÓÈ·ÎÔ› ÏÂÌÊ·‰¤ÓÂ˜ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Ó·È ·„ËÏ¿ÊËÙÔÈ. ¢ÈﬁÁÎˆÛË ÈÓÈ·ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ÚÔÎ·ÏÔ‡Ó

1. ƒÂ˘Ì·ÙÔÂÈ‰‹˜ ·ÚıÚ›ÙÈ‰· 2. ™˘ÛÙËÌ·ÙÈÎﬁ˜ ÂÚ˘ı˘Ì·ÙÒ‰Ë˜ Ï‡ÎÔ˜

3. ¢ÂÚÌ·ÙÔÌ˘ÔÛ›ÙÈ‰·

4. ∞ÁÁÁÂÈ›ÙÈ‰Â˜

5. ªÈÎÙ‹ ÓﬁÛÔ˜ ÎÔÏÏ·ÁﬁÓÔ˘

6. ™·ÚÎÔÂ›‰ˆÛË

7. ¶ÂÚÈÔ‰ÈÎ¿ ÂÌ‡ÚÂÙ· ÓÔÛ‹Ì·Ù·

8. ¡ﬁÛÔ˜ Kikuchi-Fuzimoto 9. ¡ﬁÛÔ˜ Kimura

π Û Ù Ô Ú È Î fi : ¶˘ÚÂÙfi˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó˘¯ÙÂÚÈÓÔ› È‰ÚÒÙÂ˜, ÓfiÛÔ˜ ÎÔÏÏ·ÁfiÓÔ˘, ÓÂÔÏ·Û›·, ÛÂÍÔ˘·ÏÈÎfi ÈÛÙÔÚÈÎfi, Ù·Í›‰È·

∫ Ï È Ó È Î ‹ ∂ Í ¤ Ù · Û Ë : ª¤ÁÂıÔ˜, Û‡ÛÙ·ÛË, Â˘·ÈÛıËÛ›·, ıÂÚÌfiÙËÙ·, ÂÚ‡ıËÌ·, ÛËÌÂ›· ·fi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù· ∞ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó˘¯ÙÂÚÈÓÔ› È‰ÚÒÙÂ˜, ÔÛÙÈÎ¿ ¿ÏÁË™˘ÌÙÒÌ·Ù· ÈÔÁÂÓÔ‡˜ Û˘Ó‰ÚÔÌ‹˜ ‹ Û˘ÛÙËÌ·ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜. ÃÚfiÓÈ· Û˘ÌÙÒÌ·Ù·.

ÀÂÚÎÏÂ›‰È· ÂÓÙfiÈÛË, ·ÓÒ‰˘ÓË ÚÔÔ‰Â˘ÙÈÎ‹ §ÂÌÊ·‰¤ÓÂ˜ Ì·Ï·ÎÔ›, Û˘¯Ó¿ ÂÒ‰˘ÓÔÈ, ¯ˆÚ›˜ Û‡ÌÊ˘ÛË ∂Ó‰Â›ÍÂÈ˜ ÓfiÛÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ‹

¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ Î·Ù¿ÛÙ·ÛË˜. ¶·ıÔÏÔÁÈÎ‹ ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ Î·È ÌÈÎÚÔÛÎfiËÛË, ∂Í¿ÓıËÌ·, Ê·Ú˘ÁÁ›ÙÈ‰·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·.∂Í¿ÓıËÌ· ·ÁÁÂÈ›ÙÈ‰·˜, ·ÚıÚ›ÙÈ‰·, ·˘ÍËÌ¤ÓÔ Ô˘ÚÈÎfi ÔÍ‡ Î·È LDH. ÛËÌ·ÓÙÈÎ‹ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ¶·ıÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·.

‰ÈﬁÁÎˆÛË, Û‡ÌÊ˘ÛË ÌÂ ·Ú·ÎÂ›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ÌÂ ·Ú·ÎÂ›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜.

¶›Ó·Î·˜ 4. ∂Ó‰Â›ÍÂÈ˜ ‚ÈÔ„›·˜ ÏÂÌÊ·‰¤Ó·

1. ª¤ÁÂıÔ˜ ·‰¤Ó· >2 cm

2. ∞‰¤Ó·˜ ·˘Í·ÓﬁÌÂÓÔ˜ ÛÂ Ì¤ÁÂıÔ˜ >2 Â‚‰ÔÌ¿‰Â˜

3. ™Ù·ÛÈÌﬁÙËÙ· ÌÂÁ¤ıÔ˘˜ ÌÂÙ¿ ·ﬁ 4-6 Â‚‰ÔÌ¿‰Â˜

4. ªË ·ÓÙ·ﬁÎÚÈÛË ÛÂ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ÌÂÙ¿ ·ﬁ 2 Â‚‰ÔÌ¿‰Â˜

5. ªË Â¿ÓÔ‰Ô˜ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎﬁ Ì¤ÁÂıÔ˜ ÌÂÙ¿ ·ﬁ 8-12 Â‚‰ÔÌ¿‰Â˜

6. ∞Ô˘Û›· Û˘ÛÙËÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ

7. ∞Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ ·ﬁ ·ÓÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎﬁ Î·È ıÒÚ·Î·

8. ¶·ıÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·

9. ÀÂÚÎÏÂ›‰È· ÂÓÙﬁÈÛË

10. ∂ÌÊ¿ÓÈÛË Ó¤ˆÓ ÏÂÌÊ·‰¤ÓˆÓ

11. “∂Ï·ÛÙÈÎ‹” Û‡ÛÙ·ÛË

12. ™˘Ó‡·ÚÍË Û˘ÛÙËÌ·ÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ (˘ÚÂÙﬁ˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·ÚıÚ·ÏÁ›Â˜, Ë·ÙÔÛÏËÓÈÎ‹ ‰ÈﬁÁÎˆÛË)

13. ∞ÍÈÔÏfiÁËÛË ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ Â˘ÚËÌ¿ÙˆÓ

ÌÂÁ¤ıÔ˘˜ ÌÂÙ¿ 4-6 Â‚‰ÔÌ¿‰Â˜, ÌË ˘Ô¯ÒÚËÛË ÌÂÙ¿

8-12 Â‚‰ÔÌ¿‰Â˜, ÌË ·ÓÙ·ﬁÎÚÈÛË ÛÂ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ÌÂÙ¿ 2 Â‚‰ÔÌ¿‰Â˜, ·Ô˘Û›· Û˘ÛÙËÌ·ÙÈÎÒÓ

Û˘ÌÙˆÌ¿ÙˆÓ, ·Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ ·ﬁ ·ÓÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎﬁ Î·È ıÒÚ·Î·, ·ıÔÏÔÁÈÎ‹ ·ÎÙÈÓÔ-

ÁÚ·Ê›· ıÒÚ·Î·, ˘ÂÚÎÏÂ›‰ÈÔ˜ ÂÓÙﬁÈÛË, “ÂÏ·ÛÙÈÎ‹”

Û‡ÛÙ·ÛË, Û˘Ó‡·ÚÍË Û˘ÛÙËÌ·ÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ

(˘ÚÂÙﬁ˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·ÚıÚ·ÏÁ›Â˜, Ë·ÙÔ-

ÛÏËÓÈÎ‹ ‰ÈfiÁÎˆÛË), ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ·‰¤ÓˆÓ. ™Â Î¿ıÂ ÂÚ›ÙˆÛË, Á›ÓÂÙ·È ·ÍÈÔÏfiÁËÛË Ì›·˜ ‹ ÂÚÈÛÛfi-

ÙÂÚˆÓ ÂÓ‰Â›ÍÂˆÓ.

™˘Ì¤Ú·ÛÌ·

∏ ‰ÈﬁÁÎˆÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÛÙ· ·È‰È¿ Â›Ó·È

ÔÏ‡ Û˘ÓËıÈÛÌ¤ÓË Î·È Î·Ù¿ Î·ÓﬁÓ· ÔÊÂ›ÏÂÙ·È ÛÂ ÈÔ-

ÁÂÓ‹ ‹ ÌÈÎÚÔ‚È·Î¿ ·›ÙÈ·. ∏ Ï‹„Ë ÛˆÛÙÔ‡ ÈÛÙÔÚÈÎÔ‡, Ë ÚÔÛÂÎÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È Ë ÔÚıÔÏÔÁÈÎ‹

¯Ú‹ÛË ÙˆÓ ·Ú·ÎÏÈÓÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ, fiˆ˜ Â›Ó·È Ô ·ÈÌ·ÙÔÏÔÁÈÎfi˜, ÔÚÔÏÔÁÈÎfi˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ë ‚ÈÔ„›·, ‚ÔËıÔ‡Ó ÛÙÔÓ ÂÓÙÔÈÛÌfi Î·È ÙËÓ

fiÛÔ ‰˘Ó·ÙfiÓ Ù·¯‡ÙÂÚË ‰È¿ÁÓˆÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ™ÙÔÈ¯Â›· Ô˘ Ú¤ÂÈ Ó· ÚÔ‚ÏËÌ·Ù›ÛÔ˘Ó ÙÔÓ ·È‰›·ÙÚÔ Â›Ó·È: ·) ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÈÔÁÂÓ‹ ÂÈÎfiÓ·, ‚) ÂÙÂÚfiÏÂ˘ÚË ÂÛÙÈ·Î‹ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Ô˘ ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÙÔÈÎ¿ Â˘Ú‹Ì·Ù· ÊÏÂÁÌÔÓ‹˜ Ô˘ ¤¯ÂÈ

3. Pangalis GA, Boussiotis VA, et al. Clinical approach to a patient with lymphadenopathy. Bening and Malignant Lymphadenopathies. Pangalis G, Polliack A, editors. Harwood Academic Publishers; 1993. p. 19-22.

4. Kenneth WG. Lymph Node Disorders. EMedicine [Internet]. 2008. Webpage: http://www.emedicine.com/ ped/topic2975.htm.

5. Williamson HA Jr. Lymphadenopathy in a family practice: a descriptive study of 249 cases. J Fam Pract 1985;20:449-452.

6. Yaris ¡, Cakir ª, Sözen ∂, Cobanoglu U. Analysis of children with peripheral lymphadenopathy. Clin Pediatr (Phila) 2006;45:544-549.

7. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician 1998;58:1313-1320.

8. Segal GH, Perkins SL, Kjeldsberg CR. Benign lymphadenopathies in children and adolescents. Semin Diagn Pathol 1995;12:288-302.

9. Mason TG, Reed AM. Update in juvenile rheumatoid arthritis. Arthritis Rheum 2005;53:796-799.

10. Gehrs BC, Friedberg RC. Autoimmune hemolytic anemia. Am J Hematol 2002;69:258-271.

11. Grabowski GA, Andria G, Baldellou A, Campbell PE, Charrow J, Cohen IJ et al. Pediatric non-neuronopathic Gaucher disease: presentation, diagnosis and assessment. Consensus statements. Eur J Pediatr 2004;163:58-66.

12. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570-582.

13. Schwinghammer TL, Howrie DL. Phenytoin-induced lymphadenopathy. Drug Intell Clin Pharm 1983;17: 460-462.

14. Neild LS, Kamat D. Lymphadenopathy in children: when and how to evaluate. Clin Pediatr (Phila) 2004;43:25-33.

15. Soldes OS, Younger JG, Hirschl RB. Predictors of malignancy in childhood peripheral lymphadenopathy. J Pediatr Surg 1999;34:1447-1452.

16. Karadeniz C, Oguz A, Ezer U, Oztürk G, Dursun A. The etiology of peripheral lymphadenopathy in children. Pediatr Hematol Oncol 1999;16:525-531.

17. Bodenstein L, Altman RP. Cervical lymphadenitis in infants and children. Semin Pediatr Surg 1994;3:134-141.

18. Kelly CS, Kelly RE Jr. Lymphadenopathy in children. Pediatr Clin North Am 1998;45:875-888.

19. Chao SS, Loh KS, Tan KK, Chong SM. Tuberculous and nontuberculous cervical lymphadenitis: a clinical review. Otolaryngol Head Neck Surg 2002;126:176-179.

20. Midani S, Ayoub EM, Anderson B. Cat-scratch disease. Adv Pediatr 1996;43:397-422.

21. Lynfield R, Guerina NG. Toxoplasmosis. Pediatr Rev 1997; 18:75-83.

22. Leung AK, Robson WL. Childhood cervical lymphadenopathy. J Pediatr Health Care 2004;18:3-7.

23. Ritchey AK. Lymphadenopathy in children: a concise review. W V Med J 1990;86:402-404.

24. Umapathy N, De R, Donaldson I. Cervical lymphadenopathy in children. Hosp Med 2003;64:104-107.

1. Bamji M, Stone RK, Kaul A, Usmani G, Schachter FF, Wasserman E. Palpable lymph nodes in healthy newborns and infants. Pediatrics 1986;78:573-575.

2. Hall JG. The functional anatomy of lymph nodes. In: Stansfeld AG, editors. Lymph node interpretation. Edinburg, UK: Churchil Livinstone; 1985. p. 1-25.

25. Jaffer S, Zakowski M. Fine-needle aspiration biopsy of axillary lymph nodes. Diagn Cytopathol 2002;26:69-74.

26. Gupta RK, Naran S, Lallu S, Fauck R. Diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes: a study of 210 cases. Diagn Cytopathol 2003;28:175-180.

27. Grossman M, Shiramizu B. Evaluation of lymphadenopathy in children. Curr Opin Pediatr 1994;6:68-76.

28. Perkins SL, Segal GH, Kjeldsberg CR. Work-up of lymphadenopathy in children. Semin Diagn Pathol 1995;12:284-287.

29. Gosche JR, Vick L. Acute, subacute, and chronic cervical lymphadenitis in children. Semin Pediatr Surg 2006;15:99-106.

Quiz

30. Buchino JJ, Jones VF. Fine needle aspiration in the evaluation of children with lymphadenopathy. Arch Pediatr Adolesc Med 1994;148:1327-1330.

31. ∞Ó·ÁÓÒÛÙÔ˘-∫ÂÚ·Ì›‰· ∞, ∞ÓÙˆÓﬁÔ˘ÏÔ˜ ª, ™Â˚Ù·Ó›‰Ë˜ µ, Ã·ï‰¿˜ ™Ù. §ÂÌÊ·‰ÂÓÔ¿ıÂÈÂ˜ ÛÂ ÂÓËÏ›ÎÔ˘˜ Î·È ·È‰È¿. π·ÙÚÈÎ¤˜ ∂Î‰ﬁÛÂÈ˜ “∑‹Ù·” 1996;136-137.

1. ªÈÎÚfi ‚Ú¤ÊÔ˜ 40 ËÌÂÚÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓÈÎ‹ ‰ÈfiÁÎˆÛË ·fi Â‚‰ÔÌ¿‰Ô˜ Î·È ˘ÚÂÙfi.

¶Èı·ÓﬁÙÂÚÔ ·›ÙÈÔ, ÏÔ›ÌˆÍË ·ﬁ:

∞.ÓÂ˘ÌÔÓÈﬁÎÔÎÎÔ

µ.ÛÙÚÂÙﬁÎÔÎÎÔ ÔÌ¿‰·˜ µ

°.·Ó·ÂÚﬁ‚È·

¢.EBV

∂.ÏÈÛÙ¤ÚÈ·

2. ªÈÎÚﬁ ‚Ú¤ÊÔ˜ 3 ÌËÓÒÓ ÚÔÛÎÔÌ›˙ÂÙ·È ÌÂ ‰ÈﬁÁÎˆÛË

∂.ÏÂÌÊ·ÁÁÂ›ˆÌ·

3. ∫ÔÚ›ÙÛÈ 12 ÂÙÒÓ ÚÔÛ¤Ú¯ÂÙ·È ÌÂ ˘Ú¤ÙÈÔ, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ÚÔÛÎÔÌ›˙ÂÈ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ÌÂ ÂÙÂÚﬁÏÂ˘ÚË ‰ÈﬁÁÎˆÛË ÌÂÛÔıˆÚ·Î›Ô˘. ¶ÚÒÙÂ˜ ‰È·ÁÓˆÛÙÈÎ¤˜ ÛÎ¤„ÂÈ˜:

∞.‚ÚÔÁ¯ÈÎﬁ Î·ÚÎ›ÓˆÌ·

µ.Ê˘Ì·Ù›ˆÛË

°.Û·ÚÎÔÂ›‰ˆÛË

¢.ÈÓÔÎ˘ÛÙÈÎ‹ ÓﬁÛÔ˜

∂.ÏÔÈÌÒ‰Ë˜ ÌÔÓÔ˘Ú‹ÓˆÛË

4. ∞ÁfiÚÈ 4 ÂÙÒÓ ·fi ·ÁÚÔÙÈÎ‹ ÂÚÈÔ¯‹ ÚÔÛÎÔÌ›˙ÂÙ·È ÌÂ ˘ÚÂÙfi ·fi 10ËÌ¤ÚÔ˘ Î·È ‹È· ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ™ÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒÓÂÙ·È ˘„ËÏfi˜ ·ÚÈıÌfi˜ ËˆÛÈÓÔÊ›ÏˆÓ (25.000/mm3). ¶Èı·Ó‹

‰È¿ÁÓˆÛË:

∞.ÏÔ›ÌˆÍË ·ﬁ EBV

µ.ÏÔ›ÌˆÍË ·ﬁ ÙÔÍﬁÎ·Ú·

°.ÏÂ˚ÛÌ·Ó›·ÛË

¢.ÏÔ›ÌˆÍË ·ﬁ Â¯ÈÓﬁÎÔÎÎÔ

∂.ÓﬁÛÔ˜ Kawasaki

5. ∂Ó‰Â›ÍÂÈ˜ ÁÈ· ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· ·ÔÙÂÏÔ‡Ó ÔÈ ·Ú·Î¿Ùˆ:

∞.Ì¤ÁÂıÔ˜ ·‰¤Ó· >2 cm

µ.ÛÙ·ÛÈÌﬁÙËÙ·

∞. ª·ÓÒÏ·1, ∞. ª¿ÎË˜1, Ã. ∆Û·Ô‡ÛË2, ¡. Ã·ÏÈ¿ÛÔ˜1, ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘1

¶ÂÚ›ÏË„Ë: ∏ ‚ÚÔ˘Î¤ÏÏˆÛË Â›Ó·È ÌÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹ ˙ˆÔ·ÓıÚˆÔÓﬁÛÔ˜, Ô˘ ÂÓ‰ËÌÂ› ÛÂ ÔÚÈÛÌ¤ÓÂ˜

ÂÚÈÔ¯¤˜ ÙË˜ ∂ÏÏ¿‰·˜. ™Ù· ·È‰È¿ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ·‚ÏË¯Ú¿ Û˘ÌÙÒÌ·Ù·, fiˆ˜ ˘ÚÂÙfi˜, Î·ÎÔ˘¯›·, ·ÓÔÚÂÍ›·, ·ÚıÚ·ÏÁ›Â˜, Ì˘·ÏÁ›Â˜, ÛÏËÓÔÌÂÁ·Ï›· Î·È ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ∫·Ù¿ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ ·Ó·Ê¤ÚÔÓÙ·È ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ·Ó·ÈÌ›·, ·ÈÌfiÏ˘ÛË, ÏÂ˘ÎÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· ‹ ·ÓÎ˘ÙÙ·ÚÔÂÓ›·. ∏ ıÚÔÌ‚ÔÂÓ›· Â›Ó·È Û˘Ó‹ıˆ˜ ‹È·, ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÈÏÔÎ¤˜. ™¿ÓÈ·, Ì¤Ûˆ ·ÓÔÛÔÏÔÁÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡, ÌÔÚÂ› Ó· ÚÔÎÏËıÂ› ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›·, ÌÂ ÛËÌ·ÓÙÈÎ¤˜ ÎÏÈÓÈÎ¤˜ ÂÈ-

ÙÒÛÂÈ˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ÌÂ ÂÎÛÂÛËÌ·ÛÌ¤ÓË ıÚÔÌ‚ÔÂÓ›· Î·È ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÎ-

‰ËÏÒÛÂÈ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÓfiÛËÛË˜ ·fi Brucella melitensis. ∏ ıÂÚ·Â›· ÌÂ Á-ÛÊ·ÈÚ›ÓË, ÛÂ Û˘Ó‰˘·ÛÌfi

ÌÂ Î·Ù¿ÏÏËÏË ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ÁÈ· ÙË ‚ÚÔ˘Î¤ÏÏ·, Ô‰‹ÁËÛÂ ÛÂ ÁÚ‹ÁÔÚË ·ÔÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÚÈıÌÔ‡

ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎﬁÓ·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: £ÚÔÌ‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú·, ‚ÚÔ˘Î¤ÏÏˆÛË.

