Search

Background: Use of a widely accepted quality assurance tool is an essential procedure of effective and result-oriented quality management in the rehabilitation sector, and generally in health care and social services, but is still lacking in Greece., Objective: This study aims to explore to what extent a Quality Assurance System in Rehabilitation (QASR) in the Greek setting could respond to the needs for quality evaluation of the facilities for people with a disability and to discuss possibilities of its use in rehabilitation organizations, sites and hospitals., Methods: The European Quality in Social Services (EQUASS) Assurance self-assessment questionnaire was officially translated and used as the basis for the new tool, which consisted of 110 questions in 11 sections on development and 6 questions on its evaluation. This tool was tested in 15 specialized centers., Results: The study received a high (93.75%) response rate. Overall score ranged from 11% to one perfect 100%; 53.3% of the facilities fell short of the preset qualification standards, while 4 (26.7%) were qualified for level-1 accreditation. Evaluation of the QASR questionnaire for the function of the rehabilitation facilities for the disabled was extremely positive., Conclusions: The EQUASS assurance-based Greek QASR has received proper attention in its first implementation and it was shown promising to assess the needs of sites that would like to improve their services. The next steps are to establish its validity and reliability so that it can significantly emerge as the standard system for guiding policy in the rehabilitation sector in Greece., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Despite international interest on quality assessment systems (QAS) and their importance in health care accreditation, implementation of a Rehabilitation Services Quality Measurement System still remains a neglected subject in Greece., Objective: To identify appropriate tools for researchers and policy makers to assess the quality of rehabilitation services in Greece, within the current active debate on national health care reform., Methods: A critical review methodology was undertaken, using a systematic approach, aiming to identify the most appropriate tools in the field. Multi-step strategy was followed to gather relevant data, including bibliographical database, internet and hand searches., Results: Twenty-two studies, articles and documents were identified as meeting all inclusion criteria, representing four QAS, compared according to appropriateness, efficiency, and feasibility for general use. The European Quality in Social Services (EQUASS) was evaluated as meeting all of the desired features, such as proper certification, objective measuring, equality, education and training, established guidelines and person-centered approach., Conclusions: EQUASS initiative, developed according to European standards and implemented in resource-limited settings, was recognized as the most adaptive and appropriate system for Greek rehabilitation settings. Health policy makers are urged to take findings into consideration in establishing an integrated, quality-assured rehabilitation system throughout the country., (Copyright © 2013 Elsevier Inc. All rights reserved.)

