Comparing the current short-term cancer incidence prediction models in Brazil with state-of-the-art time-series models.

The World Health Organization has highlighted that cancer was the second-highest cause of death in 2019. This research aims to present the current forecasting techniques found in the literature, applied to predict time-series cancer incidence and then, compare these results with the current methodology adopted by the Instituto Nacional do Câncer (INCA) in Brazil. A set of univariate time-series approaches is proposed to aid decision-makers in monitoring and organizing cancer prevention and control actions. Additionally, this can guide oncological research towards more accurate estimates that align with the expected demand. Forecasting techniques were applied to real data from seven types of cancer in a Brazilian district. Each method was evaluated by comparing its fit with real data using the root mean square error, and we also assessed the quality of noise to identify biased models. Notably, three methods proposed in this research have never been applied to cancer prediction before. The data were collected from the INCA website, and the forecast methods were implemented using the R language. Conducting a literature review, it was possible to draw comparisons previous works worldwide to illustrate that cancer prediction is often focused on breast and lung cancers, typically utilizing a limited number of time-series models to find the best fit for each case. Additionally, in comparison to the current method applied in Brazil, it has been shown that employing more generalized forecast techniques can provide more reliable predictions. By evaluating the noise in the current method, this research shown that the existing prediction model is biased toward two of the studied cancers Comparing error results between the mentioned approaches and the current technique, it has been shown that the current method applied by INCA underperforms in six out of seven types of cancer tested. Moreover, this research identified that the current method can produce a biased prediction for two of the seven cancers evaluated. Therefore, it is suggested that the methods evaluated in this work should be integrated into the INCA cancer forecast methodology to provide reliable predictions for Brazilian healthcare professionals, decision-makers, and oncological researchers.

Comparing Short-Term Univariate and Multivariate Time-Series Forecasting Models in Infectious Disease Outbreak.

Predicting infectious disease outbreak impacts on population, healthcare resources and economics and has received a special academic focus during coronavirus (COVID-19) pandemic. Focus on human disease outbreak prediction techniques in current literature, Marques et al. (Predictive models for decision support in the COVID-19 crisis. Springer, Switzerland, 2021) state that there are four main methods to address forecasting problem: compartmental models, classic statistical models, space-state models and machine learning models. We adopt their framework to compare our research with previous works. Besides being divided by methods, forecasting problems can also be divided by the number of variables that are considered to make predictions. Considering this number of variables, forecasting problems can be classified as univariate, causal and multivariate models. Multivariate approaches have been applied in less than 10% of research found. This research is the first attempt to evaluate, over real time-series data of 3 different countries with univariate and multivariate methods to provide a short-term prediction. In literature we found no research with that scope and aim. A comparison of univariate and multivariate methods has been conducted and we concluded that besides the strong potential of multivariate methods, in our research univariate models presented best results in almost all regions' predictions.

Trends in global greywater reuse: a bibliometric analysis.

The increase in water demand in recent years led to the expansion of research and public policies on the reuse of water, especially greywater (GW). Given the diversity of research in the area, this paper proposes an analysis of the evolution of the area through an objectivity metric. Metadata of 1,524 publications indexed in the Scopus database between 1974 and 2021 were analyzed using the VOSviewer tool, and showed exponential growth in publications from 2013. Six different spelling variations were found for GW in the database. Despite the highly geographical scattering of academic production, developed countries, who began researching greywater earlier, had more connections and published more papers; except for Israel, which had the highest average of citations per article. While developed countries lead the research area, developing countries are emerging in GW reuse research. These aspects reveal both the dispersion of the research structure development and a trend of intellectual production in GW from developed to developing countries. Also, we noted that countries suffering from water scarcity stood out with the highest activity in paper publishing. Thus, we expect that future research on GW reuse will take place in developing countries that face water scarcity.

Improving emergency department resource planning: a multiple case study.

