Three reasons why parental burnout is more prevalent in individualistic countries: a mediation study in 36 countries

PURPOSE

The prevalence of parental burnout, a condition that has severe consequences for both parents and children, varies dramatically across countries and is highest in Western countries characterized by high individualism.

METHOD

In this study, we examined the mediators of the relationship between individualism measured at the country level and parental burnout measured at the individual level in 36 countries (16,059 parents).

RESULTS

The results revealed three mediating mechanisms, that is, self-discrepancies between socially prescribed and actual parental selves, high agency and self-directed socialization goals, and low parental task sharing, by which individualism leads to an increased risk of burnout among parents.

CONCLUSION

The results confirm that the three mediators under consideration are all involved, and that mediation was higher for self-discrepancies between socially prescribed and actual parental selves, then parental task sharing, and lastly self-directed socialization goals. The results provide some important indications of how to prevent parental burnout at the societal level in Western countries.

Effects of empathy training on psychological concerns and empathy in caregivers of older people: A randomized, double-blind, crossover, clinical trial with follow-up

OBJECTIVES

To investigate the effects of empathy training on psychological concerns and empathy in caregivers of older people.

METHODS

A randomized, double-blind, crossover, clinical trial with follow-up was conducted online. Thirty paid and unpaid caregivers of older people from different regions of Brazil participated in an empathy training program. The caregivers answered a sociodemographic questionnaire and measures for the evaluation of empathy (affective and cognitive domains), burden, the impact of providing care as well as depressive symptoms and psychiatric symptoms before and immediately after training. Empathy and its domains were also assessed at three post-intervention follow-ups.

RESULTS

Empathy training diminished levels of psychological concerns. Moreover, an increase was found in levels of cognitive empathy 15, 30 and 60 days after the intervention.

CONCLUSIONS

Empathy training with a focus on cognitive empathy diminished psychological concerns in caregivers of older people and increased the levels of this ability over time. This intervention can be considered a coping strategy for negative impacts related to providing care.

Working time arrangements and exhaustion: The role of recovery experiences and satisfaction with the schedule

Working time arrangements may be a source of strain and entail negative consequences for workers, one of which can be exhaustion. Based on the job demands-resources and the conservation of resources theories, this study explores recovery experiences from work and satisfaction with the work schedule as possible resources that may prevent or minimize such negative consequences. With a sample of 386 workers (n = 287 women; 99 men) and using a cluster analysis, we identified five working time arrangements: fixed standardized, part-time, irregular standardized, flexible standardized, and nonstandard work schedule (NWS). A one-way ANOVA found that workers in the irregular standardized schedule report higher exhaustion compared to the fixed standardized and the part-time. Exhaustion of workers in NWS is higher compared to the part-time workers. A multiple linear regression analysis found that the link between recovery experiences and exhaustion varies according to the working time arrangement. Lastly, an interaction analysis confirmed the moderator effect of satisfaction with the work schedule in the relationship between recovery experiences and exhaustion for the whole sample. When this analysis was performed separately for each cluster, this effect was only significant for NWS and by disentangling this finding by recovery dimensions, only relaxation had a significant interaction effect. This study clarifies the links between different recovery experiences and exhaustion, and points to the importance of satisfaction with the work schedule in facilitating recovery under demanding working time arrangements. Results are discussed considering the complex nature of the work-family interface.

Parental exhaustion during COVID-19 pandemic: links to relationship outcomes and dyadic coping

The COVID-19 pandemic and lockdown altered families? routines, from telework imposition to performing additional childcare, as children started studying at home. Adapting to these demands can have effects on couples' relationships. This study aimed to analyze couples? experiences of parental exhaustion during the lockdown and to understand its links to relationship satisfaction and conflict frequency. It also explored how couples' internal resources (e.g., dyadic coping) buffered these effects. We examined data from 210 individuals in a romantic relationship who were cohabiting with their partners, teleworking, and had children under 18. Absolute values of parental exhaustion and relationship quality were not severe, but there was evidence that parental exhaustion contributed to decreasing relationship satisfaction and increasing conflict. Positive forms of dyadic coping were found to moderate only the adverse effects on conflict frequency. Implications of these results to couple's support under stressful events are provided.

Accuracy of dental calcification stages for the identification of craniofacial pubertal growth spurt: proposal of referral parameters

PURPOSE

This study primarily aimed to assess the accuracy of radiographic dental calcification parameters for the identification of specific craniofacial growth stages.