In the present study a package of biomarkers was applied on land snails E. vermiculata collected from polluted areas, as well as from an unpolluted reference one. Snail collection was performed during two different sampling periods characterized by reduced and augmented organism activity, October and May, respectively. The biomarkers applied were lysosomal membrane stability on digestive cells (LMS), neutral red lysosomal retention assay on haemocytes (NRR), morphometric changes of the lysosomal system (VDL, NDL), morphometric alterations of the neutral lipids (VDLP, NDLP), acetylcholinesterase activity on digestive gland and hemolymph (AChE), metallothionein content on digestive gland (MTs) and cyclic AMP content on digestive gland (cAMP). The results revealed significant differences in biomarker values between the two sampling periods. Significant differences were also detected among the sampling groups. The fluctuation of the parameters applied indicated that spring is a more suitable period for sampling conduction compared to autumn and that biomonitoring studies should be performed with special attention during the last mentioned period., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The present study investigates the histochemical localization of N-acetyl-β-hexozaminidase (Hex), acid phosphatase (AcP) and β-glucuronidase (β-Gus) in the digestive gland of mussels Mytilus galloprovincialis, as well as the clarification of suitable enzyme for biomarkers' application dealing with lysosomes. The results show more intense and homogenous localization of Hex, in relation to AcP and β-Gus and, thus, Hex histochemistry is supported as more suitable procedure for the evaluation of "lysosomal membrane stability" and "morphometrical alterations of lysosomes". The affection of lipofuscin granules on lysosomal enzymes' activity is also discussed. Additionally, the present study examines the response of small- and large-sized mussels M. galloprovincialis by assessing the "lysosomal membrane stability", "morphometrical alterations of lysosomes", "lysosomal response index (LRI)" and "structural epithelial changes in digestive tubules". The results indicate appreciable alterations of the above parameters in large-sized mussels, supporting their greater influence by the environmental factors, in relation to small-sized ones., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The present study aimed to enrich the group of sentinel organisms of terrestrial pollution biomonitoring, by investigating the efficacy of the land snail Eobania vermiculata. For this reason, a package of biomarkers was performed on land snails E. vermiculata collected from polluted areas in the field or treated with heavy metals in the laboratory. The biomarkers used were neutral red lysosomal retention assay of the haemocytes, acetylcholinesterase activity in the digestive gland and the haemolymph, and metallothionein content of the digestive gland. Moreover, the morphometric changes in the lysosomal system and the morphometric alterations of the neutral lipids were also investigated. In addition, the content of cadmium, lead and copper was evaluated in the digestive gland of the snails. The results revealed appreciable alterations in the biomarker values both in field- and laboratory-conditions, accompanied by significant correlations among the biomarkers. Therefore, this exploratory study suggests the utility of E. vermiculata as a sentinel organism for biomonitoring the biologic impact of terrestrial pollution, and supports the package's efficacy of the selected biomarkers., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Pollution biomarkers were assessed in the digestive gland of mussels Mytilus galloprovincialis collected from Greek coasts (Thermaikos and Strymonikos Gulf, Northern Greece) on July 2004. The values of biomarkers were integrated using three ecosystem health indices: health status index (HIS) calculated by the expert system, lysosomal response index (LRI) and integrated biomarker response (IBR). The HIS is based on the integration of the biomarker values, classifying the health status of mussels according to pollution degree. The LRI combines two lysosomal responses (lysosomal membrane stability and lysosomal structural changes) in a single index, which is associated with the ecosystem contamination. The IBR is a useful tool for the visualization of biological responses in marine environments. The results support the use of HIS and LRI as powerful tools for the qualitative and quantitative evaluation of environmental stress, while enhance the use of IBR as a constructive method for the qualitative discrimination of contaminated sites. HIS and LRI revealed high stress conditions in all sampling stations of Thermaikos gulf, whereas unstressed conditions were detected in Olympiada (reference station) by the use of HIS and low stress conditions were shown by the use of LRI. The IBR illustrated higher levels of stress in mussels collected from Thermaikos Gulf, compared to mussels gathered from the reference station. The advantages and disadvantages of the HIS, LRI and IBR are also discussed., (Copyright © 2010 Elsevier Inc. All rights reserved.)

By using cellular biomarkers, such as the formation of the micronucleus, the morphometric alterations of lipids and the morphometric changes in the lysosomal system, we investigated effects of experimental exposure to phenanthrene, Cu, Cd, and Hg for 15 days in mussels. Concerning micronuclei, the evaluation of the total nuclear abnormalities, instead of the micronucleus only, as a biomarker of marine pollution, indicated more statistically significant differences between the control and the pollutant treated groups. Contrary to the existing knowledge showing that there is an increase in lipid content after pollutant exposure, our results showed that there was a decrease in the amount of lipid, as well as an increase in the number of neutral lipids. Furthermore, although prior studies found that fewer lysosomes formed after pollutant exposure, this was not confirmed by our work, as pollutant treated animals exhibited a decrease in the volume and an increase in the numerical density of lysosomes, compared to control groups.

