Systematic review: work-related stress and the HSE management standards.

BACKGROUND: The Health and Safety Executive (HSE) has defined six management standards representing aspects of work that, if poorly managed, are associated with lower levels of employee health and productivity, and increased sickness absence. The HSE indicator tool aims to measure organizations' performance in managing the primary stressors identified by the HSE management standards. AIMS: The aims of the study are to explore how the HSE indicator tool has been implemented within organizations and to identify contexts in which the tool has been used, its psychometric properties and relationships with alternative measures of well-being and stress. METHODS: Studies that matched specific criteria were included in the review. Abstracts were considered by two researchers to ensure a reliable process. Full texts were obtained when abstracts met the inclusion criteria. RESULTS: Thirteen papers were included in the review. Using factor analysis and measures of reliability, the studies suggest that the HSE indicator tool is a psychometrically sound measure. The tool has been used to measure work-related stress across different occupational groups, with a clear relationship between the HSE tool and alternative measures of well-being. Limitations of the tool and recommendations for future research are discussed. CONCLUSIONS: The HSE indicator tool is a psychometrically sound measure of organizational performance against the HSE management standards. As such it can provide a broad overview of sources of work-related stress within organizations. More research is required to explore the use of the tool in the design of interventions to reduce stress, and its use in different contexts and with different cultural and gender groups.

Beta-cell replacement and regeneration: Strategies of cell-based therapy for type 1 diabetes mellitus.

Pancreatic islet transplantation has demonstrated that long-term insulin independence may be achieved in patients suffering from diabetes mellitus type 1. However, because of limited availability of islet tissue, new sources of insulin producing cells that are responsive to glucose are required. Development of pancreatic beta-cell lines from rodent or human origin has progressed slowly in recent years. Current experiments for ex vivo expansion of beta cells and in vitro differentiation of embryonic and adult stem cells into insulin producing beta-cell phenotypes led to promising results. Nevertheless, the cells generated to date lack important characteristics of mature beta cells and generally display reduced insulin secretion and loss of proliferative capacity. Therefore, much better understanding of the mechanisms that regulate expansion and differentiation of stem/progenitor cells is necessary. Here, we review recent advances in the identification of potential cellular sources, and the development of strategies to regenerate or fabricate insulin producing and glucose sensing cells that might enable future cell-based therapies of diabetes mellitus type 1.

Human Krüppel-like factor 11 inhibits human proinsulin promoter activity in pancreatic beta cells.

AIMS/HYPOTHESIS: The Krüppel-like factor 11 (KLF11; TIEG2), a pancreas-enriched Sp1-like transcription factor, is a known negative regulator of pancreatic exocrine cell growth. A recent study indicated KLF11-induced activation of the human proinsulin promoter (hInsP). MATERIALS AND METHODS: We investigated the functional role of KLF11 in pancreatic beta cells. RESULTS: Endogenous KLF11 mRNA expression was found in whole rat pancreas, human pancreatic islets and INS-1E beta cells and was profoundly reduced by high glucose in INS-1E. Cotransfections of INS-1E and beta-TC3 beta cells with a human (h)KLF11 expression plasmid and an hInsP-driven reporter plasmid resulted in a substantial dose-dependent and glucose-independent inhibition of proinsulin promoter activity. 5'-deletion of hInsP demonstrated that hKLF11 acts via DNA sequences upstream of -173 and requires the beta cell-specific transcription machinery, since hKLF11-mediated inhibition of promoter activity was abolished in HEK293 cells. Besides a previously described GC box, we further identified a CACCC box within the hInsP, both putative KLF11-binding motifs. Electrophoretic mobility shift analysis (EMSA) verified binding of in vitro translated hKLF11 to the GC box, but neither hKLF11-induced inhibition nor basal hInsP activity was altered by mutation or 5'-deletion of the GC box. In contrast, CACCC box mutation substantially reduced basal promoter activity and partially diminished hKLF11 inhibition, although binding of in vitro translated hKLF11 to the CACCC box could not be verified by EMSA. CONCLUSIONS/INTERPRETATION: In rodent beta cell lines, we demonstrate hKLF11overexpression-mediated inhibition [corrected] of human proinsulin gene expression and characterise a prominent role for the CACCC box in maintaining basal proinsulin promoter activity.

