EFFECTS OF DEPRESSION, ANXIETY, OR LOW SELF-ESTEEM UPON GLYCEMIC VARIABILITY, IN DIABETIC PREGNANT VERSUS NON-PREGNANT PATIENTS.

Objective: We analyzed the correlation between glycemic variability and psychological problems such as depression, anxiety disorder, and low self-esteem in pregnant and non-pregnant (excluding gestational diabetes) patients with diabetes. Besides its originality, this study might contribute to better / earlier diagnosis of these psychological conditions, with a special interest in pregnant diabetic women. Better management and cost reduction of care could be a consequence. Methods: We compared diabetic pregnant and non-pregnant women from the perspective of the glycemic variability (for a period of 15 days prior inclusion in the study) and their results on the standardized questionnaires: Beck depression inventory, Hamilton anxiety scale - HRSA, Rosenberg self-esteem test. Results and Conclusions: A statistically significant correlation was identified in both groups between the glycemic oscillation and depression, anxiety, and low self-esteem. Diabetic pregnant women had a higher statistical significance for the correlation between the glycemic oscillation and depression, as well as between the glycemic oscillation and anxiety than non-pregnant diabetic patients. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients.

THE RELATIONSHIP BETWEEN DEPRESSION, ANXIETY DISORDER AND LOW SELF-ESTEEM IN REGARD TO GLYCEMIC VARIABILITY IN DIABETIC PATIENTS.

Objective: We analyzed the possible correlation between glycemic variability and psychological disorders such as depression, anxiety disorder, and low self-esteem, in diabetic patients. These correlations are relevant, as they consume a large number of resources. Their better understanding can increase the effectiveness of incident reduction techniques and could provide better management and cost reduction of care. Methods: We compared the relationships between the glycemic variability (for a period of 10 days prior to completing the depression questionnaire) and the results of two standardized questionnaires: Hamilton anxiety scale - HRSA (group 1: 500 patients), Rosenberg self-esteem test (group 2: 490 patients) and Beck depression inventory (both groups). Results: A statistically significant correlation was identified between the glycemic oscillation and depression as well as both anxiety and low self-esteem. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients. In conclusion, psychometric tests could be an important instrument in the management of diabetic patients.

Effectiveness of SolSano Program on Sun Protection Habits, Knowledge, and Attitudes Among University Students. / Efectividad del programa SolSano en los hábitos, conocimientos y actitudes en materia de fotoprotección de los universitarios.

BACKGROUND AND OBJECTIVE: The SolSano (HealthySun) project is a primary school sun education program that has been running in Aragon, Spain, since 2000. In the short term, it has proven to be effective at promoting sun protection behaviors and heightening awareness in childhood. The aim of this study was to evaluate the long-term effectiveness of the SolSano program. PARTICIPANTS AND METHODS: Retrospective, observational, analytical, cohort study of students at the University of Zaragoza between 2015 and 2016. The students answered a previously validated, purpose-designed, online questionnaire. We calculated descriptive statistics for all variables and performed bivariate and multivariate analyses to test for differences between students who had attended a primary school that ran the SolSano program and those who had not. RESULTS: Data for 324 students were analyzed. Mean age was 22.9 years and 78% of the respondents were women. In total, 44% of the students had participated in the SolSano program at primary school. Half of the respondents (50.5%) had experienced 1 or 2 sunburn episodes the previous summer. Significant differences were only observed for some aspects addressed by the questionnaire between SolSano participants and nonparticipants. CONCLUSIONS: This is the first study to evaluate the long-term effectiveness (15 years) of a primary school sun protection program. The absence of significant differences in our sample might be explained by non-continuation of the program into adolescence and the existence of sun protection campaigns outside the school.

Supporting the improvement of air quality management practices: The "FAIRMODE pilot" activity.

This paper presents the first outcomes of the "FAIRMODE pilot" activity, aiming at improving the way in which air quality models are used in the frame of the European "Air Quality Directive". Member States may use modelling, combined with measurements, to "assess" current levels of air quality and estimate future air quality under different scenarios. In case of current and potential exceedances of the Directive limit values, it is also requested that they "plan" and implement emission reductions measures to avoid future exceedances. In both "assessment" and "planning", air quality models can and should be used; but to do so, the used modelling chain has to be fit-for-purpose and properly checked and verified. FAIRMODE has developed in the recent years a suite of methodologies and tools to check if emission inventories, model performance, source apportionment techniques and planning activities are fit-for-purpose. Within the "FAIRMODE pilot", these tools are used and tested by regional/local authorities, with the two-fold objective of improving management practices at regional/local scale, and providing valuable feedback to the FAIRMODE community. Results and lessons learnt from this activity are presented in this paper, as a showcase that can potentially benefit other authorities in charge of air quality assessment and planning.

Dissemination of NDM-1 carbapenemase-producer Providencia stuartii strains in Romanian hospitals: a multicentre study.

