Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control.

BACKGROUND: International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. OBJECTIVE: To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. METHODS: Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. RESULTS: Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). CONCLUSIONS: In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up.

Application of water quality indices and analysis of the surface water quality monitoring network in semiarid North-Central Chile.

Surface water quality has increasing importance worldwide and is particularly relevant in the semiarid North-Central Chile, where agriculture and mining activities are imposing heavy pressure on limited water resources. The current study presents the application of a water quality index in four watersheds of the 29°-33°S realm for the period 1999-2008, based on the Canadian Council of Ministers for the Environment approach and the Chilean regulation for irrigation water quality. In addition, two modifications to the index are tested and a comprehensive characterization of the existing monitoring network is performed through cluster analysis. The basins studied show fairly good water quality in the overall, specially the Limarí basin. On the other hand, the lower index values were obtained for the headwaters of Elqui, associated with the El Indio mining district. The first modification of the indicator (i.e., to consider parameters differentially according to their effect on human health or the environment) did not produce major differences with respect to the original index, given the generally good water quality. The second modification (i.e., to consider as threshold values the more restrictive figures derived from a set of regulations) yielded important differences in the indicator values. Finally, an adequate characterization of the monitoring network was obtained. The results presented spatial coherence and the information can be used as a basis for the optimization of the monitoring network if required.

Natural factors and mining activity bearings on the water quality of the Choapa basin, North Central Chile: insights on the role of mafic volcanic rocks in the buffering of the acid drainage process.

This contribution analyzes water chemical data for the Choapa basin, North Central Chile, for the period 1980-2004. The parameters considered are As, Cu Fe, pH, EC, SO4⁻², Cl⁻¹, and HCO[Formula: see text], from samples taken in nine monitoring stations throughout the basin. Results show rather moderate contents of As, Cu, and Fe, with the exception of the Cuncumén River and the Aucó creek, explained by the influence of the huge porphyry copper deposit of Los Pelambres and by the presence of mining operations, respectively. When compared against results obtained in previous researches at the neighboring Elqui river basin, which host the El Indio Au-Cu-As district, a much reduced grade of pollution is recognized for the Choapa basin. Considering the effect of acid rock drainage (ARD)-related Cu contents on the fine fraction of the sediments of both river basins, the differences recorded are even more striking. Although the Los Pelambres porphyry copper deposit, on the headwaters of the Choapa river basin, is between one and two orders of magnitude bigger than El Indio, stream water and sediments of the former exhibit significantly lower copper contents than those of the latter. A main factor which may explain these results is the smaller degree of H( + )-metasomatism on the host rocks of the Los Pelambres deposit, where mafic andesitic volcanic rocks presenting propylitic hydrothermal alteration are dominant. This fact contrast with the highly altered host rocks of El Indio district, where most of them have lost their potential to neutralize ARD.