Sizing and allocating health-care professionals are a critical problem in the management of emergency departments (EDs) managed by a public company in Rio de Janeiro (Brazil). An efficient ED configuration that is cost and time effective must be developed by this company for hospital managers. In this paper, the problem of health-care professional configurations in EDs is modelled to minimise the total labour cost while satisfying patient queues and waiting times as defined by the actual ED capacity and current clinical protocols. To solve this issue, mixed integer linear programming (MILP) that allocates health-care professionals and specifies the amount of professionals who must be hired is proposed. To consider the uncertainties in this environment and evaluate their impacts, a discrete-event simulation model is developed to reflect patient flow. An optimisation and simulation approach is used to search for efficiency leads for different ED configurations. These configurations change depending on the shift and the day of the week.

Utilization of a Bovine Xenograft to Achieve Dental Root Coverage: A Pilot Study.

Eight patients with 38 Miller Class I, II, and III gingival recession defects were treated using an acellular bovine dermal matrix graft (Primatrix, Integra) under a coronal positioned flap. There was a significant 2.43-mm reduction in defect depth, 85.96% mean root coverage, and 65.79% complete root coverage at the 6-month follow-up. Patients reported a significant improvement in perceived esthetics as well as trends for reduced dentinal hypersensitivity, minimal postoperative pain, and overall satisfaction with the procedure. The favorable clinical outcomes and oral biocompatibility would benefit from comparative trials to evaluate the material against contemporary grafting techniques.

Evaluating Oral Health in Pregnant Women: Knowledge, attitudes and practices of health professionals.

Purpose: Complex physiological changes occur during pregnancy thus increasing the risk of periodontitis and potentially adverse pregnancy outcomes. The purpose of this study was to assess prenatal health care professionals' levels of knowledge regarding oral health and its effect on pregnancy outcomes, examine their current practices in evaluating oral health, and determine their attitudes towards a multidisciplinary approach to providing comprehensive prenatal care.Methods: Data was collected from a web-based survey administered to a convenience sample of prenatal health professionals in a healthcare organization located in the Midwestern United States. Responses were summarized with descriptive statistics. A knowledge score was utilized to compare midwives and nurse practitioners to physicians and residents.Results: Seventy-six prenatal health care professionals (n=76) agreed to participate for a response rate of 37%, with the majority (80%) of respondents considering oral health to be an important component of prenatal care. In regards to the inclusion of oral health in current practice, only 6% of the respondents "always" include an oral health history interview and only 7% "always" include a dental screening as part of prenatal care. A moderate correlation was found between the knowledge score and the frequency of including oral health history interviews during prenatal visits (correlation = 0.36, p=0.002).Conclusion: The majority of prenatal health care professionals surveyed were knowledgeable about oral health as it relates to prenatal care; however, a deficit was identified in current practice in regards to oral health history interviewing and conducting dental screenings. There is a need to implement best practice guidelines that include routine dental screenings and to engage pregnant women in oral health prevention practices. Optimal oral health requires a multidisciplinary approach in which dental hygienists can play a significant role by educating women's healthcare providers and raising awareness of the connection between oral health and pregnancy outcomes.

Consistency of Dental Hygiene Therapy Utilizing Various Dental Hygiene Instrumentation and Its Effect on Peri-implant Health and Survival of Dental Implants: A Retrospective Study.