METHODS

Permanent mandibular canines, premolars, and second molars of 288 patients, from 6 to 15 years old, were analysed on randomly selected panoramic radiographs, and categorised according to two calcification methods. Reproducibility analyses and data derived from panoramic records were correlated with the gold-standard method, as evaluated from lateral cephalometric teleradiographs. Accuracy tests were finally calculated, considering several cutoff points.

RESULTS

Dental calcification methods showed "strong" to "almost perfect" intra- and inter-examiner reproducibility. Significant, although weak correlations were observed for all parameters. Canine and first premolar calcification stage 8 and second premolar and second molar stage 7 showed higher sensitivity rates for identifying the pubertal growth spurt period, as well as the stage F for these teeth. Canine and first premolar stages 10 and H obtained higher specificity rates for identifying the absence of post-pubertal period.

CONCLUSIONS

The dental calcification parameters showed adequate reproducibility, in addition to significant correlations with cervical vertebrae stages. Radiographic dental calcification parameters used for the mandibular first premolar obtained high accuracy rates and were recommended for identifying specific craniofacial growth periods.

Work-Life Conflict Among Higher Education Institution Workers' During COVID-19: A Demands-Resources Approach

Higher Education Institutions' (HEI) workers were highly impacted by the COVID-19 pandemic, which magnified gender differences in terms of management of work and personal life. Most studies published so far have primarily focused on a group of HEI workers' (i.e., teachers and researchers), but not on staff members, despite their crucial role for HEI functioning. Following the Job Demands-Resources theory, we aimed to: (i) characterize work-life conflict (WLC) among men and women workers from an HEI (staff and teachers/researchers) during the COVID-19 pandemic; and (ii) explore the major predictors of WLC for both staff and teachers/researchers. This study includes a sample of 262 workers from one Portuguese HEI (n = 128 staff members; n = 134 teachers/researchers) who answered an online survey. An Independent Samples T-Test showed that the reported current WLC was significantly higher for teachers/researchers compared to staff. Moreover, women teachers/researchers showed higher WLC than men. Additionally, using a Repeated Measures ANOVA, we found that the increase in the reported levels of WLC (before the pandemic and currently) was significantly more prominent among teachers/researchers than in the staff group. Regarding the predictors of WLC for both groups separately, a Multiple Hierarchical Linear Regression showed that role overload, conceptualized as a demand, was a predictor for both staff and teachers/researchers. As for potential resources, work dedication negatively predicted WLC for staff, whereas family-friendly organization perceptions predicted less WLC for teachers/researchers. These results highlight the importance of understanding HEIs holistically, by considering workers' individual characteristics such as gender, but also distinct careers inside the institutions. As most European HEIs are currently making active efforts to promote gender-equal academic workplaces, these findings may help them design tailored and effective measures to address employees' work-life balance issues, not only considering gender, but also the different types of demands associated with each group of workers within HEIs.

Gender Equality and Maternal Burnout: A 40-Country Study

In Western countries, recent decades have witnessed a revolution toward gender equality. Inequalities have been greatly reduced in areas such as education or employment. Because inequalities lead to distress, this development has largely benefited women. One notable exception is the realm of parenting, which has remained rife with inequalities even in the most egalitarian countries. We hypothesized that experiencing inequality in parenting when one holds egalitarian values and raising a child in a country characterized by a high level of gender equality in other areas, increases mothers’ psychological distress in the specific area of parenting. Multilevel modeling analyses computed among 11,538 mothers from 40 countries confirmed this prediction: high egalitarian values at the individual level and high gender equality at the societal level are associated with higher burnout levels in mothers. The associations hold beyond differences in sociodemographic characteristics at the individual level and beyond economic disparities at the societal level. These findings show the importance of egalitarian values and gender equality and their paradoxical effect when inequalities are still present in specific areas as parenting. This study reveals the crucial need to act not only at the micro level but also at the macro level to promote gender equality in parenting and prevent parental burnout.

Enhanced solar photocatalysis of TiO2 nanoparticles and nanostructured thin films grown on paper

Titanium dioxide nanoparticles and nanostructured thin films were simultaneously synthesized using a microwave-assisted hydrothermal method. The synthesis formed very fine particles, appearing as nanospheres in the 11 nm size range. As for the nanostructured films, they have displayed similar structural characteristics to the nanoparticles, with thickness of 130 nm. These films covered uniformly and homogenously the Whatman paper, while maintaining its flexibility. The materials processed had their photocatalytic activity assessed from rhodamine B degradation under solar radiation (91% degradation after 40 min for the powder material and 68% after 6 h for the nanostructured thin films). Reusability experiments were also carried out, revealing superior performance concerning the Degussa P25, the most common photocatalyst used. The results of the present work can be thought as an option for the existing photocatalysts activated under solar light, namely for water purification, as it simultaneously produces enhanced photocatalytic powders and photocatalytic papers fully disposable and that can be easily recycled.

