The Effect of Health Education on Adolescents' Awareness of HPV Infections and Attitudes towards HPV Vaccination in Greece.

BACKGROUND: The purpose of this paper is to evaluate the role of health education among young adolescents, regarding their level of knowledge about the HPV and the acceptance of the HPV vaccination, with the aim of increasing vaccination coverage, in Trikala city, mainland of Greece. METHODS: This study included high school students from all public and private schools of Trikala city. Questionnaires related to knowledge regarding the HPV infection and HPV vaccination were administered in three phases. In the first phase of the study, the questionnaires were completed by the entire study population. During the second and third phases, the completion of the questionnaires concerned only the population that received the intervention (interactive seminars). The second and third phase questionnaires were completed immediately after the interactive seminar and three months later, respectively. The statistical analysis of the results was performed using IBM SPSS 20.0 statistical program. RESULTS: A total of 434 female students completed the questionnaire (response rate 76.26%). Most participants (66.6%) were females. The questionnaires evaluated the respondents' awareness of the HPV infection. The results show that the percentage of the participants who stated that they "do not know" what HPV is decreased from 44.4% (first phase), to 1.6% (second phase), and 8.1% (third phase). Similarly, the willingness to accept the HPV vaccine increased from 71% (first phase), to 89.1% (second phase), and 83.5% (third phase). CONCLUSIONS: The present study shows that targeted interactive informational interventions in the school environment leads to a statistically significant increase in both the level of knowledge about HPV and the willingness of young adolescent students to be vaccinated against cervical cancer.

Drug Injection-Related Norms and High-Risk Behaviors of People Who Inject Drugs in Athens, Greece.

Drug use involves social interactions. Therefore, norms in the proximal environment of people who inject drugs (PWID) can favor behaviors that may result in HIV transmission. This work aimed at studying drug injection-related norms and their potential association with risky behaviors among PWID in Athens, Greece, in the context of economic recession and political activism that followed the fiscal crisis and soon after a recent HIV outbreak had leveled off. The Transmission Reduction Intervention Project (TRIP) was a social network-based approach (June 2013 to July 2015) that involved two groups of PWID seeds-with recent HIV infection and with long-term HIV infection and one control group of HIV-negative PWID. Network contacts of seeds were also enrolled. TRIP participants answered a questionnaire that included items on injection-related norms and behaviors. TRIP recruited 320 PWID (HIV positive, 44.4%). TRIP participants, especially those without HIV, often recalled or perceived as normative among their partners and in their networks some behaviors that can lead to HIV transmission. TRIP participants who recalled that they were encouraged by their regular drug partners to use an unclean syringe were almost twice as likely to report that they share syringes [odds ratio (OR) = 2.03; 95% confidence interval (CI) = 1.86-2.21], or give syringes to someone else (OR = 1.70; 95% CI = 1.42-2.04) as those who did not recall such an encouragement. Associations were modified by HIV status. HIV negatives, who were reportedly encouraged to share nonsyringe injecting equipment, were almost 4.5 times as likely to share that material as HIV-negative participants who were not encouraged (OR = 4.59, 95% CI = 4.12-5.11). Further research is needed on the multiple determinants (social, economic, and political) of norms in the social environments of PWID. Since peer norms are associated with risky behaviors, interventions should be developed to encourage norms and peer pressure against the sharing of injection equipment.

Understanding of Young Adolescents About HPV Infection: How Health Education Can Improve Vaccination Rate.

The purpose of this systematic review was to identify adolescents' awareness on the human papillomavirus (HPV), the HPV vaccine, and the willingness to undergo the vaccination. A systematic review of studies concerning the adolescent's knowledge and education on the admission of the HPV vaccine was carried out, through the Medline/PubMed and the Google Scholar databases, covering information on adolescent attitudes towards HPV vaccination, as well as their perceptions regarding the vaccination and the need for more training, towards the public information about the HPV and the HPV vaccine. This study concludes that adolescents are poorly informed about the HPV and the preventive vaccination issues, underestimating the likelihood of the infection by the virus. The way to improve their knowledge about the HPV and the implications of the HPV infection is to provide information through the framework of compulsory schooling, primary health care, and the development of informative interactive interventions. The awareness for the need of training about the HPV and its implications should be broadened to address the major barrier to vaccination, which is regarded to be the lack of adequate information. The knowledge and the perceptible susceptibility to the HPV infection and HPV-related diseases among adolescents demonstrate the need for a well-designed training program to bridge the gap of information about the HPV virus and to accept the HPV vaccine.