PURPOSE: The purpose of this retrospective study was to provide practice-based evidence to determine if the consistency of dental hygiene therapy, despite utilizing instrumentation literature that has proven to cause alterations to implant surfaces, affects peri-implant health or survival. MATERIALS AND METHODS: The study sample comprised patients with implant-supported full-arch fixed dental prostheses who were distributed into two groups. The consistent hygiene group patients had dental hygiene therapy at a minimum biannually and were exposed to at least three dental hygiene instrument materials. The inconsistent hygiene group patients had dental hygiene therapy at a minimum once every 3 to 10 years and were exposed to at least three dental hygiene instrument materials. Years of survival free of soft tissue pathology and/or implant failure were estimated. Continuous features were summarized with medians, interquartile ranges (IQRs), and ranges; categorical features were summarized with frequency counts and percentages. RESULTS: Among 48 patients in the consistent hygiene group, 11 patients experienced soft tissue pathology or implant failure at a median of 11.3 years; among 99 patients in the inconsistent hygiene group, 17 patients experienced soft tissue pathology or implant failure at a median of 4.8 years. The survival free of soft tissue pathology or implant failure rate at 5 years was 94% for the consistent hygiene group and 91% for the inconsistent hygiene group. The survival free of soft tissue pathology or implant failure rate at 20 years was 70% for the consistent hygiene group and 79% for the inconsistent hygiene group (P = .91). CONCLUSION: Although no statistical differences were found between the groups, this practice-based evidence suggests more consistent dental hygiene therapy increases the median in years in which soft tissue pathology or implant failure is present.

Evaluation of fracture resistance in aqueous environment of four restorative systems for posterior applications. Part 1.

PURPOSE: The goals of this study were to: (1) establish a range of the performance of four restorative systems for posterior single-tooth crowns under single load to fracture submerged in an aqueous environment, (2) identify restorative system(s) of interest to be examined in the second study phase under sliding contact step-stress fatigue as full-contour anatomically appropriate single posterior tooth restoration(s), (3) establish a range for loading/testing for phase 2. MATERIALS AND METHODS: Forty specimens (n = 10/group) of 2 mm uniform thickness were tested. Group 1: monolithic lithium disilicate IPS e.max Press; group 2: IPS e.max ZirPress, 0.8 mm zirconia core with 1.2 mm pressed veneering porcelain; group 3: IPS e.max ZirPress, 0.4 mm zirconia core with 1.6 mm pressed veneering porcelain; group 4: IPS InLine PoM. Specimens were bonded to a block of polycast acrylic resin on a 30° sloped surface with resin cement. Specimens were axially single loaded to failure while submerged under water. RESULTS: There was a statistically significant difference (p < 0.001) in failure load among the four restorative systems. Lithium disilicate showed a mean failure load similar to mean maximum posterior bite forces (743.1 ± 114.3 N). IPS e.max Zirpress with a 0.4 mm zirconia core exhibited the lowest mean failure load (371.4 ± 123.0 N). CONCLUSION: Fracture resistance of monolithic lithium disilicate in an aqueous environment is promising and requires second phase testing to evaluate the potential of various thicknesses appropriate for posterior single tooth applications. Doubling the IPS e.max Zirpress zirconia core from 0.4 mm to 0.8 mm increased the fracture resistance of this restorative system threefold.

Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals.

BACKGROUND: Diabetes education can improve the quality of care of people with diabetes, but many organizations are not equipped to manage its implementation. Involving people with diabetes in the education process can overcome the problem. Thus, we compared clinical, metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes that also provided ongoing peer support. METHODS: People with type 2 diabetes (25-75 years) were randomly assigned to attend a 4-week structured diabetes education course delivered by professional educators (control) or previously trained peers (peer). Peers also received continuing psychological support, including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups (ten patients), using a structured questionnaire related to the patient's clinical, metabolic and psychological progress. Identical outcome data from both groups were used for follow-up. RESULTS: Both groups had a comparable positive effect on clinical, metabolic and psychological indicators immediately following the programme. Over the following year, peer-educated subjects had lower A(1C) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes. CONCLUSION: The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful. This approach provides an effective alternative method of education, especially in areas with limited availability of professionals and economic resources.

Survival of dental implants in irradiated head and neck cancer patients: a retrospective analysis.