Parental Burnout and the COVID-19 Pandemic: How Portuguese Parents Experienced Lockdown Measures

OBJECTIVE

This work aimed to analyze parental burnout (PB) and establish a comparison between the times before (Wave 1) and during (Wave 2) the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic brought additional stress to families. The pandemic could be particularly difficult for parents experiencing parental burnout, a condition that involves four dimensions: an overwhelming sense of exhaustion, emotional distancing from the child, saturation or a loss of fulfillment with the parental role, and a sharp contrast between how parents used to be and how they see themselves now.

METHOD

A quasi-longitudinal research design was adopted, comparing two cross-sectional studies among Portuguese parents (N = 995), with an interval of 2 years between each wave of data collection. Participants were surveyed voluntarily through an online questionnaire located on the institutional web platform of the universities involved in the study. Multivariate analysis of covariance was used to take into account the associations among variables, alongside controlling the possible confounding effects.

RESULTS

Parents have overall higher parental burnout scores in Wave 2 than Wave 1, with increased exhaustion, emotional distancing, and contrast, but decreased saturation. Although parental burnout levels remain higher for mothers across the two Waves, the growth is greater for fathers than for mothers.

CONCLUSION

Reconciling childcare with paid work is a stressful and new experience for many fathers. However, results suggest that even amid a crisis, some parents had the opportunity to deeply bond with their children.

IMPLICATIONS

We expect this work to encourage stakeholders to consider proper intervention strategies to address potential parental burnout. Also, initiatives that strengthen gender equity within parenting context are needed.

Parental Burnout Around the Globe: a 42-Country Study

High levels of stress in the parenting domain can lead to parental burnout, a condition that has severe consequences for both parents and children. It is not yet clear, however, whether parental burnout varies by culture, and if so, why it might do so. In this study, we examined the prevalence of parental burnout in 42 countries (17,409 parents; 71% mothers; M_age = 39.20) and showed that the prevalence of parental burnout varies dramatically across countries. Analyses of cultural values revealed that individualistic cultures, in particular, displayed a noticeably higher prevalence and mean level of parental burnout. Indeed, individualism plays a larger role in parental burnout than either economic inequalities across countries, or any other individual and family characteristic examined so far, including the number and age of children and the number of hours spent with them. These results suggest that cultural values in Western countries may put parents under heightened levels of stress.

The Strengths and Difficulties Questionnaire: An examination of factorial, convergent, and discriminant validity using multitrait-multirater data

This study examined the factorial, convergent, and discriminant validity of scores on the Strengths and Difficulties Questionnaire (SDQ), a tool for screening children's psychological adjustment. Data were collected from a community sample of 346 children (46% girls, M age = 54.07 months), using teacher, mother, and father reports. Results from confirmatory factor analyses indicated that the SDQ's hypothesized 5-factor structure fit the data well and partial strict measurement invariance was established across raters. Using teachers' reports as reference method, a correlated trait-correlated method minus 1 model (Eid et al., 2008) was fitted to investigate convergent and discriminant validity. The convergent validity of parents' ratings relative to teachers' ratings was modest. Mothers and fathers had a unique perspective on children's behavior above and beyond their partial overlap with teacher reports. Results indicated good discriminant validity between most of the traits measured by the SDQ. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Epiduroscopic intervention in patients with a failed back surgery syndrome

BACKGROUND

Epiduroscopy is a percutaneous endoscopic technique with an interesting diagnostic and therapeutic potential.

AIM

The study was aimed to evaluate the effectiveness of this modern minimally invasive method in treating pain together with the accompanying neurological symptoms of patients with a failed back surgery syndrome (FBSS).

RESULTS

In the retrospective multicentre clinical study, we monitored the effect of epiduroscopic performance in 40 patients with FBSS before epiduroscopy and after 6 and 12 months. The results of the study indicated a significant improvement in back pain after 6 months, at p<0.05. At the same time, a significant improvement was observed in pain radiating to the lower limbs after 6 and 12 months at p<0.05, as well as a significant improvement in the Oswestry Disability Index of the limbs after 6 months and after 12 months (p<0.05).

CONCLUSION

The current summarised results indicate a significant positive effect of epiduroscopy in the treatment of chronic back pain with a reduction in radiating pain to the lower extremities and an increase in patients' quality of life after the procedure (Tab. 2, Fig. 1, Ref. 23).

