European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence

Objective: To summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians. Design: A systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria. Setting: Physicians of any medical, surgical or community specialty, working in any possible setting (hospitals, primary healthcare, etc), as well as trainees, residents, junior house officers or postgraduate interns, were included. Participants: The total number of participants was 14 338. Primary and secondary outcome measures: Health effects classified under the International Classification of Diseases (ICD-10). Results: Over 3000 citations and 110 full articles were reviewed. From these, 11 studies of high or intermediate quality carried out in North America, Europe and Japan met the inclusion criteria. Six studies included medical residents, junior doctors or house officers and the five others included medical specialists or consultants, medical, dental, and general practitioners and hospital physicians. Evidence of an association was found between percutaneous injuries and road traffic accidents with extended long working hours (LWH)/days or very LWH/weeks. The evidence was insufficient for mood disorders and general health. No studies on other health outcomes were identified. Conclusions: LWH could increase the risk of percutaneous injuries and road traffic accidents, and possibly other incidents at work through the same pathway. While associations are clear, the existing evidence does not allow for an established causal or ‘dose–response’ relationship between LWH and incidents at work, or for a threshold number of extended hours above which there is a significantly higher risk and the hours physicians could work and remain safe and healthy. Policymakers should consider safety issues when working on relaxing EWTD for doctors

Dietary Supplements and Sport Performance - A Comprehensive Review

Comprehensive articles on dietary supplements and their impact of on sport performance which would enable professional and recreational sportsmen evidence based information are sparse. Therefore, we investigated eight different dietary supplements, commonly used among recreative and endurance sportsmen according to available literature were analyzed, namely: Antioxidants, B-alanine, Branched chain amino acids (BCAAs), Caffeine, Carbohydrates, Creatine, Nitric oxide /nitrates, and proteins. Their mechanisms of action was shortly presented along with their potential beneficial and harmful side effects and safety. i.) Antioxidants: Sufficient amount of antioxidants is available in a balanced diet ii.) B-alanine: Supplementation is likely to be beneficial in high-intensity exercises. iii.) BCAAs: No review articles in English were available iv.) Caffeine: Caffeine supplementation is beneficial in endurance exercises v.) Carbohydrates: Carbohydrate supplementation is probably beneficial in exercises of durations longer than one hour vi.) Creatine: Creatine supplementation is effective in high intensity, short-lasting exercises, while it does not seem to have any ergogenic effect in aerobic exercises. vii.) Nitric oxide/nitrates: Nitrate supplementation has a small but meaningful performance enhancing effect, most apparent in situations of insufficient perfusion (hypoxia…). viii.) Proteins: Protein supplementation, in combination with resistance exercise, most likely has beneficial effects on lean body mass and muscle strength. Studies on the long term safety of the above supplements are mostly lacking. Most of the revised dietary supplements, if used for intended exercise regime, provide some sort of sport performance enhancement. On the other hand, the studies about the safety of the long term supplementation are mostly lacking

So podatki o umrljivosti za rakom verodostojni - analiza podatkov o umrljivosti zaradi raka materničnega vratu

