BackgroundThe purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization.MethodsWe developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center.ResultsOf 291 surveys sent, 83 (29%) were undeliverable and three (1%) were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%). Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian) transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2–16.5) or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3–31.5) were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79%) were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5–24.0) compared with those receiving diabetes care from a general internist/adult primary care doctor (17%). Two-thirds (66%) reported receiving all recommended diabetes screening tests in the previous year, with no difference according to provider type.ConclusionIn this sample, transition preparation was variable and one quarter reported gaps in obtaining adult diabetes care. Nevertheless, the majority endorsed currently receiving regular diabetes care, although visit frequency differed by provider type. Because locating patients after transition was incomplete, our findings suggest the need for standardized methods to track transitioning patients.
The aim of this study was to determine heavy metal content (As, Cd, Cu, Hg, Cd, Pb, and Zn) in oysters transplanted in Ebro Delta bays (Alfacs and Fangar) where oysters are traditionally cultured for human consumption. Metal body burdens were monitored weekly during the period of maximal agriculture activity from May to June in 2008 and 2009. Results indicate that regardless of the high levels of metals reported in biota living in Ebro River, metal levels in oysters from both bays were similar to those found in unpolluted areas and far below the maximum limits of tolerance recommended by the European Commission. Nevertheless, metal accumulation patterns in oysters differentiate two sources of pollution: one coming from agriculture activities within the Ebro's delta for As, Cd, Cu, and Zn and other coming from Ebro River probably related to industrial activities upstream (Hg, Pb) or to lead shot pellets form hunting activities (Pb). Reported results, thus, are in concern with previous studies and indicate that metallic pollutants do not affect oysters cultures in Ebro Delta associated bays.
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