Teacher-child dependency in preschool: links with teacher-child closeness, conflict and children's effortful control

Dependency is a scarcely investigated dimension of teacher-child (T-C) relationships that can reflect a lack of security and obstruct children's autonomous exploration in the school context. We examined the within- and cross-time associations between T-C dependency, closeness, and conflict, and children's effortful control, an ability related to children's self-regulation. Data were collected during the preschool period at two time-points (T1 and T2) 1-year apart. Participants were 199 children (44% girls, M age = 47.47) attending 46 middle-class preschool classrooms. Results from path analyses indicated that, though marginally significant, there was a positive association between T-C dependency and conflict at T1. At T2, dependency was positively related to both conflict and closeness. Dependency at T1 positively predicted children's effortful control at T2. This study clarifies the interconnection between T-C dependency, closeness and conflict, and the unique contribution of dependency onchildren's effortful control. Findings are discussed considering the socio-cultural meaning of dependency.

Attachment, emotion regulation, and well-being in couples: Intrapersonal and interpersonal associations

Objective

There is a well‐established link in the literature between secure romantic attachment orientation and psychological well‐being. The underlying processes of this link and the couple interplay between attachment and well‐being are notably less explored. Using a dyadic framework, this study examines both couple members' emotion regulation strategies as potential mediators of this link.

Method

One hundred and nineteen heterosexual couples completed self‐report measures on attachment style, psychological well‐being, tendency to suppress emotions, and emotion expression. Analyses were performed using the actor–partner interdependence mediation model that distinguishes between intrapersonal and interpersonal influences.

Results

Results showed that controlling for relationship length, there was an intrapersonal indirect effect of attachment avoidance on psychological well‐being through emotion suppression. Moreover, interpersonal indirect effects were found (a) with individual attachment avoidance being associated with partner's psychological well‐being through own emotion expression and (b) individual's attachment anxiety being associated with partner's psychological well‐being through both own's emotion expression and partner's emotion suppression.

Conclusions

These findings highlight the complex associations among attachment, emotion regulation, and well‐being and point out the role of emotion regulation as a potential underlying pathway explaining these associations. The results suggest the importance of considering the relational nature of emotional and attachment dynamics in couples.

School-to-Family and Family-to-School Enrichment in Women pursuing Post-Secondary Education

Mature and reentry female students enrolled in post-secondary education, in most cases, combine school with other life roles. Despite the growing trend to study how multiple roles may conflict with each other, evidence suggests that multiple roles can be enriching and that female non-traditional students are particularly prone to experience these benefits. Thus, we tested a school-to-family and family-to-school enrichment model, in which school dimensions (mastery experiences, low school exclusion, school satisfaction and school-to- -family balance) were antecedents to school-to-family enrichment and family dimensions (family satisfaction and family-to-school balance) were antecedents of family-to-school enrichment. This model was tested, through path analysis, using 88 non-traditional Portuguese students (female student parents) enrolled in an evening undergraduate program. The model showed an adequate fit to the data, suggesting that aspects of school-to-family and family-to-school enrichment coexist. Mastery experiences and low school exclusion were associated with school-to-family enrichment while perceptions of school-to-family balance and satisfaction with the school role were not. Perceptions of family-to-school balance were associated with family-to-school enrichment but family satisfaction was not. These findings unveil a new view on mature students enrolled at the university, pointing to the role of positive experiences at school and on school-family balance to a better interface of school and family roles.

Trajectories of parental engagement in early childhood among dual-earner families: Effects on child self-control

Parental engagement in positive activities with the child may show significant variation across time, assuming a crucial influence on child development. In dual-earner families, work-family conflict can interfere with parental engagement, with negative consequences for children's behavior. The current study examined the change trajectories of mothers' and fathers' engagement in early childhood, analyzing whether these trajectories are influenced by parents' work-family conflict and whether they predict child behavioral self-control. Data from 156 four-year-old children (67 girls) from dual-earner families were collected annually for 3 consecutive years, through mothers', fathers', and teachers' reports. Results from latent growth curve analysis revealed mothers' engagement remained stable across time while fathers' engagement had a significant increase over time. The negative association between work-family conflict and parental engagement was constant over time both for mothers and fathers. For mothers, initial levels of engagement positively predicted child behavioral self-control. As for fathers, both the initial level and positive change in engagement positively predicted child self-control. These findings emphasize the role of parental engagement in fostering child behavioral adjustment, underlining the need for considering work-family dynamics to understand changes in parental engagement. (PsycINFO Database Record