Background. Valid inference on cervical cancer mortality is very difficult since - on the basis of death certificates - it is not always possible to distinguish between cervix, corpus and unspecified uterine cancer deaths. Our aim was to estimate the extent to which cervical cancer as the official cause of death reflects the true mortality from cervical cancer in Slovenia. Material and methods. The data on 2245 deaths from cervix, corpus uteri, and uterus-unspecified cancers for the period 1985-1999 were linked to the Cancer Registry of Slovenia database from the mortality database of Slovenia. Results. Officially, in the period 1985-1999, there were 878 cervical cancer deaths. The comparison of these causes of death with the cancer sites registered in the Cancer Registry revealed that they include only 87.7 % patients with a previous diagnosis of cervical cancer. Of 650 corpus uteri cancer deaths, 17.1% of patients were registered to have cervical cancer, and of 717 unspecified uterine cancer deaths, 31.4% were registered. Taking into account the correctly identified cervical cancer cases among cervical cancer deaths and misclassified cervical cancer deaths as corpus uteri and unspecified uterine, the corrected number of deaths would be 1106. Conclusions. When evaluating the impact of cervical cancer mortality from national mortality rates, the stated underestimation should be taken into account. However, this does not hold for some other cancers.Izhodišče. Uradni podatki o umrljivosti za rakom materničnega vratu so manj zanesljivi, saj v zdravniških poročilih o vzroku smrti mesto izvora raka v maternici ni vedno dovolj natančno opredeljeno. Želeli smo oceniti, v kolikšnimeri objavljeni podatki o umrljivosti za rakom materničnega vratu v Sloveniji odražajo dejansko umrljivost za to boleznijo. Gradivo in metode. 2245 smrti, pri katerih je bil v podatkovni zbirki Inštituta za varovanje zdravja v letih 1985-1999 kot vzrok smrti naveden rak materničnega vratu, telesa ali maternice, smo računalniško povezali s podatkovno zbirko Registra raka za Slovenijo. Izsledki. V obdobju 1985-1999 je po uradnih podatkih za rakom materničnega vratu umrlo 878 žensk, v Registru raka je bilo od njih prijavljenih s to boleznijo le 87,7%. Med ženskami, ki naj bi umrle zaradi raka materničnega telesa, jih je 17,1 % imelo v resnici raka materničnega vratu, od 717, pri katerih je bil kot vzrok smrti naveden le rak maternice, paje 31,4 % dejansko imelo raka materničnega vratu. Če med vzroki smrti upoštevamo pravilno opredeljen rak materničnega vratu, dodatno pa še napačno ali premalo natančno opredeljene primere, je zaradi raka materničnega vratu umrlo 1106 žensk, kar pomeni, da so uradni podatki o umrljivosti za rakom materničnega vratu podcenjeni za 26 %. Zaključek. Uradni podatki o umrljivostiza rakom materničnega vratu podcenijo dejansko stanje, kar je trebaupoštevati pri vrednotenju bremena te bolezni. To pa ne velja za vse rakave bolezni

Utility of Telomerase Gene Mutation Testing in Patients with Idiopathic Pulmonary Fibrosis in Routine Practice

Recent studies have suggested that causative variants in telomerase complex genes (TCGs) are present in around 10% of individuals with idiopathic pulmonary fibrosis (IPF) regardless of family history of the disease. However, the studies used a case-control rare variant enrichment study design which is not directly translatable to routine practice. To validate the prevalence results and to establish the individual level, routine clinical practice, and utility of those results we performed next generation sequencing of TCGs on a cohort of well-characterized consecutive individuals with IPF (diagnosis established according to ATS/ERS/JRS/ALAT guidelines). Of 27 IPF patients, three had a family history of idiopathic interstitial pneumonia (familial IPF) and 24 did not (sporadic IPF). Pathogenic/likely-pathogenic variants (according to American College of Medical Genetics criteria) in TCG were found in three individuals (11.1%) of the whole cohort; specifically, they were present in 2 out of 24 (8.3%) of the sporadic and in 1 out of 3 (33.3%) of the patients with familial IPF. Our results, which were established on an individual-patient level study design and in routine clinical practice (as opposed to the case-control study design), are roughly in line with the around 10% prevalence of causative TCG variants in patients with IPF

