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Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
Preventive, predictive and personalized medicine
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Preventive, predictive and personalized medicine

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  • 1. Preventive, predictive and personalized medicine National Representative: Prof. Luiza Spiru , MD, PhD President of Ana Aslan International Foundation Ana Aslan International Academy of Aging Head of the Geriatric Department & Day Hospital of Memory Diseases of “Elias” University Hospital Professor of Geriatric Dept . of ”Carol Davila” University of Medicine and Pharmacy Bucharest, ROMANIA Chronic Disease and Health Management 2 nd Edition 22-23 th September 2010 Bucharest, Romania ANA ASLAN INTERNATIONAL ACADEMY ANA ASLAN INTERNATIONAL FOUNDATION
  • 2. 1 http :// www . euromonitor . com
      • Chronic diseases management
    • Chronic diseases can only be controlled, not cured .
    • Living with a chronic disease impacts the quality of life of the patients and their families
    • The incidence of chronic pathology increases with age .
    • The care of people with chronic conditions also requires a important health and social care resources.
    • People with chronic conditions are accounting for about 80% of GP consultations ,
    • and use more inpatient days .
    • The World Health Organization:
    • chronic conditions will be the leading cause of disability by 2020
    • if not successfully managed, will become the most expensive problem for health care systems.
    All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 3. 1 The long-term condition pyramid (LTC pyramid) is suggested as an important framework for designing services. The Quality and Outcomes Framework of the General Medical Services contract aims to improve primary care standards. Investment in Expert Patient programs and health literacy support self-care at lower levels of the pyramid. S.Hamilton et al., 2008. Mind the gap between policy imperatives and service provision: a qualitative study of the process of respiratory service development in England and Wales. BMC Health Services Research 2008, 8:248. Pyramid of care for long-term conditions . (adapted from Improving Chronic Disease Management b y Hamilton et al. 2008 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 4. 1 Department of Health: [http://www.dh.gov.uk/en] Improving Chronic Disease Management. London . 2004
      • Imperatives
    Healthcare systems reconfiguration to address the needs of people with long-term conditions. Reconfiguring specific workforce to develop highly efficient and cost/benefit suitable services. Improvement of the background factors influencing redesign of specific services. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 5. 1
    • Semi-structured qualitative telephone interviews with the person(s) responsible for driving respiratory service reconfiguration in a purposive sample of 30 Primary Care Organizations (PCOs).
    • Outcomes:
    • “ There is a large gap between central policy rhetoric driving workforce change, and the practical reality of implementing change within PCOs when faced with:
        • limited resources,
        • diverse professional attitudes
        • an uncertain organizational context”.
    • “ Research should concentrate on understanding these complex dynamics in order to inform the policymakers, commissioners, health service managers and professionals” .
    S.Hamilton et al., 2008. Mind the gap between policy imperatives and service provision: a qualitative study of the process of respiratory service development in England and Wales. BMC Health Services Research 2008, 8:248. S.Hamilton et al. Study [UK], 2008 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 6. 1
      • Challenges
    Healthcare systems reconfiguration to address the needs of people with long-term conditions. Reconfiguring specific workforce to develop highly efficient and cost/benefit suitable services. Improvement of the background factors influencing redesign of specific services. S.Hamilton et al., 2008. Mind the gap between policy imperatives and service provision: a qualitative study of the process of respiratory service development in England and Wales. BMC Health Services Research 2008, 8:248. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 7. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. WHO STRATEGIC AGENDA
    • WHO will work with the Government of Romania to narrow the gap between policy
    • objectives and policy implementation
    • Stewardship, health financing, service delivery and resource development
    • Communicable disease surveillance and control
    • Public health system reform
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD © World Health Organization 2007 – All rights reserved.
  • 8. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. The need of 3P-Medicine approach
    • The result:
    • despite high care costs, long-term prognosis usually remains poor due to:
      • inadequate control of disease manifestations,
      • treatment failure,
      • disease-recurrence
      • appearance of severe secondary complications,
      • relatively low life-quality of the treated persons,
      • high morbidity and mortality.  