Parents' work-family experiences and children's problem behaviors: The mediating role of the parent-child relationship

Studies on the impact of work-family dynamics on both parenting and children's outcomes are scarce. The present study addressed this gap by exploring how parents' negative (conflicting) and positive (enriching) experiencing of work and family roles related to children's internalizing and externalizing problem behaviors through its association with the quality of parent-child relationships. A sample of 317 dual-earner couples with preschool children was used to conduct a dyadic analysis of both within- and cross-dyad influences of parents' work-family experiences on child problem behaviors. Our results indicated that the way parents balance work and family is associated with their parent-child relationships, which in turn is differentially linked with their children's behaviors. We found that mothers' work-family conflict (WFC) contributed to children's externalization difficulties through its detrimental associations with their own and with their partners' parent-child relationship quality. By contrast, mothers' work-family enrichment (WFE) was negatively linked to children's externalization difficulties through its positive link with the mother-child relationship. Fathers' experience of WFC was associated with both children's internalization and externalization difficulties through its negative association with their own father-child relationship quality. In addition, fathers' experience of WFE also linked to children's externalization difficulties, but only indirectly, via its positive association with the quality of their relationship with the child. Further implications of these findings for advancing understanding of the impact of work-family dynamics on intrafamily relationships, as well as for individual and organizational interventions, are discussed. (PsycINFO Database Record

Coping with work and family: how do dual-earners interact?

Juggling the demands of both work and family has become increasingly difficult, especially for dual-earner households; nevertheless, families have developed strategies to deal with work-family challenges. This paper uses couple level analyses (APIM models) with 100 dual-earner couples to provide insight about partners' mutual influence on the use of work-family coping strategies. The results show that women's use of coping strategies is more associated with work-family conflict and work-family enrichment than men's coping. In addition, using partner coping, having a positive attitude towards multiple roles, using planning and management skills and avoiding having to cut back on professional responsibilities is associated with better outcomes (more enrichment and less conflict). Surprisingly, the use of childcare facilities is associated with women's conflict and partner effects were only found concerning the use of management and planning skills. These skills, however, have distinct effects for men and women's outcomes: their use by men reduces their own conflict but increases their wives', while their use by women decreases their own conflict and increases their own and their partner's enrichment. These results point to the fact that gender roles continue to be a hallmark of work-family issues. Our design and results point out the need for new interventions that take couple interdependences into account.

Cat scratch disease and lymph node tuberculosis in a colon patient with cancer

A 71-year-old man operated for a sigmoid tumour remained in the surveillance after adjuvant chemotherapy. After 3 years, a left axillary lymph node was visible on CT scan. The biopsy revealed a necrotising and abscessed granulomatous lymphadenitis, suggestive of cat scratch disease. The patient confirmed having been scratched by a cat and the serology for Bartonella henselae was IgM+/IgG-. Direct and culture examinations for tuberculosis were negative. The patient was treated for cat scratch disease. One year later, the CT scan showed increased left axillary lymph nodes and a left pleural effusion. Direct and cultural examinations to exclude tuberculosis were again negative. Interferon-γ release assay testing for tuberculosis was undetermined and then positive. Lymph node and pleural tuberculosis were diagnosed and treated with a good radiological response. This article has provides evidence of the importance of continued search for the right diagnosis and that two diagnoses can happen in the same patient.

Unusual head metastasis of kidney cancer

Renal cell carcinoma (RCC) metastasis can involve any organ. Head metastasis are rare, namely tongue, scalp and nose and only a few cases have been described. The authors describe three cases of unusual presentation of head metastasis of RCC. In case 1, a 50-year-old man with RCC underwent left nephrectomy, and presented 16 months later with nasal metastasis. In case 2, a 64-year-old woman with RCC operated 12 years ago, relapsed at multiple sites including scalp, which was treated surgically. In case 3, a 47-year-old man with RCC developed metastasis in multiple organs including a mass on the tongue that was operated and was compatible with primary tumour metastasis. These cases show the importance of correct diagnosis of rare presentations and local treatment of metastasis of RCC.

