Relevant Negative Impact Research Articles

Genetic selection for post-weaning growth rate shows no relevant negative impact on reproductive performance in breeding rabbit does

Genetic selection for post-weaning growth rate shows no relevant negative impact on reproductive performance in breeding rabbit does

Tube current reduction and iterative image reconstruction for computed tomography myelography

This study aimed to systematically evaluate the impact of a low-dose (LD) protocol using tube current reduction on image quality, the confidence for intervention planning and guidance, and diagnostic yield for computed tomography (CT) myelography. We retrospectively analyzed 68 patients who underwent CT myelography, with 34 investigations performed with a standard-dose (SD) and 34 investigations performed with a LD protocol (using tube current reduction). The different scans were matched considering variables such as sex, age, presence of spinal instrumentation, and body diameter. All images were evaluated by two readers (R1 and R2) using Likert scales. Image noise was measured using attenuation values of paraspinal muscle tissue. Images were reconstructed with model-based iterative reconstruction (post-myelography diagnostic scans) or hybrid reconstruction (planning, periprocedural, and diagnostic scans). Image quality, overall artifacts, image contrast, and confidence for planning or intervention guidance were rated good to perfect for both SD and LD scans according to evaluations of both readers. Inter-reader agreement was good to very good for the images from intervention planning (κ ≥ 0.80) as well as for intervention guidance (κ ≥ 0.77), as well as for diagnostic scans (κ ≥ 0.85). Image noise was similar between SD and LD scans performed for planning of the interventional procedures (model-based iterative reconstruction: SD 45.37 ± 7.29 HU vs. LD 45.17 ± 9.12 HU; hybrid reconstruction: SD 46.05 ± 7.43 HU vs. LD 45.05 ± 8.69 HU; p > 0.05). The volume-weighted CT dose index (CTDIvol) and size-specific dose estimate (SSDE) were significantly lower for the planning scans as well as the periprocedural scans when using the LD protocol as compared to the SD protocol (p < 0.05). In conclusion, implementation of a LD protocol with tube current reduction for CT myelography is a feasible option to reduce radiation exposure, especially when combined with iterative image reconstruction. In our study, LD imaging did not have a relevant negative impact on image quality, confidence for intervention planning or guidance, or diagnostic certainty for CT myelography.

Mastitis has a cumulative and lasting effect on milk yield and lactose content in dairy cows

Milk lactose content (LC) physiologically decreases with parity order in dairy cows, but also after udder health inflammation(s) and/or in presence of elevated milk SCC in subclinical cases. Therefore, the progressive decrease in milk LC observed along cows' productive life can be attributed to a combination of factors that altogether impair the epithelial integrity, resulting in weaker tight junctions, e.g., physiological aging of epithelium, mechanical epithelial stress due to milking, and experienced clinical or subclinical mastitis. Mastitis is known to affect the udder synthesis ability too, so our intention through this study was to evaluate if there is a cumulative and lasting effect of mammary gland inflammation(s) on milk yield (MY) and LC. For this purpose, we used diagnoses of clinical mastitis and milk data of Austrian Fleckvieh cows to evaluate the effect of cumulative mastitis events on LC and MY. Only mastitis diagnoses recorded by trained veterinarians were used. Finally, we investigated if cumulative mastitis is a heritable trait and whether it is genetically correlated with either LC or MY. Estimates were obtained using univariate and bivariate linear animal models. A significant reduction in LC and MY was observed in cows that suffered from mastitis compared with those that did not experience udder inflammation. The h2 of cumulative mastitis is promising and much greater (0.09) than the h2 of the binary event itself (≤0.03). The genetic correlations between cumulative mastitis with LC and MY were negative, suggesting that cows with a great genetic merit for MY and LC are expected to be more resistant to repeated inflammations and less recidivist. When we used number of lifetime SCC peaks (≥200,000 or 400,000 cells/mL) to calculate cumulative inflammation events, h2 was even higher (up to 0.38), implying that also subclinical mastitis has a relevant negative impact on both LC and MY. Finally, the present study demonstrated how repeated mastitis events can permanently affect the mammary gland epithelial integrity and synthesis ability, and that the number of cumulative mastitis is a promising phenotype to be used in selection index in combination with other indicator traits toward more resistant and resilient mammary glands.

