BACKGROUND: Discrepancies in primary health care (PHC) services between urban and rural settings have already been studied in many countries; however, limited information exists regarding countries, such as Greece, where public Health Centres dedicated to primary care have not been in existence in major cities. The objective of this study was to evaluate points of divergence or convergence between an urban and a rural health centre, in an attempt to underline challenges faced by the introduction of urban health centres in Greece. METHODS: A cross-sectional analysis was conducted in the Health Centre of Vyronas, Athens, Greece and in the Health Centre of Nea (New) Madytos, Thessaloniki Prefecture, Greece between February 2004 and February 2006. The profile of the population seeking care, as well as data on the services provided were collected and compared. In addition, the reason for choosing each primary health care unit was also recorded. RESULTS: More patients visited the urban centre (145415 vs. 112513), while the pattern of services utilized by the citizens differed significantly (p < 0.001) between the two Health Centres. The frequency of diagnoses made according to ICPC-2 was not similar in the two Health Centres (p < 0.001). The three most frequent reasons for the adults choosing the Health Centre for their problem were low waiting time, proximity to residence and satisfaction with the services provided in previous visits in Vyronas. CONCLUSION: The results of this study highlight the significant differences regarding PHC services utilization between an urban and a rural population. Urban citizens seem to have different health needs and reasons for choosing a PHC unit than residents of the Greek countryside. Proximity to health services and the public character of the urban health centre seem to be its main advantages.

Anorectal melanoma (AM) is a rare disease and few guidelines have been established regarding its therapeutic management. Wide local excision, or less frequently, abdominoperineal resection is the treatment of choice. We present a female patient with an excised AM who was submitted to our Nuclear Medicine department for sentinel lymph node (SLN) mapping of the area. Under rigid proctoscopy the anal scar received four submucosal injections of technetium-99m-sulfur nanocolloid of 29.6 MBq each. Lymphoscintigraphy and intraoperative gamma-probe guided detection of the SLNs followed. SLNs were localized in the inguinal basins bilaterally and were negative on histology. A wide local excision followed the above test. Thirty months postoperatively the patient developed distant metastases, underwent radiotherapy and died six months later. Without changing prognosis sentinel lymph node detection, excision and histology were important in sparing the patient a futile inguinal lymph node dissection.

BACKGROUND: E2F-1 expression is positively associated with tumour growth in oesophageal squamous-cell carcinomas (OSCC), while it exhibits oncosuppressive features in colonic adenocarcinomas (AC). To date there are no data regarding E2F-1 expression and its relationship with tumour kinetics (proliferation, apoptosis) in adenocarcinomas that develop on Barrett oesophagus. AIM: As oesophageal adenocarcinomas occur almost exclusively in the metaplastic Barrett epithelium and the opposing E2F-1 behaviour seems to be cell and tissue-type dependent, we examined the manner in which E2F-1 acts in ACs of Barrett oesophagus. METHODS: We estimated the immunohistochemical expression of E2F-1, Ki-67, caspase-3 and p53 immunohistochemical status in 35 Barrett oesophagus ACs. RESULTS: E2F-1 immunopositivity correlated inversely with Ki-67, by semi-serial section and statistical analysis (p = 0.023, Spearman correlation). Semi-serial section analysis revealed a direct association between E2F-1 and caspase-3 staining. No correlation was found with p53 status. Cases with higher E2F-1 immunoexpression exhibited longer survival (p = 0.047, Cox-regression). CONCLUSIONS: E2F-1 expression was negatively related to tumour proliferation in ACs of Barrett oesophagus. Additionally, E2F-1 immunohistochemical status correlated positively with patient survival. These findings are opposite from those seen in OSCCs, suggesting that the tumour-suppressing E2F-1 behaviour in oesophageal adenocarcinomas is possibly due to the intestinal-type nature of the metaplastic Barrett mucosa.

INTRODUCTION: It seems that there is a trend in undergraduate medical education towards including clinical attachments in primary health care (PHC) worldwide. The benefits of such initiatives are already well described. The aim of this study was to evaluate the effect of a clinical attachment in undergraduate medical students in a European country with an odd medical educational system that essentially lacks any kind of academic PHC departments. METHODS: The study was undertaken during 2005-2007. A non-mandatory 1-week clinical attachment in PHC/general practice was organized in an urban PHC unit by general practitioners with educational experience in collaboration with the Department of Physiology of the local medical school. The participants were a prospective cohort of medical students in the 2nd year of undergraduate studies. All participating students sat a pre-defined clinical exam which consisted of multiple choice questions, mini case papers and an objective-structured clinical examination before and after the attachment. In addition, the students rated the whole process. RESULTS: The response ratio was 77.06%. The mean score on objective structured clinical examination of participants increased from 30.70/100 to 62.28/100 (p < 0.001). The students' impression of the study was rather positive (4.39/5). DISCUSSION: The educational intervention of including a clinical attachment in an undergraduate curriculum seems to have encouraging results, considering the peculiarity of inexistence of academic departments of PHC or General Practice in the national medical schools and the inexperience of students regarding similar concepts.

INTRODUCTION: Access to local providers of primary health care (PHC) services and their utilisation is a challenge faced by the authorities of developed as well as developing countries. The aim of our study was to assess and evaluate the level of satisfaction with the currently provided cardiovascular and PHC services in the southernmost region of continental Greece (and of the European Union), Southern Mani. METHODS: The sample (422 individuals, 375 of whom finally participated: 187 men and 188 women, response ratio: 88.86%), was selected between January-December 2006, using stratified randomisation by sex and age. Participants were asked to fill in a validated questionnaire containing socio-demographic data and items about the health needs/level of satisfaction with cardiovascular health and PHC services, as well as two indices for cardiovascular health: i) frequency of international normalised ratio (INR) measurement in case of atrial fibrillation, and ii) history of timely thrombolysis in case of acute myocardial infarction. RESULTS: The majority of the responders stated that their level of satisfaction with PHC services was "low" or "very low" (total: 52.80%), while the percentage of dissatisfaction with cardiovascular health services was 56.0%. In addition, most of the participants expressed a strong wish for improvement of PHC services (71.33%). The level of satisfaction with PHC services was higher than with cardiovascular health services (2.49 +/- 1.26 vs. 2.38 +/- 1.24; p < 0.001). Satisfaction scores for both cardiovascular health and PHC services were negatively associated with the distance from the nearest PHC Unit. Only 11.1% of patients (95% CI: 0.3%-48.2%) reported annual testing of prothrombin time more than once, while among those with a history of acute myocardial infarction, none reported timely thrombolysis (0%, one-sided 97.5% CI: 0%-41.0%). CONCLUSION: It is evident that a large portion of the Southern Mani population perceives the provided cardiovascular health and PHC services as problematic, while the distance from the nearest PHC unit seems to be one of the most important factors and predictors of dissatisfaction. The provision of efficient PHC services in isolated areas is a matter that should be re-evaluated.

The objective of this study was to evaluate whether Parental Body Mass Index is associated with overweight/obesity in a sample of Greek adolescents, taking into consideration dietary and lifestyle habits. The Vyronas study is a cross-sectional health and nutrition survey. During 2004/2005, 2008 schoolchildren were selected. BMI was calculated for both parents and adolescents. A semi-quantitative Food Frequency Questionnaire was applied. Results demonstrated that there is a strong positive association between the parental overweight/obesity status and their offspring's BMI. Some dietary and lifestyle habits seem to affect boys and girls BMI in relation to parental status differently.