    The facts: current healthcare practices essentially rely on emergence of signs and symptoms of human pathologies prior to initiation of interventional modalities. A major limitation: often the disease process has already taken its toll through manifestation of its complications (http://www.epmanet.eu) Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 9. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • I nitially chronic pathologies are generally triggered at the molecular level ,
    • followed by pathology-specific molecular events predisposing to certain pathologies
    • long before organ damage and symptomatic manifestation of the disease.
    • Genetic and environmental factors are interacting:
    F Borrell-Carrió et al., 2004. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Annals of Family Medicine 2:576-582 The Bio-Psycho-Social model 3P-Medicine - a golden premise for improved strategies Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD inner, individual predisposing factors ( old age, certain genetic polymorphisms, oxidative stress, vitamin deficiencies, inflammation, immune, endocrine, vascular And metabolic conditions, depression, tumors, gender, level of education) susceptibility to disease development environmental risk factors (head trauma, certain infections, smoking and chemical exposure, bad stress management) subtle, cumulative alterations
  • 10. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Innovative biotechnologies are golden tools for:
        • prediction of human pathologies,
        • design of appropriate and timely preventive strategies,
        • personalized treatment planning .
    [Costigliola V et al., Predictive Medicine as the new philosophy in health care. In: Predictive Diagnostics & Personalized Treatment: Dream or Reality?, Golubnitschaja O. Ed., Nova Science Publishers, New York, USA, 2009] Therefore: Early detection of pathology-specific molecular patterns can create a well-founded basis for the predictive approaches . Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 11. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Therefore:
    • 3P Medicine offers great promise for the future practice of chronic disease management.
    • Essential components of 3P Medicine approach are:
      • well-organized population screening protocols
      • novel diagnostic biomarkers
      • targeted prevention of common human pathologies
      • personalized, optimal treatment planning.
    • Resulting main outcomes:
      • substantial improvement of the quality of life
      • care delivery at potentially reduced costs to the population at large
      • addressing social and ethical issues related to access
      • affordability of healthcare
    [Costigliola V et al., Predictive Medicine as the new philosophy in health care. In: Predictive Diagnostics & Personalized Treatment: Dream or Reality?, Golubnitschaja O. Ed., Nova Science Publishers, New York, USA, 2009; www.epmanet.eu] Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 12. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. EPMA has the coordinating MISSION of the European-Network in Predictive, Preventive & Personalised Medicine. The EPMA-Network is open for issue-related cooperation worldwide. (http://www.epmanet.eu)
    • EPMA Mission
    • Raising awareness and recognition of 3P Medicine throughout all EU Member and Associated countries;
    • Providing up-to-date information and educational materials on Predictive & Personalised Medicine and targeted preventive measures;
    • Promoting:
    • the adequate allocation of resources for 3P Medicine;
    • advanced programs for personalized patient treatment;
    • high-quality research focused on predictive diagnostics and personalised patient treatment;
    • standardisation of bio-analytical technologies for predictive pre-clinical and clinical applications;
    • multidisciplinary efforts in 3P Medicine;
    • creation of Guidelines in European health care with the accentuated role of prediction, prevention and personalised patient treatment
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 13. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. http://www.epmanet.eu/index.php/education/professionals EPMA 3P-Medicine concept Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 14. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Actors called to contribute
    • Students and professionals in:
      • conventional and molecular diagnostics,
      • biomedicine,
      • biotechnologies,
      • ethics, and economics
    • Universities, research units, hospitals (private and public)
    • Patients and/or their care givers (family members) organizations
    • Scientific media
    • International associations with healthcare-oriented scientific, research and public health-related activities/responsibilities
    • Political organisations and authorities active in the healthcare sector
    • Civil society representatives
    • Healthcare industry including policy-makers.