PURPOSE: To study the long-term survival of dental implants placed in irradiated bone in subjects who received radiation for head and neck cancer. MATERIALS AND METHOD: A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 through July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. RESULTS: A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987 to July 2008. The estimated survival at 1, 5, and 10 years was 98.9%, 89.9%, and 72.3%, respectively. Implants placed in the maxilla were more likely to fail than implants placed in the mandible (p = .002).There was also a tendency for implants placed in the posterior region to fail compared with those placed in the anterior region (p =.051). CONCLUSION: Dental implants placed in irradiated bone have a greater risk for failure. Survival is significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior).

Survival of turned and roughened dental implants in irradiated head and neck cancer patients: a retrospective analysis.

STATEMENT OF PROBLEM: Dental implants placed into previously radiated fields in survivors of head and neck cancer can demonstrate survival rates that are less than optimal. Understanding this behavior may assist with treatment planning in accordance with expected survival rates in these patients. PURPOSE: The purpose of this study was to compare the survival of implants with turned and roughened surfaces placed in patients who had previously received head and neck radiation, and to identify factors associated with implant failure. MATERIAL AND METHODS: The records of 48 patients who had prior head and neck radiation and had 271 dental implants placed between May 1987 and July 2008 were examined. All of the implants were placed in a previously irradiated field dosed to at least 50 Gy. Implant survival was estimated using the Kaplan-Meier method and univariate Cox models with robust standard errors were fitted to evaluate the association between patient/implant factors and implant failure. RESULTS: There were 62 implants placed in the maxilla (32 roughened, 30 turned) and 209 implants (107 roughened, 102 turned) placed in the mandible. The 5-year implant survival rate for implants placed in the maxilla was 72.6% for turned implants and 87.5% for roughened implants. For implants placed in the mandible, the 5-year survival rate was 91.7% for turned implants and 100% for roughened implants. Among implants with a turned surface, implants were more likely to fail if they were placed in the maxilla (P=.008) and if the diameter was ≤3.75 mm (P=.002). CONCLUSIONS: Implants with turned surfaces were 2.9 times more likely to fail compared to the roughened dental implants, although the difference did not reach statistical significance. For implants with turned surfaces, there was a tendency for implants in the maxilla to fail more frequently compared to the mandible. Implants with turned surfaces had a higher likelihood of failure in the posterior region than in the anterior region. For implants with roughened surface there was no significant association between implant survival and location of the implant, type of bone, or length or diameter of the implant.

Peripheral T-Cell lymphoma manifested as gingival enlargement in a patient with chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in adults and is associated with increased risk of malignancy. T-cell lymphoma associated with CLL has never been reported. The case report presents a unique case of peripheral T-cell lymphoma on the gingiva of a patient with CLL. A 66-year-old man with a history of CLL was referred to the Mayo Clinic, Department of Dental Specialties, for evaluation of swelling in the upper left posterior sextant. An intraoral examination revealed a soft tissue swelling in the area of teeth number 13 and 15, including the present edentulous ridge between number 13 and 15. An incisional biopsy was performed on the palatal aspect of tooth No. 15 and submitted for histologic evaluation. The histopathology revealed proliferation of large atypical cells beneath the epithelium, positive for antigens CD2, CD3, Beta-F1, TIA-1, and Granzyme B consistent for a diagnosis of a peripheral T-cell lymphoma. A team approach including the hematologist, general dentist and periodontist resulted in timely referrals leading to an early diagnosis and early intervention and treatment.

Relationship between systemic bone mineral density and local bone quality as effectors of dental implant survival.