Thyroid autoimmunity in children with coexisting type 1 diabetes mellitus and celiac disease: a multicenter study.

BACKGROUND: Children with type 1 diabetes mellitus (DM1) are more prone to developing thyroid autoimmunity (TAI); TAI also occurs more frequently in patients with celiac disease (CD). AIM: To determine whether TAI occurs more frequently in children with coexisting DM1 and CD compared to children with DM1 only, and whether the clinical course of DM1 is influenced by concomitant TAI. PATIENTS AND METHODS: We performed a multicenter retrospective case-control study comparing data from 84 diabetic children with CD (group 1) to 167 diabetic children without CD (group 2), matched by age at DM1 onset, duration of DM1 and center. Markers of TAI, thyroid function and HbA1c were recorded. The TAI follow-up lasted 4.9 +/- 2.8 years. RESULTS: TAI was diagnosed in 13% of children in group 1 and 19% of children in group 2 (ns). Diabetes control was not influenced by TAI in either group. CONCLUSIONS: Occurrence of TAI in diabetic children is not related to coexisting CD. TAI does not lead to worsening of metabolic control in children with DM1.

Improving child protection: a systematic review of training and procedural interventions.

AIM: To synthesise published evidence regarding the effectiveness of training and procedural interventions aimed at improving the identification and management of child abuse and neglect by health professionals. METHODS: Systematic review for the period 1994 to 2005 of studies that evaluated child protection training and procedural interventions. Main outcome measures were learning achievement, attitudinal change, and clinical behaviour. RESULTS: Seven papers that examined the effectiveness of procedural interventions and 15 papers that evaluated training programmes met the inclusion criteria. Critical appraisal showed that evaluation of interventions was on the whole poor. It was found that certain procedural interventions (such as the use of checklists and structured forms) can result in improved recording of important clinical information and may also alert clinical staff to the possibility of abuse. While a variety of innovative training programmes were identified, there was an absence of rigorous evaluation of their impact. However a small number of one-group pre- and post-studies suggest improvements in a range of attitudes necessary for successful engagement in the child protection process. CONCLUSION: Current evidence supports the use of procedural changes that improve the documentation of suspected child maltreatment and that enhance professional awareness. The lack of an evidence based approach to the implementation of child protection training may restrict the ability of all health professionals to fulfil their role in the child protection process. Formal evaluation of a variety of models for the delivery of this training is urgently needed with subsequent dissemination of results that highlight those found to be most effective.

Counselling following the Prenatal Diagnosis of Klinefelter Syndrome: Comparisons between Geneticists and Obstetricians in Five European Countries.

Objective: To describe and compare the information obstetricians and geneticists in five European countries report they would give following the prenatal diagnosis of Klinefelter syndrome. Methods: 388 obstetricians and 269 geneticists from Germany, the Netherlands, Portugal, Spain and the UK completed a brief questionnaire assessing two variables: the information they reported providing to parents following the prenatal diagnosis of Klinefelter syndrome (categorized as positive or negative); and their perceptions of the quality of life with the condition. Results: Geneticists were more likely than obstetricians to report providing more positive than negative information about Klinefelter syndrome than equal amounts of positive and negative information or more negative than positive information about the condition (excess positive information). Regardless of specialty, the information that health professionals reported providing was predicted by their perceptions of the quality of life with the condition, and the country from which they came. Those perceiving quality of life as greater were more likely to provide an excess positive information, as were health professionals from Germany and the UK. Conclusions: These results suggest that the information parents across Europe receive after the prenatal diagnosis of Klinefelter syndrome varies according to the specialty and country of the health professionals consulted, and their perceptions of quality of life with the condition. This variation seems to reflect personal, cultural and professional differences between health professionals. Copyright 2002 S. Karger AG, Basel

Structure quality management in pediatric diabetes care.