Thrombocytopenic purpura in a child with brucellosis: case report and literature review

∞. ªanola1, ∞. ªakis1, C. ∆saousi2, ¡. Chaliasos1, ∞. Siamopoulou-Mavridou1

Abstract: Brucellosis is still endemic and continues to be a significant public health problem in many parts of Greece. It is a multisystemic disease with a broad spectrum of clinical manifestations, including haematological disorders, such as anaemia, pancytopenia, leucopenia and thrombocytopenia. Thrombocytopenia is usually moderate and attributed to bone marrow suppression or hypersplenism. Rarely, autoimmune stimulation can cause severe thrombocytopenia with clinically significant haemorrhagic manifestations. The case is presented of a girl with severe thrombocytopenic purpura as one of the presenting symptoms of Brucella melitensis infection. Treatment with intravenous immunoglobulin and the appropriate antimicrobial agents promptly resulted in the platelet counts returning to normal.

Key words: Thrombocytopenic purpura, brucellosis. ∂ÈÛ·ÁˆÁ‹

ÛÔ˜ Ô˘ ÂÓ‰ËÌÂ› ÛÙË µÔÚÂÈÔ‰˘ÙÈÎ‹ ∂ÏÏ¿‰· (1)

Î·È ÔÊÂ›ÏÂÙ·È ÛÂ Gram ·ÚÓËÙÈÎ¿ ‚·ÎÙËÚ›‰È·

ÙÔ˘ Á¤ÓÔ˘˜ Brucellae. ∏ Brucella melitensis

ÚÔÎ·ÏÂ› ÙËÓ ÈÔ ÛËÌ·ÓÙÈÎ‹ ÓﬁÛËÛË ÛÙÔÓ ¿Ó-

ıÚˆÔ (2,3). ™ÙÔÓ ·È‰È·ÙÚÈÎﬁ ÏËı˘ÛÌﬁ, Ë

ÏÔ›ÌˆÍË ÚÔÎ·ÏÂ›Ù·È ·ﬁ ¿ÌÂÛË Â·Ê‹ ÌÂ Ù·

ÌÔÏ˘ÛÌ¤Ó· ˙Ò· Î·È Ù· ˘ÁÚ¿ ÙÔ˘˜ Î·È ·ﬁ Î·-

Ù·Ó¿ÏˆÛË ÌË ·ÛÙÂÚÈˆÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ‹ Á·-

Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ (4). ∫·Ù¿ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ ·Ó·Ê¤ÚÔÓÙ·È ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ·Ó·ÈÌ›·, ·ÈÌfiÏ˘ÛË, ÏÂ˘ÎÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· ‹ ·ÓÎ˘ÙÙ·ÚÔÂÓ›· (5). √È Î˘ÚÈfiÙÂÚÔÈ ÌË¯·ÓÈÛÌÔ› ÚfiÎÏËÛË˜ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ Â›Ó·È Ë ¿ÌÂÛË ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, Ô ˘ÂÚÛÏËÓÈÛÌfi˜, Ë ·ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË Î·È Ë ÂÓÂÚÁÔÔ›ËÛË ·ÓÔ-

ÛÔÏÔÁÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡ ÌÂ ‰ËÌÈÔ˘ÚÁ›· ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ (1,6-11). ∏ ıÚÔÌ‚ÔÂÓ›· Ô˘ ‰È·ÈÛÙÒÓÂÙ·È ÛÙË ‚ÚÔ˘Î¤ÏÏˆÛË Â›Ó·È Û˘Ó‹ıˆ˜ ‹È·, ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÈÏÔÎ¤˜ (1,5,6). ™¿ÓÈ·, Ì¤Ûˆ ·ÓÔÛÔÏÔÁÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡, ÌÔÚÂ› Ó· ÚÔÎÏËıÂ› ÛÔ‚·-

Ú‹ ıÚÔÌ‚ÔÂÓ›· ÌÂ ÛËÌ·ÓÙÈÎ¤˜ ÎÏÈÓÈÎ¤˜ ÂÈÙÒÛÂÈ˜. ∞Ó·Ê¤ÚÂÙ·È ﬁÙÈ ÌÔÚÂ› Ó· ÂÌÊ·ÓÈ-

ˆ˜

1 Department of Paediatrics, University Hospital of Ioannina

2 Haematology Laboratory, University Hospital of Ioannina

Correspondence: Alexandros Makis amakis@cc.uoi.gr

Department of Paediatrics, University Hospital of Ioannina

∞ÈÌ·ÙÔÎÚ›ÙË˜, %36,833,337,636,638,8

∞ÈÌÔÛÊ·ÈÚ›ÓË, g/dl12,511,412,612,112,9

∞ÈÌÔÂÙ¿ÏÈ·, /mm3 3.0001.000218.000503.000315.000

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

¶ÚﬁÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ 5,5 ÂÙÒÓ ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈÛÂ

˘ÚÂÙﬁ ¤ˆ˜ 38,5ÔC, ‰È¿ÚÎÂÈ·˜ ¤ÍÈ ËÌÂÚÒÓ, Î˘Ú›ˆ˜ ÙÈ˜

·ÔÁÂ˘Ì·ÙÈÓ¤˜ ÒÚÂ˜. ø˜ Û˘ÓÔ‰ﬁ Û‡ÌÙˆÌ· ·Ó·Ê¤Ú-

ıËÎÂ ¿ÏÁÔ˜ ÛÙË ‰ÂÍÈ¿ Ë¯ÂÔÎ·ÚÈÎ‹ ¿ÚıÚˆÛË Î·È

ÛÙËÓ ¿ÚıÚˆÛË ÙÔ˘ ‰ÂÍÈÔ‡ ·ÁÎÒÓ·. ∏ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘

ÎÔÚÈÙÛÈÔ‡ ‰È·Ì¤ÓÂÈ ÛÙË £ÂÛÚˆÙ›· Î·È ·Û¯ÔÏÂ›Ù·È ÌÂ

ÙËÓ ÎÙËÓÔÙÚÔÊ›·. ∞Ó·Ê¤ÚıËÎÂ ﬁÙÈ ÙÔ ·È‰› Â›¯Â Î·-

Ù·Ó·ÏÒÛÂÈ Á·Ï·ÎÙÔÎÔÌÈÎ¿ ÚÔ˚fiÓÙ· Ô˘ Â›¯·Ó ·Ú·ÛÎÂ˘·ÛÙÂ› ÚfiÛÊ·Ù· ·fi

ÚÔ

ÂÈÛ·ÁˆÁ‹˜ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ÂÍÂÙ¿ÛÙËÎÂ ÛÂ ¿ÏÏÔ ÓÔÛÔÎÔÌÂ›Ô, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆıÔ‡Ó ·ÍÈfiÏÔÁ· Â˘Ú‹Ì·Ù· ·fi ÙÈ˜ ·ÚıÚÒÛÂÈ˜ ‹ ·fi Ù· ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 7.200/mm3, ·ÈÌÔÂÙ¿ÏÈ· 180.000/mm3, ·ÈÌ·ÙÔÎÚ›ÙË˜ 40%, ·ÈÌÔÛÊ·ÈÚ›ÓË 13,1 g/dl, ∆∫∂ 19 mm (1Ë ÒÚ·), CRP 10 mg/L, Monotest ·ÚÓËÙÈÎfi, AST 62 U/L, ‰ÔÎÈÌ·Û›· Û˘ÁÎfiÏÏËÛË˜ Wright ıÂÙÈÎ‹ (Ù›ÙÏÔ˜ 1/1280), Rose Bengal ·ÚÓËÙÈÎ‹. ªÂ ‚¿ÛË Ù· Û˘ÌÙÒÌ·Ù· Î·È ÙË ıÂÙÈÎ‹ Wright, ¤ÁÈÓÂ ¤Ó·ÚÍË ıÂÚ·Â›·˜ ÁÈ· ‚ÚÔ˘Î¤ÏÏˆÛË. ÃÔÚËÁ‹ıËÎÂ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË (10 mg/kg/ËÌ¤Ú·) Î·È ÚÈÊ·ÌÈÎ›ÓË (15 mg/kg/ËÌ¤Ú·) ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜.

∆ËÓ ÙÚ›ÙË ËÌ¤Ú· ·ÁˆÁ‹˜ ÂÌÊ·Ó›ÛÙËÎÂ ÁÂÓÈÎÂ˘-

Ì¤ÓÔ ÂÙÂ¯ÂÈÒ‰Â˜ ÂÍ¿ÓıËÌ· Î·È ‰È·ÈÛÙÒıËÎÂ ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· 3.000/mm3, ÔﬁÙÂ ÙÔ ·È‰› ·Ú·¤ÌÊıËÎÂ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜. ™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ‰È·ÈÛÙÒıËÎÂ ıÂÚ-

ÌÔÎÚ·Û›· 38,8ÔC, ÁÂÓÈÎÂ˘Ì¤ÓÔ ÂÙÂ¯ÂÈÒ‰Â˜-ÔÚÊ˘-

ÚÈÎﬁ ÂÍ¿ÓıËÌ· Î·È ÂÎ¯˘ÌÒÛÂÈ˜, ˘ÁÚ‹ ÔÚÊ‡Ú· ÛÙËÓ

˘ÂÚÒ· Î·È ·ÈÌÔÚÚ·Á›· ÛÙ· Ô‡Ï·, ÂÓÒ Ô ÛÏ‹Ó·˜

Î·È ÙÔ ‹·Ú ‹Ù·Ó ÌﬁÏÈ˜ „ËÏ·ÊËÙ¿. ¢ÂÓ ‰È·ÈÛÙÒıË-

Î·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ·fi ÙÈ˜ ·ÚıÚÒÛÂÈ˜, Ô‡ÙÂ ·fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù·.

√ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 7.510/mm3 (Ô˘‰ÂÙÂÚfiÊÈÏ· 45%, ÏÂÌÊÔÎ‡ÙÙ·Ú· 52%, ÌÔÓÔÎ‡ÙÙ·Ú· 3%), ·ÈÌÔÂÙ¿ÏÈ· 1.000/mm3,·ÈÌÔÛÊ·ÈÚ›ÓË 12 g/dl, ∆∫∂ 15 mm (1Ë ÒÚ·), CRP 7 mg/L, AST 64 U/L, ALT 47 U/L, Á-GT 35 U/L, Ô˘Ú›· 20 mg/dl, ÎÚÂ·ÙÈÓ›ÓË 0,8 mg/dl, ÔÏÈÎ‹ ¯ÔÏÂÚ˘ıÚ›ÓË 0,7 mg/dl. ∏ ‰ÔÎÈÌ·Û›· Û˘ÁÎfiÏÏËÛË˜ Wright ‚Ú¤ıËÎÂ ıÂÙÈÎ‹ (Ù›ÙÏÔ˜ 1/1280), fiˆ˜ Â›ÛË˜ Î·È Ù· ÂÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù· IgM, IgA ¤Ó·ÓÙÈ ÙË˜ Brucella melitensis

∆· ÂÈ‰ÈÎ¿ IgG ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈÎ¿. √È Î·Ï-

ÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜ ‹Ù·Ó ÛÙÂ›ÚÂ˜. ∏ ¿ÌÂÛË Î·È ¤ÌÌÂÛË Coomb’s ‹Ù·Ó ·ÚÓËÙÈÎ¤˜. √ ÔÛÔÙÈÎﬁ˜ ÚÔÛ-

‰ÈÔÚÈÛÌﬁ˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ IgG, IgM, IgA Î·È

ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜

‹Ù·Ó ÂÓÙﬁ˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. ∆· ·ÓÙÈ˘ÚËÓÈÎ¿

·ÓÙÈÛÒÌ·Ù·, Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ‰ÈÏ‹˜ ¤ÏÈÎ·˜

ÙÔ˘ DNA Î·È Ô ÚÂ˘Ì·ÙÔÂÈ‰‹˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó ·Ú-

¤ÏÂÁ¯Ô˜.

§fiÁˆ ÙÔ˘ ÔÏ‡ ¯·ÌËÏÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ ·fi ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, ¯ÔÚËÁ‹ıËÎÂ Á-ÛÊ·ÈÚ›ÓË (2 g/kg ÛÂ ‰‡Ô ËÌ¤ÚÂ˜), Î·È ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ÌÂ ·ÌÈÎ·Û›ÓË ÂÓ‰ÔÊÏ¤‚È· (15 mg/kg/ËÌ¤Ú· ÁÈ· ÂÙ¿ ËÌ¤ÚÂ˜), ÂÓÒ Û˘ÓÂ¯›ÛÙËÎÂ Ë ÚÈÊ·ÌÈÎ›ÓË ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜. ¢ÈÂÎfiË Ë ¯ÔÚ‹ÁËÛË ÙÚÈÌÂıÔÚ›ÌË˜-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË˜, ‰ÈfiÙÈ Ù¤ıËÎÂ Ë ˘Ô„›· ÚfiÎÏËÛË˜ ÙË˜ ıÚÔÌ‚ÔÂÓ›·˜ ·fi ÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ Ê¿ÚÌ·ÎÔ (13).

¶·Ú·ÙËÚ‹ıËÎÂ ÛÙ·‰È·Î‹ ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ¤ÓÙÂ ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜ Ô ·ÚÈıÌfi˜ ÙÔ˘˜ ¤ÊÙ·ÛÂ Ù· 218.000/mm3. ™ÙË Ê¿ÛË ·˘Ù‹ ¤ÁÈÓÂ ‰ÔÎÈÌ·ÛÙÈÎ‹ Â·Ó¤Ó·ÚÍË ÙË˜ ÙÚÈÌÂıÔÚ›ÌË˜-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË˜ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ¯ˆÚ›˜ Ó· ˘¿ÚÍÂÈ ·ÚÓËÙÈÎ‹ Â›‰Ú·ÛË ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ∞ÓÙ›ıÂÙ·, Ë ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Û˘ÓÂ¯›ÛÙËÎÂ Ì¤¯ÚÈ Î·È Ù· 503.000/mm 3. √ ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛÂ ÙË ‰Â‡ÙÂÚË ËÌ¤Ú· ÓÔÛËÏÂ›·˜, ÂÓÒ ‰ÂÓ ÂÌÊ·Ó›ÛÙËÎ·Ó Ó¤Â˜ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô, Â‰fiıË ·ÁˆÁ‹ ÌÂ ÚÈÊ·ÌÈÎ›ÓË Î·È ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·-

ÌÂıÔÍ·˙ﬁÏË ÁÈ· Û˘ÓÔÏÈÎ¿ ¤ÍÈ Â‚‰ÔÌ¿‰Â˜. ∏ ·ÛıÂÓ‹˜ ¤Ï·‚Â ÙËÓ ·ÁˆÁ‹ ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù· Î·È

‚ÏÂÓÓÔÁﬁÓÔ˘˜. À‹Ú¯Â, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ÛÔ‚·Úﬁ˜ Î›Ó‰˘-

ÓÔ˜ ÂÛˆÙÂÚÈÎ‹˜ ‹ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ·Ó·-

ÁÎ·ÈfiÙËÙ· ¿ÌÂÛË˜ ·Ú¤Ì‚·ÛË˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ¯Ô-

ÚËÁ‹ıËÎÂ Á-ÛÊ·ÈÚ›ÓË Î·È ÂÓ‰ÔÊÏ¤‚È· ·ÁˆÁ‹ ÌÂ ·ÌÈ-

ÓÔÁÏ˘ÎÔÛ›‰Ë, ÌÂ Ù·¯Â›· Î·È ÛËÌ·ÓÙÈÎ‹ ¿ÓÔ‰Ô ÙÔ˘

·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ÕÏÏÔ ı¤Ì· ÚÔ˜ Û˘˙‹ÙË-

ÛË Â›Ó·È Ë Èı·ÓﬁÙËÙ· Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ

Ô˘ ‹‰Ë ÂÏ¿Ì‚·ÓÂ Ë ·ÛıÂÓ‹˜ ÛÙËÓ ÚﬁÎÏËÛË ÙË˜

ıÚÔÌ‚ÔÂÓ›·˜. ∏ ÚÈÊ·ÌÈÎ›ÓË Â›Ó·È ¤Ó· Ê¿ÚÌ·ÎÔ Ô˘

ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ıÚÔÌ‚ÔÂÓ›·, Ë ÔÔ›· ﬁÌˆ˜ Â›-

Ó·È Û˘Ó‹ıˆ˜ ‹È· Î·È ÎÏÈÓÈÎ¿ ÌË ÛËÌ·ÓÙÈÎ‹, ÂÓÒ Ë

ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙ﬁÏË ÂÓ›ÔÙÂ ÌÔÚÂ› Ó·

ÚÔÎ·Ï¤ÛÂÈ ÛÔ‚·Ú‹ ÙÒÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÌÂ ÛËÌ·ÓÙÈÎ¤˜ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ (13).