[Cost analysis and evaluation of a PET/CT system-department in a public Greek hospital].

OBJECTIVE: Positron emission tomography/computed tomography (PET/CT) is an imaging technology that has experienced rapid development in recent years. The aim of this paper was to present the financial viability of a PET/CT department in a public hospital of Athens, Greece. This study performs a detailed financial analysis of the operating revenues and expenses of the department for the years 2007-2017. SUBJECTS AND METHODS: For each year considered, detailed analysis of incomes and expenses has been performed. During a normal working day 15 scans are acquired by the PET/CT department. Over the 11 years of operation, 22.035 scans had been performed in total. The turnover for the examined period reached €40.395.275 is this cumulative revenue over the 11 years. RESULTS: The following 6 evaluation and decision-making methods are presented: a) Net present value of the investment 2.245.251€ (factor ß beta 0,6923), b) Internal rate of return was estimated 34,89%, c) The payback period is achieved by 2011, d) The profitability index is 2,10, e) Average rate of return or accounting rate of return is 27,20%, and f) Return On Investment is estimated 299,25%. CONCLUSION: Even if we have to consider that it is not proper to evaluate with financial terms health, it is concluded through the present study that the investment for settling and operating the under-examination PET/CT unit of the present public hospital was financially profitable.

Risk factors for carriage of Streptococcus pneumoniae in children.

BACKGROUND: During the past decades Streptococcus pneumoniae has developed significant resistance to many classes of antimicrobial drugs. Potential risk factors for colonization of the nasopharynx by Streptococcus pneumoniae in children and for carriage of drug resistant strains were examined. METHODS: Between 2007 and 2008 nasopharyngeal swabs were collected from 402 children 6 months to 5 years old visiting the public sector immunization centers and outpatient departments as well as offices of paediatricians from private practice in Nicosia district in Cyprus. Information on demographic characteristics and potential risk factors of participating children were collected using a standardized questionnaire distributed to parents. RESULTS: In multivariable analyses we found that attendance at day care center, having siblings in the family and having both parents originating from Cyprus, statistically increased the risk of pneumococcal colonization. Full immunization with PCV7 appears to be a protective factor against colonization by pneumococcus. Previous administration of antimicrobials during the last month prior to specimen collection appeared to be the most consistent risk factor for carrying a non susceptible strain of Streptococcus pneumoniae to either penicillin or erythromycin. Factors such as age, nationality, previous or current breastfeeding, passive exposure to cigarette smoke and attendance in a day care center do not appear as independent risk factors for colonization by non susceptible strains. CONCLUSIONS: Prudent use of antibiotics especially for upper respiratory tract infections in children as well as increased vaccination coverage by the pneumococcal conjugate vaccines could prove effective in reducing levels of colonization by drug resistant pneumococcal strains.

Effect of Vitamin D Supplementation in Prostate Cancer: A Systematic Review of Randomized Control Trials.