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 15. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. is open for issue-related cooperation worldwide. The EPMA Network More accurate research is needed to enlighten and validate individual “clusters” of inner and outer interacting risk factors responsible for the onset of degenerative processes . Until the elaboration of cutting-edge, highly efficient disease-modifying drugs and other interventions, the most important way to be pursued is the most obvious one: prevention . The ongoing development of Predictive, Preventive and Personalized Medicine (3P Medicine) is a step forward dealing with the elaboration of good answers to demographic aging and its outcomes . Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 16. 1 (http://www.epmanet.eu) Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 17. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Like the conventional, but also the new branches of biomedicine, 3P Medicine is facing a lot of challenges :
    • Should molecular diagnostic approaches to complement or substitute measures to conventional approaches? *
    • How reliable are biomarkers for any given pathology? *
    • What about ethical aspects in genetic approach?
    • How to distinguish between the highly predictive power of innovation and quackery in diagnostics? *
    • How to overcome currently well-recognizable (inter)national barriers in knowledge transfer? *
    • How to correctly educate the new generation of experts in 3P Medicine? *
    (*http://www.epmanet.eu) Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 18. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. PREDICTIVE Medicine tasks/means
    • Expanding research in genomic/proteomic testing
    • Innovative approach
    • sustained funding needed
    • genomic testing more accessible
    • Expanding research in sophisticated imaging tools
    • to confirm lab tests
    • to develop powerful predictive markers
    • To assure easier, direct consumer access to lab testing
    • Expanding research regarding the predictive value of environmental and life style predisposing risk factors
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 19. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Challenges of predictive biomarkers
    • The biomarkers have different temporal relationships with the manifestation of disease.
      • Abnormal concentrations of the two liver enzymes indicate existing liver damage, not just an increased risk.
      • Abnormal insulinemia indicate that pathological changes and clinically manifest disease may occur.
      • There is now clear evidence that the pathological processes
      • that lead to manifest cardiovascular disease may be underway in children under 10 years of age.
    [Markers of chronic disease. NSW Schools Physical Activity and Nutrition Survey – SPANS Report 2004, NSW Health, pp.206-212] Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 20. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. NSW Schools Physical Activity and Nutrition Survey – SPANS Report 2004: Conclusions: Adolescence is a time when risk behaviors and biological conditions become established. An overweight adolescent with cardiovascular and other risk factors is likely to become an overweight adult with heart disease. The earlier in life these behaviors and conditions become established, the earlier the natural course of the disease process begins. Chronic diseases manifest earlier in life. Risk factors for serious chronic diseases proved highly prevalent among young people. [Markers of chronic disease. NSW Schools Physical Activity and Nutrition Survey – SPANS Report 2004, NSW Health, pp.206-212] Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 21. 1 Development of screening guidelines to confront “ Alzheimer’s crisis” Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 22. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 23. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 24. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • The patterns of transmission and biological mechanisms through which a family history of LOAD confers risk to the offspring – still not known.
    • Brain imaging with 18 F-FDG PET:
    • normal individuals with a maternal history of LOAD, but not with a paternal one, express a phenotype characterised by a pattern of progressive reductions of brain glucose metabolism, similar to that in AD patients.
    • genetic mutations implicated in EOFAD and their effects on brain chemistry, structure and function may induce selective patterns of hypometabolism in maternally inherited AD
    Prodromal metabolic phenotype and the search for genes in AD L Mosconi et al, 2010. Maternal transmission of Alzheimer's disease: Prodromal metabolic phenotype and the search for genes. Human Genomics, 4(3): 170 - 193 L Mosconi et al, 2010 Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 25. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Another aspect of PREDICTIVE Medicine
    • Due to the individual variability and the complexity of human biological systems, diagnostic imaging and empirical data alone are insufficient to predict the outcome of a given treatment for an individual patient.
    • A new paradigm of predictive medicine issued since the last decade of the 20 th century:
      • the physician utilizes computational tools to construct and evaluate a combined anatomic/physiologic model to predict the outcome of alternative treatment plans for an individual patient.
      • A software system provides an integrated set of tools to test hypotheses regarding the effect of alternate treatment plans
      • The system is applied to the evaluation of alternate, patient-specific treatments.