ø˜ ÂÎ ÙÔ‡ÙÔ˘, ·ÔÊ·Û›ÛÙËÎÂ Ó· ‰È·ÎÔÂ› ÌfiÓÔ Ë ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË. ¢Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ·ÛıÂÓ‹˜ ¤ÚÂÂ Ó· Û˘ÓÂ¯›ÛÂÈ ‰ÈÏ‹ ·ÓÙÈÌÈÎÚÔ‚È·Î‹

·ÁˆÁ‹ Î·È ÌÂÙ¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÁÈ· Û˘ÓÔÏÈÎ¿ ¤ÍÈ Â‚‰ÔÌ¿‰Â˜, ·ÔÊ·Û›ÛÙËÎÂ Ó· Û˘ÓÂ¯ÈÛÙÂ› Ë

ÚÈÊ·ÌÈÎ›ÓË˜. ¶ÚÔ˜ ·ÔÎÏÂÈÛÌﬁ ÙË˜ Èı·Ó‹˜ Ê·ÚÌ·-

ÎÂ˘ÙÈÎ‹˜ ıÚÔÌ‚ÔÂÓ›·˜ ·ﬁ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙ﬁÏË, Î·È ·ÊÔ‡ ÛÙ·ıÂÚÔÔÈ‹ıËÎÂ Ë Î·Ù¿ÛÙ·-

ÛË ÙË˜ ·ÛıÂÓÔ‡˜, ¤ÁÈÓÂ Â·Ó·¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÂÎÙ›ÌËÛË ÂÎ Ó¤Ô˘ ÙË˜ ÂÈÎﬁÓ·˜ ÙÔ˘ ÂÚÈÊÂÚÈ-

ÎÔ‡ ·›Ì·ÙÔ˜. ∏ ÛÙ·ıÂÚÔÔ›ËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È-

ÌÔÂÙ·Ï›ˆÓ Ì¿˜ ·ÔÌ¿ÎÚ˘ÓÂ ·ﬁ ÙËÓ ·Ú¯ÈÎ‹ ÛÎ¤„Ë

ÙË˜ Èı·Ó‹˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ıÚÔÌ‚ÔÂÓ›·˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÂ ÂÚÈÔ¯¤˜ ÙË˜ ∂ÏÏ¿‰·˜ ﬁÔ˘

ÂÓ‰ËÌÂ› ·ÎﬁÌË Ë ‚ÚÔ˘Î¤ÏÏˆÛË, Ë ÓﬁÛÔ˜ ·˘Ù‹ ı·

Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿-

ÁÓˆÛË, ÛÂ ÂÚÈÙÒÛÂÈ˜ È‰ÈÔ·ıÔ‡˜ ıÚÔÌ‚ÔÂÓÈÎ‹˜

ÔÚÊ‡Ú·˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ

ı· Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È ÛÂ Î¿ıÂ ·ÛıÂÓ‹,

ÔˆÛ‰‹ÔÙÂ ﬁÌˆ˜ Ë ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›ÓË˜ ‹ ÎÔÚ-

ÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ‚ÔËı¿ ÛËÌ·ÓÙÈÎ¿, ÂÓÒ Ë ÙÂÏÈÎ‹ Î·È

Î‡ÚÈ· Â›Ï˘Û‹ ÙÔ˘˜ Â¤Ú¯ÂÙ·È ÌÂ ÙËÓ Î·Ù¿ÏÏËÏË

·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Galanakis E, Bourantas KL, Leveidiotou S, Lapatsanis PD. Childhood brucellosis in North-Western Greece: a retrospective analysis. Eur J Pediatr 1996;155:1-6.

2. ÀÔung EJ. An overview of human brucellosis. Clin Infect Dis 1995;21:283-289.

3. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005;352:2325-2336.

4. ∞l-Eissa YA, Kambal AM, al-Nasser MN, al-Habib SA, alFawaz IM, al-Zamil FA. Childhood brucellosis: a study of 102 cases. Pediatr Infect Dis J 1990;9:74-79.

5. ª·˘ÚÔÎÒÛÙ· ª, °·Ï·Ó¿ÎË˜ ∂. ¡ÔÛËÚﬁÙËÙ· Î·È ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ‚ÚÔ˘Î¤ÏÏˆÛË˜ ÛÙËÓ ∂ÏÏ¿‰·. ¶·È‰È·ÙÚÈÎ‹ 2006;69:37-44.

6. Shalev H, Abramson O, Levy J. Hematological manifestations of brucellosis in children. Pediatr Infect Dis J 1994; 13:543-545.

7. ∞l-Eissa Y, al-Nasser M. Haematological manifestations of childhood brucellosis. Infection 1993;21:23-26.

8. Galanakis E, Bourantas KL, Kefallinou A, Kakossimos G, Lapatsanis P. Haematological findings in childhood brucellosis. Paediatrics North Greece 1994;6:146-151.

9. Aysha MH, Shayib MA. Pancytopenia and other haematological findings in brucellosis. Scand J Haematol 1984; 36:335-338.

10. Crosby E, Llosa L, Miro Quesada M, Carrillo C, Gotuzzo E. Hematologic changes in brucellosis. J Infect Dis 1984;150: 419-424.

11. Pappas G, Kitsanou M, Christou L, Tsianos E. Immune thrombocytopenia attributed to brucellosis and other mechanisms of Brucella-induced thrombocytopenia. Am J Hematol 2004;75:139-141.

12. Yilmaz M, Tiryaki O, Namiduru M, Okan V, Oguz A, Buyukhatipoglu H, et al. Brucellosis-induced immune thrombocytopenia mimicking ITP: a report of seven cases. Int J Lab Hematol. 2007;29:442-445.

13. Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med 2007;357:580-587.

14. ∆igano F, Larosa F. Brucellosis of hemorrhagic origin. Clinical and pathogenic considerations. Riforma Med 1964;78:684-690.

15. Benjamin B, Annobil SH. Childhood brucellosis in southwestern Saudi Arabia: a 5-year experience. J Trop Pediatr 1992;38:167-172.

16. Benjamin B. Acute thrombocytopenic purpura in childhood brucellosis. Ann Trop Paediatr 1995;15:189-192.

17. Benecos P, Spingou T, Galanakis E, Lapatsanis PD. Thrombocytopenic purpura secondary to brucellosis. Eur J Pediatr 1998;157:698.

18. Young EJ, Tarry A, Genta RM, Ayden N, Gotuzzo E. Thrombocytopenic purpura associated with brucellosis: report of 2 cases and literature review. Clin Infect Dis 2000;31:904-909.

19. Sevinc A, Kutlu NO, Kuku I, Ozgen U, Aydogdu I, Soylu H. Severe epistaxis in brucellosis-induced isolated thrombocytopenia: a report of two cases. Clin Lab Haematol 2000;22:373-375.

20. Marom R, Miron D, Gabriel H, Horowitz Y. Thrombocytopenic purpura as sole manifestation of brucellosis in children. Harefuah 2000;139:278-279.

21. El-Amin EO, George L, Kutty NK, Sharma PP, Choithramani RS, Jhaveri VP, et al. Brucellosis in children of Dhofar Region, Oman. Saudi Med J 2001;22:610-615.

22. Yaramis A, Kervancioglu M, Yildirim I, Soker M, Derman O, Tas MA. Severe microangiopathic hemolytic anemia and thrombocytopenia in a child with Brucella infection. Ann Hematol 2001;80:546-548.

23. Tsirka A, Markesinis I, Getsi V, Chaloulou S. Severe thrombocytopenic purpura due to brucellosis. Scand J Infect Dis 2002;34:535-536.

24. Tsolia M, Drakonaki S, Messaritaki A, Farmakakis T, Kostaki M, Tsapra H, et al. Clinical features, complications and treatment outcome of childhood brucellosis in central Greece. J Infect 2002;44:257-262.

25. Yalaz M, Arslan MT, Kurugöl Z. Thrombocytopenic purpura as only manifestation of brucellosis in a child. Turk J Pediatr 2004;46:265-267.

¶·È‰› ÌÂ “ÏÂÈÙÔ˘ÚÁÈÎﬁ” Ê‡ÛËÌ·

N. ∞Ó·ÁÓˆÛÙ¿ÙÔ˘, π. °ÂÚÌ·Ó¿ÎË˜, ª. ∫·ÏÌ·ÓÙ‹

“Innocent” heart murmur in a child

N. Anagnostatou, I. Germanakis, M. Kalmanti

∞ÁfiÚÈ ËÏÈÎ›·˜ 3,5 ÂÙÒÓ ÚÔÛ‹ÏıÂ ÛÙÔ ¶·È‰ÔÎ·Ú‰ÈÔÏÔÁÈÎfi ÂÍˆÙÂÚÈÎfi È·ÙÚÂ›Ô ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜

∫ÏÈÓÈÎ‹˜, ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË Ê˘Û‹Ì·ÙÔ˜.

¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ 2Ô Ù¤ÎÓÔ Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ÌÂ ·ÚÓËÙÈÎfi Î·Ú‰ÈÔÏÔÁÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ÂÚ›Ô‰Ô˜ ·Ó·Ê¤ÚÂÙ·È ÂÏÂ‡ıÂ-

ÚË. ∏ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË Î·È Ë ÛˆÌ·ÙÈÎ‹ ÙÔ˘ ·Ó¿Ù˘ÍË ‹Ù·Ó ·fiÏ˘Ù· Û˘Ì‚·Ù‹ ÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚıËÎ·Ó Û˘¯Ó¤˜

ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Û˘¯Ó‹ ¯Ú‹ÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÒÓ ÁÈ· ‚ÚÔÁ¯ﬁÛ·ÛÌÔ, Ô˘ ÂÌÊ¿ÓÈ˙Â Î˘Ú›ˆ˜ Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

∆Ô Î·Ú‰È·Îfi Ê‡ÛËÌ· Â›¯Â Á›ÓÂÈ ·ÓÙÈÏËÙfi ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÂ ËÏÈÎ›· 1 ¤ÙÔ˘˜ ·fi ÙÔÓ ·È‰›·ÙÚfi

ÙÔ˘˜ Î·È ıÂˆÚ‹ıËÎÂ ˆ˜ Û‡ÓËıÂ˜ “ÏÂÈÙÔ˘ÚÁÈÎﬁ” Ê‡-

ÛËÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. §ﬁÁˆ ÂÌÌÔÓ‹˜ ÙÔ˘ Ê˘Û‹Ì·ÙÔ˜ Î·È Û˘ÓÔ‰Ô‡ ·ÓËÛ˘¯›·˜ ÙˆÓ ÁÔÓ¤ˆÓ, ¤ÁÈÓÂ ·Ú·ÔÌ‹ ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ Â˘Ú‹Ì·ÙÔ˜.

∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, ÙÔ ·È‰› Â›¯Â Ê˘ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÙ˘Ô ¯ˆÚ›˜ ‰˘ÛÌÔÚÊ›Â˜, Î·Ï‹ ·Ó¿Ù˘ÍË, Ê˘ÛÈÔÏÔÁÈÎfi ·Ó·ÓÂ˘ÛÙÈÎfi „Èı‡ÚÈÛÌ· ¯ˆÚ›˜ Ù·¯‡ÓÔÈ· ‹ Î˘¿ÓˆÛË (Sat 98%), ÌfiÏÈ˜ „ËÏ·ÊËÙfi ‹·Ú, „ËÏ·ÊËÙ¤˜ ÌËÚÈ·›Â˜ ¯ˆÚ›˜ ‰È·ÊÔÚ¿ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ¿Óˆ-Î¿Ùˆ ¿ÎÚˆÓ (BP = 98/75 mmHg). ¢ÂÓ ˘‹Ú¯Â „ËÏ·ÊËÙfi˜

ÚÔ›˙Ô˜ ÛÙËÓ „ËÏ¿ÊËÛË ÙË˜ ÚÔÎ¿Ú‰È·˜ ¯ÒÚ·˜ Î·È ÙÔ˘ ÛÊ·ÁÈÙÈ‰ÈÎÔ‡ ‚fiıÚÔ˘. ™ÙËÓ Î·Ú‰È·Î‹ ·ÎÚfi·ÛË Â›¯Â Ú˘ıÌÈÎ‹ Î·Ú‰È·Î‹ ÏÂÈÙÔ˘ÚÁ›·. ŒÓ· ‹ÈÔ (2/6) Û˘ÛÙÔÏÈÎfi Ê‡ÛËÌ·, ÌÂ ¯·Ú·ÎÙ‹Ú· crescendo-decrescendo ÛÙË ÌÂÙ·‚ÔÏ‹ ÙË˜ ¤ÓÙ·Û‹˜ ÙÔ˘ ÌÂ ÙÔ ¯ÚfiÓÔ Î·È Ì¤ÁÈÛÙË ¤ÓÙ·ÛË ÛÙÔ 2Ô ÌÂÛÔÏÂ‡ÚÈÔ ‰È¿ÛÙËÌ· ·ÚÈÛÙÂÚ¿ ·Ú·ÛÙÂÚÓÈÎ¿ ‹Ù·Ó ·ÓÙÈÏËÙfi. √ ÚÒÙÔ˜ Î·Ú‰È·Îfi˜ ÙfiÓÔ˜

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ‰ÂÓ ˘‹Ú¯·Ó ¿ÏÏÔÈ ÚfiÛıÂÙÔÈ ‹¯ÔÈ, Ô ‰Â‡ÙÂÚÔ˜ Î·Ú‰È·Îfi˜ ÙfiÓÔ˜ ÂÌÊ¿ÓÈ˙Â ÛÙ·ıÂÚfi ‰È¯·ÛÌfi ÙfiÛÔ ÛÙËÓ ÂÈÛÓÔ‹ fiÛÔ Î·È ÛÙËÓ ÂÎÓÔ‹ (∂ÈÎfiÓ· 1). ™ÙÔ ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· Î·Ù·ÁÚ¿ÊËÎ·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ ÊÏÂ‚ÔÎÔÌ‚ÈÎfi˜ Ú˘ıÌfi˜, ˘„ËÏ¿ Â¿ÚÌ·Ù· ÎÔÏÈÎ‹˜ ÂÎfiÏˆÛË˜ (ÓÂ˘ÌÔÓÈÎ¿ p) Î·È ·ÙÂÏ‹˜ ‰ÂÍÈfi˜ ÛÎÂÏÈÎfi˜ ·ÔÎÏÂÈÛÌfi˜ ÎÔÈÏÈ·Î‹˜ ÂÎfiÏˆÛË˜ (∂ÈÎfiÓ· 2).

∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ó¤‰ÂÈÍÂ ·˘ÍËÌ¤ÓÔ

‰È¯·ÛÌfi˜ ÙÔ˘ 2Ô˘ ÙfiÓÔ˘ (S2) (·ÚÈÛÙÂÚ¿) Î·È Û˘ÛÙÔÏÈÎfi Ê‡ÛËÌ· ÌÈÎÚ‹˜

¤ÓÙ·ÛË˜ ÌÂÙ·Í‡ 1Ô˘ (S1) Î·È 2Ô˘ ÙﬁÓÔ˘ (S2) (‰ÂÍÈ¿).

∂ÈÎﬁÓ· 2. ∏ÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ‹ Î·Ù·ÁÚ·Ê‹ ‰ÂÍÈ¿˜

ÚÔÎ¿Ú‰È·˜ ··ÁˆÁ‹˜ V1, ÌÂ ·ÚÔ˘Û›· ˘„ËÏÒÓ

Â·ÚÌ¿ÙˆÓ p ·ÎÔÏÔ˘ıÔ‡ÌÂÓˆÓ ·fi ·ÙÂÏ‹ ‰ÂÍÈfi ÛÎÂÏÈÎfi

·ÔÎÏÂÈÛÌﬁ (rsR).

∂ÈÎﬁÓ· 3. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜. ªÂÁ·ÏÔÎ·Ú‰›·, ÌÂ

ÚÔ‚ÔÏ‹ ÙÔ˘ ÙﬁÍÔ˘ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜ (‚¤ÏÔ˜).