Several Romanian hospitals have noted increasing isolation of Providencia stuartii strains in recent years, with an alarming rate of carbapenem resistance. In order to provide molecular epidemiological data regarding their dissemination, 77 P. stuartii strains collected from five hospitals located in different regions of Romania were analysed. All strains harboured IncA/C plasmid, and 67 carried the blaNDM-1 gene. Six clonal clusters were differentiated by pulsed-field gel electrophoresis. The predominant subtype was found in all five hospitals. Our study highlights the need for efficient infection-control measures, the optimization of antibiotic use and the targeted surveillance for carbapenemase-producing P. stuartii.

Medico-legal reasoning in disability assessment: a focus group and validation study.

BACKGROUND: Decisions on disability pensions are based, among others, on medical reports. The way these medical assessments are performed is largely unclear. The aim of the study was to determine which grounds are used by social insurance physicians (SIPs) in these assessments and to determine if the identification of these grounds can help improve the quality of assessments in social insurance practice. The article describes a focus group study and a questionnaire study with SIPs in four different countries. METHOD: Using focus group discussions of SIPs discussing the same case in Belgium, the Netherlands, Norway and Slovenia (N = 29) we determined the arguments and underlying grounds as used by the SIP's. We used a questionnaire study among other SIPs (N = 60) in the same countries to establish a first validation of these grounds. RESULTS: Grounds in the focus groups were comparable between the countries studied. The grounds were also recognized by SIPs who had not participated in the focus groups. SIPs agreed most on grounds with regard to the claimant's health condition, and about the claimant's duty to explore rehabilitation and work resumption, but less on accepting permanent incapacity when all options for treatment were exhausted. CONCLUSION: Grounds that SIPs use refer to a limited group of key elements of disability evaluation. SIPs interpret disability in social insurance according to the handicapped role and strive at making their evaluation fair trials. ICF is relevant with regard to the health condition and to the process of evaluation. Identification of grounds is a valuable instrument for controlling the quality of disability evaluation. The grounds also appear to be internationally comparable which may enhance scientific study in this area.

Refinement of the basic treatment equivalent model to reflect radiotherapy treatment throughput using Australasian data.

A model of radiotherapy linear accelerator throughput has been developed and shown to be a more sensitive measure of throughput than current measures of throughput. The present study aims to develop a more sensitive basic treatment equivalent (BTE) model that still measures linear accelerator throughput and considers some of the shortcomings of the previous model. All radiation oncology departments in Australia and New Zealand were invited to participate. Departments were asked to time with a stopwatch all episodes of radiotherapy treatment over a 4-week period. Data collected for each treatment fraction included treatment intent, tumour site, patient age, Eastern Cooperative Oncology Group (ECOG) performance status, number of fields used, number of wedges used, number of junctions, number of shielding blocks used, whether the treatment was the first fraction, the use of general anaesthesia and whether port films or electronic portal imaging was used. Twenty-six departments of radiation oncology (70%) participated in this trial. A total of 7929 fractions of treatment, administered to 2424 patients, were timed. The factors found to most significantly impact on treatment duration on multivariate analysis were the type of fraction (first fraction was longer than subsequent fractions), type of beam (electrons were quicker than photons, which were quicker than mixed), number of fields, number of shields, number of junctions, number of port films and performance status (ECOG < 2 vs > 2). The age of the patient, number of compensators and the sex of the patient were not significant. The relationships between factors were assessed, and models of measuring linear accelerator throughput which consider complexity corrections were derived. It is possible to show that linear accelerator throughput is poorly measured by just considering numbers of patients or fields treated per unit time; and that other factors that impact on treatment duration must be considered. A more sensitive model of patient throughput is suggested; but even when a large number of factors are considered, some insensitivity still remains in the model.

An Australasian assessment of the basic treatment equivalent model derived from New South Wales data.

The current method of assessment of radiation oncology linear accelerator throughput is either by patients per unit time or fields per unit time. This, however, does not take into consideration the complexity of different treatment techniques or of casemix. A model has been developed in an earlier study, called 'basic treatment equivalent' (BTE), to measure patient throughput of a linear accelerator, which includes consideration of the complexity of treatment techniques. The present study compared the BTE model with the current best measure of patient throughput of fields per hour. All 37 departments in Australia and New Zealand were invited to participate in testing the model, and 36 agreed to participate. The study period for each department was a consecutive 4 weeks between August and December, 1996. The prospective data collected were the total BTE units treated per linear accelerator per day, the total number of patients and fields treated per linear accelerator per day, and the total linear accelerator hours of operation per day excluding calibration time and significant breaks of linear accelerator time such as planned meal breaks. The treatment breaks between consecutive treatment fractions were not excluded from the linear accelerator treatment time. The throughput data for 36 departments (92 linear accelerators) were collected over the 4-week study period. The average throughput for the departments was 10.8 fields per hour and 4.2 patients per hour. The average BTE per department was 5.7 BTE per hour. The average BTE per episode per department was 1.38. The BTE model was found to be a more sensitive measure of productivity compared with fields per hour (P < 0.001). Some treatment techniques were thought to be not well represented by the BTE formula, particularly those techniques where junctions were present. The BTE model is a more sensitive measure than fields per hour and better reflects the variations in complexity in techniques. Despite this result there is further refinement to be performed to make the model even more sensitive.

