Assessment of the operation of a pilot program of preventive medicine for adults in three primary care centers of Athens and Piraeus: a cross-sectional study: Evaluating P.P.M.A. in three primary care centers of Athens and Piraeus

Objective. To evaluate the operation of the pilot Program of Preventive Medicine for Adults (PPMA) from the provision of healthcare services in three primary health care centers of Athens and Piraeus (Greece). Design. An observational, cross-sectional study was undertaken. A structured questionnaire was used to collect data.Setting. Three public primary health centers of Athens, Greece. Participants. 142 participants, 40-55 years of age, with no previously identified/diagnosed health issues (overall healthy) that should not have undergone any type of screening in the past 12 months. Measures and results. The majority of participants were female (75.4%), aged 40-45 years (43.7%), Greek nationals (88%), employed (62.7%) and high school graduates (52.8%). 68.3% of participants scheduled an appointment in the first two days and 58.9% waited up to 5 minutes in the waiting room. The paramedical personnel scored higher evaluation (4.94) than the doctor (4.61), but all health care centers received a very high general evaluation (4.87). Multiple linear regression showed significant association between the evaluation of the pilot PPMA, the evaluation of health visitor/nurse (B = .240) and the communication of results to participants (B = .245). Conclusions. Findings show an extremely positive evaluation of the pilot PPMA, a result that can be used by healthcare managers for the expansion of the screening program to the general population

Study of intermediate mitotic signals and changes in gene expression by using inducible cellular expression systems of RAS oncogene.

Cancer is a disease where the fundamental rules of cell behavior break down. The development of cancer could be due to abnormal expression or function of specific cellular genes like oncogenes (e.g.Ras). In this thesis we describe the Ras expression and we study the signaling events following H-Ras activation. The gene expression profile analysis of Ras using macroarrays is a second goal of this thesis that gives us the opportunity of examining the target genes that are related to initiation and/or maintenance of carcinogenesis. It is worth mentioning that the RAS mutations are restricted to a single RAS gene and are often tissue specific or dependent upon cancer type. Thus, Ras helped us to characterize downstream events and to identify signaling factors that regulate the expression of genes that are involved in cell death, cellular growth and transformation. To examine early signaling events following the Ha-RASV12 activation [a constitutively active mutated form of the protein with substitution of Gly to Val (12)] and the effect of expression towards cell proliferation, a constitutive expression system of Ras and an ecdysone inducible expression system were developed in HEK - 293 human epithelial kidney cells. The Ecdysone inducible system uses a heterodimer of the ecdysone receptor (VgEcR) and the retinoid X receprtor (RXR) that binds 5 modified ecdysone response elements in the presence of a steroid hormone, ponasterone A, to activate expression of the transfected gene. Thus, to examine early Ras signaling events towards cell proliferation and cell death, the ecdysone inducible expression system of Ha-RASV12 was used (293indRas cells). This inducible expression system of oncogenic Ras under low serum conditions 180 induced biological functions such as growth arrest, cellular senescence and apoptosis. Moreover, the inducible expression of HaRASV12 under low serum conditions led to transient activation of MAPK. We also used a second system in which Ha-RASV12 oncoprotein (293conRas cells) is constitutively expressed under normal serum conditions and in which the transformation process is induced in a larger fraction than in 293indRas cells. In order to validate the cellular properties resulting from the oncogenic expression of HaRASV12 in transformed HEK-293 cells expressing Ras either in an inducible manner at an early stage (2 hours post induction with ponasterone) or intermediate stage (6 hours post induction with ponasterone) or in a constitutive manner (293conRas), gene expression profile analysis was performed by using a human oncoarray cDNA. In parallel, early genes that are regulated specifically after Ras induction and not after induction by serum were identified. Thus genes related to all cell functions were revealed. It was observed that target genes that are upregulated from Ras signaling can act independently or cooperate with each other to trigger early, intermediate and late Ras events. In conclusion, we refer to identification of early genes such as the proline oxidase (POX) gene that has not been previously been reported in Ras signaling. These genes could be further studied in the near future as potentially novel targets for therapy in Ras bearing tumors.Ο καρκίνος είναι μια ασθένεια όπου οι βασικοί κανόνες της κυτταρικής συμπεριφοράς αναιρούνται. Η ανάπτυξη του καρκίνου μπορεί να είναι αποτέλεσμα της μη ομαλής έκφρασης ή λειτουργίας ειδικών κυτταρικών γονιδίων όπως τα ογκογονίδια (π.χ. ras). Στην παρούσα διατριβή περιγράφουμε την έκφραση του RAS και την μελέτη της μεταγωγής σήματος που ακολουθούν την ενεργοποίηση της HRAS με τα μετέπειτα στάδια της μεταγωγής μηνυμάτων από τη συγκεκριμένη πρωτεΐνη. Η ανάλυση έκφρασης των γονιδίων-στόχων του RAS με την χρήση μακροσυστοιχιών γονιδίων (gene expression profile analysis – macroarrays) είναι ένας δεύτερος σκοπός της διατριβής αυτής που δίνει την δυνατότητα μελέτης γονιδίων-στόχων που σχετίζονται με την έναρξη, εξέλιξη ή/και διατήρηση του νεοπλάσματος. Aξίζει να αναφερθεί ότι οι μεταλλάξεις στο RAS συνήθως περιορίζονται σε ένα από τα ras γονίδια και συχνά εξαρτώνται από τον ιστό ή τον τύπο του καρκίνου. Έτσι, το oγκογονίδιο RAS μας βοήθησε να χαρακτηρίσουμε καθοδικά γεγονότα και να ταυτοποιήσουμε παράγοντες σηματοδότησης που ρυθμίζουν την έκφραση των γονιδίων που εμπλέκονται στον κυτταρικό θάνατο, την κυτταρική ανάπτυξη και μετασχηματισμό. Προκειμένου να μελετηθούν τα πρώιμα γεγονότα μεταγωγής σήματος που ακολουθούν την ενεργοποίηση της Ha-RAS (V12) (μιας μεταλλαγμένης συνεχώς ενεργού μορφής της πρωτεΐνης με αντικατάσταση βαλίνης αντί γλυκίνης στην θέση 12) και η επίδραση της έκφρασης στον κυτταρικό πολλαπλασιασμό, χρησιμοποιήθηκαν συστήματα μόνιμης έκφρασης του RAS και το σύστημα επαγωγής έκφρασης εκδυσόνης, τα οποία μελετήθηκαν σε ανθρώπινα νεφρικά κύτταρα ΗΕΚ-293. Το σύστημα εκδυσόνης χρησιμοποιεί ένα ετεροδιμερές από τον υποδοχέα εκδυσόνης (VgEcR) και τον υποδοχέα ρετινοϊκού οξέος RXR, που προσδένεται σε μια τροποποιημένη λειτουργία αναγνώρισης ΕcRE παρουσία της ορμόνης της ποναστερόνης Α, η οποία επάγει την έκφραση του γονιδίου με το οποίο 177 έχει γίνει η επιμόλυνση. Έτσι, για να εξεταστούν πρώιμα γεγονότα της ογκογενούς RAS σηματοδότησης ως προς την κυτταρική ανάπτυξη και κυτταρικό θάνατο, χρησιμοποιήθηκε το επαγόμενο σύστημα του Ηa-RASV12 έκφρασης εκδυσόνης (293indRas κύτταρα). Αυτό το επαγόμενο σύστημα έκφρασης του ογκογενούς RAS σε χαμηλό ορό προσομοιάζει βιολογικές λειτουργίες όπως η ανάσχεση, η κυτταρική γήρανση και η απόπτωση. Επιπλέον, η επαγόμενη ενεργοποίηση του Ηa-RASV12 σε συνθήκες χαμηλού ορού οδήγησε στην περιοδική ενεργοποίηση της ΜΑΡΚ. Χρησιμοποιήσαμε επίσης ένα δεύτερο σύστημα, όπου η ογκοπρωτεΐνη Ha-RASV12 (293conRas) εκφράζεται μόνιμα σε κανονικό ορό και προσομοιάζει την διαδικασία του μετασχηματισμού περισσότερο απo ότι το 293indRas