Vitamin D is important in many cellular functions including cell cycling and proliferation, differentiation, and apoptosis. Via the induction of cell cycle arrest and/or apoptosis, vitamin D inhibits normal prostatic epithelial cells growth. Review the evidence of the effect of vitamin D supplementation on prostate cancer (PC) biomarkers and patient survival and assess optimal dosage, formulation and duration. Pubmed, Medline and Ebsco Host databases were systematically searched for relevant literature. 8 Randomized Controlled Trials were included in this review. All studies, besides one, were of high methodological quality. 4 studies used calcitriol (0,5-45 µg/weekly), 2 studies have used vitamin D3 (150-1000 µg/daily) and 2 other studies have used 1α-hydroxy Vitamin D2 (10 µg/ daily or weekly). Duration of supplementation varied between 28 days up to 18.3 months. Two studies had positive effects on prostate specific antigen (PSA) (p < .05), 1 study had a significant positive effect on median survival (p < .05) and 1 study showed a significant reduction of vitamin D receptor (VDR) expression (p < .05). The remaining studies showed negative or no effect on PC characteristics, clinical outcomes and/or survival. Current evidence suggests that vitamin D supplementation in conjunction with standard of care (e.g. chemotherapy, radiation therapy) may confer clinical benefits such as a decrease in serum PSA levels and VDR expression but further research is required to ascertain these results. Calcitriol supplementation in doses ranging from 250-1000 mg for 3-8 weeks or a lower dose of 45 mg for 18.3 months, appear most beneficial regarding outcomes of PC progression and survival.

The Effects of Vitamin D Supplementation in Newly Diagnosed Type 1 Diabetes Patients: Systematic Review of Randomized Controlled Trials.

AIM: The aim of this study was to examine the effects of vitamin D supplementation in patients newly diagnosed with type 1 diabetes (T1D) assessed by insulin needs and changes in glycemic indices, as evidenced by randomized controlled trials (RCTs). METHODS: A total of 7 RCTs were retrieved from PubMed/Medline and EBSCO databases by MeSH term search, and were reviewed systematically. The RCTs included examined the effects of alphacalcidole (n = 2), cholecalciferol (n = 2), and calcitriol (n = 3) supplementation on changes in daily insulin dose (DID), fasting Cpeptide (FCP), stimulated C-peptide (SCP), and HbA1c. In total, 287 individuals, diagnosed with T1D within a period of 4 weeks to 1 year and aged between 5 to 38 years, were examined. RESULTS: Significant positive effects on DID, FCP, and SCP levels were observed after supplementation with alphacalcidole and cholecalciferol, whereas supplementation with calcitriol showed no effect. CONCLUSIONS: Vitamin D supplementation in the form of alphacalcidole and cholecalciferol appears to be beneficial in the treatment of T1D patients by attenuating the natural history of the disease.

Estimation of quality of life in Cypriot patients with inflammatory bowel disease.

AIM: To investigate the health-related quality of life (HRQoL) of patients suffering with idiopathic inflammatory bowel disease (IBD). METHODS: The Greek validated version of the Short Inflammatory Bowel Disease Questionnaire was used for evaluating the quality of life of IBD patients. The questionnaire was distributed to 100 consecutive patients suffering from IBD and presenting for a clinic appointment at the endoscopy unit of Larnaca General Hospital during the period from October to November 2012. The criteria for participating in this study were constituted by the documented diagnosis of either ulcerative colitis (UC) or Crohn's disease (CD) after endoscopy and histologic examination at least 6 months before the study, adult patients (18 years old or older), the capability of verbal communication and the patient's written consent for attending this study. The majority of the questionnaires were completed by a nurse practitioner who specializes in IBD patient care. RESULTS: Regarding the physical dimension in patients with UC, males scored significantly higher than females (4.2 vs 3.4, P = 0.023). Higher scores were also observed in UC patients younger than 35 or older than 50 years (4.0 and 4.2 vs 3.2, respectively, P = 0.021). The psychological dimension revealed similar results in patients with UC, with males, and older ages scoring higher (5.0 vs 3.0, P = 0.01 and 4.7 vs 2.7, P < 0.5, respectively), whereas regarding CD higher scores were observed in married compared to unmarried (3.83 vs 2.33, P = 0.042). No statistical differences in any parameters in the social dimension were observed. Regarding the treatment of, patients with CD, overall higher scores were observed when treated with biological factors compared to standard therapy in all dimensions but with statistical significant difference in the social dimension (5.00 vs 3.25, P = 0.045). CONCLUSION: The study reveals a negative impact of IBD on HRQoL. Increased risks are age and gender in patients with UC and family status in patients with CD.

Still's-like Disease Induced by Breast Implants in a Middle-Aged Female Health Professional.