Î·Ú‰ÈÔıˆÚ·ÎÈÎfi ‰Â›ÎÙË (0.61), ÚÔ‚ÔÏ‹ ÙÔ˘ ÙfiÍÔ˘ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ Î·È ·˘ÍËÌ¤ÓË ÓÂ˘ÌÔÓÈÎ‹ ·ÁÁÂ›ˆÛË (∂ÈÎfiÓ· 3). ¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂÈ˜: 1. §ÂÈÙÔ˘ÚÁÈÎfi Ê‡ÛËÌ· 2. ¶ÓÂ˘ÌÔÓÈÎ‹

¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∏Ú·ÎÏÂ›Ô˘ AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓË˜ °ÂÚÌ·Ó¿ÎË˜ germjohn@med.uoc.gr ¶·È‰ÔÎ·Ú‰ÈÔÏÔÁÈÎ‹ ªÔÓ¿‰·, ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °.¡. ∏Ú·ÎÏÂ›Ô˘, µÔ‡ÙÂ˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

Department of Pediatrics University Hospital of Heraklion, Crete

Correspondence: Ioannis Germanakis germjohn@med.uoc.gr Pediatric Cardiology Unit Dept of Pediatrics University Hospital Heraklion, Crete

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜

∞ÏÏËÏÔÁÚ·Ê›·:

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜ emmgalan@med.uoc.gr

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹

¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜

Department of Paediatrics, University of Crete

Correspondence:

Emmanouil Galanakis

emmgalan@med.uoc.gr

Department of Paediatrics, University of Crete

∞ÏÁﬁÚÈıÌÔÈ,

2008

Algorithms, Recommendations, Guidelines and Scientific Statements 2008

E. Galanakis

ÌÂÙ¿ ÂÌ‚ÔÏÈ·ÛÌﬁ

(ÂÚ›Ô˘ 1:50.000 ‰ﬁÛÂÈ˜ ‰ÈÊıÂÚ›ÙÈ‰·˜ÙÂÙ¿ÓÔ˘-ÎÔÎÎ‡ÙË ¤ˆ˜ 1:500.000-1:1.000.000

ÁÈ· Ù· ˘fiÏÔÈ· ÂÌ‚fiÏÈ·). øÛÙfiÛÔ ‰ÂÓ ÌÔ-

ÚÔ‡Ó Ó· ·ÁÓÔËıÔ‡Ó, Î·ıÒ˜ ﬁÏ· Ù· ·È‰È¿ ÂÌ-

‚ÔÏÈ¿˙ÔÓÙ·È Î·È Ì¿ÏÈÛÙ· ÌÂ ·ÚÎÂÙ¤˜ ‰ﬁÛÂÈ˜ ÂÌ-

‚ÔÏ›ˆÓ. ™ÙÔ ÙÂ‡¯Ô˜ ™ÂÙÂÌ‚Ú›Ô˘ ÙÔ˘ Pediatrics (2008;122:e771-7), ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È

·ﬁ ÙÔ Hypersensitivity Working Group of the Clinical Immunization Safety Assessment (CISA) Network, ∏¶∞, Û¯ÂÙÈÎ¤˜ Ô‰ËÁ›Â˜ Î·È

·ÏÁﬁÚÈıÌÔ˜ Û¯ÂÙÈÎ¿ ÌÂ Ù· ÂÍ‹˜: ·) Ï‹„Ë ÈÛÙÔ-

ÚÈÎÔ‡ Î·È ÔÚıÔÏÔÁÈÎ‹ ·ÍÈÔÏﬁÁËÛË ÙˆÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ·ÏÏÂÚÁÈÎ¤˜

·ﬁ ÙÔ˘˜ ÁÔÓÂ›˜, ‚) ÌÂıÔ‰ÔÏÔÁ›· ‰ÈÂÚÂ‡ÓËÛË˜

Î·È ÂÈ‚Â‚·›ˆÛË˜ ÙË˜ ˘ÂÚÂ˘·ÈÛıËÛ›·˜, Á) ·ﬁ ÔÈÔÓ Î·È Ô‡ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È Ë ‰ÈÂÚÂ‡ÓËÛË/ÂÈ‚Â‚·›ˆÛË Î·È Ô Â·ÓÂÌ‚ÔÏÈ·ÛÌﬁ˜

ÔÌ¿‰Â˜. ™ÙÔ ÙÂ‡¯Ô˜ ∞˘ÁÔ‡ÛÙÔ˘ ÙÔ˘ Pediatrics (2008;122:462-470), ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·fi ÙËÓ American Academy of Pediatrics (APA) Committee on Adolescence ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó·, ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÏÂÙÔÌÂÚÂ›˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÎÏÈÓÈÎ‹ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹ ÚÔÛ¤ÁÁÈÛË, ÙËÓ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ Î·È ÙËÓ ¤Ó·ÚÍË/ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ÙËÓ ÂÂ›ÁÔ˘Û· ·ÓÙÈÛ‡ÏÏË„Ë Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ. ∆ÔÓ›˙ÂÙ·È Ë ÛËÌ·Û›· ÙË˜ ÂÈÎÔÈÓˆÓ›·˜ Î·È ÙË˜ Û˘˙‹ÙËÛË˜ ÙˆÓ ÁÈ·ÙÚÒÓ ÌÂ ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÙË˜ Î·Ï‹˜ ÁÓÒÛË˜ ÙÔ˘ ÓÔÌÈÎÔ‡ Î·È ‰ÂÔÓÙÔÏÔÁÈÎÔ‡ Ï·ÈÛ›Ô˘ ¯ÂÈÚÈÛÌÔ‡ Ù¤ÙÔÈˆÓ ÂÚÈÙÒÛÂˆÓ Î·È ÙË˜ ˘ÔÛÙ‹ÚÈÍË˜ ·fi ¿ÏÏÂ˜ ÂÈ‰ÈÎfiÙËÙÂ˜ Î·È ÎÔÈÓˆÓÈÎÔ‡˜ ıÂÛÌÔ‡˜. √È ÚÔËÁÔ‡ÌÂÓÂ˜ Ô‰ËÁ›Â˜ ›Û¯˘·Ó ·fi ÙÔ 2001.

∫ · Ù Â ˘ ı ˘ Ó Ù ‹ Ú È Â ˜ Á Ú · Ì Ì ¤ ˜ Á È · Ù Ë Ó · Ó Ù È Ì ÂÙ Ò  È Û Ë Ù Ë ˜ Â Á Î Â Ê · Ï › Ù È ‰ · ˜ . ™ÙÔ ÙÂ‡¯Ô˜ ÙÔ˘ Clinical Infectious Diseases ∞˘ÁÔ‡ÛÙÔ˘ 2008 (CID 2008;47:203-27) ÂÎÙ›ıÂÓÙ·È ÛÂ 25 ÛÂÏ›‰Â˜ ÔÈ Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ ÁÚ·ÌÌ¤˜ ÙË˜ Infectious Diseases Society of America (IDSA) ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÂÁÎÂÊ·Ï›ÙÈ‰·˜ ·fi ÈÔ‡˜, ‚·ÎÙ‹ÚÈ·, Ì‡ÎËÙÂ˜, ÚˆÙfi˙ˆ· Î·È ¤ÏÌÈÓıÂ˜. √È Ô‰ËÁ›Â˜ Â›Ó·È ÎÔÈÓ¤˜ ÁÈ· ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó fiÏÔ ÙÔ Ê¿ÛÌ· ÙË˜ ÎÏÈÓÈÎ‹˜ ·˘Ù‹˜ ÔÓÙfiÙËÙ·˜, ·fi ÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›·, ·Ó¿ÏÔÁ· ÌÂ ÙË ÁÂˆÁÚ·Ê›· Î·È ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, ¤ˆ˜ ÙÈ˜ ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi ‹ ¿ÏÏ· Û˘ÛÙ‹Ì·Ù· Î·È ÙË

ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Î·È ÙË ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤Á-

ÁÈÛË ÂÓ Á¤ÓÂÈ Î·È ·Ó¿ÏÔÁ· ÌÂ ÙÔ Èı·Óﬁ ·ıÔÁﬁÓÔ, ÙËÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê›· Î·È ·ÂÈ-

ÎfiÓÈÛË (·fi ÙË CT ˆ˜ ÙÔ FDG-PET scanning), Î·ıÒ˜ Î·È ÙËÓ ·ÁˆÁ‹, ·ıÔÁfiÓÔ ÚÔ˜ ·ıÔÁfiÓÔ. ∏ ·Ó·ÛÎfiËÛË Û¯ÔÏÈ¿˙ÂÈ ÙËÓ ÙÂÎÌËÚ›ˆÛË

ÙˆÓ Ô‰ËÁÈÒÓ ÌÂ ‚¿ÛË ÙËÓ ˘¿Ú¯Ô˘Û· ÂÌÂÈÚ›·

Î·È Â›Ó·È ‰È·ÓıÈÛÌ¤ÓË ÌÂ ÏÂÙÔÌÂÚÂ›˜ ›Ó·ÎÂ˜

Î·È Û˘ÓÔÙÈÎ‹ ·ÚÔ˘Û›·ÛË ÙˆÓ ÈÔ Û˘¯ÓÒÓ

Ù‡ˆÓ ÂÁÎÂÊ·Ï›ÙÈ‰·˜.

™ ˘ Û Ù ¿ Û Â È ˜ Á È · Ù Ë Ó · Ó Ù È Ì Â Ù Ò  È Û Ë Ù Ë ˜  ·¯˘Û·ÚÎ›·˜. ™ÙÈ˜ ∏¶∞, ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ (ÈÛ¯‡ˆÓ ÔÚÈÛÌfi˜ CDC: µªπ >95Ë ∂£) ÂÎÙÈÌ¿Ù·È fiÙÈ ·Ó¤Ú¯ÂÙ·È ÛÂ 14%, 19% Î·È 17% ÁÈ· ÙÈ˜ ËÏÈÎ›Â˜ 2-5, 6-11 Î·È 1219 ÂÙÒÓ, ·ÓÙ›ÛÙÔÈ¯·. ∞Ó·ÁÓˆÚ›˙ÔÓÙ·˜ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ¤ˆ˜ ÙÒÚ· Ô‰ËÁÈÒÓ, Ë American Medical Association (AMA) fiÚÈÛÂ ÔÌ¿‰· ÂÈ‰ÈÎÒÓ Ô˘

Î·Ù¤ÏËÍÂ ÛÙÈ˜ Û˘ÛÙ¿ÛÂÈ˜ ÙÔ˘ ÙÂ‡¯Ô˘˜ πÔ˘Ï›Ô˘

ÙÔ˘ American Family Physician (Am Fam Physician 2008;78:56-63) ÁÈ· ÙËÓ ÚÔÛ¤ÁÁÈÛË

Î·È ÙËÓ ·ÁˆÁ‹ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ ·È‰ÈÔ‡. √È Û˘-

ÛÙ¿ÛÂÈ˜ ·Â˘ı‡ÓÔÓÙ·È ÛÂ ÁÈ·ÙÚÔ‡˜ ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„Ë˜ Î·È ÛÂ ¿ÏÏÂ˜ ÎÏÈÓÈÎ¤˜ ÂÈ‰ÈÎfiÙËÙÂ˜, ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Î·Ù¿ÏÏËÏË ÎÏÈÓÈÎ‹ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹ ÚÔÛ¤ÁÁÈÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË, ÏÂÙÔÌÂÚÂ›˜ Ô‰ËÁ›Â˜ ‰È·ÙÚÔÊ‹˜ (·Ó·„˘ÎÙÈÎ¿, ¯˘ÌÔ›, Ù·¯˘ÁÂ‡Ì·Ù·), Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙËÏÂfiÚ·ÛË˜ ‹ ¿ÏÏË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÂ ÔıfiÓË Î·È Î·Ù·Ï‹ÁÔ˘Ó ÛÂ 4 ‰È·‰Ô¯ÈÎ¿ ÛÙ¿‰È· ·ÁˆÁ‹˜ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ ·È‰ÈÔ‡ Î·È ÂÊ‹‚Ô˘ ËÏÈÎ›·˜ 2-19 ÂÙÒÓ. ∂ÈÏ¤ÔÓ, Ë AMA ÚÔÙÂ›ÓÂÈ ÎÔÈÓÔ‡˜ ÔÚÈÛÌÔ‡˜ ·¯˘Û·ÚÎ›·˜ ÁÈ· ·È‰È¿

Î·È ÂÓ‹ÏÈÎÂ˜: ˘¤Ú‚·Ú· (BMI 85Ë - 95Ë ∂£),

·¯‡Û·ÚÎ· (BMI >95Ë ∂£) Î·È ÛÔ‚·Ú¿ ·¯‡Û·ÚÎ· (µªπ >99Ë ∂£).

∫·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ ÁÚ·ÌÌ¤˜ ÁÈ· ÙËÓ ÂÔ¯È·Î‹ ÁÚ›Ë ÁÈ· ÙÔ 2008 , ·ﬁ ÙËÓ Advisory Committee on Immunization Practices (ACIP) ÙÔ˘ CDC ÛÙÈ˜ ∏¶∞: MMWR Morb Mortal Wkly Rep 2008;57:1-60.

∫ · Ù Â ˘ ı ˘ Ó Ù ‹ Ú È Â ˜ Á Ú · Ì Ì ¤ ˜ Á È · Ù Ë Ó  Ú Ô Ê ‡Ï·ÍË ¤Ó·ÓÙÈ ÙË˜ ÂÓ‰ÔÎ·Ú‰›ÙÈ‰·˜ , ·ﬁ ÙÈ˜ ∏¶∞ (American Heart Association, J Am Dent Assoc 2008;139:3S-24S) Î·È ÙÔ ∏ÓˆÌ¤ÓÔ µ·Û›ÏÂÈÔ (National Institute for Health and Clinical Excellence [NICE], http://www.nice.org.uk/ nicemedia/pdf/CG64NICEguidance.pdf).

£¤ÛÂÈ˜ ÁÈ· ÙË Û˘ÓÂ¯‹ Î·Ù ’ Ô›ÎÔÓ Î·Ù·ÁÚ·Ê‹ ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚ Ô ˘ ˜ , ·ﬁ ÙËÓ American Heart Association (AHA): Atherosclerosis, Hypertension, and Obesity in Youth Committee, Hypertension; 2008;52:433-451.

£¤ÛÂÈ˜ ÁÈ· ÙËÓ ÚﬁÏË„Ë Î·È ıÂÚ·Â›· ÙˆÓ È Û

· È Ì

Ò Ó Î · È · È Ì Ô Ú Ú · Á È Î Ò Ó Â Á Î Â Ê · Ï È Î Ò Ó ÂÂÈÛÔ‰›ˆÓ ÛÙ· ·È‰È¿ , ·ﬁ ÙÔ Special Writing Group of the American Heart Association (AHA) Stroke Council and the Council on Cardiovascular Disease in the Young, Stroke 2008;39:2644-2691.

™ÙÚ·ÙËÁÈÎ¤˜ ÁÈ· ÙËÓ Â˘ﬁ‰ˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ , ÛÙÔ American Family Physician (Keister D, et al. Strategies for breastfeeding success. Am Fam Physician 2008;78:180,225232). ™ÙÔ ›‰ÈÔ ÙÂ‡¯Ô˜ ‰ËÌÔÛÈÂ‡ÔÓÙ·È Ô‰ËÁ›Â˜ ÙË˜ American Academy of Family Physicians Î·È ÁÈ· ÁÔÓÂ›˜ (Am Fam Physician 2008;78:233-234).

ÁÈ· ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ‚ÈÙ·Ì›ÓË˜ D ÛÂ ·È‰È¿ , ·ﬁ ÙË Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society, ∏¶∞, Pediatrics 2008;122: 398-417.

¢ Â Î ¿ Ï Ô Á Ô ˜ Á È · Ù Ë Ó ·  Ô Ê ˘ Á ‹ Ù Ë ˜ Î · Î ‹ ˜

¯Ú‹ÛË˜ ÙË˜ ÁÂÓÂÙÈÎ‹˜ ¤ÚÂ˘Ó·˜ ÛÙÔÓ ¿ÓıÚˆÔ , ·ﬁ ÙÔ Center for Biomedical Ethics and Department of Pediatrics, Stanford University, Genome Biol 2008;9:404.

∫·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ ÁÚ·ÌÌ¤˜ Û˘ÓÙ·ÁÔÁÚ·Ê›·˜

· Ó Ù È ‚ È Ô Ù È Î Ò Ó Á È · Ï Ô È Ì Ò Í Â È ˜ · Ó ·  Ó Â ˘ Û Ù È Î Ô ‡

ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÂÚ›ı·Ï„Ë , ·ﬁ ÙÔ ‚ÚÂÙ·ÓÈÎﬁ National Institute for Health and Clinical Excellence (NICE), BMJ 2008;337:a437.

∫ · Ù Â ˘ ı ˘ Ó Ù ‹ Ú È Â ˜ Á Ú · Ì Ì ¤ ˜ Á È · Ù Ë ‰ È ¿ Á Ó ˆ Û Ë Ù Ë ˜ Î ˘ Û Ù È Î ‹ ˜ › Ó ˆ Û Ë ˜ ·  fi Ù Ô Ó Â Ô Á Ó fi ˆ ˜ Ù Ô Ó ÂÓ‹ÏÈÎ· Cystic Fibrosis Foundation Consensus Report, J Pediatr 2008;153:S4-S14. ∫·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ ÁÚ·ÌÌ¤˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ıÂÚ·Â›· ÙË˜ ÚÈÓ›ÙÈ‰·˜ , ·fi Ù· Joint Task Force on Practice; American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology: J Allergy Clin Immunol 2008;122:S1-84.

√‰ËÁ›Â˜ ÁÈ· ÙËÓ ·ﬁÊÚ·ÍË ÙÔ˘ ·ÎÔ˘ÛÙÈÎÔ‡

 fi Ú Ô ˘ ·  fi Î ˘ „ Â Ï › ‰ · , ·fi ÙËÓ American Academy of Otolaryngology - Head and Neck Surgery Foundation, Otolaryngol-Head Neck Surg 2008;139:S1-S21.

√‰ËÁ›Â˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÏÈÈ‰›ˆÓ ÛÙ· ·È‰È¿ , ·ﬁ ÙËÓ American Academy of Pediatrics Committee on Nutrition, Pediatrics 2008;122: 198-208, ÁÈ· ÙËÓ ÎÏÈÓÈÎ‹, ÂÚÁ·ÛÙËÚÈ·Î‹, ‰È·ÈÙËÙÈÎ‹ Î·È Ê·ÚÌ·ÎÔÏÔÁÈÎ‹ ÚÔÛ¤ÁÁÈÛË. √È ÚÔËÁÔ‡ÌÂÓÂ˜ Ô‰ËÁ›Â˜ ›Û¯˘·Ó ·ﬁ ÙÔ 1998.

∫·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ ÁÚ·ÌÌ¤˜ ÁÈ· ÙËÓ ÔÈÎÔÁÂÓ‹ ˘  Â Ú ¯ Ô Ï Ë Û Ù Â Ú Ô Ï · È Ì › · , ·ﬁ ÙÔ ‚ÚÂÙ·ÓÈÎﬁ

National Institute for Health and Clinical Excellence (NICE), BMJ 2008;337:a1095.

