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On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p

This chapter aims to identify key roles and functions of the endocrine system to appreciate how altered physiology can result in a disruption of homeostasis and lead to a medical emergency. The chapter discusses the more commonly experienced endocrine disorders and uses case studies to explore the nurse’s role in recognising and responding appropriately to patients with acute endocrine problems. The major organs of the endocrine system are identified along with their role in maintaining homeostasis. The use of assessment, and therapeutic interventions used to maximise the health status of patients with endocrine disorders are described as along with the responsibilities of the nurse in assessing, monitoring and managing patients with acute endocrine disorders.

The original version of this article unfortunately contained a mistake in the Study Population section under Materials and Method.

CYSTIC FIBROSIS RELATED DIABETES: CLINICAL CASES IN TERMS OF PRINCIPLES OF PEDIATRIC PALLIATIVE CAREChaychenko T., Gonchar M., Muratov G., Kharkova M., Rybka O., Buginskaya N., Shulga N., Lutay T., Dolgareva S., Bashkirova N. Cystic fibrosis related diabetes (CFRD)- is the most common comorbidity in people with cystic fibrosis , occurring in 20% of adolescents and 40–50% of adults. According to the Guidetothe Development of Children's Palliative Care Services life-limiting conditions may be delineated at four broad groups. Cystic fibrosis is a problem from group 2 - conditions where there may be long periods of intensive treatment aimed at prolonging life and allowing participation in normal childhood activities, but premature death is still possible.Basic aspects of CFRD were discussed, such as cause of the disease, genetic defects, differential diagnosis and principles of treatment. Two clinical cases of pediatric CFRD patients resented to highlight problems of management in terms of potential palliative care.According to our observations, patients with the CFRD, unfortunately, are perceived as patients with cystic fibrosis with no clear attention to diabetes. Both of them were presented with pure diabetes control due to unclear understanding CFRD with concomitant diet incompliance, irregular records, missed insulin injections, exercising limitations.We concluded that CFRD patients must be assessed by members of multidisciplinary team at CF centers, working by the principle of palliative care. There is necessary since the moment of CF diagnosing to involve endocrinologist and dietician due to of endocrine problems. Psychologist, social worker and well-trained educators are necessary to increase awareness of the CF comorbidities problem.Key words: Cystic fibrosis, cystic fibrosis related diabetes, pediatric palliative care, multidisciplinary team ДІАБЕТ, АСОЦІЙОВАНИЙ З МУКОВІСЦИДОЗОМ: КЛІНІЧНІ ВИПАДКИ З ТОЧКИ ЗОРУ ПРИНЦИПІВ ПЕДІАТРИЧНОЇ ПАЛІАТИВНОЇ ДОПОМОГИТ. Чайченко, М. Гончарь, Г. Муратов, М. Харькова, О. Рибка, Н. Бужинская, Н. Шульга, Т. Лутай, С. Долгарева, Н. БашкіроваЦукровий діабет асоційований з муковісцидозом - найбільш поширене ускладнення у осіб, що страждають на муковісцидоз, яке реєструється у 20% підлітків та 40-50 % дорослих. Відповідно до рекомендацій з надання паліативної допомоги дітям, умови для обмеження життя можуть бути визначені у чотирьох широких групах. Муковісцидоз є проблемою, що відноситься до другої групи - стани, при яких передчасна смерть неминуча, але тривале інтенсивне лікування може збільшити тривалість життя дитини і дозволить зберегти якість і фізичну активність.