Adolescents with type 1 diabetes and risky behaviour

Aim: The aim of the student is to assess whether adolescents with type 1 diabetes mellitus (T1DM) in Italy differ from their healthy peers in regard to risky behaviour. Methods: Data were collected from 215 patients, aged 14 ± 2 years with a mean disease duration of 7 ± 5 years. The control group was comprised of 464 healthy adolescents recruited among high school students. Each patient completed an anonymous confidential questionnaire to determine the prevalence of sexual behaviour, alcohol and tobacco consumption, illicit drug use, and, among patients with diabetes and frequency of mismanagement related to diabetes care. Results: Compared with controls, subjects with diabetes showed a similar rate of sexual intercourse among males and lower rates among females (34.8% vs 35.5%, p NS and 29.4% vs 41.4%, p < 0.05, respectively). Males in the diabetes group reported a higher rate of tobacco use, whereas females showed similar or higher rates of use for every illicit drug studied. Among patients with diabetes, those who are engaged in risky behaviour showed a higher rate of treatment mismanagement (76% vs 34%, p < 0.01). Conclusion: Adolescents with T1DM are as likely as their healthy peers to engage in risky behaviour, indicating the potential benefit of anticipatory guidance concerning glycaemic control and increased risk of acute and chronic complications.     

The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010‐2015

This article presents the findings of a theory‐based evaluation of the Sierra Leone Free Health Care Initiative (FHCI), using mixed methods. Analytical approaches included time‐series analysis of national survey data to examine mortality and morbidity trends, as well as modelling of impact using the Lives Saved Tool and expenditure trend analysis. We find that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries, and did indeed bring funds and momentum to produce important systemic reforms. However, its ambition was also a risk, and weaknesses in implementation have been evident in a number of core areas, such as drugs supply. We conclude that the FHCI was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. Modelled cost‐effectiveness is high—in the region of US$ 420 to US$ 444 per life year saved. The findings suggest that even—or perhaps especially—in a weak health system, a reform‐like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.     

Understanding patient acceptance and refusal of HIV testing in the emergency department

Background  

Despite high rates of patient satisfaction with emergency department (ED) HIV testing, acceptance varies widely. It is thought that patients who decline may be at higher risk for HIV infection, thus we sought to better understand patient acceptance and refusal of ED HIV testing.     

Efficacy and tolerability of pantoprazole 40 mg versus 80 mg in patients with reflux oesophagitis.

BACKGROUND: Pantoprazole is a substituted benzimidazole which is a potent inhibitor of gastric acid secretion by its action upon H+, K+- ATPase. METHODS: Pantoprazole 40 mg and 80 mg were compared in a randomized double-blind study in 192 out-patients with stage II or III (Savary-Miller classification) reflux oesophagitis. Patients received either pantoprazole 40 mg (n = 97) or pantoprazole 80 mg (n = 95), once daily before breakfast for 4 weeks. Treatment was extended for a further 4 weeks if the oesophagitis had not healed. RESULTS: After 4 weeks complete healing of the reflux oesophagitis was seen in 78% of protocol-correct patients given pantoprazole 40 mg daily (n = 86), and in 72% in the 80 mg (n = 87) group. The cumulative healing rates after 8 weeks were 95 and 94%, respectively (P > 0.05, Cochran-Mantel- Haenszel), and time until healing of oesophagitis comparable in both groups. Differences between doses were also not significant in an intention-to-treat analysis. Both dosing schedules were well tolerated and the patients experienced remarkable symptom relief. No adverse event or changes in laboratory values of clinical significance could definitely be ascribed to the trial medication. CONCLUSION: The 40 mg pantoprazole dosage is comparable to 80 mg in reflux oesophagitis, both in efficacy and tolerability.     

RADIOACTIVE IRON ABSORPTION BY GASTRO-INTESTINAL TRACT : INFLUENCE OF ANEMIA,ANOXIA, AND ANTECEDENT FEEDING DISTRIBUTION IN GROWING DOGS

Iron absorption is a function of the gastro-intestinal mucosal epithelium. The normal non-anemic dog absorbs little iron but chronic anemia due to blood loss brings about considerable absorption—perhaps 5 to 15 times normal. In general the same differences are observed in man (1). Sudden change from normal to severe anemia within 24 hours does not significantly increase iron absorption. As the days pass new hemoglobin is formed. The body iron stores are depleted and within 7 days iron absorption is active, even when the red cell hematocrit is rising. Anoxemia of 50 per cent normal oxygen concentration for 48 hours does not significantly enhance iron absorption. In this respect it resembles acute anemia. Ordinary doses of iron given 1 to 6 hours before radio-iron will cause some "mucosa block"—that is an intake of radio-iron less than anticipated. Many variables which modify peristalsis come into this reaction. Iron given by vein some days before the dose of radio-iron does not appear to inhibit iron absorption. Plasma radio-iron absorption curves vary greatly. The curves may show sharp peaks in 1 to 2 hours when the iron is given in an empty stomach but after 6 hours when the radio-iron is given with food. Duration time of curves also varies widely, the plasma iron returning to normal in 6 to 12 hours. Gastric, duodenal, or jejunal pouches all show very active absorption of iron. The plasma concentration peak may reach a maximum before the solution of iron is removed from the gastric pouch—another example of "mucosa block." Absorption and distribution of radio-iron in the body of growing pups give very suggestive experimental data. The spleen, heart, upper gastro-intestinal tract, marrow, and pancreas show more radio-iron than was expected. The term "physiological saturation" with iron may be applied to the gastro-intestinal mucosal epithelium and explain one phase of acceptance or refusal of ingested iron. Desaturation is a matter of days not hours, whereas saturation may take place within 1 to 2 hours. We believe this change is a part of the complex protein metabolism of the cell.     

Moderne CT-Diagnostik des akuten Thorax- und Abdominaltraumas

Zielsetzung. Ziel dieses Beitrages ist es, einen modifizierten Algorithmus für die Abkl?rung von polytraumatisierten Patienten mit Thorax- und Abdominalverletzungen vorzustellen, in dem die prim?re Untersuchung mittels Ganzk?rper-Multislice-CT (MSCT) eine zentrale Rolle einnimmt.     

RED CELL AND PLASMA VOLUMES (CIRCULATING AND TOTAL) AS DETERMINED BY RADIO IRON AND BY DYE

1. Application of the principles of hydrodynamics to the problem of blood flow and blood volume indicates that the calculation of blood volume and cell volume from the venous hematocrit and plasma volume (as determined by the dye method) is subject to considerable error. 2. This conclusion is borne out by determinations of total cell volume by viviperfusion and with the use of radioactive iron tagged erythrocytes, which have shown the erythrocyte volume to be only 70 to 75 per cent of the volume indicated by the previously mentioned calculations. 3. The average hematocrit of the entire vascular system is considerably lower than the hematocrit of the large vessels, and the cell-plasma ratio of the smaller vessels is still less. 4. In the dog there are no considerable stores of immobilized erythrocytes, and the total erythrocyte volume and circulating erythrocyte volume are identical. 5. The "rapidly circulating blood volume" can be determined by dividing the erythrocyte volume by the venous hematocrit, and is found to be considerably less than the total blood volume. 6. The concept of the "rapidly circulating plasma volume" is introduced, and it is found to be approximately 80 per cent of the total plasma volume. 7. The volume of plasma in the peripheral, cell free, sluggishly moving plasma films, plus that contained in small vessels in which no red cells are present, is also determined and found to be approximately 20 per cent of the entire plasma volume. 8. The existence and magnitude of these fractions of the blood plasma volume should receive consideration in studies of blood flow and blood volume.