We report a case of silicone-induced Still's-like inflammatory syndrome diagnosed after extensive investigation in the department of internal medicine of a secondary hospital. A 45-year-old female healthcare specialist presented with fever, headache, sore throat, myalgia and fatigue. A history of breast augmentation surgery in 2007 was confirmed. Physical examination of the patient was normal while laboratory tests showed a very high white blood cell count. The patient was admitted to hospital due to suspected infection and further laboratory tests were carried out. Inflammatory markers were persistently high despite empirical treatment with doxycycline for possible infection by Rickettsia/Coxiella. As the fever did not resolve and the patient had not improved after more than 3 weeks, the case was investigated as fever of unknown origin. Eventually, the existence of liver granulomas as well as the presence of anti-silicone antibodies confirmed the diagnosis of silicone-induced Still's-like inflammatory syndrome. In conclusion, this case supports a linkage between silicone breast implants and autoimmune connective tissue diseases. LEARNING POINTS: Consider and investigate a silicone-induced foreign body reaction as a cause of fever of unknown origin.Consider the possible harmful outcomes of breast augmentation.Develop a greater understanding of the potential linkage between silicone breast implants and autoimmune connective tissue diseases.

Discriminating Between the Roles of Androgens and Estrogens in Cardiovascular Disease.

Cardiovascular disease shows a distinct difference in incidence rates between men and women, a fact that has been known for many years. While initial theories supported that this could be attributed to the protective effect of estrogens in women, attempts to correlate endogenous estrogen levels with cardiovascular risk factors and the progression of atherosclerosis-related indexes indicate otherwise. Similarly, endogenous androgen levels seem to correlate with opposite effects in males and females, whereas exogenous treatment with either androgens or estrogens fails to correspond to scientific expectations entirely. A brief discussion of the merits and pitfalls of placing either estrogens or androgens alone at the root of the problem shows that current understanding is inadequate concerning this major anthropological issue, as it refers to the primary global mortality and morbidity cause.

Octreotide inhibits liver regeneration by suppressing regional estrogen receptor type a expression.

BACKGROUND AND RATIONALE: Liver regeneration involves a significant variety of growth and paracrine factors. Octreotide has long been shown to inhibit liver regeneration, although the exact mechanism of its action remains unclear. This paper aims to examine the effect of long-term octreotide administration on the expression of the estrogen receptor type alpha (Era) as a potential novel pathway via which liver regeneration may be hindered. Sixty adult male Wistar rats were submitted to 70% (extensive) hepatectomy and subsequently randomized to receive either a subcutaneous injection of 50grams/kg body weight octreotide diluted in 1mL of 0.9% normal saline (SS group) or simply 1mL of 0.9% normal saline (NS group). Animals were followed up to 168 or 1440h (1 week and 1 month, respectively) post-hepatectomy and subsequently sacrificed. Removed livers were weighted, diluted in paraformaldehyde, embedded in paraffin wax, sliced at 5 micrometer intervals and prepared for the immunohistochemical detection of ERa. The control group labeling indices for both hepatocytes and cholangiocytes at 168 and 1440h were higher at a statistically significant degree compared to age-matched SS group animals. Interestingly, ERa expression is significantly increased over time in control animals for both cell types examined, while this is not true for animals receiving octreotide. In conclusion, octreotide-mediated inhibition of liver regeneration involves the long-term down-regulation of ERa expression in hepatocytes and cholangiocytes. This hormonal cross-talk may be of particular significance to explain sex-specific differences in liver repair dynamics.

Sex steroids: beyond conventional dimorphism.