В статті обговорено основні поняття про цукровий діабет асоційований з муковісцидозом, такі як причини захворювання, генетичні дефекти, диференційний діагноз та принципи лікування. Два клінічних випадки педіатричних пацієнтів розглянуто з метою вивчення проблем лікування з точки зору потенційної паліативної допомоги.Згідно з нашими спостереженнями, пацієнти з цукровим діабетом асоційованим з муковісцидозом, сприймаються як пацієнти з муковісцидозом без чіткої уваги до діабету. Обидва пацієнти не мали адекватного глікемічного контролю із-за нечіткості розуміння проблеми, що призводило до недотримання дієти, нерегулярності записів у щоденниках самоконтролю, пропущені ін'єкцій інсуліну.Ми прийшли до висновку, що пацієнти з цукровим діабетом асоційованим з муковісцидозом мають спостерігатися членами міждисциплінарної команди в спеціалізованих центрах, що функціонують за принципом паліативної допомоги. Починаючи з моменту діагностики муковісцидозу до таких команд необхідно залучати ендокринолога та дієтолога із-за високого ризику ендокринних розладів. Психолог, соціальний працівник та добре навчені педагоги необхідні для підвищення обізнаності про проблему та супутні захворювання.Ключові слова: муковісцидоз, цукровий діабет асоційований з муковісцидозом, дитяча паліативна допомога, міждисциплінарна командаДИАБЕТ, АССОЦИИРОВАННЫЙ С МУКОВИСЦИДОЗОМ: КЛИНИЧЕСКИЕ СЛУЧАИ С ТОЧКИ ЗРЕНИЯ ПРИНЦИПОВ ПЕДИАТРИЧЕСКОЙ ПАЛІАТИВНОЙ ПОМОЩИТ. Чайченко, М. Гончарь, Г. Муратов, М. Харькова, О. Рыбка, Н. Бужинская, Н. Шульга, Т. Лутай, С. Долгарева, Н. БашкироваСахарный диабет, ассоциированный с муковисцидозом - наиболее распространенное осложнение у лиц, страдающих муковисцидозом, которое регистрируется у 20 % подростков и 40-50 % взрослых. В соответствии с рекомендациями по оказанию паллиативной помощи детям, условия для ограничения жизни могут быть определены в четырех широких группах. Муковисцидоз является проблемой, которая относится ко второй группе - состояния, при которых преждевременная смерть неизбежна, но длительное интенсивное лечение может увеличить продолжительность жизни ребенка и позволит сохранить качество и физическую активность.В статье обсуждены основные понятия о сахарном диабете ассоциированного с муковисцидозом, такие как причины заболевания, генетические дефекты, дифференциальный диагноз и принципы лечения. Два клинических случая педиатрических пациентов рассмотрено с целью изучения проблем лечения с точки зрения потенциальной паллиативной помощи.Согласно нашим наблюдениям, пациенты с сахарным диабетом ассоциированным с муковисцидозом, воспринимаются как пациенты с муковисцидозом без четкой внимания к диабету. Оба пациента не имели адекватного гликемического контроля из-за нечеткости понимания проблемы, что приводило к не соблюдению диеты, не регулярности записей в дневниках самоконтроля, пропущенных инъекций инсулина.Мы пришли к выводу, что пациенты с сахарным диабетом ассоциированным с муковисцидозом должны наблюдаться членами междисциплинарной команды в специализированных центрах, которые функционируют по принципу паллиативной помощи. Начиная с момента диагностики муковисцидоза к таким командам необходимо привлекать эндокринолога и диетолога из-за высокого риска эндокринных расстройств. Психолог, социальный работник и хорошо обученные педагоги необходимы для повышения осведомленности о проблеме и сопутствующих заболеваниях.Ключевые слова: муковисцидоз, сахарный диабет ассоциированный с муковисцидозом, детская паллиативная помощь, междисциплинарная команда