    Taylor CA et al., 1999. Predictive medicine: computational techniques in therapeutic decision-making. Comput Aided Surg. 1999;4(5):231-247 Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 26. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. PREVENTION of chronic conditions
    • Older people are not the only ones affected by chronic diseases. Rising numbers of young and middle-aged people have some form of chronic health problem (Pomerleau, Knai and Nolte 2008 1 ).
    • The WHO’s project The Global Burden of Disease 2 :
    • 72% of all deaths before the age of 60 years in 2002 were due to chronic or noncommunicable conditions in developed countries.
    • 68% of DALYs (disability-adjusted life years) lost to chronic diseases in developed countries occurred among those of working age.
    • These findings suggest that chronic disease can no longer be considered just a problem of the elderly (Suhrcke et al. 2006; Mathers et al. 2003 3 ).
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 27. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. [Markers of chronic disease. NSW Schools Physical Activity and Nutrition Survey – SPANS Report 2004, NSW Health, pp.206-212]
    • Prevention of chronic diseases lie several main factors :
    • Early detection of the disease :
      • allows the initiation of medical and non-medical intervention plans when pathological processes are still susceptible to them;
      • allows sufficient time to treatment adjustments;
      • may facilitate the stabilization of pathology or delay disease progression.
    • Actual technological progress highly support this imperative.
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 28. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. [Markers of chronic disease. NSW Schools Physical Activity and Nutrition Survey – SPANS Report 2004, NSW Health, pp.206-212] The important outcomes of Nature and Nurture concept The knowledge of gene-environment interaction may provide valuable insights for the scientific, evidence based design of preventive strategies Epigenetics - changes in gene expression under the influence of well targeted drug and non-drug interventions Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 29. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Scientific positions in defining the impact of environment
    • behavioral psychologists accept the importance of environmental exposures, but recognize only those that are cognitively mediated (e.g. life events signifying loss)
    • while environmental hazards can be important, individual probabilities of exposure to them are largely genetically determined (a person's genetic endowment governs the selection of a personal environment and the person's relationship with it (Neiderhiser, 2001).
      • We know too little about the mode of action of environmental risk factors.
      • The real progress requires much basic research.
      • McGuffin, P., Asherson, P., Owen, M., et al (1994) The strength of the genetic effect. Is there room for an environmental influence in the aetiology of schizophrenia? British Journal of Psychiatry , 164, 593-599; Neiderhiser, J. M. (2001) Understanding the roles of genome and envirome: methods in genetic epidemiology. British Journal of Psychiatry , 178 (suppl. 40), s12-s1
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 30. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Preventive evaluation and interventions must be performed during:
      • Prenatal and neonatal period
      • In infancy and childhood
      • In adolescence and early adult life
      • In middle and later adult life  
    The continuum of Prevention Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 31. 1 All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Preventive evaluation and interventions must be performed during:
      • Prenatal and neonatal period
      • In infancy and childhood
      • In adolescence and early adult life
      • In middle and later adult life  
    The continuum of Prevention Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 32. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Prenatal and neonatal interventions
    • Immunisation against maternal rubella and influenza  
    • Voluntary screening for HIV and syphilis infection  
    • Dietary supplementation during pregnancy, including folates 
    • prenatal prevention of teratogenic toxicity, foetal alchohol syndrome and neonatal narcotic dependency  
    Brian COOPER, Nature, nurture and mental disorder: old concepts in the new millennium, The British Journal of Psychiatry (2001) 178: s91-s101 Preventive actions aiming to reduce mental health damage caused by environmental exposures or their consequences:   Nature, Nurture and Prevention Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 33. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Measures in infancy and childhood
    • Immunisation against measles, pertussis and herpes simplex encephalitis  
    • meningococcal meningitis and congenital syphilis
    • Iodine supplementation in deficiency-endemic areas
    • Detection and dietary treatment of phenylketonuria and other metabolic errors  
    • Detection of non-accidental injury, physical and sexual abuse  
    • Monitoring of prolonged medication (e.g. anti-epileptic drugs)  
    • Reduction of neurotoxic exposures (e.g. lead pollution from petrol additives)
    Brian COOPER, Nature, nurture and mental disorder: old concepts in the new millennium, The British Journal of Psychiatry (2008) 178: s91-s101 Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 34. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    •   Measures in adolescence and early adult life  
    • Prevention of brain trauma
    • Programmes targeting risk-taking behavior (use of alcohol and ‘designer’ drugs, AIDS infection, etc.)  