Sexual dimorphism is a characteristic of a large number of species, ranging from lower invertebrates to mammals and, last but not least, humans. Recognition of the various factors regulating sexual dimorphism initial establishment (i.e. sex determination and differentiation) and subsequent life-long adaptation to distinct functional and behavioural patterns has remained a hot topic for several decades. As our understanding of the various molecular pathways involved in this process increases, the significant role of sex steroids becomes more evident. At the same time, the recognition of new sites of steroid production (e.g. parts of the brain) and aromatization, as well as new target cells (owing to the proposed presence of additional receptors to those classically considered as primary steroid receptors) has lead to the need to revisit their spectrum of actions within a novel, multifactorial context. Thus, anthropology and medicine are presented with the challenge to unravel a major mystery, i.e. that of sexual orientation and differentiation and its potential contribution in human evolution and civilization development, taking advantage of the high-tech research tools provided by modern biotechnology. This short review summarizes the basic principles of sex determination and sex steroid function as they have been classically described in the literature and then proceeds to present examples of how modern research methods have started to offer a new insight on the more subtle details of this process, stressing that it is extending to virtually every single part and system of the body.

Fertility in the aging male: molecular pathways in the anthropology of aging.

The aging process is a normal stage in development characterized by the gradual deterioration of all life functions. As far as reproduction is concerned, aging is characterized by a significant limitation of fertility in both sexes. This process is, at least partially, attributed to the action (or loss of action) of sex steroids, coinciding with low activity of the pituitary-gonad axis. From an anthropological point of view, the study of reproductive aging is a unique opportunity to investigate various environmental and endogenous factors influencing sexual behavior and, thus, playing a significant role in human biology. Various techniques are now widely available to allow the detailed examination of reproductive hazards using only minor samples of genetic material. These methods are highly sensitive and specific and allow the characterization of distortions at subcellular and even molecular level. This short review briefly summarizes the current understanding of reproductive aging, as well as its potential clinical and anthropological impact.

Assessment of sperm nucleus integrity in infertile men: a novel research field for anthropology in the molecular era.

Anthropology has always been particularly interested in the origin of human life and the development towards adulthood. Although originally working with skeletal measurements and bio-morphological markers in modern populations, it has now entered the growing field of applied molecular biology. This relatively recent advance allows the detailed study of major events in human development and senescence. For instance, sperm DNA integrity and chromatin re-organization are crucial factors for fertilization and embryo development. Clinical researchers have developed improved methods for the evaluation of DNA integrity and protaminosis in sperm nuclei, such as the TUNEL and the CMA3 assays. DNA damage in spermatozoal nuclei is detected using the TUNEL assay which depends on the specific enzymatic reaction of TdT with the end strand breaks of DNA. Protaminosis in spermatozoal nucleus is evaluated using CMA3 assay, which is based on the in situ competition between CMA3 and protamines. Such measurements may provide useful data on human reproductive health, aiding the explanation of demographic differences across the world.

Sex determination strategies in 2012: towards a common regulatory model?

Sex determination is a complicated process involving large-scale modifications in gene expression affecting virtually every tissue in the body. Although the evolutionary origin of sex remains controversial, there is little doubt that it has developed as a process of optimizing metabolic control, as well as developmental and reproductive functions within a given setting of limited resources and environmental pressure. Evidence from various model organisms supports the view that sex determination may occur as a result of direct environmental induction or genetic regulation. The first process has been well documented in reptiles and fish, while the second is the classic case for avian species and mammals. Both of the latter have developed a variety of sex-specific/sex-related genes, which ultimately form a complete chromosome pair (sex chromosomes/gonosomes). Interestingly, combinations of environmental and genetic mechanisms have been described among different classes of animals, thus rendering the possibility of a unidirectional continuous evolutionary process from the one type of mechanism to the other unlikely. On the other hand, common elements appear throughout the animal kingdom, with regard to a) conserved key genes and b) a central role of sex steroid control as a prerequisite for ultimately normal sex differentiation. Studies in invertebrates also indicate a role of epigenetic chromatin modification, particularly with regard to alternative splicing options. This review summarizes current evidence from research in this hot field and signifies the need for further study of both normal hormonal regulators of sexual phenotype and patterns of environmental disruption.

Higoumenakis' sign in the diagnosis of congenital syphilis in anthropological specimens.