This is part 2 of an article exploring the endocrinopathies associated with cancer treatments, a growing area of care. More than 80% of all childhood cancers are treatable and the number of survivors of childhood cancer is increasing, but up to two thirds of these children reportedly present with significant health problems resulting from their treatments and about 25% of survivors have endocrine problems. This article explains how an understanding of oncology and endocrinology enables nurse specialists to educate young people about their past treatment, and its implications for their current and future health. It focuses on the specific endocrine risks to survivors of childhood cancer following treatment with chemotherapy and radiotherapy. This is the final article in a series that has illustrated the breadth of work undertaken by nurse specialists in endocrinology and oncology.

This article explores endocrinopathies associated with late effects of treatments for childhood cancers. It is the first of two articles on the subject, the second to be published in November. This is a growing area of care, as more than 80% of all childhood cancer is treatable, resulting in an increase in survivors of childhood cancer. However, up to two thirds of these children are reported to present with significant health problems resulting from their treatments, and approximately 25% of survivors have endocrine problems. This article explains how an understanding of oncology and endocrinology enables nurse specialists to educate young people about their past treatment and its implications for their health. This knowledge is the foundation for individually-tailored care plans that enable young people to be confident to self-care and self-monitor their long-term health.

Children and young people referred to paediatric endocrinology services present with a wide range of illnesses and disorders varying from minor to life-threatening conditions. This article introduces the role of the children's endocrine nurse in caring for children and families undergoing investigations that are frequently undertaken to identify specific problems associated with pituitary, adrenal and thyroid glands. Although children with endocrine problems may be cared for in specialist centres, they may also present, for other health reasons, in secondary and primary care. In schools some children may need teachers to administer emergency medication. There is a high incidence of children diagnosed with growth hormone deficiency and an even higher incidence of congenital hypothyroidism. These children would benefit from health professionals having a broader understanding of their conditions. This article--the third in the endocrinology nursing series--aims to disseminate information and educate colleagues in children's nursing to raise the profile of children with long-term endocrine conditions.

Acacia sensu lato is a large and widespread genus of the family Fabaceae with more than 1350 species. Taxonomically, this genus is complex and has undergone substantial controversial revisions recently. Acacia have been used as folk medicines for the treatment of a wide range of disorders including gastrointestinal, respiratory, eye, skin, teeth, blood, uterine, and endocrine problems. Gums (heteropolysaccharides) and condensed tannins (flavan-3-ol derivatives) are the most commonly reported constituents in Acacia. Pharmacological studies, at least in vitro, have demonstrated antioxidant, analgesic, antihypertensive, antidiabetic, anti-Alzheimer’s, and antimalarial effects of Acacia extracts. A number of secondary metabolites including phenols, alkaloids, and terpenoids, some with useful biological activities, have been reported in acacias. Very few species have been investigated for their phytochemical composition and biological activities. Hitherto, Acacia is largely an untapped resource of valuable secondary plant metabolites that have not gained enough scientific attention. This review aims to survey and critically appraise current literature on Acacia to provide sufficient baseline information for future work and potential commercial exploitation of Acacia.

The majority of endocrine problems are a result of hormones being too much, too little, too early, or too late. The mechanisms of hormone action involve the temporal envelope of its concentration as well as the sensitivity of the cellular response to the hormone. This is mediated by specific receptors that detect and bind to the hormone and then signal to the cell over a variety of pathways, thus shaping the response of the cell. Therefore, determining optimal levels for a given hormone must be achieved by paying attention to these mechanistic steps. The correct timing of the actions of hormones in development is essential for normal growth. The wrong amount of hormone too early can have profound behavioral consequences.

Members of the College of Physicians and Surgeons of Ontario Endocrinology and Metabolism Peer Review Network have been involved in a quality improvement project to help standardize the peer assessment of physicians practicing in endocrinology and metabolism. This has included developing state-of-the-art summaries of common endocrine problems by Canadian experts in endocrinology and metabolism. These tools have been developed in response to the educational needs, as identified by peer reviewers, of practicing endocrinologists in Ontario. These pedagogical tools aim not only to standardize the documentation of the clinical performance of endocrinologists but also to make the process more transparent and to improve the quality of patient care in Ontario. This article summarizes the project and also provides the tools developed for the endocrinology and metabolism section of the College of Physicians and Surgeons of Ontario.

Thyroid disorders are one of the most common endocrine problems encountered at primary care. The role and importance of dietary factors in their prevention and management are largely unknown with inadequate scientific evidence. In this review, we examine the scientific evidence of the effect of various dietary elements in causation, prevention, and management of common thyroid disorders.