Review and prospect of emerging contaminants in waste--key issues and challenges linked to their presence in waste treatment schemes: general aspects and focus on nanoparticles

The presence in waste of emerging pollutants (EPs), whose behaviours and effects are not well understood, may present unexpected health and environmental risks and risks for the treatment processes themselves. EP may include substances that are newly detected in the environment, substances already identified as risky and whose use in items is prohibited (but which may be present in old or imported product waste) or substances already known but whose recent use in products can cause problems during their future treatment as waste. Several scientific studies have been conducted to assess the presence of EP in waste, but they are mostly dedicated to a single category of substance or one particular waste treatment. In the absence of a comprehensive review focused on the impact of the presence of EP on waste treatment schemes, the authors present a review of the key issues associated with the treatment of waste containing emerging pollutants. This review presents the typologies of emerging pollutants that are potentially present in waste along with the major challenges for each treatment scheme (recycling, composting, digestion, incineration, landfilling and wastewater treatment). All conventional treatment processes are affected by these new pollutants, and they were almost never originally designed to consider these substances. In addition to these general aspects, a comprehensive review of available data, projects and future R&D needs related to the impact of nanoparticles on waste treatment is presented as a case study.

A conciliação de papéis profissionais e familiares: o mecanismo psicológico de spillover

A maioria dos estudos sobre o tema da conciliação entre a vida profissional e familiar tem assumido uma perspectiva negativa e de conflito, focando as dificuldades nesta conciliação. Mais recentemente, as vantagens e aspectos positivos desta gestão têm sido analisadas. Neste artigo, sistematiza-se o principal mecanismo da análise da interface trabalho e família: o mecanismo psicológico de spillover. Discutem-se as diferentes dimensões de spillover (negativa e positiva), as direções de influência e tipologias de variáveis associadas. Considera-se que uma abordagem multidimensional permitirá uma análise completa da relação trabalho e família, sustentando medidas de apoio à conciliação que tenham em vista não só a diminuição das relações negativas, mas também a promoção das relações positivas entre as duas esferas.

A retrospective analysis of Terlipressin infusion in patients with refractory hypotension after cardiac surgery

AIM

The aim of this retrospective study was to evaluate the effectiveness of Terlipressin in the treatment of severe hypotension in cardiosurgical patients and to assess the differences between the groups of survivors and nonsurvivors.

METHODS

The study population was 27 patients who developed hypotension after cardiac surgery.

RESULTS

All surviving patients developed refractory hypotension early after extracorporeal circulation. Of the 9 nonsurvivors, 3 also experienced postcardiotomy hypotension, while the remaining 6 developed severe hypotension during sepsis. Terlipressin given continuously significantly increased the mean arterial pressure and reduced the heart rate in both groups. Norepinephrine requirements decreased significantly among survivors only. The mean pulmonary artery pressure and pulmonary capillary wedge pressure levels remained unchanged or increased insignificantly, while several liver markers in the survivor group significantly increased.

CONCLUSION

Terlipressin given continuously is a potent vasopressor in patients with norepinephrine-resistant postcardiotomy hypotension; however, Terlipressin treatment failed in patients who developed refractory hypotension during sepsis. We cannot recommend this therapy in such patients as it proved to be hemodynamicaly ineffective and may even worsen the circulatory situation.

[The treatment of hyperglycaemia in critically ill patients: comparison of standard protocol and computer algorithm]

INTRODUCTION

Hyperglycemia is commonly observed in patients hospitalized on intensive care units. It is has been demonstrated that normalization of blood glucose level using intensive insulin therapy significantly improves prognosis of these patients. The aim of our study was comparison of standard protocol of intensive insulin therapy used on cardiac surgery ICU in General University Hospital in Prague and computer algorithm MPC (Model Predictive Control).

PATIENTS AND METHODS

20 patients with glycaemia higher than 6.7 mmol/l at the time of admission to ICU were included into the study, 10 subjects were randomized for standard treatment, 10 for treatment with MPC algorithm. Glycaemia was measured hourly during 48 hours, insulin infusion was rate was adjusted hourly in MPC algorithm or in 1-2 hours in standard protocol group.

RESULTS

Blood glucose levels were in the target range significantly longer in MPC relative to standard protocol group (26.3 +/- 2.1 hrs vs 20.3 +/- 2.5 hrs). Mean blood glucose was also lower using MPC algorithm (6.47 +/- 0.11 vs 6.72 +/- 0.23 mmol/l). On the contrary the target range was established faster using standard protocol (8.9 +/- 1.2 vs 10.3 +/- 0.9 hrs), duration of hyperglycaemia was the same in both groups (7.3 +/- 1.9 in standard protocol vs 7.3 +/- 1.3 hrs in MPC algorithm). Average 48-hours insulin dose was higher in MPC than standard protocol group (230.2 +/- 38.8 vs 199.1 +/- 27.8 IU/48 hrs). 2 hypoglycaemic episodes occured in 2 patients in standard protocol group.

CONCLUSIONS

Our results show that the use of MPC algorithm result in more effective blood glucose control in critically ill patients than standard protocol.