Higoumenakis' sign (HS) is a diagnostic criterion referring to the enlargement of the sternal end of the (right) clavicle, frequently observed in patients with late congenital syphilis. Although indexed for several years in clinical medicine textbooks, it has not been extensively applied for the diagnosis of congenital syphilis among anthropological specimens. This is highly significant, since the other major palaeopathology findings refer almost exclusively to the skull and diagnosis thus becomes difficult if only peripheral skeletal remains are available for evaluation. The potential effectiveness of the proposed use of HS as a marker of syphilis in anthropology appears adequate, since descriptions very similar to that of HS have been reported for certain findings, although no attempt has been made to correlate them with the presence of the disease. Higoumenakis himself originally observed this sign in 86% of his patients with congenital syphilis, and this report was subsequently verified by other independent researchers. His attempt to explain the pathophysiology of the sign and its localisation, on the basis of anatomical, biological, and mechanical reasons, however, has been questioned. On the other hand, the application of the remaining markers of congenital syphilis is also problematic, due to sensitivity and/or specificity limitations, and other signs may not be detected due to inability to retain soft tissue samples in anthropological populations and a lack of reliable techniques for treponematous DNA amplification in such old samples. Thus, the fact that the onset of any of the signs of syphilis is not a constant finding justifies the authors' suggestion that HS should be checked for in any available anthropological specimen, because it is highly indicative of possible infection by Treponema pallidum.

ROS in the aging male: model diseases with ROS-related pathophysiology.

The aging process is a complex biological phenomenon that can be attributed to several mechanisms. ROS (reactive oxygen species) activity is widely considered one of them, as it is associated with extensive damage in a variety of cells. For example, the gradual decrease in fertility often accompanying aging males can be traced back to oxidative stress, since ROS are released throughout life from the mitochondrial respiratory chain. Cumulative intracellular damage as a result of the increased ROS concentration affects all tissues that perform aerobic metabolism and, owing to blood circulation, anaerobic tissues as well. Naturally, other mechanisms such as cell inflammation and lack or incapacity of antioxidant enzymes also contribute to the variety of systematic distortions that characterize aging. Finally, the particularly elevated number of adult men that show, among others, a gradual deterioration in reproductive functions suggests a central role of ROS generation in senescence in general and male aging, in particular.

Follicular cells versus oocytes: cell population dynamics in the developing ovary.

The aim of the current paper is to evaluate the correlation of germ and follicular cells kinetics during ovarian morphogenesis. Thus, immunohistochemical detection of PCNA and Ki-67 proteins has been examined using PC10 (Dako) and NCL-Ki-67 (Novocastra) antibodies in the developing ovaries of Wistar rat embryos and neonates [14.5, 18.5, 20.5days post-coitum (dpc), birth (day 0), 1, 3, 5, 7day post-partum (dpp)]. Estimation of reactive/total cell ratio, per cell type (germ and follicular cells) and visual field was achieved using the Image Pro Plus Software. The statistical interpretation of the results has shown that, before birth, using the PCNA antibody, the percentage of labeled/total germ cells (labeling index, LI) increases from 71.19% at 14.5dpc to 75.66% at 18.5dpc. It then decreases to 73.26% at 20.5dpc. At birth, the labeling index drops significantly (28.57%). Immediately after birth, the percentage of labeled/total germ cells increases, reaching 43.58% at 1dpp. Subsequently, a further decrease in the percentage of reactive cells is observed resulting to a maximum drop of the LI at 7dpp (18.41%). Using the Ki-67 antibody, the percentage of labeled/total germ cells is generally lower although the fluctuation is similar with that observed using the first marker of cell proliferation. Using the PCNA antibody, the LI of follicular cells in the developing ovary, increases from 0.70% (at 14.5dpc) to 28.94% (at 18.5dpc) and then drops to 18.03% (at 20.5dpc). At birth, the percentage of reactive follicular cells, reaches 27.66% and remains high thereafter. Similar results are obtained using the Ki-67 antibody. In conclusion, follicular cell reaction ratio, using both antibodies (PCNA and Ki-67), increases continuously throughout the examined period with a maximum value at 7dpp, suggesting a kinetics profile similar to that observed for Sertoli cells in the testis. In all age groups, PCNA labeling is more intense than Ki-67, a result that may be attributed to selective staining at different periods of the cell cycle.