Acute physical or emotional stresses are the most important activators of the hypothalamic–pituitary–adrenal (HPA) axis (Antoni 1986; Aguilera 1994; Thomason et al. 1999). Surgery is one the most potent activators of the axis. The degree of activeness depends on factors such as type of the surgery and the anesthetic agents used during the procedure (Chernow et al. 1987; Jabbour 2001; Bromberg et al. 1991). ... The level of cortisol changed during both major and minor surgeries. It fell initially after premedication and rose rapidly ...

Advanced therapies have improved outcomes and also resulted in a growing risk of long-term adverse health events. This study intends to estimate incidences of adverse health events and examine differences in adverse health events among childhood cancer survivors, and to understand the concerns of mothers after their child has completed cancer treatment. An explanatory sequential mixed-method was used. A total of 201 paediatric cancer survivors' mothers with mean age 43.6 years were recruited. Of the survivors, 12.4% experienced five or more adverse health events. The incidence of adverse health events of altered body image, fatigue and neurocognitive problems were 31.54%, 14.77% and 12.53% respectively. Among survivors, significant differences in adverse health events of pain, endocrine problems and altered body image issues were identified. Survivors receiving radiotherapy, bone marrow transplants or completing treatment after 6-10 years experienced significantly more adverse health events. Maintaining health was the greatest concern for mothers, and the qualitative reports of their concerns could be categorised: living in uncertainty, and keeping forward-looking. Childhood brain tumour survivors were identified as experiencing more adverse health events than other survivors. The need for healthcare teams to consider mothers' health concerns was highlighted.

Purpose The purpose of this paper is to identify primary health concerns prompting older and younger prisoners in Switzerland to consult a nurse or a general practitioner (GP) within the prison healthcare setting, and explores if these reasons for visits differ by age group (49 years and younger vs 50 years and older). The authors used 50 years and older as the benchmark for older prisoners in light of literature indicating accelerated aging among prisoners. Design/methodology/approach Retrospective information from medical records of 406 prisoners were collected for a period of six months. This study analyzed the reasons for which prisoners visited the nurses and GPs available to them through the prison healthcare service. These reasons were coded using the International Classification of Primary Care-version 2. Data were analyzed descriptively and four generalized linear models were built to examine whether there was an age group difference in reasons for visiting nurses and GPs. Findings The health reasons for visiting nurses and GPs by 380 male prisoners from 13 Swiss prisons are presented. In the six month period, a total of 3,309 reasons for visiting nurses and 1,648 reasons for visiting GPs were recorded. Prisoner participants' most common reasons for both visits were for general and unspecified complaints and musculoskeletal problems. Older prisoners sought significantly more consultations for cardiovascular and endocrine problems than younger prisoners. Research limitations/implications Nurses play an important role in addressing healthcare demands of prisoners and coordinating care in Swiss prisons. In light of age-related healthcare demands, continuing education and training of both nurses and GPs to adequately and efficiently address the needs of this prisoner group is critical. Allowing prisoners to carry out some care activities for minor self-manageable complaints will reduce the demand for healthcare. Originality/value This study presents unique data on healthcare concerns for which prisoners visit prison nurses and GPs. It highlights the varied needs of older prisoners as well as how these needs are addressed based on the availability of the primary healthcare provider within the prison.

[Extract] Inadequate sleep is associated with a range of adverse outcomes, such as increased risk of cardiovascular metabolic and endocrine problems in addition to obesity and impaired cognition [1]. However, the existing literature has mostly used 'sleep duration' as the main measure of sleep adequacy. Emerging evidence from epidemiological studies indicates that other dimensions of sleep, ie, sleep quality and pattern, also play important roles in the biochemical pathways related to glucose metabolism [2].

Once diabetes is excluded, thyroid gland diseases form the main bulk of endocrine problems that the practicing physician encounters in their clinical practice. As patients with thyroid gland dysfunction may present with varied symptoms of different severity levels, physicians often have to identify such patients, so that appropriate treatment for thyroid disorders can be instituted at the earliest to prevent potential future complications. The current review will cover the evaluation and interpretation of thyroid function tests in the diagnosis of thyroid disorders.