    • Anxiety/Depression treatment 
    • Occupational health and safety programmes (reducing exposure to organic solvents, organophosphates, heavy metal compounds)
    Brian COOPER, Nature, nurture and mental disorder: old concepts in the new millennium, The British Journal of Psychiatry (2001) 178: s91-s101 Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 35. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Measures in middle and later adult life  
    • Reduction of cerebrovascular disease risk, hypertension and stroke (control of diet, alcohol consumption, etc.)  
    • Detection of conditions with neuropsychiatric complications (e.g. vitamin B 12 deficiency and megaloblastic anaemia, hypothyroidism, Borrelia infection)  
    • Avoidance of iatrogenic neuropsychiatric syndromes
    • Medico-social support in high-risk situations (e.g. admission to long-term care)  
    Brian COOPER, Nature, nurture and mental disorder: old concepts in the new millennium, The British Journal of Psychiatry (2001) 178: s91-s101 Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 36. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. The WHO report 2002 - Reducing Risks, Promoting Healthy Life   http://www.who.int/whr/2002/en/
    • The objectives of Integrated Chronic Disease Prevention and Control Programme:
    • to strengthen prevention and control of chronic no communicable diseases by tackling the major risk factors
    • to reduce premature mortality and morbidity
    • to improve quality of life, with particular focus on developing countries, working through the Global Forum and the regional networks, in accordance with the global strategy approved by the 53rd World Health Assembly.
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 37. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. http://www.who.int/whr/2002/en/
    • The areas of work of the WHO Integrated Chronic Disease Prevention and Control Programme (ICP) include:
    • To raise awareness for chronic diseases;
    • to ensure that chronic disease prevention is placed on top of the
    • agenda of health care policies;
    • to promote development and implementation of national policy & strategy, programmes, community-based demonstration projects for prevention and control of chronic diseases (with a special focus on developing countries);
    • to promote the development of regional networks of national chronic disease prevention programmes;
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 38. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. http://www.who.int/whr/2002/en/
    • to promote collaboration and coordination of chronic diseases
    • prevention and control activities within and among WHO Regions;
    • to link regional networks and international partners with the Global Forum to promote collaboration for chronic noncommunicable disease prevention and control;
    • to encourage the dissemination of scientific knowledge, experiences and best practices;
    • to develop guidance packages for chronic noncommunicable disease prevention and control;
    • to stimulate training and capacity building.
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 39. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. http://www.who.int/whr/2002/en/
    • to promote collaboration and coordination of chronic noncommunicable disease
    • prevention and control activities within and among WHO Regions;
    • to link regional networks and international partners with the Global Forum to promote collaboration for chronic noncommunicable disease prevention and control;
    • to encourage the dissemination of scientific knowledge, experiences and best practices;
    • to develop guidance packages for chronic noncommunicable disease prevention and control;
    • to stimulate training and capacity building.
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 40. To providing the Right Treatment for the Right Person at the Right Time Personalized Medicine (PM) = tailoring of medical treatment to the individual characteristics of each patient. To use the information about individuals’ personal traits: genomes, health states, behavioral, environmental, socioeconomic, cultural and other personal determinants in order to manage the response to health care interventions. PM provides the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, or their response to a specific treatment .
      • PERSONALIZED Medicine
    All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Chronic Diseases and Personalized Medicine Needs. Ignite Institute for Individualized Health . http://www.ctisinc.com/Chronic_Diseases_and_Personalized_Medicine.aspx Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 41.
    • Health Information Technology Accelerates Personalized Medicine and Chronic Disease Management.
    • Solutions:
    • Uses sophisticated molecular scanning technologies to identify at-risk individuals prior to disease symptoms .
    • Develop and test therapies .