The aim of all diabetes treatment in childhood and adolescence is to counteract the development of complications (acute as well as late), to achieve normal growth and development, and to provide the patients with as good as possible a quality of life. Many studies have confirmed the benefits of intensified medical management regarding the prevalence and/or the progression of diabetic microvascular complications. Intensified medical management means of course much more than intensified insulin substitution; diabetes care includes diet, physical exercise, diabetes education, continuous monitoring, and psychosocial support. To improve the outcome of patients with diabetes mellitus, optimizing structure quality is one of the goals. A number of prerequisites (regarding the social-socioeconomic-health care system) are not yet fulfilled everywhere; structures necessary to provide qualified diabetes care (e.g. pediatric diabetes center, team of experts, outpatient care) are not yet sufficiently available in some areas. According to both the declarations of St. Vincent and of Kos, every effort should be made to enhance structure quality in an attempt to improve the situation and the outcome of our young patients with diabetes.

Severe hypoglycemia in children and adolescents with IDDM: frequency and associated factors.

Severe hypoglycemia is a very common complication in youths with insulin-dependent diabetes mellitus (IDDM). Seventy four children and adolescents were surveyed for a 1-year period to evaluate the frequency and associated factors of severe hypoglycemia. Patients or their parents completed a standardized questionnaire which inquired about severe and mild episodes, treatment, and prevention of hypoglycemia. Forty-four percent of the patients experienced at least one severe hypoglycemic episode [need for assistance (grade III), loss of consciousness with or without convulsions (grade IV)] during the survey period. The event rate was 0.77 episodes (grade III and IV) per patient-year. The group with severe hypoglycemic episodes was significantly older (mean age, 16.3 years; SD, 3.6 years versus mean age 13.7 years; SD, 4.9 years; p = 0.01) and had significantly longer duration of diabetes (mean, 8.2 years; SD, 4.3 years versus mean, 6.1 years; SD, 4.0 years; p = 0.04) than the group without severe hypoglycemic episodes. There were no significant differences in mean glycosylated hemoglobin (HbA1c), daily doses of insulin, type of insulin regimen, gender, and age at diagnosis between patients who reported severe episodes and those who did not. Mild hypoglycemia was reported by 72 patients. Fifty percent of the patients recognized potential precipitating factors. Older age and longer duration of diabetes seem to predispose the patient to severe hypoglycemia. This may be the result of a diminution of the counterregulation system including lower neuroadrenergic reaction, or the still unphysiologic treatment of diabetes. Continued vigilance and education is important in older adolescents with longer duration of diabetes.

[Sex education, sex behavior, contraception]. / Sexualaufklärung, Sexualverhalten, Kontrazeption.

Sexual behavior has changed during the last decades. Teenage fertility rate, and the number of gonococcal infections are both extremely high; the incidence of HIV-infections is increasing. Preventive measures include sex education. Sex education may help the adolescents to identify their own goals for sexual behavior, to avoid unintended and unwanted pregnancy, and to avoid sexually transmitted diseases.

PIP: Data indicate that in the US 10-20% of boys and 5-10% of girls have their 1st sexual intercourse at age 14 and 50% at age 17 during which 70% do not use safe contraception. In 1981 a total of 1 million teenagers became pregnant, and 400,000 underwent abortion. The incidence of gonorrhea is 1300/100,000 among adolescents aged 15-19, and AIDS is spreading among this age group. The role of sex education is vital in providing the right information mainly through the school, as parents often feel uneasy about the topic, and youth organization and religious community groups tend to be too ideological. The teachers have to be well-versed in the topic, but teams of doctors and social workers can also help with practical experience. The curriculum includes the biological basics, sexually transmitted diseases and their prevention, contraceptives, and responsible sexual behavior. Topics for discussion consist of choosing a partner, risk groups, prostitutes, promiscuity, drug use, homosexuality, condoms, and nonoxynol-containing vaginal sponges. Contraceptives include conventional methods (coitus interruptus, Knaus-Ogino, Billings, and basal temperature methods); barrier methods (condom, diaphragm, cervical cap); the IUD; highly effective hormonal contraception (low-dose estrogen and gestagen-containing pills are especially suitable for young people, but cyproteroneacetate-containing combination pills, pure gestagen-component minipills, and depot-gestagen pills also have to be considered); and postcoital measures (day-after pill, Yuzpe method, day-after IUD) that are least used because of moral and religious reasons.