The results of the present study suggest that the signaling molecule cAMP could constitute a reliable biomarker of pollution monitoring. Increased levels of cAMP were observed in tissues of mussels Mytilus galloprovincialis exposed to PAHs, 2,4-dichlorophenoxyacetic acid and lindane for 15 days. cAMP levels were higher in mantle/gonad complex, in relation to other tissues studied (digestive gland and gills). In support of our suggestion, cAMP was significantly correlated with established biomarkers, such as lysosomal membrane stability, AChE activity and metallothionein content. In addition, our results support the establishment of morphometrical alterations of neutral lipids as biomarker of organic pollution, since high accumulation of neutral lipids in the digestive gland of mussels exposed to organic pollutants in relation to non-exposed mussels was noted. In addition, correlation analysis between cellular and biochemical biomarkers showed that the volume density of neutral lipids negatively correlated with both lysosomal membrane stability and AChE activity. Regarding micronucleus test, our results do not support its use as a biomarker of organic pollution, since no statistical differences were found between control and exposed mussels. On the other hand, significant correlations were observed among the battery of biomarkers, such as lysosomal membrane stability, AChE activity and metallothionein content after the mussels' exposure to the specific organic compounds, thus supporting the important role of these biomarkers as reliable indicators of organic pollution. In conclusion, our results support cAMP and morphometrical alterations of neutral lipids as biomarkers of environmental pollution.

The histological and ultrastructural localization of heavy metals in the digestive gland of the mussel, Mytilus galloprovincialis, was evaluated using autometallography and X-ray microanalysis on epoxy resin sections. Mussels were collected from two populations along Thermaikos gulf (port of Thessaloniki and Halastra) and one population in Strymonikos Gulf (Olympiada). With the use of autometallography, the light and electron microscopic observations indicated that in the digestive gland, the metals are localized in lysosomal structures, such as heterolysosomes and the residual bodies of digestive cells. Through both techniques, mussels collected from the port of Thessaloniki displayed concentrations of metals higher than those recorded in mussels from Halastra and Olympiada. This fact is consistent with other reports indicating a similar distribution of metals in Thermaikos Gulf and Strymonikos Gulf. The results of the study support the use of both techniques, autometallography and X-ray microanalysis, as a suite of stress indices for pollution biomonitoring studies., (Copyright 2003 Elsevier Inc.)

The simultaneous study of two biomarkers, the lysosomal membrane stability (LMS) of the digestive gland and the metallothionein (MT) content of the digestive gland, the gills and the mantle/gonad complex of the mussel Mytilus galloprovincialis was examined in an enclosed estuarine system in June and October 2001. Mussels were collected along the Gulf of Thermaikos (northern Greece) from stations displaying a pollution gradient, while Olympiada in the Gulf of Strymonikos was used as a reference station. In addition, the heavy metal (Cd, Pb, Cu and Zn) content, using atomic absorption spectrophotometry (AAS), were evaluated in the digestive gland, the gills and the mantle/gonad complex of mussels collected from the same sites and seasons. LMS values were significantly greater, and the MT content of the studied tissues were significantly less in mussels collected from the reference station compared to mussels from more polluted stations located in the Gulf of Thermaikos. Significant correlation was observed between the MT content of the gills and the mantle/gonad complex with the LMS values.

The neutral red lysosomal retention assay (NRR) of the haemocytes, and the acetylcholinesterase activity (AChE) in the haemolymph, the digestive gland, the gills and the mantle/gonad complex have been evaluated on mussels Mytilus galloprovincialis collected from Thermaikos and Strymonikos gulfs (northern Greece) in June and October 2001. The validity of performing the above core biomarkers is supported, firstly by their ability to respond to different pollution levels and, secondly, by the significant linear correlation among them. The evaluation of the micronuclei frequency (MN) has been performed in gill tissue and haemocytes of the same mussels and, according to the results, it needs more research in order its use as stress indices to be validated. In addition, the first results on cAMP levels in the gills, the mantle/gonad complex and the digestive gland, whose concentrations correlated to both, NRR and AChE introduce this signal transduction molecule as a new, promising biomarker.