∫·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ ÁÚ·ÌÌ¤˜ ÁÈ· ÙËÓ ·ÁˆÁ‹ ÙË˜ ÏÔ›ÌˆÍË˜ ·fi ÙÔÓ Èfi ÙË˜ ·ÓıÚÒÈÓË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ HIV ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ , ·fi ÙËÓ

International AIDS Society, JAMA 2008;300:555570. √È ÚÔËÁÔ‡ÌÂÓÂ˜ ›Û¯˘·Ó ·ﬁ ÙÔ 2006. ¶ÚﬁÛÊ·ÙÂ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÏÔ›ÌˆÍË ÛÙ· ·È‰È¿ ÛÙÔ Expert Rev Anti Infect Ther 2008;6:167-180 Î·È ÛÔ˘Ë‰ÈÎ¤˜ Û˘ÛÙ¿ÛÂÈ˜ ÁÈ· ÙËÓ Î‡ËÛË ÛÙÔ Scand J Infect Dis 2008;40:451-461.

∫ · Ù Â ˘ ı ˘ Ó Ù ‹ Ú È Â ˜ Á Ú · Ì Ì ¤ ˜ Á È · Ù Ë Ó · Ó Ù È Ì ÂÙ Ò  È Û Ë Ù Ë ˜ Ì Ë Ó È Á Á È Ù È ‰ Ô Î Ô Î Î È Î ‹ ˜ Ó ﬁ Û Ô ˘ Û Â  · È ‰ È ¿ Î · È Ó ¤ Ô ˘ ˜ , ·ﬁ ÙÔ Scottish Intercollegiate Guidelines Network (SIGN), Guideline Development Group, BMJ 208;336: 1367-1370.

∞ÏÁﬁÚÈıÌÔ˜ ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯ÓÂ˘ÛË ·Ó·Ù˘ÍÈ·ÎÒÓ

‰È·Ù·Ú·¯ÒÓ

§. £ˆÌ·˝‰Ô˘

An algorithm for Developmental Surveillance and Screening

L. Thomaidis

Ì·ÙÈÎ‹ Î·È „˘¯ÈÎ‹ ˘ÁÂ›· ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. ∂Í¿ÏÏÔ˘, ·ÔÙÂÏÂ› Â˘ı‡ÓË ÙˆÓ

·È‰È¿ÙÚˆÓ Î·È ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘ÁÂ›·˜, ÔÈ ÔÔ›ÔÈ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Û˘ÛÙËÌ·ÙÈÎ¿ ÙËÓ ·Ó¿Ù˘ÍË

ÙˆÓ ·È‰ÈÒÓ. ∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ (AAP)

µ’ Department of Pediatrics Children’s Hospital “P. & ∞. ∫iriakou”

Correspondence: Loretta Thomaidis developmental_health@yahoo.gr µ’ Department of Pediatrics Children’s Hospital “P. & ∞. ∫iriakou”

Are the Screening Tool Results Positive/ Concerning?

http://www.pediatrics.org/cgi/content/full/118/1/405

¯Ú‹ÛÈÌÂ˜ Î·È ÂÏ›˙ˆ ﬁÙÈ ı· Û·˜ ÂÓ‰È·Ê¤ÚÔ˘Ó.

ÛÙÔ ¢È·‰›ÎÙ˘Ô - http://www.dbpeds.org/

√È ÏËÚÔÊÔÚ›Â˜ Ô˘ ·Ú¤¯ÂÈ ·˘Ù‹ Ë ÈÛÙÔÛÂÏ›‰· Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÂ˜ ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ

Ô˘ ÂÓ‰È·Ê¤ÚÂÙ·È Ó· Û˘ÌÂÚÈÏ¿‚ÂÈ ÙÔÓ ÚÔÏËÙÈÎfi ·Ó·Ù˘ÍÈ·Îfi ¤ÏÂÁ¯Ô ÛÙË ‰È·‰ÈÎ·Û›· ‰È¿ÁÓˆÛË˜ Î·È ·ÍÈÔÏfiÁËÛË˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ú·ÎÔÏÔ˘ıÂ›.

∂‰Ò Ô ·È‰›·ÙÚÔ˜ ÌÔÚÂ› Ó· ‚ÚÂÈ, ÌÂÙ·Í‡ ¿ÏÏˆÓ, ÂÓ‰È·Ê¤ÚÔÓÙ· ¿ÚıÚ· ÔÚÁ·ÓˆÌ¤Ó· ÛÂ ıÂÌ·ÙÈÎ¤˜ ÂÓﬁÙËÙÂ˜, Ú·ÎÙÈÎ¿ ÂÚÁ·ÏÂ›· ÁÈ· ÙÔÓ ·Ó·Ù˘ÍÈ·Îﬁ ¤ÏÂÁ¯Ô, ÂÓËÌÂÚˆÙÈÎ¿ Ê˘ÏÏ¿‰È· ÁÈ· ÙÔ˘˜ ÁÔÓÂ›˜ ÁÈ· ı¤Ì·Ù· ·Ó¿Ù˘ÍË˜ ÙÔ˘ ·È‰ÈÔ‡, Î·ıÒ˜ Î·È ¯Ú‹ÛÈÌ· links.

VICTOR A. McKUSICK

(21 √ÎÙˆ‚Ú›Ô˘ 1921 – 22 πÔ˘Ï›Ô˘ 2008) ÃÚ‹ÛÙÔ˜ ™. ª·ÚÙÛﬁÎ·˜

∏ ÂÈÛÙ‹ÌË ıÚËÓÂ› ÙÔÓ “·Ù¤Ú· ÙË˜

È·ÙÚÈÎ‹˜ ÁÂÓÂÙÈÎ‹˜”

ªÂÙ¿ ·ﬁ Û‡ÓÙÔÌË Ì¿¯Ë ÌÂ ÙÔÓ Î·ÚÎ›ÓÔ, Ô Dr. Victor Almon McKusick ·Â‚›ˆÛÂ, ÛÂ ËÏÈÎ›· 87 ÂÙÒÓ, ÛÙÈ˜ 22 πÔ˘Ï›Ô˘ ÙÔ˘ 2008. √ Victor, Â›ÙÈÌÔ˜ ‰È‰¿ÎÙˆÚ ÙÔ˘ ∂ıÓÈÎÔ‡ Î·È

∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ‹Ù·Ó

ÁÓˆÛÙfi˜ ÛÙÔ˘˜ ŒÏÏËÓÂ˜ ·È‰È¿ÙÚÔ˘˜ ÙfiÛÔ ·fi

ÙÔ “ÁÈÁ¿ÓÙÈÔ” ¤ÚÁÔ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈÎ‹ ÁÂÓÂÙÈÎ‹

ﬁÛÔ Î·È ·ﬁ ÙÈ˜ ÁÏ·Ê˘Ú¤˜ ·ÚÔ˘ÛÈ¿ÛÂÈ˜ ÙÔ˘ ÛÙ·

Û˘Ó¤‰ÚÈ·.

√ Victor Î·È Ô ÌÔÓÔˆÔÁÂÓ‹˜ ‰›‰˘ÌÔ˜ ·‰ÂÏ-

Êﬁ˜ ÙÔ˘ Vincent L. McKusick, LL.B., Ô ÔÔ›Ô˜ Â›-

¯Â Á›ÓÂÈ ·Ú¯È‰ÈÎ·ÛÙ‹˜ ÛÙÔ ∞ÓÒÙ·ÙÔ ¢ÈÎ·ÛÙ‹ÚÈÔ

ÙË˜ ¶ÔÏÈÙÂ›·˜ Maine, ÁÂÓÓ‹ıËÎ·Ó ÛÙÈ˜ 21 √ÎÙˆ‚Ú›Ô˘ 1921 ÛÂ ÌÈ· ÔÈÎÔÁ¤ÓÂÈ· ÌÂ Û˘ÓÔÏÈÎ¿ 5 ·È‰È¿. √ ·Ù¤Ú·˜ Â›¯Â ˘ËÚÂÙ‹ÛÂÈ ˆ˜ Á˘ÌÓ·ÛÈ¿Ú-

¯Ë˜ ÛÙË ¶ÔÏÈÙÂ›· Vermont ÁÈ· 9 ¯ÚﬁÓÈ·. ∏ ÌËÙ¤Ú· ÙÔ˘ ‹Ù·Ó ‰·ÛÎ¿Ï·. ∏ ÔÈÎÔÁ¤ÓÂÈ· ¤˙ËÛÂ ÛÂ Á·-

Ï·ÎÙÔ·Ú·ÁˆÁﬁ ·ÁÚﬁÎÙËÌ· ÛÙÔ Parkman ÙË˜

ÔÏÈÙÂ›·˜ Maine.

TÔ Î·ÏÔÎ·›ÚÈ ÙÔ˘ 1937, Ô Victor ·Ó¤Ù˘ÍÂ ‚·ÚÈ¿˜ ÌÔÚÊ‹˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË, ÁÈ·

ÙËÓ ÔÔ›· ÓÔÛËÏÂ‡ıËÎÂ ·Ú¯ÈÎ¿ ÛÂ ÓÔÛÔÎÔÌÂ›Ô

ÛÙÔ Maine ÁÈ· Ì›· Â‚‰ÔÌ¿‰· Î·È ÛÙË Û˘Ó¤¯ÂÈ·

ÁÈ· 10 Â‚‰ÔÌ¿‰Â˜ ÛÙÔ Massachusetts General Hospital ÙË˜ µÔÛÙÒÓË˜. ∆ÂÏÈÎ¿, ıÂÚ·Â‡ÙËÎÂ ÌÂ

ÛÔ˘ÏÊ·ÓÈÏ·Ì›‰Ë, Ë ÔÔ›· ÌﬁÏÈ˜ ÙﬁÙÂ Â›¯Â Î˘ÎÏÔÊÔÚ‹ÛÂÈ ÛÙÈ˜ ∏¶∞. ŒÙÛÈ, ÂÓÒ Û¯Â‰›·˙Â Ó· Á›ÓÂÈ

ÈÂÚˆÌ¤ÓÔ˜, Ë Â·Ê‹ ÙÔ˘ ÌÂ ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ ÙÔÓ ÂËÚ¤·ÛÂ Î·È ÛÔ‡‰·ÛÂ È·ÙÚÈÎ‹. ∆Ô 1940, ÌÂÙ¿ ÙÈ˜ Á˘ÌÓ·ÛÙÈÎ¤˜ ÛÔ˘‰¤˜, Ô

Victor ÂÓÂÁÚ¿ÊË ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Tufts Î·È, ÌÂÙ¿ ÙÔ ÙÚ›ÙÔ ¤ÙÔ˜, ÂÓÂÁÚ¿ÊË ÛÙËÓ π·ÙÚÈÎ‹ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ John Hopkins, ÛÙÔ ÔÔ›Ô ‰È·ÎÔÓÔ‡Û·Ó ÔÈ ÎÔÚ˘Ê·›ÔÈ Ù¤ÛÛÂÚÈ˜ Î·ıËÁËÙ¤˜ William H. Welch, William Osler, Howard Atwood Kelly Î·È William Stewart Halsted. §fiÁˆ ÙË˜ ÂÈÛÙÚ·ÙÂ‡ÛÂˆ˜, ˘‹Ú¯·Ó ÔÏÏ¤˜ ÎÂÓ¤˜ ı¤ÛÂÈ˜ ÛÙ· ¶·ÓÂÈÛÙ‹ÌÈ· Î·È ¤ÙÛÈ Ô Victor ‰ÂÓ ¯ÚÂÈ¿ÛıËÎÂ Ó· ÂÚ·ÙÒÛÂÈ ÚÒÙ· ÙÈ˜ ÎÔÏÂÁÈ·Î¤˜ ÛÔ˘‰¤˜. ™‡ÌÊˆÓ· ÌÂ ÙÔÓ McKusick, Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ‹Ù·Ó ıÚËÛÎÂ˘fiÌÂÓË Î·È ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ Ù·ÎÙÈÎ¿ ÙËÓ ÂÎÎÏËÛ›·. ∏ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ‹Ù·Ó Â›ÛË˜ ÔÏ‡ ‰È·ÓÔÔ‡ÌÂÓË Î·È ·˘Ùfi ‰ÈÂ˘ÎfiÏ˘ÓÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÚÔÛ¤ÁÁÈÛË ÛÙËÓ È·ÙÚÈÎ‹. ∂ÓÒ ÂÙÔÈÌ·˙fiÙ·Ó Ó· ÂÈÛÙÚ¤„ÂÈ ÛÙÔ Maine ÁÈ· Ó· ·ÛÎ‹ÛÂÈ ÁÂÓÈÎ‹ È·ÙÚÈÎ‹, ÂÂÏ¤ÁË ˆ˜ ÂÈ‰ÈÎÂ˘fiÌÂÓÔ˜ “William Osler” ÛÙËÓ ¶·ıÔÏÔÁ›·, ÔfiÙÂ Î·È

·Ú¤ÌÂÈÓÂ ÛÙÔ Johns Hopkins Ì¤¯ÚÈ Ù· ÙÂÏÂ˘Ù·›·

∫ÏÈÓÈÎ‹ ÃÚﬁÓÈˆÓ ¶·ı‹ÛÂˆÓ Î·È ÌÂÙ·Í‡

1957-1973 ÚÔ˝ÛÙ·ÙÔ ÙË˜ Œ‰Ú·˜ π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜, Ë ÔÔ›· Â›¯Â ‰ËÌÈÔ˘ÚÁËıÂ› ÚÔ˜ ÙÈÌ‹Ó ÙÔ˘. ∞ﬁ ÙÔ 1973 Ì¤¯ÚÈ ÙÔ 1985 ‰ÈË‡ı˘ÓÂ ˆ˜ ∫·ıËÁËÙ‹˜-∞Ú¯›·ÙÚÔ˜ ÙÔ ¡ÔÛÔÎÔÌÂ›Ô

Johns Hopkins Î·È ‹Ù·Ó Ô William Osler Î·ıËÁËÙ‹˜ ÙË˜ ¶·ıÔÏÔÁ›·˜

Î·È ¢ÈÂ˘ı˘ÓÙ‹˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ¶·ıÔÏÔÁ›·˜.

∞ﬁ ÙÔ 1985 Ì¤¯ÚÈ ÙÈ˜ ·Ú·ÌÔÓ¤˜ ÙÔ˘ ı·Ó¿ÙÔ˘ ÙÔ˘, Ô Victor ‰›‰·ÍÂ, ‰ÈÂÍ‹Á·ÁÂ ¤ÚÂ˘ÓÂ˜ Î·È

È·ÙÚÈÎ‹ ÛÙ· ∆Ì‹Ì·Ù· ¶·ıÔÏÔÁ›·˜ Î·È

π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜ ÙÔ˘ Johns Hopkins. À‹ÚÍÂ ¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜ ‰‡Ô ÂÈÛÙËÌÔÓÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ, ÙˆÓ “Genomics” Î·È “Medicine”.

O McKusick ÂÍ¤‰ˆÛÂ ÙÔ 1966 ÙËÓ ÚÒÙË ¤Î‰ÔÛË Î·Ù·ÏfiÁÔ˘ fiÏˆÓ ÙˆÓ ÙfiÙÂ ÁÓˆÛÙÒÓ ÁÔÓÈ‰›ˆÓ Î·È ÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÙÔ “Mendelian Inheritance in Man (MIª)”. ∏ ÙÂÏÈÎ‹ 12Ë ¤Î‰ÔÛË ÙÔ˘ Î·Ù·ÏfiÁÔ˘ Î˘ÎÏÔÊfiÚËÛÂ ÙÔ 1998. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÙÔ ªπª ‰È·Ù›ıÂÙ·È ·fi ÙÔ 1987 ‰ˆÚÂ¿Ó ÛÙÔ ‰È·‰›ÎÙ˘Ô, ˆ˜ Online Mendelian Inheritance in Man (OMIM), Û˘Ó‰ÂfiÌÂÓÔ ÌÂ ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ µÈÔÙÂ¯ÓÔÏÔÁÈÎ‹˜ ¶ÏËÚÔÊÔÚ›·˜ (NCBI) Î·È ÙËÓ ∂ıÓÈÎ‹ π·ÙÚÈÎ‹ µÈ‚ÏÈÔı‹ÎË (NLM). O McKusick ‹Ù·Ó Â›ÛË˜ È‰Ú˘Ù‹˜ ÙÔ 1989 Î·È ÚfiÂ‰ÚÔ˜ ÙÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÙÔ˘ ∞ÓıÚÒÈÓÔ˘ °ÔÓÈ‰ÈÒÌ·ÙÔ˜ (Human Genome Organization - HUGO).

∞ﬁ ÙÔ 1960 Î·ıÈ¤ÚˆÛÂ ÙÔ ÂÙ‹ÛÈÔ ‚Ú·¯‡ course π·ÙÚÈÎ‹˜ Î·È ¶ÂÈÚ·Ì·ÙÈÎ‹˜ °ÂÓÂÙÈÎ‹˜ ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ Jackson, ÛÙÔ Bar Harbor ÙË˜ ¶ÔÏÈÙÂ›·˜ Maine Î·È ·ﬁ ÙÔ 1987 ÙÔ ÂÙ‹ÛÈÔ Course π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙË˜ Bologna, ÛÙÔ Bertinoro di Romagna ÛÙËÓ πÙ·Ï›·.

