Instability of the non-activated rotational thromboelastometry assay (NATEM) in citrate stored blood.

INTRODUCTION: The non-activated rotational thromboelastometric assay (NATEM) is increasingly used as sensitive test for the evaluation of the endogenous activation of haemostasis. The reproducibility of the test results in citrate stored blood has never been investigated. MATERIALS AND METHODS: The NATEM assay was performed in citrated blood samples stored for 0, 45 and 90minutes using ROTEM® (TEM International, Munich, Germany). Blood samples were drawn from healthy volunteers and a population of patients admitted to the intensive care (ICU). In 10 ICU patients, citrate concentrations were measured at baseline and after 90minutes of storage. RESULTS: The NATEM clotting time shortened in stored citrated blood from healthy volunteers (t=0 1226±160; t=45 986±171; t=90 903±177; p<0.001) and ICU patients (t=0 986±318; t=90 750±187; p<0.001). A similar decrease in clot formation time (CFT) was seen whereas the MCF remained unaffected. Citrate concentration did not change over time, baseline 13.3±0.5mmol/l; after 90minutes 13.2±0.7mmol/l; n.s.. CONCLUSIONS: The non-activated rotational thromboelastometric assay test results change over time in citrate stored blood. The NATEM test should be initiated at a standardised time point, in order to prevent bias by different test initiation times, preferably directly after blood withdrawal.

Preventive healthcare surveillance can detect emerging behavioural problems that are related to later school dropouts.

AIM: School dropout is a multidimensional problem with negative consequences for socio-economic status. Most interventions to reduce school dropout have been implemented in education rather than in preventive healthcare. Our goal was to determine whether measurements used in preventive healthcare surveillance enabled us to detect internalising and externalising problems in relation to later school dropouts. METHODS: Using a case-control design, we compared Dutch dropouts (n = 301) and nondropouts (n = 270), who were aged 18-23 in 2008, by examining their youth healthcare, socio-medical records from birth onwards. Logistic regression models were estimated. RESULTS: Young adults with externalising problems in their earlier life had 56% higher odds of dropping out compared to those without externalising problems (OR = 1.56; 95% CI: 1.02-2.37), when data were adjusted for sex, socio-economic and ethnic background and family composition. Internalising problems did not differ between the cases and controls. CONCLUSION: Our findings suggest that early life symptoms of emerging behavioural problems, as detected by preventive healthcare surveillance, are related to later school dropout. Preventive healthcare professionals can play a role in helping to prevent school dropouts, and this study underlines that school dropout is an important preventive healthcare issue.

Supervision in social health insurance: a four country study.

This article presents the results of an international comparative study of a widely neglected element in social health insurance: supervision upon the sickness funds as implementing agents of social health insurance. The following countries were included: Belgium, Germany, Switzerland and the Netherlands. A comparative analysis of the institutional structure of supervision revealed many differences. The goals of supervision are more or less the same in each country: preserving the lawfulness of implementation; ensuring trust and stability; preserving efficiency and supporting policymaking. The analysis of the supervision process focused upon three sub-processes: the collection of information; the assessment of the performance of the sickness funds and interventions to correct deviant behaviour. Finally, the analysis deals with changes in supervision, in particularly the impact of market competition in social health insurance upon supervision. It is argued that market competition will substantially alter the role of supervisory agents in social health insurance.