Basic Treatment Equivalent (BTE): a new measure of linear accelerator workload.

The measurement of linear accelerator workload in radiation oncology departments is usually based on the number of fields treated per unit time. However, this approach ignores variations in treatment complexity. This prospective study, was designed to measure treatment workload directly, taking into account the variations in complexity of different treatment techniques. From this, a model was to be developed, which would be simple to apply and reproducible, both within and between radiation oncology departments in Australasia. It would provide a realistic basis for assessing treatment costs and enable the comparison of patient throughput between departments. This paper describes the derivation of the model. Over a 4-week period in the Radiation Oncology Department of Westmead Hospital, all fractions of radiotherapy were timed. The data collected included: tumour site; treatment intent; number of fields; number of wedges, compensators and shielding blocks; fraction number; patient age; performance status; and need for general anaesthesia. Multivariate modelling was performed to identify factors that significantly affected fraction duration, so that these could be used to develop a model of resource utilization. The durations of 2371 fractions were measured in 219 patients. Seventy-five per cent of fractions were given with radical intent. The factors found to influence fraction duration on multivariate modelling were: number of fields; number of shielding blocks; first treatment fraction; need for anaesthesia; and performance status. The number of wedges and compensators were also found to be significant but were not included in the model in order to maintain simplicity. This was felt to be necessary if the model is to be applied to the widest possible variety of machines. A model of resources utilization called 'Basic Treatment Equivalent' (BTE) was derived, which incorporated these factors. When tested at Westmead Hospital, this model accurately reflected the predicted BTE value over a further 1-week study period. This model of linear accelerator use, which incorporates complexity has been derived and evaluated in one radiation oncology department. This requires further prospective testing before its widespread use. The model appears to reflect linear accelerator workload better than previous measures. An Australasian study to validate the model further will be undertaken. If adopted, this model has implications for comparative workload reports, diagnostic-related groups, waiting list calculations, and patient scheduling.

An assessment of the Basic Treatment Equivalent (BTE) model as measure of radiotherapy workload.

Current methods of linear accelerator workload analysis in radiation oncology use patients per hour or fields per hour as the basic unit of measurement but fail to take account of the variations in complexity of different treatment techniques. The Basic Treatment Equivalent (BTE) model of productivity assessment has been derived as a potentially better measure of workload because it includes a complexity factor. This model has now been tested prospectively in ten radiation oncology departments in New South Wales and compared with the numbers of fields and patients per hour. Over a 4-week period there were 50,115 fields administrated in 18,466 fractions in 441 hours of machine time in ten radiation oncology departments. The average productivity results for all departments were 4.18 patients, 11.25 fields and 5.66 BTE per hour. When compared with patients per hour and fields per hour, there was less variability of BTE per patient per hour in all departments, suggesting that most departments deliver radiation therapy in a consistent way, which is not appropriately reflected in the numbers of fields or patients per hour. Departments that were able to treat a high number of patients or fields per hour were able to do so because they used less complicated techniques or had a less complicated casemix of patients. The BTE model allows for variations in the complexity of treatment techniques, is simple to apply, and is reproducible under different conditions in different departments. Following revision of the model, an Australasian study is now proposed. The confirmation of our findings will have significant implications for resource utilization comparisons, patient time allocations, waiting list estimates and cost-benefit analysis.

The equivalent simple treatment visit (ESTV) model does not measure radiation oncology productivity under Australian conditions.

The measurement of workload in radiation oncology departments has been based on the number of patients treated per linear accelerator per unit time, or on the number of fields treated per linear accelerator per unit time. The Equivalent Simple Treatment Visit (ESTV) model was proposed to allow for the incorporation of a factor for complexity of treatment techniques, to permit more detailed comparisons than those offered by previous measures. This prospective study was designed to assess the suitability of the ESTV model as a measure of radiation oncology productivity within an Australian radiation oncology department. A calculated ESTV value was assigned to all treatment fractions delivered in our department over a 4-week period. Treatment fractions were then timed using a stopwatch, and average treatment times for simple, intermediate and complex techniques were calculated and analysed by multiple t-tests for statistical significance. Average treatment times were 8.1 minutes (standard deviation (SD) = 4.2) for 'simple' techniques, 14.1 minutes (SD = 4.4) for 'intermediate' techniques, and 11.8 minutes (SD = 5.6) for 'complex' techniques. These times were significantly different from each other (P < 0.05). Although ESTV attempts to allow for the incorporation of a complexity factor into productivity reporting, a revision of the model is necessary, given the inconsistency by which a 'complex' technique takes significantly less time than an 'intermediate' technique.

[Delayed diagnosis of esophageal perforation].

Esophageal perforation is a rare complication of endotracheal intubation. Usually clinical symptoms are manifested shortly after the injury. Delayed diagnosis and treatment are associated with high morbidity and mortality. In a 38-year-old woman esophageal perforation was diagnosed 31 days after its occurrence, but prompt treatment, including surgery, led to a successful outcome. It is recommended that all available means be used to diagnose suspected cases of this fatal complication as early as possible.