√ Victor McKusick Â›¯Â Â˘Ú‡ Û˘ÁÁÚ·ÊÈÎﬁ ¤ÚÁÔ

ÛÙËÓ πÛÙÔÚ›· ÙË˜ π·ÙÚÈÎ‹˜, ÙË °ÂÓÂÙÈÎ‹ Î·È, È‰È·›ÙÂÚ·, ÙËÓ π·ÙÚÈÎ‹ °ÂÓÂÙÈÎ‹. π‰È·›ÙÂÚË ÌÓÂ›· Ú¤ÂÈ Ó·

ÛÙ· “Selected Papers Assembled with commentary” (1978), “Probable Assignment of the Duffy Blood Group Locus to Chromosome 1 in Man” (PNAS 61:949-955) Î·È “A Synopsis of Clinical Auscultation, Being a Treatise on Cardiovascular and Respiratory Sound, Intro-duced by a Historical Survey, Illustrated by Sound Spectrograms and Supplemented by a Comprehensive Bibliography”

¯ÚﬁÓÈ· ÙË˜ ˙ˆ‹˜ ÙÔ˘. ∆È˜ ÂﬁÌÂÓÂ˜ ‰ÂÎ·ÂÙ›Â˜, Ô McKusick ‰È‹˘ı˘ÓÂ ÙËÓ

(1956), Ù· ÔÔ›· Î·È Î·Ù¤ÛÙËÛ·Ó ÈÛÙÔÚÈÎ‹˜ ·Í›·˜. °È·

ÙËÓ ÈÛÙÔÚ›· ÙË˜ È·ÙÚÈÎ‹˜ ÁÂÓÂÙÈÎ‹˜ Û˘Ó¤ÁÚ·„Â ÔÏÏ¿

¿ÚıÚ· Î·È ÎÂÊ¿Ï·È· ÛÂ ‚È‚Ï›·: “Heritable Disorders of Connective Tissue” (¤ÓÙÂ ÂÎ‰fiÛÂÈ˜ 1956-1993), “Cardiovascular Sound in Health and Disease” (1958), “Medical Genetics” (ÙÚÂÈ˜ ÂÎ‰fiÛÂÈ˜ 1958-1961), “Human Genetics” (‰‡Ô ÂÎ‰fiÛÂÈ˜ 1964 Î·È 1969), “On the X-Chromosome of Man” (1964), “Mendelian Inheritance in Man” (‰Ò‰ÂÎ· ÂÎ‰fiÛÂÈ˜ 1966-1998), “Medical Genetics Self-Instruction Guide” (1993), “Osler’s Textbook Revisited” (1967), “Genetics of Hand Malformations”, (1978), “Medical Genetic Studies of the Amish” (1978), “∞ Model of its Kind” (1989), “Osler’s Legacy” (1990), “A Century of Biomedical Science at Johns Hopkins” (1993). ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ‰È·‰Ú·Ì¿ÙÈÛÂ ÛÙËÓ ¤ÚÂ˘Ó· ÁÈ· ÙÔ Â¿Ó Ô

∞‚Ú·¿Ì §›ÓÎÔÏÓ ¤·Û¯Â ·ﬁ Û‡Ó‰ÚÔÌÔ Marfan.

™ÙÔÓ McKusick ·ÂÓÂÌ‹ıË ÙÔ ‚Ú·‚Â›Ô Albert Lasker ÁÈ· ∂ÈÙ˘¯›· ÛÙËÓ π·ÙÚÈÎ‹ ∂ÈÛÙ‹ÌË ÙÔ 1997.

∆Ô 2001 ¤Ï·‚Â ÙÔ ∂ıÓÈÎﬁ ªÂÙ¿ÏÏÈÔ ∂ÈÛÙ‹ÌË˜ ÙˆÓ

∏¶∞, ÂÓÒ ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Johns Hopkins ÙÔÓ ÂÙ›ÌË-

ÛÂ ‰‡Ô ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, ‰›ÓÔÓÙ·˜ ÙÔ fiÓÔÌ¿ ÙÔ˘ ÛÙÔ

πÓÛÙÈÙÔ‡ÙÔ °ÂÓÂÙÈÎ‹˜ π·ÙÚÈÎ‹˜. ªÂÙ·Í‡ ÙË˜ ÏËıÒ-

Ú·˜ ÙˆÓ ‰È·ÎÚ›ÛÂˆÓ, Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÂ› ﬁÙÈ Ô McKusick ·Ó·ÁÔÚÂ‡ıËÎÂ Â›ÙÈÌÔ˜ ‰È‰¿ÎÙˆÚ ÙÔ˘ ¶·-

ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÙÔ 2000. ¢ÈÎ·›ˆ˜ Ô Victor A. McKusick Â›¯Â ıÂˆÚËıÂ› ˆ˜ Ô

·Ù¤Ú·˜ ÙË˜ π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜. ªÂÁ¿ÏË ‹Ù·Ó Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ˆ˜ ÂÎ·È‰Â˘Ù‹ ÙˆÓ ÔÏ˘¿ÚÈıÌˆÓ research

fellows Ô˘ ¤Ú·Û·Ó ·ﬁ ÙÔ Johns Hopkins, Î·ıÒ˜

Î·È ·ﬁ Ù· ÂÙ‹ÛÈ· Ì·ı‹Ì·Ù· (Delineation of Birth Defects) Ô˘ ÔÚÁ¿ÓˆÓÂ ÛÙË µ·ÏÙÈÌﬁÚË, ÌÂ Û˘ÌÌÂÙÔ¯‹

ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂÈÛÙËÌﬁÓˆÓ, ‹ ÛÙÔ Bar Harbor, Maine, ÁÈ· ÙËÓ ¶ÂÈÚ·Ì·ÙÈÎ‹ °ÂÓÂÙÈÎ‹ ‹ Â›ÛË˜ ÛÙËÓ

πÙ·Ï›·. √ Û˘ÓÂ¯Ò˜ ·Ó·ÓÂÔ‡ÌÂÓÔ˜ Î·Ù¿ÏÔÁÔ˜ ÙˆÓ ÎÏË-

ÚÔÓÔÌÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ (Mendelian Inheritance in

Man) ·ÔÙ¤ÏÂÛÂ ÙÔ ··Ú·›ÙËÙÔ ÂÁÎﬁÏÈÔ ÛÂ Î¿ıÂ

ÎÏÈÓÈÎfi ÁÂÓÂÙÈÛÙ‹. √ McKusick Û˘Ó¤‰ÂÛÂ ÙÔ fiÓÔÌ¿ ÙÔ˘ ÌÂ 4-5 ÁÂÓÂÙÈÎ¿ Û‡Ó‰ÚÔÌ·. ™ÙË Ì·ÎÚ¿ ÛÙ·‰ÈÔ‰ÚÔÌ›· ÙÔ˘ Û˘Ó¤‚·ÏÂ ÚˆÙÔÔÚÈ·Î¿ ˆ˜ Î·Ú‰ÈÔÏfiÁÔ˜ ÌÂ Û˘ÁÁÚ¿ÌÌ·Ù· fiˆ˜ “The Heart Murmur” Î·È “Heritable Disorders of Connective Tissue”. ™ÙÔÓ ÙÔÌ¤· ·˘Ùfi ‰ÈÂ˘ÎÚ›ÓÈÛÂ Ù· Û‡Ó‰ÚÔÌ· Marfan, Ehlers-Danlos Î.¿. ∂›¯Â Î·Ù·ÚÙ›ÛÂÈ ÌÈ· ÙÂÚ¿ÛÙÈ· Û˘ÏÏÔÁ‹ ‰È·Ê·ÓÂÈÒÓ ·fi fiÏÔ˘˜ Û¯Â‰fiÓ ÙÔ˘˜ ÁÂÓÂÙÈÛÙ¤˜ ·Ó¿ ÙÔÓ ÎfiÛÌÔ, ÌÂ ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÛÙÂÓ¿ Û˘Ó‰Â‰ÂÌ¤ÓÔ˜ ÌÂ Û˘¯Ó‹ ·ÏÏËÏÔÁÚ·Ê›·, ÂÓËÌ¤ÚˆÛË, Î·ıÔ‰‹ÁËÛË Î·È ¤ÎÊÚ·ÛË ÂÈÏÈÎÚÈÓÔ‡˜ ÊÈÏ›·˜. O McKusick ˘‹ÚÍÂ ‰Ú·ÛÙ‹ÚÈÔ˜ ÎÏÈÓÈÎfi˜ ÂÈÛÙ‹ÌˆÓ, ÚˆÙÔfiÚÔ˜ ÛÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û¯¤ÛË˜ ÌÂÙ·Í‡

ÎÏËÚÔÓÔÌÈÎﬁÙËÙ·˜ Î·È ÓﬁÛÔ˘. ∏ ‰ÈÂıÓ‹˜ ÂÈÛÙËÌÔÓÈÎ‹

ÎÔÈÓﬁÙËÙ· ÙÔÓ Ù›ÌËÛÂ Â·ÓÂÈÏËÌÌ¤Óˆ˜ ˆ˜ ÙÔÓ ·Ù¤Ú·È‰Ú˘Ù‹ ÙË˜ È·ÙÚÈÎ‹˜ ÁÂÓÂÙÈÎ‹˜ ˆ˜ Ó¤·˜ ÂÈ‰ÈÎﬁÙËÙ·˜

ÓÙ·È ÛÂ ¯ÈÏÈ¿‰Â˜. §¤ÁÂÙ·È ﬁÙÈ ¤¯ÂÈ ÂÎ·È‰Â‡ÛÂÈ 4.000 ÁÂÓÂÙÈÛÙ¤˜.

ÙÈÌËıÂ› ÌÂ ÌÂÁ¿ÏÔ ·ÚÈıÌﬁ ‰ÈÂıÓÒÓ Î·È ÂıÓÈÎÒÓ ‰È·ÎÚ›ÛÂˆÓ, ‰È‰·ÎÙÔÚÈÒÓ honoris causa , ÛÂ ÌÈ· ÂÈÛÙËÌÔÓÈÎ‹ Î·ÚÈ¤Ú· Û˘ÓÂ¯Ô‡˜ ‰È¿ÚÎÂÈ·˜ ¿Óˆ ÙˆÓ 60 ÂÙÒÓ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Johns Hopkins. ⁄„ÈÛÙÂ˜

ÙÈÌ¤˜ ‹Ù·Ó Ù· ‚Ú·‚Â›· Albert Lasker ÙÔ 1997 Î·È ÙÔ

∂ıÓÈÎﬁ ªÂÙ¿ÏÏÈÔ ∂ÈÛÙ‹ÌË˜ ÙÔ 2001. Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ô McKusick ˘‹ÚÍÂ Ô È‰Ú˘Ù‹˜-ÚﬁÂ‰ÚÔ˜ ÙÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ∞ÓıÚÒÈÓÔ˘ °ÔÓÈ‰ÈÒÌ·ÙÔ˜ (HUGO) Î·È

Ì¤ÏÔ˜ ÙË˜ ÂıÓÈÎ‹˜ ∞Î·‰ËÌ›·˜ ∂ÈÛÙËÌÒÓ ÙˆÓ ∏¶∞, ·fi ÙÔ 1973. ªÂ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ McKusick Ë ÂÈÛÙ‹ÌË ¤¯·ÛÂ ¤Ó·Ó “Á›Á·ÓÙ·”. ªÂ ÙÔÓ ı¿Ó·Ùfi ÙÔ˘ ÎÏÂ›ÓÂÈ ÙÔ ÎÂÊ¿Ï·ÈÔ ÙË˜ ∫ÏÈÓÈÎ‹˜ °ÂÓÂÙÈÎ‹˜. ∂›ıÂ Ó· ‚ÚÂıÂ› ·ÓÙ¿ÍÈÔ˜ ‰È¿‰Ô¯fi˜ ÙÔ˘ ÛÙËÓ ∫ÏÈÓÈÎ‹ °ÔÓÈ‰ÈˆÌ·ÙÈÎ‹, ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙË˜ ÔÔ›·˜ Û˘ÓÂÙ¤ÏÂÛÂ Ô McKusick.

∞¶∞¡∆∏™∏

¢È¿ÁÓˆÛË: ªÂÛÔÎÔÏÈÎ‹

∆Ô ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· ·Ó¤‰ÂÈÍÂ ÙËÓ

·ÎÚÈ‚‹ ·Ó·ÙÔÌÈÎ‹ ÂÓÙfiÈÛË ÙË˜ ÂÈÎÔÈÓˆÓ›·˜ ÛÙÔ Ì¤ÛÔ ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (¤ÏÏÂÈÌÌ· ÙÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜) Î·È ÙÈ˜ ·ÈÌÔ‰˘Ó·ÌÈÎ¤˜ Û˘Ó¤ÂÈ¤˜ ÙË˜ (‰È¿Ù·ÛË ‰ÂÍÈÔ‡ ÎfiÏÔ˘, ÎÔÈÏ›·˜, ·‡ÍËÛË ·ÈÌ·ÙÈÎ‹˜ ÚÔ‹˜ ÛÙ· ÓÂ˘ÌÔÓÈÎ¿ ·ÁÁÂ›·) (∂ÈÎfiÓ· 4). ∞ÎÔÏÔ‡ıËÛÂ ÂÈÙ˘¯‹˜ Î·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎ‹ Û‡ÁÎÏÂÈÛË ÙË˜ ÂÈÎÔÈÓˆÓ›·˜, Î·ıÒ˜ ÙÔ ÌÂÁ¿ÏÔ Ì¤ÁÂıfi˜ ÙË˜ (1) ‰ÂÓ Â¤ÙÚÂÂ ÙË Û‡ÁÎÏÂÈÛË ÌÂ ÂÈ‰ÈÎ‹ Û˘ÛÎÂ˘‹ ÌÂ Î·ıÂÙËÚÈ·ÛÌfi (2).

∆Ô ÂÚÈÛÙ·ÙÈÎﬁ Ô˘ ÂÚÈÁÚ¿ÊËÎÂ ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÌÈ· Ù˘ÈÎ‹ ÂÚ›ÙˆÛË ÙÔ˘ ÙÚﬁÔ˘ ÌÂ

ÙÔÓ ÔÔ›Ô ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î·È ‰È·ÁÈÁÓÒÛÎÂÙ·È Ë

ÌÂÛÔÎÔÏÈÎ‹ ÂÈÎÔÈÓˆÓ›· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ∫·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹ ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÌÈ·

¯Ú‹ÛÈÌË ÂÓ‰ÔÎ·Ú‰È·Î‹ Ô‰ﬁ ·Ú¿Î·Ì„Ë˜ ÙË˜

ÓÂ˘ÌÔÓÈÎ‹˜ Î˘ÎÏÔÊÔÚ›·˜: ÔÍ˘ÁÔÓˆÌ¤ÓÔ ·ﬁ

ÙÔÓ Ï·ÎÔ‡ÓÙ· ·›Ì· Êı¿ÓÂÈ ÛÙÔÓ ‰ÂÍÈﬁ ÎﬁÏÔ

Î·È, Ì¤Ûˆ ÙÔ˘ ·ÓÔ›ÁÌ·ÙÔ˜ ÙÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜

‰È·ÊÚ¿ÁÌ·ÙÔ˜, ·ˆıÂ› ÙÔ ÏÂÙﬁ ÚˆÙÔÁÂÓ¤˜

‰È¿ÊÚ·ÁÌ· (Ô˘ Î·Ï‡ÙÂÈ ÙÔ ‰Â˘ÙÂÚÔÁÂÓ¤˜)

ÛÙÔÓ ·ÚÈÛÙÂÚﬁ ÎﬁÏÔ, Î·Ù·Ï‹ÁÔÓÙ·˜ ÛÙÔÓ ·ÚÈ-

ÛÙÂÚﬁ ÎﬁÏÔ (‰ÂÍÈÔ·ÚÈÛÙÂÚ‹ ‰È·Ê˘Á‹). ªÂÙ¿

ÙÔÓ ÙÔÎÂÙﬁ, Ë ·˘ÍËÌ¤ÓË ›ÂÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡

ÎﬁÏÔ˘ ˆıÂ› ÙÔ ÚˆÙÔÁÂÓ¤˜ ‰È¿ÊÚ·ÁÌ· ¿Óˆ

ÛÙÔ ‰Â˘ÙÂÚÔÁÂÓ¤˜, ÎÏÂ›ÓÔÓÙ·˜ ÙË ÌÂÛÔÎÔÏÈÎ‹

ÂÈÎÔÈÓˆÓ›·. ∂¿Ó Ë Û‡ÁÎÏÂÈÛË ·˘Ù‹ ‰ÂÓ Â›Ó·È

Ï‹ÚË˜, ÙﬁÙÂ ˘¿Ú¯ÂÈ ·Ó·ÙÔÌÈÎ‹ ÂÈÎÔÈÓˆÓ›·

ÙˆÓ ‰‡Ô ÎﬁÏˆÓ Î·È ·ÓÙ›ÛÙÚÔÊË ÚÔ‹ ·›Ì·ÙÔ˜

(·ÚÈÛÙÂÚÔ‰ÂÍÈ¿ ‰È·Ê˘Á‹). √ ·˘ÍËÌ¤ÓÔ˜ ﬁÁÎÔ˜

ÔÍ˘ÁÔÓˆÌ¤ÓÔ˘ ·›Ì·ÙÔ˜ Ô˘ ‰È¤Ú¯ÂÙ·È ÙÒÚ·

‰È·Ì¤ÛÔ˘ ÙˆÓ ‰ÂÍÈÒÓ Î·Ú‰È·ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ

¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙË ‰È¿Ù·Û‹ ÙÔ˘˜, Ô˘ Á›ÓÂÙ·È

·ÓÙÈÏËÙ‹ ·ÎÙÈÓÔÏÔÁÈÎ¿ ˆ˜ Î·Ú‰ÈÔÌÂÁ·Ï›·, ÌÂ

ÚÔ‚ÔÏ‹ ÙÔ˘ ÙﬁÍÔ˘ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜

Î·È ·‡ÍËÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÁÁÂ›ˆÛË˜. ™ÙÔ

ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·, ·ÓÙ›ÛÙÔÈ¯·, Î·Ù·ÁÚ¿ÊÔÓÙ·È ˘„ËÏ¿ ÎÔÏÈÎ¿ Â¿ÚÌ·Ù· p (ÏﬁÁˆ ‰È¿Ù·ÛË˜ ‰ÂÍÈÔ‡ ÎﬁÏÔ˘) Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ

ËÏÂÎÙÚÈÎ‹ ÂÎﬁÏˆÛË ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (ÏﬁÁˆ ‰È¿Ù·ÛË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜).

∆Ô Ê‡ÛËÌ· ÙË˜ ÌÂÛÔÎÔÏÈÎ‹˜ ÂÈÎÔÈÓˆ-

Ó›·˜, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ¿ÏÏÂ˜ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜, ‰ÂÓ ÚÔ¤Ú¯ÂÙ·È ·ﬁ ÙÔ ÛËÌÂ›Ô ÙË˜ ·Ó·ÙÔÌÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜ ÙˆÓ ÎﬁÏˆÓ, ·ÏÏ¿

4. ÀÂÚË¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ‹ ‰È¿ÁÓˆÛË ÌÂ ·ÂÈÎﬁÓÈÛË

ÂÏÏÂ›ÌÌ·ÙÔ˜, ˆ˜ ÂÚÈÔ¯‹ ·Ô˘Û›·˜ ÙÔ˘ Ë¯ÔÁÂÓÔ‡˜ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (‚¤ÏÔ˜, ·ÚÈÛÙÂÚ¿) Î·È ·ÚÈÛÙÂÚÔ‰ÂÍÈ¿˜ ·ÈÌ·ÙÈÎ‹˜ ÚÔ‹˜ ÛÙÔ ¤Á¯ÚˆÌÔ Doppler (‰ÂÍÈ¿).