PURPOSE: This study aimed to assess (1) the relationship of systemic bone mineral density (BMD) and osteoporotic status with the surgeon's subjective assessment of local jawbone quality, and (2) whether the surgeon's subjective assessment of local jawbone quality is a predictor of implant failure. MATERIALS AND METHODS: A retrospective analysis of 2,867 dental implants placed in 645 patients was accomplished. The surgeon's assessment of bone quality at the time of dental implant placement was recorded. Of those, 208 patients with 701 implants had BMD data available within 3 years. Statistical analyses were conducted to determine relationships between BMD, osteoporotic status, and local jawbone quality and to determine the relationship between local jawbone quality and implant survival. RESULTS: There was no association between systemic BMD and the surgeon's assessment of bone quality (p =.52) nor between osteoporotic status and the surgeon's assessment of local jawbone quality (Spearman rank correlation coefficient=0.08). Additional retrospective analysis revealed implants placed in moderate- (hazard ratio=1.67; p=.043) or poor-quality (HR=3.45, p< .001) bone (surgeon's assessment) were significantly more likely to fail than implants placed in good-quality bone. CONCLUSION: Systemic BMD and osteoporotic status are not associated with local jawbone quality. Implants placed in good-quality bone, as assessed subjectively by the surgeon at the time of implant placement, have significantly better survival characteristics than implants placed in moderate-/poor-quality bone.

Survival of dental implants in native and grafted bone in irradiated head and neck cancer patients: a retrospective analysis.

AIM: To study the long-term survival of dental implants placed in native or grafted bone in irradiated bone in subjects who had received radiation for head and neck cancer. MATERIALS AND METHODS: A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 and July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. RESULTS: A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987-July 2008. There was no statistically significant difference between implant failure in native and grafted bone (P=0.76). Survival of implants in grafted bone was 82.3% and 98.1% in maxilla and mandible, respectively, after 3 years. Survival of implants in native bone in maxilla and mandible was 79.8% and 100%, respectively, after 3 years. For implants placed in the native bone, there was a higher likelihood of failure in the maxilla compared to the mandible and there was also a tendency for implants placed in the posterior region to fail compared to those placed in the anterior region. CONCLUSION: There was no significant difference in survival when implants were placed in native or grafted bone in irradiated head and neck cancer patients. For implants placed in native bone, survival was significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior).

A retrospective study of the survival of smooth- and rough-surface dental implants.

PURPOSE: To compare the time-dependent cumulative survival rates of smooth- and rough-surface dental implants. MATERIALS AND METHODS: A retrospective chart review was conducted for two time periods: January 1, 1991, through December 31, 1996, during which smooth-surface implants were used, and January 1, 2001, through December 31, 2005, during which rough-surface implants were used. This study included all implants placed and restored in one institution during the two time frames. Data were collected relative to patient age, gender, implant diameter, implant length, and anatomic location of implants. To facilitate the comparison, implants from the first and second time periods were followed through mid-1998 and mid-2007, respectively. Associations of patient/implant characteristics with implant survival were evaluated using marginal Cox proportional hazards models (adjusted for age and gender) and summarized with hazard ratios and corresponding 95% confidence intervals. RESULTS: A total of 593 patients (322 women and 271 men; mean age, 51.3 +/- 18.5 years) received 2,182 smooth-surface implants between 1991 and 1996, while 905 patients (539 women and 366 men; mean age, 48.2 +/- 17.8 years) received 2,425 rough-surface implants between 2001 and 2005. At 5 years after implant placement, survival rates were 94.0% and 94.5%, respectively, for smooth- and rough-surface implants (difference not significant). Among the smooth implants, implant length

Effect of osteoporotic status on the survival of titanium dental implants.