    • Focuses on molecular analysis and translational research on chronic disease detection, management, and treatment .
    • Applies a chronic disease-centric approach to public health burdens .
    • Integrates Health Information Technology to enable clinical decision support for personalized medicine.
    All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. Chronic Diseases and Personalized Medicine Needs. Ignite Institute for Individualized Health . http://www.ctisinc.com/Chronic_Diseases_and_Personalized_Medicine.aspx Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 42. Through personalized medicine, medical professionals are developing sub populations for complex diseases and physical conditions such as: Diabetes Dementia Cancer Heart Disease. Personalized medicine may help medical community to make the most effective clinical decisions for each patient (individual approach). All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. http://www.personalizedmedicine.com/contact.php Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 43. When coupled with personal pharmacogenetics, Personalized medicine is a unique approach that may be well suited for the health challenges of population grow up. Personalized medicine may help medical community to make the most effective clinical decisions for each patient (individual approach). Personalized medicine may help to determine the right dose for a patient, to avoid hazards based on familial history, environmental influences, and genetic variation. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. http://www.personalizedmedicine.com/contact.php EPMA – ROMANIA - National Report 2009, Prof. Luiza Spiru, MD, PHD Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 44. When coupled with personal pharmacogenetics, Personalized Medicine is a unique approach that may be well suited for the health challenges of aging population Personalized medicine may help medical community to make the most effective clinical decisions for each patient (individual approach). All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. http://www.personalizedmedicine.com/contact.php Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 45. Chronic and degenerative disease is a major health issue. Its multifactorial etiology requires a multifactorial but integrative attempt. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
      • 3P Medicine and the holistic, integrative
      • approach of chronic conditions
    inner, individual predisposing factors susceptibility to disease development environmental risk factors subtle, cumulative alterations Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 46. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©. The holistic, integrative research paradigm of 3P Medicine
    • Specific Epigenetic and Metabolomic Alterations
    • SAM-SAH / Folates cycles
    • DNA merhylation patterns
    • Relevant genes’ expression
    • Detection
    • Markers
    Early Diagnosis tools Improved Therapeutic Interventions Preventive strategies Final Outcomes
    • Healthy aging
    • Social
    • benefits
    • (medical,
    • economical)
    Bio-Medical Outcomes Environmental
    • Nutrigenomic
    • Sociomic
    (Risk) factors Organism
    • detection
    • amendment
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 47. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • NERO-MIND Concept -
    • CRITICAL NEUROMES IN COGNITIVE AGING
    • AND COGNITIVE PATHOLOGY
    • A comparative and integrated study of epigenomic, metabolomic, sociomic and nutriomic aspects in young /elderly healthy people vs. MCI / Alzheimer’s patients.
    • Expected outcomes:
    • New, integrated knowledge of capital, basic etiological aspects in cognitive disturbances induced by aging and dementia
    • Possible new, important insights tangent to the improvement of (differential) diagnosis tools
    • Possible important insights tangent to the elaboration of new medical and non-medical, preventive and curative interventions in aging and dementia
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 48. All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.
    • Established in 2009
    • Coordinator:
    • Prof. Luiza Spiru MD, PhD.
    • ,
    • Head of the Geriatric and Old Age Psichiatry Clinic
    • Elias University Emergency Hospital
    • Carol Davila University of Medicine and Pharmacy,
    • Bucharest
    • President of the Ana Aslan International Foundation
    • By its activity, the Romanian EPMA Representative
      • Promotes EPMA philosophy, principles and values
      • Adapts them to the realities from Romania
      • Advocate 3P Medicine in the benefit of patients, policy makers,
      • And society as a whole
      • Romanian EPMA Representative
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 49. http :// www . euromonitor . com / FactFile . aspx ? country = RO 3 rd age population segment (dynamics 2005-2009)
      • Romanian realities - Demography
    2005 2006 2007 2008 2009 Population aged 65+: January 1st 3,174.98 3,197.10 3,197.95 3,186.31 3,162.92 Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 50.
      • Romania – Morbidity
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 51.