Vrste iz rodu forsitija (Forsythia Vahl) v Sloveniji

Z nalogo smo želeli ugotoviti kako so vrste iz rodu Forsythia Vahl v Slovenijirazširjene in kako se med seboj razlikujejo. Ključev, ki opisujejo rod forsitija, je veliko, vendar za našo analizo vsi niso uporabni, ker nimajoopisanih vseh vrst, ki se v Evropi pojavljajo, nimajo enotnih vhodov v ključe ali pa niso dovolj natančni. Da ne bi prihajalo do odstopanj in določitve različnih vrst, smo se odločili za uporabo enega ključa, tistega, kije imel opisanih največ vrst in je imel najbolj natančne vhode. Po določevalnem ključu Gehölze nismo ugotovili variabilnosti med vrstami iz rodu Forsythia Vahl v Sloveniji. Potrdili smo prisotnost vrste Forsythia * intermedia, in njene številne sorte. Prisotnosti drugih vrst nismo mogli potrditi. Z morfometrijsko analizo listov smo dokazali značilne razlike med listi, ki so rasli na severni oz. južni strani grmov. S PCA analizo pa teh razlik nismo dokazali. Pojavljale so se razlike med grmi v Ljubljani in Kranjuter tistimi v Postojni. Morda zato, ker se forsitija razmnožuje s potaknjenci, ki izhajajo iz istih lokalnih drevesnic.The main goal of this research was to determine the distribution of genus Forsythia Vahl species and variability among them in Slovenia. Determination keys of Forsythia genus are numerous, but not all are appropriate for our analysis, because they do not contain all the species which occur in Europe, they also do not have unified entrances or they are simply not accurate enough. To avoid the deviations and determination of different species we decided to use the key with the highest number of described species and the most accurate entrances. With the Gehölze determination key we did not manage to determine variability within Forsythia Vahl genus species in Slovenia. We confirmed the presence of Forsythia * intermedia species, and its numerous types. The presence of the other species could not have been confirmed. Morphological analysis of the leaves verified a significant difference among leaves growing on the northern and southern side of the bush. With PCA analysis the differences could not have been proved. The differences in the specimens from Ljubljana, Kranj and Postojna may be due to clonal reproductionof Forsythia with clones originating from the same local tree nurseries

THE UDERLYING CAUSES OF DEATH WITH MORTALITY INDICES IN SLOVENIA IN 2001

Background. Mortality rates are one of the basic measures for population health estimation. The mortality data in Slovenia are collected according to well-defined methodology. Thus our results can be easily compared with the results of other countries. The purpose of this article is to display the most important causes of death with emphasis on premature deaths. This way the authors try to provide aggregate information to those doctors who are filling in the mortality data and those public health workers who have been designing Slovenian public health policy.Methods. The basic descriptive epidemiology methods are used to present the mortality in Slovenia in the year 2001 classified by gender, age groups and regions. Standard mortality indices were calculated: the number of deceased, crude death rate, age standardised death rate, median age at death and years of potential life lost.Results. The crude mortality rate among women is falling with time while the crude mortality rate among men is constant. The median among men is growing while among women is constant. According to analysis of combination of all mortality indices the most endangered regions in Slovenia are those of Murska Sobota and Novo mesto.The babies and preschool children die mostly because of conditions originating in perinatal period and congenital anomalies. For children after seven and adolescents the most frequent causes of death were injuries and poisoning. Suicides on the first place and traffic accidents on the second are the most frequent causes of death among young adults. Among old adults the frequency of causes of death depends on the gender: women die mostly because of breast and gastrointestinal cancer, but men because of liver diseases and ishemic heart diseases. Most frequent cause of death among elderly is cardiovascular diseases.Conclusions. The aggregate mortality data are adequate for crude population health estimation. The mortality indices in Slovenia do not change considerately with time observed. The health status of western part of Slovenia is better in comparison with the eastern part.</p

Remission of chronic urticaria in patients treated with omalizumab

Introduction: This study examined the remission probability and duration in chronic spontaneous urticaria (CSU) patients resistant to second-generation H1-antihistamines (sgAHs) undergoing omalizumab treatment. Methods: This is a retrospective observational study of 176 adult CSU patients exhibiting a significant pruritus component (≥ 8) of the weekly urticaria activity score (UAS7) despite four daily sgAH tablets and starting omalizumab treatment with 300 mg every 4 weeks. After excluding 13 nonresponders, we analyzed 163 omalizumab responders (mean age 51.8 years, 74.4% female). The intervals between applications were increased. Discontinuation was considered for patients that remained asymptomatic on a gradually reduced dosage (to 150 mg every 12 weeks) without sgAHs. Results: Omalizumab discontinuation was possible in 25.8% (42/163). The duration of omalizumab treatment before remission ranged from 7 to 6 months. Twenty-one patients (50.0%) maintained complete remission until the end of the observation period (September 2021) for 8 to 68 months. Of the relapsed patients, 71.4% (15/21) effectively controlled CSU with sgAHs. Six patients (28.6%6/21) required omalizumab reintroduction after 6 to 40 months of remission, responding favorably. Conclusions: The study shows that a quarter of severe CSU patients achieve long-term remission. In addition, sgAHs effectively manage symptoms in a majority of relapsed cases, and those requiring omalizumab reintroduction respond favorably