OBJECTIVES: The aim of this study was to determine whether a diagnosis of osteoporosis affected the survival rate of osseointegrated dental implants. Other variables that were studied were age, arch location of the implant, and smoking status on the effect of dental implant survival. MATERIALS AND METHODS: A retrospective chart review was completed on all women who were 50 years of age or older at the time of dental implant placement at the Mayo Clinic between October 1, 1983, and December 31, 2004. Osteoporotic status was defined on the basis of bone mineral density (BMD) score utilizing World Health Organization criteria. Univariate analyses were performed to evaluate the following independent variables' effect on implant survival: BMD T-score, age, osteoporosis status, arch location of the implant, and smoking status at the time of implant placement. RESULTS: A total of 3,224 implants in 746 female patients 50 years of age or older at the time of implant placement were evaluated. BMD scores within 3 years of implant placement were available for 646 implants (192 patients). In this group, 37 implant failures were noted. The 5-year implant survival rate was 93.8% in the group of patients with BMD scores. In this group of 192 patients, there were 94 (49%) who were not diagnosed with osteopenia or osteoporosis, 57 (29.7%) with a diagnosis of osteopenia, and 41 (21.4%) with a diagnosis of osteoporosis. Patients with a diagnosis of osteoporosis or osteopenia were not significantly more likely to develop implant failure compared to those without such a diagnosis (HR = 1.14, 95% CI = 0.50 to 0.60, P = .76 and HR = 0.98, 95% CI = 0.40 to 2.42, P = .97, respectively). Arch location and BMD score did not have a statistically significant effect on implant survival rates. The only tested variable to demonstrate a significant effect was smoking. Implants in patients who were smokers during the time of implant placement were 2.6 times more likely to fail compared to implants placed in patients who did not smoke (HR = 2.6, 95% CI = 1.20 to 5.63; P = .016). CONCLUSIONS: Based upon the data derived from this retrospective study of 192 women at least 50 years of age at the time of implant placement, the following observations were made: (1) a diagnosis of osteoporosis and osteopenia did not contribute to increased risk of implant failure and (2) implants placed in patients who were smokers at the time of implant placement were 2.6 times more likely to fail than implants placed in nonsmokers. Based on these data, a diagnosis of osteoporosis or osteopenia is not a contraindication to dental implant therapy.

The effects of smoking on the survival of smooth- and rough-surface dental implants.

PURPOSE: To compare the long-term survival rates of smooth- and rough-surface dental implants among smokers and nonsmokers. MATERIALS AND METHODS: A retrospective chart review was conducted for 2 time periods: January 1, 1991, through December 31, 1996, during which smooth-surface implants were utilized, and January 1, 2001, through December 31, 2005, during which rough-surface implants were utilized. This review included all implants placed and restored in 1 institution during the 2 timeframes. Data were specifically collected relative to patient age, gender, smoking status, implant diameter, implant length, and anatomic location of implants. Implants from the first and second time periods were followed through mid-1998 and mid-2007, respectively. Associations of patient/implant characteristics with implant survival were evaluated using marginal Cox proportional hazards models (adjusted for age and gender) and summarized with hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS: A total of 593 patients (322 [54.3%] female; mean [SD] age, 51.3 [18.5] years) received 2,182 smooth-surface implants between 1991 and 1996, while 905 patients (539 [59.6%)] female; mean [SD] age, 48.2 [17.8] years) received 2,425 rough-surface implants between 2001 and 2005. Among the rough-surface implants, smoking was not identified as significantly associated with implant failure (HR = 0.8; 95% CI = 0.3 to 2.1; P = .68). In contrast, smoking was associated with implant failure among the group with smooth-surface implants (HR = 3.1; 95% CI = 1.6 to 5.9; P < .001). Implant anatomic location was not associated with implant survival among patients with rough-surface implants (P = .45) and among nonsmokers with smooth-surface implants (P = .17). However, anatomic location affected the implant survival among smokers with smooth-surface implants (P = .004). In particular, implant survival was the poorest for implants placed in the maxillary posterior areas of smokers. CONCLUSIONS: Based on this retrospective study, the following observations were made: Smoking was identified as a risk factor for implant failure of smooth-surface implants only; among the smokers who received smooth-surface implants, an association was identified between implant failure and location of the implant placement; no association was identified between implant failure and location among the smokers who received rough-surface implants.

[Evaluation of an intensive treatment education program for type 1 diabetes in a group of adolescents. A two year follow up]. / Evaluación de un programa de educación de tratamiento intensivo en adolescentes con diabetes tipo 1. Seguimiento por dos años.