[Pilot study to evaluate blood glucose control by a model predictive control algorithm with variable sampling rate vs. routine glucose management protocol in peri- and postoperative period in cardiac surgery patients]

BACKGROUND

Increased blood glucose levels are frequently observed in critically ill patients. Recent studies have shown that the normalization of glycemia by intensive insulin therapy decreases mortality, length of the hospitalization and number of complications.

METHODS AND RESULTS

The aim of this pilot study was to compare blood glucose control by an automated model predictive control algorithm with variable sampling rate (eMPC) with routine glucose management protocol (RP) in peri- and postoperative period in cardiac surgery patients. 20 patients were included into this study (14 men and 6 women, mean age 68 +/- 10 let, BMI 28.3 +/- 5.0 kg/m2). 10 patients were randomized for treatment using eMPC algorithm and 10 patients for routine protocol. All patients underwent elective cardiac surgery and were treated with continuous insulin infusion to maintain glycemia in target range 4.4-6.1 mmol/l. The study duration was 24 hours. Mean blood glucose was significantly lower in eMPC vs. RP group (5.80 +/- 0.45 vs. 7.23 +/- 0.84 mmol/l, p < 0.05). Percentage of time in target range was significantly higher in eMPC vs. RP group (67.6 +/- 8.7% vs. 27.6 +/- 15.8%, p < 0.05). Percentage of time above the target range was higher in RP vs. eMPC group. Average insulin infusion rate was higher in eMPC vs. RP group (4.18 +/- 1.19 vs. 3.24 +/- 1.43 IU/hour, p < 0.05). Average sampling interval was significantly shorter in eMPC vs. RP group (1.51 +/- 0.24 vs. 2.03 +/- 0.16 hour, p < 0.05). No severe hypoglycaemia in either group occurred during the study.

CONCLUSIONS

The results of our pilot study suggest that eMPC algorithm is more effective in maintaining euglycemia in peri- and post-operative period in patients after cardiac surgery and comparably safe as compared to RP.

[Monitoring of glucose concentration in critical patients, comparing arterial blood glucose concentrations and interstitial glucose concentration measured by microdialysis technique]

INTRODUCTION

Recent studies have shown that normalization of blood glucose in critically ill patients by intensive insulin therapy significantly decreases their mortality and morbidity. The aim of our study was to compare interstitial glucose concentrations in subcutaneous adipose tissue (measured by microdialysis technique) and arterial blood glucose concentrations to test the suitability of subcutaneous adipose tissue for long-term placement of biosensors for glucose measurement in critically ill patients.

PATIENTS AND METHODS

20 patients (16 men and 4 women) after cardiac surgery hospitalized at postoperative intensive care unit were included into the study. Mean age was 68 +/- 10 years, BMI was 28.3 +/- 3.9 year. Only patients with glycemia higher than 6.7 mmol/l at a time of admission to the ICU were included. Samples for measurement of interstitial glucose concentrations were collected in 60 minutes intervals during 48 hours using microdialysis of the subcutaneous adipose tissue. Perfusion fluid was 5% mannitol, perfusion rate was 1 microl/min. Arterial blood glucose concentration was measured in 60 minutes intervals, absolute concentrations of interstitial glucose were calculated using ionic reference technique.

RESULTS

Mean arterial glucose concentration during the study was 6.7 +/- 0.56 mmol/l, absolute concentration of glucose in interstitial fluid was 3.55 +/- 0.58 mmol/l. Mean correlation coefficient between arterial and interstitial concentrations was 0.77 +/- 0.15.

CONCLUSION

Our study demonstrated good correlation between interstitial glucose concentrations in subcutaneous adipose tissue and arterial blood glucose concentrations in post-cardiac surgery patients. Further studies are needed to evaluate this relationship in patients with more severely disturbed perfusion of subcutaneous adipose tissue.

Homocysteine and risk of cardiovascular disease among postmenopausal women

CONTEXT

Individuals with elevated levels of homocysteine tend to have higher prevalence of cardiovascular disease. However, prospective studies of homocysteine are inconsistent and data among women are limited.

OBJECTIVE

To determine whether elevated homocysteine levels in healthy postmenopausal women predict risk of developing cardiovascular disease.

DESIGN

Prospective, nested case-control study with a mean 3-year follow-up.

SETTING

The Women's Health Study, an ongoing US primary prevention trial initiated in 1993.