      • Romania - Morbidity
    Trends in incidence of occupational morbidity, 1996–2006 European Working Conditions Observatory (EWCO), November, 2007 http://www.eurofound.europa.eu/ewco/2007/10/RO0710019I.htm Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 52.
      • Romania - Main morbidity data
      • for the geriatric population (2008)
    THE CENTER FOR RESEARCH AND EVALUATION OF HEALTH SERVICES, SNSPMS - Romania, 2009, http://www.drg.ro/ Cardiovascular diseases 31.80% Neurodegenerative diseases 24.44% Respiratory diseases 6.17% Gastroenterologic disorders 4% Endocrine disorders 2.94% Otolaryngology problems 1.77% Urinary tract disorders 1.42% Other disorders 0.99% Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 53.
      • Romania – WHO cooperation
    OPPORTUNITIES CHALLENGES
    • EU opportunities for increasing of quality health services
    • Not equal access to health services
    • More efficient health systems
    • Upgrading the public services, especially into primary health care
    • Reforms of mental health care
    • Health system funded – still at a low level
    • Mental Health Action Plan
    • An aging population – a need for increased resources for the health system dedicated to the elderly
    • Comprehensive approach of the health policies
    • Geographically imbalanced human resources
    • EU structural funds – developing the infrastructure
    • The need of decentralized administration and development of regional centres
    © World Health Organization 2007 – All rights reserved. Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 54.
    • Submitted to approval in June 2009
    • Initiator: Prof. Luiza Spiru MD, PhD as president of the Consultative Commission of the Romanian Health Ministry of the Specialization in Geriatrics and Gerontology
    • early diagnosis
    • monitoring and treatment, personalized interventions and preventive tools in the field of brain aging and memory impairment diseases
    • elaborating the guidelines for the early diagnosis in neurodegenerative diseases according to the European and international definitions
    • developing the new research criteria in preventive clinical trials in brain aging
    • professional training in the field of early diagnosis of brain aging for GPS, geriatricians, neurologists, psychiatrists, psychologists, social assistants, home care assistants
      • The National Program of Memory Diseases –
      • A first endeavor
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 55.
    • Running area - national level
    • Running time – 2009-2011
    • Coordinator: Ana Aslan International Academy of Aging
        • Prof. Luiza Spiru MD , PhD
        • developing the competences of specialists in
          • neurosurgery,
          • anesthesiology,
          • psychiatry,
          • geriatrics,
          • Immagery
          • molecular medicine and genomics/ epigenetics
        • in the field of brain aging
      • BRAINAGING - A 3P Medicine based, educational Project
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 56.
    • In December 2008 Ana Aslan International Foundation launched
    • The Clinic for Longevity Medicine, Healthy Aging
    • and Brain Aging Prevention
    • Bucharest – Otopeni, Romania
    • Under the auspices of:
    • the Romanian Academy and Ana Aslan International Foundation
    • Partnership:
    • „ Carol Davila” University of Medicine and Pharmacy ,
    • “ Elias” Universitary Emergency Hospital, Bucharest
    • Departments:
      • Alzheimer Unit
      • Geriatrics and Gerontology University
      • Department
      • The Centre for Diagnosis and Treatment
      • for Longevity and Brain Aging Prevention
    • Initiator and Coordinator:
    • Prof. Luiza Spiru , MD, PhD
      • A new unit for holistic, integrated 3P Geriatric approach in Romania
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 57.