During the past decade several reports were published showing that intensive treatment of type 1 diabetes can prevent and delay disease-related microvascular complications. However, several problems were reported in children and adolescents such as frequent hypoglycemic episodes and weight gain. The aim of this study was to describe the results of intensified treatment for type 1 diabetes in a group of Argentinean adolescents after a follow-up of two years. Twenty five adolescents with type 1 diabetes older than 10 years with at least one year from diagnosis were selected. All patients received a one-week teaching program during admission to our center. All patients were followed-up monthly during two years. Treatment schedule included 4-5 controls in fasting conditions, two doses of NPH insulin and four doses of regular insulin according to glycemia and the amount of calculated carbohydrate intake. Median age was 13.5 years (range 10 to 19 years). Mean time from diagnosis to inclusion in the study was 3.8 years (range 1.25 to 9 years). Mean total dose of NPH insulin decreased significantly when measured at the inclusion in the study (0.9 IU/kg) and after a year of follow-up 0.8 IU/kg (p 0.04). However, there were no changes in NPH insulin dose after two years follow-up (0.85 IU/kg). On the contrary, the dose of regular insulin administered on fasting conditions with normal glycemia increased from 0 to 0.21/kg after a year (p 0.0001) and to 0.69 after two years (non significant). Median HbA1C showed a significant reduction from 10 +/- 1.62% to 8.53 +/- 1.04% after a year (p 0.03) and to 8.72 +/- 0.81% after two years. BMI Z score increased from significantly from 0.7 +/- 0.9 to 1.06 +/- 1.15 after a year (p 0.03) with a further reduction without a significant difference from the basal value after two years. We found no significant differences in the frequency of hypoglycemia or other metabolic features. Our results show that intensive treatment of type 1 diabetes in children and adolescents can achieve significant and sustained reductions of HbA1C without increasing the risk of hypoglycemia or other adverse effects.

Evaluación de un programa de educación de tratamiento intensivo en adolescentes con diabetes tipo 1. Seguimiento por dos años. / [Evaluation of an intensive treatment education program for type 1 diabetes in a group of adolescents. A two year follow up]

During the past decade several reports were published showing that intensive treatment of type 1 diabetes can prevent and delay disease-related microvascular complications. However, several problems were reported in children and adolescents such as frequent hypoglycemic episodes and weight gain. The aim of this study was to describe the results of intensified treatment for type 1 diabetes in a group of Argentinean adolescents after a follow-up of two years. Twenty five adolescents with type 1 diabetes older than 10 years with at least one year from diagnosis were selected. All patients received a one-week teaching program during admission to our center. All patients were followed-up monthly during two years. Treatment schedule included 4-5 controls in fasting conditions, two doses of NPH insulin and four doses of regular insulin according to glycemia and the amount of calculated carbohydrate intake. Median age was 13.5 years (range 10 to 19 years). Mean time from diagnosis to inclusion in the study was 3.8 years (range 1.25 to 9 years). Mean total dose of NPH insulin decreased significantly when measured at the inclusion in the study (0.9 IU/kg) and after a year of follow-up 0.8 IU/kg (p 0.04). However, there were no changes in NPH insulin dose after two years follow-up (0.85 IU/kg). On the contrary, the dose of regular insulin administered on fasting conditions with normal glycemia increased from 0 to 0.21/kg after a year (p 0.0001) and to 0.69 after two years (non significant). Median HbA1C showed a significant reduction from 10 +/- 1.62

to 8.53 +/- 1.04

after a year (p 0.03) and to 8.72 +/- 0.81

after two years. BMI Z score increased from significantly from 0.7 +/- 0.9 to 1.06 +/- 1.15 after a year (p 0.03) with a further reduction without a significant difference from the basal value after two years. We found no significant differences in the frequency of hypoglycemia or other metabolic features. Our results show that intensive treatment of type 1 diabetes in children and adolescents can achieve significant and sustained reductions of HbA1C without increasing the risk of hypoglycemia or other adverse effects.