PARTICIPANTS

From a total cohort of 28,263 postmenopausal women with no history of cardiovascular disease or cancer at baseline, 122 women who subsequently experienced cardiovascular events were defined as cases, and 244 age- and smoking status-matched women who remained free of disease during follow-up were defined as controls.

MAIN OUTCOME MEASURES

Incidence of death due to cardiovascular disease, nonfatal myocardial infarction (MI), stroke, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft by baseline homocysteine level.

RESULTS

Of the 122 cases, there were 85 events of MI or stroke and 37 coronary revascularizations. Case subjects had significantly higher baseline homocysteine levels than controls (14.1 vs 12.4 micromol/L; P = .02). Subjects with homocysteine levels in the highest quartile had a 2-fold increase in risk of any cardiovascular event (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1-3.8). This effect was largely due to an excess of cases with high levels of homocysteine; the RR for those with homocysteine levels at or higher than the 95th percentile (20.7 micromol/L) was 2.6 (95% CI, 1.1-5.7). Risk estimates were independent of traditional risk factors and were greatest for the end points of MI and stroke (RR for those with baseline homocysteine levels in the top quartile, 2.2; 95% CI, 1.1-4.6). Self-reported multivitamin supplement use at study entry was associated with significantly reduced levels of homocysteine (P<.001). However, the association between increasing quartile of homocysteine level and risk of MI or stroke remained significant in analyses controlling for baseline multivitamin supplement use (P = .003 for trend), and subgroup analyses limited to women who were (P = .02 for trend) or were not (P = .04 for trend) taking multivitamin supplements.

CONCLUSIONS

Among healthy postmenopausal US women, elevated levels of homocysteine moderately increased the risk of future cardiovascular disease. Whether lowering the homocysteine level reduces risk of cardiovascular events requires testing in randomized controlled trials.

[A hysteroscopic and anatomicopathological study in women with breast cancer]

OBJECTIVE

To study the uterine mucosa of women with breast cancer in order to evaluate the frequency of endometrial diseases.

EXPERIMENTAL DESIGN

Prospective, controlled study carried out from January to December 1996. SURROUNDINGS: Patients with breast cancer and normal controls from 4 out-patient university services in Porto Alegre, Brazil.

PATIENTS

Postmenopausal women without hormonal therapy were compared: 67 of them with breast cancer and 101 normal controls.

METHODS

Hysteroscopy followed by endometrial biopsy carried out in both groups as an out-patient procedure.

RESULTS

In patients with breast cancer, 29.85% abnormal biopsies were found as follows: 10 endometrial polyps (15.0%), 8 with proliferative changes (11.9%), 1 case of cancer (1.5%), and one case of hyperplasia (1.5%). In the control group 8% abnormal morphological findings were found, as follows: 4 (4%) with endometrial polyps and 4 (4%) with proliferative changes. The differences in abnormal biopsies were statistically significant, mainly in patients with corporal mass index above 27.3. The sensibility of hysteroscopy was 82.14%; its specificity 97.16%; its predictive positive value 85.18% and its predictive negative value 96.48% in detecting endometrial activity, for a prevalence of 16.7% of endometrial activity.

CONCLUSIONS

Endometrial evaluation must be included in the initial evaluation of patients with breast cancer, mainly if they were obese. Hysteroscopy, performed in out-patient basis, showed to be an adequate method to evaluate the uterine mucosa, helping to select the area of this cavity for biopsy.

Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women

BACKGROUND

C-reactive protein (CRP) predicts risk of myocardial infarction (MI) and stroke among apparently healthy men, but in women, virtually no data are available.

METHODS AND RESULTS

CRP was measured in baseline blood samples from 122 apparently healthy participants in the Women's Health Study who subsequently suffered a first cardiovascular event and from 244 age- and smoking-matched control subjects who remained free of cardiovascular disease during a 3-year follow-up period. Women who developed cardiovascular events had higher baseline CRP levels than control subjects (P=0.0001), such that those with the highest levels at baseline had a 5-fold increase in risk of any vascular event (RR=4.8; 95% CI, 2.3 to 10.1; P=0.0001) and a 7-fold increase in risk of MI or stroke (RR=7.3; 95% CI, 2.7 to 19.9; P=0.0001). Risk estimates were independent of other risk factors, and prediction models that included CRP provided a better method to predict risk than models that excluded CRP (all P values <0.01). In stratified analyses, CRP was a predictor among subgroups of women with low as well as high risk as defined by other cardiovascular risk factors.

CONCLUSIONS

In these prospective data among women, CRP is a strong independent risk factor for cardiovascular disease that adds to the predictive value of risk models based on usual factors alone. (Circulation. 1998;98:731-733.)