ÓÂ˘ÌÔÓÈÎ‹˜ ‚·Ï‚›‰·˜. ∏ ¤ÓÙ·ÛË ¤ÙÛÈ ÙÔ˘ Û˘ÛÙÔÏÈÎÔ‡ Ê˘Û‹Ì·ÙÔ˜ Û˘Ó‹ıˆ˜ Â›Ó·È ‹È·, Ô ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ˆ˜ crescendo-decrescendo (‹ ÂÍÒıËÛË˜) Î·È Ë ı¤ÛË ‚¤ÏÙÈÛÙË˜ ·ÎÚﬁ·ÛË˜ Ë ÂÛÙ›· ·ÎÚﬁ·ÛË˜ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ‚·Ï‚›‰·˜.

Ã·Ú·ÎÙËÚÈÛÙÈÎfi, fiÌˆ˜, ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎfi

·ÎÚÔ·ÛÙÈÎfi Â‡ÚËÌ· Â›Ó·È Ë ·ÚÔ˘Û›· ÛÙ·ıÂÚÔ‡ ‰È¯·ÛÌÔ‡ ÙÔ˘ 2Ô˘ ÙfiÓÔ˘ Ô˘, ·Ó ·Ó·˙ËÙËıÂ› ÌÂ ÚÔÛÔ¯‹, Û¯Â‰fiÓ ¿ÓÙ· ı¤ÙÂÈ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÌÂÛÔÎÔÏÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜ (3). º˘ÛÈÔÏÔÁÈÎ¿ ˘¿Ú¯ÂÈ Î·ı˘ÛÙ¤ÚËÛË Û‡ÁÎÏÂÈÛË˜ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ‚·Ï‚›‰·˜ ÌfiÓÔ Î·Ù¿ ÙËÓ ÂÈÛÓÔ‹, Ë

ÔÔ›· Á›ÓÂÙ·È ·ÎÚÔ·ÛÙÈÎ¿ ·ÓÙÈÏËÙ‹ ˆ˜ ÂÈÛÓÂ˘ÛÙÈÎfi˜ ‰È¯·ÛÌfi˜ ÙÔ˘ 2Ô˘ ÙfiÓÔ˘ (Ô˘ ÂÍ·Ê·Ó›˙ÂÙ·È ÛÙËÓ ÂÎÓÔ‹). ∏ ·˘ÍËÌ¤ÓË fiÌˆ˜ ·ÈÌ·ÙÈÎ‹ ÚÔ‹ ‰È·Ì¤ÛÔ˘ ÙˆÓ ‰ÂÍÈÒÓ ÎÔÈÏÔÙ‹ÙˆÓ

ÛÂ ·ÚÔ˘Û›· ÌÂÛÔÎÔÏÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜ Ô‰ËÁÂ› ÛÂ ÛÙ·ıÂÚ‹ Î·ı˘ÛÙ¤ÚËÛË Û‡ÁÎÏÂÈÛË˜ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜

˘¤ÚÙ·ÛË˜ (4,5).

ÏÂÈÙÔ˘ÚÁÈÎfi Ê‡ÛËÌ· fiÌˆ˜ ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚÔ

Â‡Ë¯Ô (ÌÔ˘ÛÈÎﬁ) ¿ÎÔ˘ÛÌ·, Â›Ó·È ‚Ú·¯Â›·˜ ‰È¿Ú-

ÎÂÈ·˜ ÌÂÛÔÛ˘ÛÙÔÏÈÎﬁ, ·ÎÔ‡ÁÂÙ·È Î·Ï‡ÙÂÚ· ¯·-

ÌËÏﬁÙÂÚ· ·ÚÈÛÙÂÚ¿ ·Ú·ÛÙÂÚÓÈÎ¿, ÂÓÒ ‰ÂÓ Û˘-

ÓÔ‰Â‡ÂÙ·È ·fi ÛÙ·ıÂÚfi ‰È¯·ÛÌfi ÙÔ˘ 2Ô˘ ÙfiÓÔ˘.

∫·ıÒ˜ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ÂÌÊ·Ó›˙ÂÈ ÛÂ

Î¿ÔÈ· ÂÍ¤Ù·ÛË ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· Ê‡ÛË-

Ì·, Ë ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ ·ﬁ ÙÔ Û·ÓÈﬁÙÂÚÔ Ê‡ÛËÌ·

ÙË˜ ÌÂÛÔÎÔÏÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜ Ô˘ ÂÚÈÁÚ¿„·ÌÂ Â›Ó·È ÛËÌ·ÓÙÈÎ‹.

∏ ÓÂ˘ÌÔÓÈÎ‹ Î·Ú‰›·, ˆ˜ Û˘Ó¤ÂÈ· ¯Úﬁ-

ÓÈ·˜ ÓÂ˘ÌÔÓÔ¿ıÂÈ·˜, ‰ÂÓ Â›Ó·È Û¿ÓÈ· ÛÙËÓ

·È‰ÈÎ‹ ËÏÈÎ›·. ∆Ô ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·

ÌÔÚÂ› Ó· ‰Â›¯ÓÂÈ ·ÓÙ›ÛÙÔÈ¯· Â˘Ú‹Ì·Ù· ‰ÂÍÈ¿˜

ÂÈ‚¿Ú˘ÓÛË˜, ÎÏÈÓÈÎ¿ ﬁÌˆ˜ ˘¿Ú¯ÂÈ ¤ÓÙÔÓÔ˜

2Ô˜ ÙfiÓÔ˜ (Î·È fi¯È ‰È¯·ÛÌfi˜), ÂÓÒ ·ÎÙÈÓÔÏÔÁÈÎ¿ ˘¿Ú¯ÂÈ Û˘¯Ó¿ ÌÂ›ˆÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÁÁÂ›ˆÛË˜.

Â›ÛË˜ ·ﬁ Ê‡ÛËÌ· ÂÍÒıËÛË˜ (ﬁˆ˜

ÁÚ¿ÊËÌ· ‰ÂÓ Â›Ó·È Ô‡ÙÂ ÂÊÈÎÙ‹ Ô‡ÙÂ Î·È ÔÈÎÔÓÔÌÈÎ¿ ·Ô‰ÂÎÙ‹ ÚÔÛ¤ÁÁÈÛË (7), ÌﬁÓÔ Ë ÛˆÛÙ‹ ÂÎ·›‰Â˘ÛË ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙËÓ Î·Ú‰È·Î‹ ·ÎÚﬁ·ÛË ÌÔÚÂ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·Ó›¯ÓÂ˘ÛË

µÈ‚ÏÈÔÁÚ·Ê›·

1. Kharouf R, Luxenberg DM, Khalid O, Abdulla R. Atrial septal defect: spectrum of care. Pediatr Cardiol 2008;29:271-280.

2. Thanopoulos BD, Laskari CV, Tsaousis GS, Zarayelyan A, Vekiou A, Papadopoulos GS. Closure of atrial septal defects with the Amplatzer occlusion device: preliminary results. J Am Coll Cardiol 1998; 31:1110-1116.

3. McCrindle BW, Shaffer KM, Kan JS, Zahka KG, Rowe SA, Kidd L. Cardinal clinical signs in the differen-tiation of heart murmurs in children. Arch Pediatr Adolesc Med 1996;150:169-174.

4. Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999;340:839-846.

5. Engelfriet P, Meijboom F, Boersma E, Tijssen J, Mulder B. Repaired and open atrial septal defects type II in adulthood: an epidemiological study of a large European cohort. Int J Cardiol 2008;126:379385.

ÁÈ· ÙË ÛˆÛÙ‹ ‰È¿ÎÚÈÛË ÙË˜

ÂÏ¤Á¯Ô˘ (6). ∫·ıÒ˜ Ë ·Ú·ÔÌ‹

Î¿ıÂ ·È‰ÈÔ‡ ÌÂ Ê‡ÛËÌ· ÁÈ· ˘ÂÚË¯ÔÎ·Ú‰ÈÔ-

6. Germanakis I, Dittrich S, Perakaki R, Kalmanti M. Digital phonocardiography as a screening tool for heart disease in childhood. Acta Paediatr 2008;97: 470-473.

7. Yi MS, Kimball TR, Tsevat J, Mrus JM, Kotagal UR. Evaluation of heart murmurs in children: costeffectiveness and practical implications. J Pediatr 2002; 141:504-511.

™˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV

∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ, ªÂÙ¿ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ, Ô √ÚÁ·ÓÈÛÌfi˜ ¶ÂÚ›ı·Ï„Ë˜ ∞ÛÊ·ÏÈÛÌ¤ÓˆÓ ÙÔ˘ ¢ËÌÔÛ›Ô˘ (√¶∞¢), ÛÙÈ˜ 08/02/2008 ÌÂ ÙËÓ ˘’ ·ÚÈıÌ. 5124 ÂÁÎ‡ÎÏÈfi ÙÔ˘, ··ÁÔÚÂ‡ÂÈ ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Ó· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó ÙÔ ÂÌ‚fiÏÈÔ HPV ÛÂ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 15 ÂÙÒÓ.

∆Ô ¢.™. ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜, ÌﬁÏÈ˜ ÏËÚÔÊÔÚ‹ıËÎÂ ÙËÓ ÂÁÎ‡ÎÏÈÔ ·˘Ù‹, ·ÓÙ¤‰Ú·ÛÂ ¤ÓÙÔÓ· ÚÔ˜ ÙÔ ∫∂™À (¤ÁÁÚ·ÊÔ 1).

ªÂ ÙËÓ ˘’ ·ÚÈıÌ. 6 ·ﬁÊ·ÛË ÙË˜ 215Ë˜ ÔÏÔÌ¤ÏÂÈ·˜ ÙÔ˘ ∫∂™À ÛÙÈ˜ 03-04-2008, Ë Û˘ÓÙ·ÁÔÁÚ¿-

ÊËÛË ÂÂÙÚ¿Ë Î·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ÂÙÒÓ (¤ÁÁÚ·ÊÔ 2).

™ÙÔ ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÙË˜ ∫¤ÚÎ˘Ú·˜ Û·˜ ·Ó·ÎÔ›ÓˆÛ· ÙËÓ ÈÔ ¿Óˆ ·ﬁÊ·ÛË. ¶·Ú¿ Ù·‡Ù·,

ÌfiÏÈ˜ ÚÔ¯ı¤˜ ÂÓËÌÂÚÒıËÎ· ·fi Û˘Ó·‰¤ÏÊÔ˘˜ fiÙÈ Ù· Ê·ÚÌ·ÎÂ›· ‰ÂÓ ¯ÔÚËÁÔ‡Ó ÙÔ ÂÌ‚fiÏÈÔ, ÁÈ’ ·˘Ùfi ıÂˆÚÔ‡ÌÂ ÛÎfiÈÌÔ Ó· Û·˜ ÂÓËÌÂÚÒÛÔ˘ÌÂ.

¶·Ú¿ÏÏËÏ·, ÂÓËÌÂÚÒÛ·ÌÂ ÙÔÓ √¶∞¢ Î·È ÙÔÓ ¶·ÓÂÏÏ‹ÓÈÔ º·ÚÌ·ÎÂ˘ÙÈÎﬁ ™‡ÏÏÔÁÔ.

√ ¶ÚﬁÂ‰ÚÔ˜ ÙË˜

∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜

∫·ı ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙﬁÔ˘ÏÔ˜

ŒÁÁÚ·ÊÔ 1: ∂ÈÛÙÔÏ‹ ÙÔ˘ ¶ÚÔ¤‰ÚÔ˘ ÙË˜ ∂.¶.∂. ÚÔ˜ ÙÔÓ ¶ÚﬁÂ‰ÚÔ ÙÔ˘ ∫∂.™.À

¶ÚÔ˜ ÙÔÓ ¶ÚﬁÂ‰ÚÔ ÙÔ˘ ∫∂™À

∫·ıËÁ. Î. ∫˘ÚÈ¿ÎÔ ™ÙÚÈÁÁ¿ÚË

ª·ÎÂ‰ÔÓ›·˜ 8, 104 33, ∞ı‹Ó·

∫‡ÚÈÂ ¶ÚﬁÂ‰ÚÂ, ∆Ô ¢ÈÔÈÎËÙÈÎﬁ ™˘Ì‚Ô‡ÏÈÔ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ÌÂÙ¿ Ï‡Ë˜ ÙÔ˘ ‰È·›ÛÙˆÛÂ

ﬁÙÈ Î˘ÎÏÔÊÔÚÔ‡Ó ¤ÁÁÚ·Ê· Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Ú·ÁÌ·ÙÈÎﬁÙËÙ·.

√ ¢ÈÂ˘ı˘ÓÙ‹˜ ÙÔ˘ √¶∞¢ Î. ¡. º·ÚÌ¿ÎË˜, ÌÂ ÙÔ ˘’ ·ÚÈıÌ. 5124 ¤ÁÁÚ·Êﬁ ÙÔ˘ Û¯ÂÙÈÎ¿ ÌÂ ÙË ¯Ô-

Ú‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV, ·Ó·Ê¤ÚÂÈ “°È· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15 ¤ˆ˜ 18 ÂÙÒÓ ÙÔ ÂÌ‚ﬁÏÈÔ ı· Û˘ÓÙ·-

ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ Á˘Ó·ÈÎÔÏfiÁÔ˘˜, ÁÂÓÈÎ‹˜ È·ÙÚÈÎ‹˜ Î·È ·ıÔÏfiÁÔ˘˜, ÂÎÙfi˜ Î·È Â¿Ó ÙÔ ∫∂™À ·ÔÊ·Û›ÛÂÈ ‰È·ÊÔÚÂÙÈÎ¿”. ¢È·Ì·ÚÙ˘ÚfiÌÂı· ¤ÓÙÔÓ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ·È‰È¿ÙÚˆÓ, ÁÈ· ÙÔ˘˜ ÂÍ‹˜ ÏfiÁÔ˘˜: 1. ∆· ÂÌ‚fiÏÈ· ÛÂ fiÏÂ˜ ÙÈ˜ ËÏÈÎ›Â˜ Ù· ¯ÂÈÚ›˙ÔÓÙ·È Ì¤¯ÚÈ Û‹ÌÂÚ·

ªÂ ÙÈÌ‹, ∫·ı. ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙﬁÔ˘ÏÔ˜

¶ÚﬁÂ‰ÚÔ˜ ¶·ÓÂ˘Úˆ·˚Î‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜

¶ÚﬁÂ‰ÚÔ˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜

¶ÚﬁÂ‰ÚÔ˜ ∂ıÓÈÎ‹˜ ∂ÈÙÚÔ‹˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ

∫ÔÈÓÔÔ›ËÛË:

ÀÔ˘ÚÁﬁ ÀÁÂ›·˜ Î. ¢. ∞‚Ú·ÌﬁÔ˘ÏÔ

ÀÊ˘Ô˘ÚÁﬁ ÀÁÂ›·˜ Î. °. ∫ˆÓÛÙ·ÓÙﬁÔ˘ÏÔ

°ÂÓ. °Ú·ÌÌ. ÀÁÂ›·˜ Î. ∫·ÏÔÁÂÚﬁÔ˘ÏÔ

¶ÚﬁÂ‰ÚÔ ¶·ÓÂÏÏ‹ÓÈÔ˘ π·ÙÚÈÎÔ‡ ™˘ÏÏﬁÁÔ˘ Î. ∂ÌÌ.

¢ÈÂ˘ı˘ÓÙ‹ √¶∞¢ Î. ¡. º·ÚÌ¿ÎË

∂§§∏¡π∫∏ ¢∏ª√∫ƒ∞∆π∞∞ı‹Ó· 30.5.2008

™Àªµ√À§π√ À°∂π∞™∞ÚÈıÌ. ∞ﬁÊ. 6 ÙË˜ 215Ë˜ √ÏÔÌ./3.4.2008

∞¶√º∞™∏ “™¯ÂÙÈÎÒ˜ ÌÂ ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV”

ªÂ ÙÔ ˘’ ·ÚÈıÌ. ÚˆÙ. oÈÎ.4832/6.2.2008 ¤ÁÁÚ·ÊÔ ÙÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ¶ÂÚ›ı·Ï„Ë˜ ∞ÛÊ·ÏÈÛÌ¤ÓˆÓ ¢ËÌÔÛ›Ô˘ (√.¶.∞.¢.), ˙ËÙÔ‡ÓÙ·È ÏËÚÔÊÔÚ›Â˜ ·fi ÙÔ ∫∂.™.À. Û¯ÂÙÈÎ¿ ÌÂ ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV, ·Ó·Ê¤ÚÔÓÙ·˜ Ù· ·ÎfiÏÔ˘ı·: ™ÙÔ ¡¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV), ÙÔ ÔÔ›Ô Û˘ÓÈÛÙ¿Ù·È ÛÂ ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 12-15 ÂÙÒÓ Î·È ÛÂ ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15 ¤ˆ˜ 26 ÂÙÒÓ Â¿Ó ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛıÂ› ÛÙË Û˘ÓÈÛÙÒÌÂÓË ËÏÈÎ›· (¯ˆÚ›˜ Ó· ‰È·ÛÊ·Ï›˙ÂÙ·È Ë ÚÔÊ‡Ï·Í‹

ÙÔ˘˜ Â¿Ó ¤¯Ô˘Ó ÌÔÏ˘ÓıÂ› ·fi Ù‡Ô ÙÔ˘ ÈÔ‡ Ô˘ ÂÚÈ¤¯ÂÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ, È‰È·›ÙÂÚ· Â¿Ó ¤¯Ô˘Ó ·ÏÏ¿ÍÂÈ 3-4 ÛÂÍÔ˘·ÏÈÎÔ‡˜ Û˘ÓÙÚfiÊÔ˘˜).