      • Romanian o rganizations informed
      • about the EPMA-related activities
    Romanian Medical Association http://www.ong.ro/ong/amr/societati.htm Romanian Association for Hepatic Research http://www.ficat.ro/ Romanian Urological Association http://www.aru.ro/aru/ie/index.jsp Romanian Association for the Prevention of Osteoporrhosis -   ASPOR http://www.aspor.ro/ Romanian Society of Clinical Allergology and Immunology http://www.sraic.ro Romanian Society of Anesthesia and Intensive Care www.srati.ro/ Romanian Society of Cardiology http://www.cardioportal.ro/ Romanian League of Cancer http://www.romaniancancerleague.org/ro/index.php Society for the Study of Neuroprotection and Neuroplasticity http://www.ssnn.ro/
      • The Romanian organizations invited as potential
      • members of the National EPMA Network
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 58. Romanian Society of Endocrinology http://www.sre.ro/asp/statut.asp Romanian Society of Gastroenterology and Hepathology http://www.gastrohep.ro/index.php Romanian Society of Rheumatology http://www.srreumatologie.ro/index1.html Romanian Society of Dermatology www.srd.ro The Romanian Society of Medical Informatics http://www.medinfo.umft.ro/rsmi/ Romanian Society of Ultrasound in Medicine and Biology http://www.srumb.ro/ Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 59. Romanian Government http://www.guv.ro/ Ministry of Research and Education http://www.edu.ro/ Health Ministry http://www.ms.ro/ Ministry of Labour, Family and Social Protection http://www.mmuncii.ro/en/ National House of Health Assurances http://www.cnas.ro National Council of Elderly Persons http://www.cnpv.ro/ National Council of Scientific Research in High Education Institutions http://www.cncsis.ro/ Romanian Aacademy http://www.acad.ro/ Academy of Medical Sciences     http://www.ms.ro/a_ms/asm/asm.htm The MD’s Romanian National College http://www.cmr.ro/ The Order of Nurses and Midwifes from Romania http://www.oammrbuc.ro/index.php
      • Romanian Governmental Institutions invited
      • to join EPMA national network
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 60. Universities “ Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania "Alexandru Ioan Cuza“University, Iasi, Romania University of Bucharest , Epigenetic Lab Polytechnic University of Bucharest, Bioanalysis Lab “ Ovidius” University, Constanta, Romania Dunarea de Jos University, Galati, Romania “ Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj, Romania “ Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania University "Transilvania" of Brasov , Romania
      • Potential University members of Romanian EPMA Network
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 61.
      • Other potential members of EPMA National Network
    • Patient groups
    • Association of Communitary Social Assistance – AGAPE
    • Oradea, Romania
    • Down Association , Oradea Romania
    • Association of Persons with Psychical Handicap , Oradea Romania
    • National Association of Deaf Persons , Oradea Romania
    • National Association of Blind Persons , Oradea Romania
    • Coalition of the Organizations of the Patients with Chronic
    • Diseases - C.O.P.A.C., Bucharest, Romania
    • National League for Rare Diseases (APWR) , Zalau, Salaj, Romania
    • National Association for Patients’ Protection , Bucharest, Romania
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 62. MEDICA – the review of the MD’s Romanian National College http://www.medicalnet.ro/index.php ROMANIAN JOURNAL OF GASTROENTEROLOGY http://www.rjge.ro/ BRAIN AGING INTERNATIONAL JOURNAL http://www.brainaging.ro ROMANIAN JOURNAL OF HAND AND RECONSTRUCTIVE MICROSURGERY http://www.rjhrm.ro/ THORAX http://www.umfcluj.ro/ BULLETIN OF MOLECULAR MEDICINE http://www.umfcluj.ro/ VIATA MEDICALA http://www.vmr.ro ROMANIAN REVIEW OF HEPATOLOGY http://www.ficat.ro/?unde=rh ROMANIAN REVIEW OF LEGAL MEDICINE http://www2.cmb.ro/romjlegmed ROMANIAN REVIEW OF UROLOGY http://www.aru.ro/aru/ie/navigation.jsp?node=1375 JOURNAL OF CELLULAR AND MOLECULAR MEDICINE www.blackwellpublishing.com/jcmm ROMANIAN MEDICAL RESOURCES   http://www.medical-romania.com
      • Medical media need for building
      • the EPMA National Network
    Preventive, predictive and personalized medicine , Prof. Luiza Spiru, MD, PHD
  • 63. Thank you for attention and your feedback Prof. Luiza Spiru, MD, PhD ANA ASLAN INTERNATIONAL ACADEMY OF AGING ANA ASLAN INTERNATIONAL FOUNDATION Healthy Brain Aging Healthy Aging

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