Spinning Off Business Activities for Care Giver Support: The DISCOVER Attempt

Demographic changes in Europe show an increased demand for quality care for family members, through innovative, broadly accessible solutions that have an overarching focus of improving the quality of life for carers through learning. DISCOVER platform is such a technology, based on existing eLearning systems and delivers digital skills training for carers, focusing in particular on opportunities for informal carers as a socially excluded group. DISCOVER business strategy provides a sustainable entity in order to deliver benefits to the carer, and cared-for communities in the future. An appropriate business model is required to support spinning off business activities for care giver support services, but allow the inclusion of those who may be disadvantaged or those who have a high need for support, but a limited ability to afford to pay for solutions. </jats:p

Intrathecal Baclofen for Spasticity: Is There an Effect on Bladder Function? Report of Three Cases and Review of the Literature

Introduction: traumatic brain injury (TBI) is very often associated with spasticity. Medical interventions may include medications such as baclofen, a Gamma-Aminobutyric Acid (GABA) -receptor agonist of poor lipid solubility. Intrathecal baclofen (ITB) administration is a contemporary treatment option which minimizes adverse effects in contrast with the oral form of the drug. Regarding low urinary tract dysfunction, TBI, as a suprapontine lesion, results in neurogenic detrusor overactivity. Frequency, urgency and urge incontinence are the predominant signs and symptoms of this condition. Our study aims to report the potential changes in bladder function in patients with spasticity, due to TBI, after the implantation of the baclofen pump and the control of spasticity. Material and Methods: We report three cases of TBI whose spasticity responded well to ITB. We evaluated our medical reports regarding bladder function retrospectively, before and after baclofen pump implantation. We compared the data of bladder diaries and urodynamic parameters. Results: Bladder function was improved in all patients. Regarding bladder diaries; the number of incontinence and micturition episodes was decreased and the volume per void was slightly increased. Regarding urodynamic parameters; bladder capacity and reflex volume increased, Pdetmax decreased, PVR was the same and DLPP was slightly decreased. Conclusions: Although the baclofen pump is implanted to treat spasticity, detrusor activity may be also affected. Therefore, patients&rsquo; urologic profiles should also be reevaluated after ITB. Further prospective studies are required to investigate the effect of ITB on bladder function in the clinical field and also at the basic science level