¶ÚÔÎÂÈÌ¤ÓÔ˘ Ô √.¶.∞.¢. Ó· ‰ÒÛÂÈ Ô‰ËÁ›Â˜ ÛÙÈ˜ ÀËÚÂÛ›Â˜ ÙÔ˘, ˙ËÙ¿ Ó· ÙÔ˘ ÁÓˆÚ›ÛÂÈ ÙÔ ∫∂.™.À. ÔÈÂ˜ ÂÈ‰ÈÎﬁÙËÙÂ˜ È·ÙÚÒÓ ‰‡Ó·ÓÙ·È Ó· ÙÔ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó Î·È ÂÈ‰ÈÎ¿ ÁÈ· ÙÈ˜ ËÏÈÎ›Â˜ 12 ¤ˆ˜ Î·È 14 ÂÙÒÓ Î·È ÁÈ· ÙÈ˜ ËÏÈÎ›Â˜ 15 ¤ˆ˜ Î·È 18 ÂÙÒÓ.

∂ÈÚfiÛıÂÙ· ÁÓˆÛÙÔÔÈÂ›Ù·È fiÙÈ Ô √.¶.∞.¢., ÚÔÛˆÚÈÓ¿ Î·È ¤ˆ˜ fiÙÔ˘ ·ÔÊ·Û›ÛÂÈ ÙÔ ∫∂.™.À., ÂÍ¤‰ˆÛÂ ÙÈ˜ ÂÍ‹˜ Ô‰ËÁ›Â˜: °È· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ ·fi 12 ¤ˆ˜ 14 ÂÙÒÓ, ÙÔ ÂÓ ÏfiÁˆ ÂÌ‚fiÏÈÔ ı· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ ÂÈ‰ÈÎfiÙËÙ·˜ ¶·È‰È·ÙÚÈÎ‹˜, °˘Ó·ÈÎÔÏÔÁ›·˜, °ÂÓÈÎ‹˜

Î·È ¶·ıÔÏÔÁ›·˜. °È· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ ·ﬁ 15 ¤ˆ˜ Î·È 18 ÂÙÒÓ, ÙÔ ÂÌ‚ﬁÏÈÔ ı· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È

∫·ÙﬁÈÓ ÙÔ‡ÙÔ˘, Ë ∂ÎÙÂÏÂÛÙÈÎ‹ ∂ÈÙÚÔ‹ ¤ıÂÛÂ ÙÔ ı¤Ì· ÚÔ˜ Û˘˙‹ÙËÛË ÛÙËÓ 215Ë ™˘ÓÂ‰Ú›·ÛË ÙË˜

√ÏÔÌ¤ÏÂÈ·˜ ÙÔ˘ ∫∂.™.À. (3.4.08), Ë ÔÔ›·, ÌÂÙ¿ ·ﬁ ÌÂÏ¤ÙË Î·È ‰ÈÂÍÔ‰ÈÎ‹ Û˘˙‹ÙËÛË, ·ÔÊ¿ÛÈÛÂ ÔÌﬁÊˆÓ· Ù· ÂÍ‹˜:

∆Ô ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) ‰‡Ó·Ù·È Ó· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ ÂÈ‰ÈÎfiÙËÙ·˜ ¶·È‰È·ÙÚÈÎ‹˜, °˘Ó·ÈÎÔÏÔÁ›·˜, °ÂÓÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¶·ıÔÏÔÁ›·˜.

°È· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ ·fi 15 ¤ˆ˜ Î·È 18 ÂÙÒÓ, ÙÔ ÂÌ‚fiÏÈÔ ı· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ ÂÈ‰ÈÎfiÙËÙ·˜ ¶·È‰È·ÙÚÈÎ‹˜, °˘Ó·ÈÎÔÏÔÁ›·˜, °ÂÓÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¶·ıÔÏÔÁ›·˜.

∆¤ÏÔ˜, ÁÈ· ÎÔÚ›ÙÛÈ· Ô˘ ¤¯Ô˘Ó Û˘ÌÏËÚÒÛÂÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ÂÙÒÓ, ÁÈ· ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ··ÈÙÂ›Ù·È ÂÈÏ¤ÔÓ Î·È È·ÙÚÈÎ‹ ÁÓˆÌ¿ÙÂ˘ÛË ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡ °˘Ó·ÈÎÔÏfiÁÔ˘ Ô˘ ı· ·Ó·Ê¤ÚÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÚÔÛ‚ÏËıÂ› ·fi fiÏ· Ù· ÛÙÂÏ¤¯Ë ÙÔ˘ ÈÔ‡ Ô˘ Î·Ï‡ÙÂÈ ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÂÍ˘·ÎÔ‡ÂÙ·È fiÙÈ Ë ·Ó·ÁÚ·Ê‹ ı· Á›ÓÂÙ·È ·fi È·ÙÚfi ÂÈ‰ÈÎfiÙËÙ·˜ °˘Ó·ÈÎÔÏÔÁ›·˜.

∂ÛˆÙÂÚÈÎ‹ ¢È·ÓÔÌ‹ °È· ÙÔ ∫∂ ™ À

1) °Ú·ÊÂ›Ô Î. ÀÔ˘ÚÁÔ‡ ÀÁÂ›·˜ √ ¶ÚﬁÂ‰ÚÔ˜ Î·È ∫ÔÈÓ. ∞ÏÏËÏÂÁÁ‡Ë˜ ∫˘ÚÈ¿ÎÔ˜ ™ÙÚÈÁÁ¿ÚË˜

2) °Ú·ÊÂ›Ô Î. ÀÊ˘Ô˘ÚÁÔ‡ ÀÁÂ›·˜

3) °Ú·ÊÂ›Ô Î. °ÂÓ. °Ú·ÌÌ·Ù¤· ÀÁÂ›·˜

4) °Ú·ÊÂ›Ô Î·˜ °ÂÓ. ¢/ÓÙÚÈ·˜ ¢ËÌﬁÛÈ·˜ ÀÁÂ›·˜

5) ¢/ÓÛË °Ú·ÌÌ·ÙÂ›·˜ ∫∂.™.À.

∆Ì‹Ì· ∞ã (2)

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Correct answers for the Quiz of the article “A quadrivalent HPV vaccine”

1.Cervical cancer is the second most common cancer among women 15-44yearsold in Europe.

2.Cervical cancer has been shown to be caused by HPV infection in over 99% of cases.

3.Over 50% of girls will acquire HPV within 48 months of becoming sexually active.

4.Up to 12% of HPV-associated precancerous changes might progress to cervical cancer.

5.HPV types 16 and 18 account for 75% of cervical cancer and HPV types 6 and 11 for 90% of genital warts in Europe.

6.Amorphous Aluminium Hydroxide Sulphate (AAHS) hasthegreatestcapacitytobindHPVVLPsand generatesubstantiallyhigherantibodytitresthanALOH.

7.The quadrivalent HPV vaccine has demonstrated high efficacy against the following 6,11,16,18 HPV related diseases: cervicalcancer,highgradecervical,vulvar,vaginalintraepithelialneoplasiasandgenitalwarts.

8.In 9-15 year old adolescents, the quadrivalent HPV vaccine has demonstrated higherimmunogenicitythanin women15-26yearsold.

9.The most effective practice to reduce cervical cancer worldwide iscombinedimplementationofscreening programs(Paptest)insexuallyactivewomenandroutinevaccinationinwomenaged12-26years.

™ˆÛÙ¤˜ ··ÓÙ‹ÛÂÈ˜ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ

1.ªÈÎÚﬁ ‚Ú¤ÊÔ˜ 40 ËÌÂÚÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓÈÎ‹

·fi Â‚‰ÔÌ¿‰Ô˜ Î·È ˘ÚÂÙfi. ¶Èı·ÓfiÙÂÚÔ ·›ÙÈÔ: ÏÔ›ÌˆÍË ·fi ÛÙÚÂÙfiÎÔÎÎÔÔÌ¿‰·˜µ.

2.ªÈÎÚﬁ ‚Ú¤ÊÔ˜ 3 ÌËÓÒÓ ÚÔÛÎÔÌ›˙ÂÙ·È

ÌÈÎÚÔ‡ Ì·ÓÙ·ÚÈÓÈÔ‡,

ÂÓÙÔ›˙ÂÙ·È ÛÙË ‰ÂÍÈ¿ ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ·, Â›Ó·È Ì·Ï·Î‹ Î·È ÔÌÔÈfiÌÔÚÊ· Â˘›ÂÛÙË, ¯ˆÚ›˜ ˘ÚÂÙfi ‹ ÙÔÈÎ¿ ÈÂÛÙÈÎ¿ Ê·ÈÓfiÌÂÓ·. ∏ ÌËÙ¤Ú· ·Ú·Ù‹ÚËÛÂ ÙË ‰ÈfiÁÎˆÛË Ï›ÁÂ˜ ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ¶Èı·Ó‹ ‰È¿ÁÓˆÛË: ÏÂÌÊ·ÁÁÂ›ˆÌ·.

3.∫ÔÚ›ÙÛÈ 12 ÂÙÒÓ ÚÔÛ¤Ú¯ÂÙ·È ÌÂ ˘Ú¤ÙÈÔ, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ÚÔÛÎÔÌ›˙ÂÈ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ÌÂ ÂÙÂÚﬁÏÂ˘ÚË ‰ÈﬁÁÎˆÛË ÌÂÛÔıˆÚ·Î›Ô˘. ¶ÚÒÙÂ˜ ‰È·ÁÓˆÛÙÈÎ¤˜ ÛÎ¤„ÂÈ˜: Ê˘Ì·Ù›ˆÛË.

4.∞ÁfiÚÈ 4 ÂÙÒÓ ·fi ·ÁÚÔÙÈÎ‹ ÂÚÈÔ¯‹ ÚÔÛÎÔÌ›˙ÂÙ·È ÌÂ ˘ÚÂÙfi ·fi 10ËÌ¤ÚÔ˘ Î·È ‹È· ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ™ÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒÓÂÙ·È ˘„ËÏfi˜ ·ÚÈıÌfi˜ ËˆÛÈÓÔÊ›ÏˆÓ (25.000/mm3). ¶Èı·Ó‹ ‰È¿ÁÓˆÛË: ÏÔ›ÌˆÍË·fiÙÔÍfiÎ·Ú·

5.∂Ó‰Â›ÍÂÈ˜ ÁÈ· ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· ·ÔÙÂÏÔ‡Ó ÔÈ ·Ú·Î¿Ùˆ: Ì¤ÁÂıÔ˜·‰¤Ó·>2cm,ÛÙ·ÛÈÌfiÙËÙ·ÌÂÁ¤ıÔ˘˜ ÌÂÙ¿·fi4-6Â‚‰ÔÌ¿‰Â˜,ÌË·ÓÙ·fiÎÚÈÛËÛÂ·ÓÙÈ‚ÈÔÙÈÎ‹·ÁˆÁ‹ÌÂÙ¿·fi2Â‚‰ÔÌ¿‰Â˜,·ıÔÏÔÁÈÎ‹·ÎÙÈÓÔÁÚ·Ê›·ıÒÚ·Î·,˘ÂÚÎÏÂ›‰È·ÂÓÙfiÈÛË

•ÂÓÔ‰Ô¯Â›Ô “King George Palace”

√ÚÁ¿ÓˆÛË: ∞ã ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¡ÔÛÔÎÔÌÂ›Ô˘

¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

¶ÏËÚÔÊÔÚ›Â˜: ∫∂°ª ∆Ô˘ÚÈÛÙÈÎ¤˜ &

™˘ÓÂ‰ÚÈ·Î¤˜ ∂È¯ÂÈÚ‹ÛÂÈ˜, Congress World

∆ËÏ.: 210-7210052, 7210001

Fax: 210-7210051

E-mail: info@congressworld.gr

Website: http://www.congressworld.gr

18 √ÎÙˆ‚Ú›Ô˘ 2008 22o ™ÂÌÈÓ¿ÚÈÔ ∂Â›ÁÔ˘Û·˜ Î·È ∂ÓÙ·ÙÈÎ‹˜ ∞ı‹Ó·

¶·È‰È·ÙÚÈÎ‹˜: ¡Â˘ÚÔÏÔÁÈÎ¿ ¶ÚÔ‚Ï‹Ì·Ù· Î·È

∂ÓÙ·ÙÈÎ‹ £ÂÚ·Â›· ÛÙ· ¶·È‰È¿ ∞ÌÊÈı¤·ÙÚÔ °.¡. ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜

∆ËÏ.: 210-7798033

Fax: 210-7798357

E-mail: picupapadatosgr@yahoo.com

23-26 √ÎÙˆ‚Ú›Ô˘ 2008 31st Congress of the Union of Middle-Eastern & Tunis, Tunisia

Mediterranean Pediatric Societies

Contact: Prof. Ahmed Sahloul Essoussi

Tel.: +216.73.219494/221411

Fax: +216.73.224899

E-mail: sahloulessoussi@ms.tn

24-28 √ÎÙˆ‚Ú›Ô˘ 2008 EAP 2008 - 2nd Congress of the Nice, France

European Academy of Paediatrics

Contact: Daniela Morein-Bar

Tel.: 41-229-080-488

Fax: 41-227-322-850

E-mail: paediatrics@kenes.com

Website: www.kenes.com/paediatrics/index.asp

25-26 √ÎÙˆ‚Ú›Ô˘ 2008 1Ô ¶·ÓÂÏÏ‹ÓÈÔ

ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ÙÔ˘ ∂Ê‹‚Ô˘

Àﬁ ÙËÓ

6937676725

E-mail: anasgr@gmail.com

5-7 ¡ÔÂÌ‚Ú›Ô˘ 2008 36th Meeting of the British Society for Swansea, Paediatric Endocrinology and Diabetes United Kingdom

¶ÏËÚÔÊÔÚ›Â˜: Shirine Borbor, Joanne Galer

∆ËÏ.: 01-454-642-210

Fax: 01-454-642-222

E-mail: conferences@endocrinology.org

13-14 ¡ÔÂÌ‚Ú›Ô˘ 2008

17-19 ¡ÔÂÌ‚Ú›Ô˘ 2008

2nd National Conference: New Trends in London, Paediatric Asthma and Allergy United Kingdom

¶ÏËÚÔÊÔÚ›Â˜: Amy Tranter

∆ËÏ.: 02-0-75-016-711

E-mail: amy.t@markallengroup.com

1st International Congress of UENPS Rome, Italy

(Union of European Neonatal and Perinatal Societies)

Global Neonatology & Perinatology

Contact: L. Zmuda

Tel.: 39-0-680-693-320

Fax: 39-0-680-692-586

E-mail: uenps2008@emec-roma.com

Website: www.uenps2008.eu/homepage.htm

28-30 ¡ÔÂÌ‚Ú›Ô˘ 2008 ™‡Á¯ÚÔÓÂ˜

¶·È‰È·ÙÚÈÎ‹ 2008

√ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈÎﬁ

¶ÏËÚÔÊÔÚ›Â˜: The Mastermind Group

∆ËÏ.: 210-6827405, 6839690

Fax: 210-6827409

E-mail: estasinou@tmg.gr

Website: www.mastermind.gr

3-5 ¢ÂÎÂÌ‚Ú›Ô˘ 2008

Primary Care Pediatrics Boston, MA,

¶ÏËÚÔÊÔÚ›Â˜: CME Office United States

∆ËÏ.: 617-384-8600

Fax: 617-384-8686

E-mail: hms-cme@hms.harvard.edu

13-14 ¢ÂÎÂÌ‚Ú›Ô˘ 2008 8Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰ÔÓÂ˘ÚÔÏÔÁÈÎﬁ

•ÂÓÔ‰Ô¯Â›Ô “Athens Imperial”

√ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈÎ‹ ¶·È‰ÔÓÂ˘ÚÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›·

¶ÏËÚÔÊÔÚ›Â˜: AC&C International

TËÏ.: 210-6889100

Fax: 210-6844777

E-mail: Paidneuro-info@acnc.gr Website: www.paidneuro.gr

15-16 ¢ÂÎÂÌ‚Ú›Ô˘ 2008 ∂ÓÙ·ÙÈÎ‹ ∂Î·›‰Â˘ÛË: 11Ô˜

“¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁ›·”

√ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈÎ‹ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎ‹

∆ËÏ.: 210-7774370

Fax: 210-7701552

E-mail: info@endo.gr

Website: www.endo.gr

£ÂÛÛ·ÏÔÓ›ÎË ∂›Î·ÈÚ· £¤Ì·Ù· ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ •ÂÓÔ‰Ô¯Â›Ô “Makedonia Palace”

√ÚÁ¿ÓˆÛË: º. ∞ı·Ó·ÛÈ¿‰Ô˘

¶ÏËÚÔÊÔÚ›Â˜: Global Events

TËÏ.: 2310-247743, 4

Fax: 2310-247746

E-mail: info@globalevents.gr Website: www.globalevents.gr

Παιδιατρική | Τόμος 71 • Τεύχος 5 • Σεπτέμβριος - Οκτώβριος 2008

¶·È‰È·ÙÚÈÎ‹

Paediatriki

Contents

Psychology of embryos, neonates and infants: current developmental research**

A quadrivalent human papillomavirus (HPV) vaccine to prevent cervical cancer and other HPV related anogenital diseases

Immunogenicity – Duration of Protection

Cross protection

Safety

Ongoing studies with quadrivalent HPV vaccine

Cost-Effectiveness Studies

Implementation Issues

Quiz

ÀÈÔı¤ÙËÛË ÙË˜ ÌÂÛÔÁÂÈ·Î‹˜ ‰›·ÈÙ·˜ ·ﬁ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

The relation of body mass index with selected behavioural parameters in 11 year-old children

The prevalence and epidemiology of obesity in children of southeastern Attica. The modern lifestyle and the role of the primary care paediatrician

ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË:

Ethical dilemmas due to prenatal diagnostics: preliminary results of the multicentre research programme EDIG

ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿

Diagnostic approach to lymphadenopathy in children

¶·È‰› ÌÂ “ÏÂÈÙÔ˘ÚÁÈÎﬁ” Ê‡ÛËÌ·

2008

∞ÏÁﬁÚÈıÌÔ˜ ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯ÓÂ˘ÛË ·Ó·Ù˘ÍÈ·ÎÒÓ