Examining the impact of substance use on hospital length of stay in schizophrenia spectrum disorder: a retrospective analysis

BackgroundAmong patients diagnosed with schizophrenia, the presence of substance use poses an aggravating comorbidity, exerting a negative impact on the course of the disease, adherence to therapeutic regimens, treatment outcomes, duration of hospital stays, and the frequency of hospitalizations. The primary objective of the present study is to investigate the relationship between comorbid substance use disorders, antipsychotic treatment, and the length of stay in individuals hospitalized for treatment of schizophrenia.MethodsWe conducted a retrospective analysis of electronic health records spanning a 12-month period, specifically focusing on adult patients diagnosed with schizophrenia who were discharged from the University Hospital of Psychiatry Zurich between January and December 2019. We documented the number and types of diagnosed substance use disorder, the antipsychotic treatment, the length of stay, and the number of previous hospitalizations for each patient.ResultsOver a third (n = 328; 37.1%) of patients with schizophrenia had comorbid substance use with cannabis being the most frequent consumed substance. Patients with substance use (either single or multiple) were more frequently hospitalized; those with multiple substance use more frequently than those with a single substance use (F(2, 882) = 69.06; p < 0.001). There were no differences regarding the rate of compulsory admission. Patients with no substance use had a lower HoNOS score at discharge (F(2, 882) = 4.06). Patients with multiple substance use had a shorter length of stay (F(2, 882) = 9.22; p < 0.001), even after adjusting for duration of illness, previous hospitalizations, diagnosis, and antipsychotic treatment.ConclusionsIn patients with schizophrenia, comorbid single or multiple substance use has a relevant negative impact on treatment and thus on the course of disease. Substance use in patients with schizophrenia should therefore receive special attention in order to reduce re-hospitalization rates and improve the clinical outcome.

Design of a multi-epitope-based vaccine candidate against Bovine Genital Campylobacteriosis using a reverse vaccinology approach

BackgroundBovine Genital Campylobacteriosis (BGC), a worldwide distributed venereal disease caused by Campylobacter fetus subsp. venerealis (Cfv), has a relevant negative economic impact in cattle herds. The control of BGC is hampered by the inexistence of globally available effective vaccines. The present in silico study aimed to develop a multi-epitope vaccine candidate against Cfv through reverse vaccinology.ResultsThe analysis of Cfv strain NCTC 10354 proteome allowed the identification of 9 proteins suitable for vaccine development. From these, an outer membrane protein, OmpA, and a flagellar protein, FliK, were selected for prediction of B-cell and T-cell epitopes. The top-ranked epitopes conservancy was assessed in 31 Cfv strains. The selected epitopes were integrated to form a multi-epitope fragment of 241 amino acids, which included 2 epitopes from OmpA and 13 epitopes from FliK linked by GPGPG linkers and connected to the cholera toxin subunit B by an EAAAK linker. The vaccine candidate was predicted to be antigenic, non-toxic, non-allergenic, and soluble upon overexpression. The protein structure was predicted and optimized, and the sequence was successfully cloned in silico into a plasmid vector. Additionally, immunological simulations demonstrated the vaccine candidate’s ability to stimulate an immune response.ConclusionsThis study developed a novel vaccine candidate suitable for further in vitro and in vivo experimental validation, which may become a useful tool for the control of BGC.

Analysis of the impacts of carbon dioxide emission on climate change

In recent years, the global excess carbon dioxide emission had caused severe climate change and increase in global temperature since the start of Industrial Revolution. To be specific, extreme weathers have been observed all over the world due to global warming. Therefore, it is of vital importance that the causes of excess carbon dioxide emission should be studied along with respective mitigating strategies. On this basis, this study aims to study and investigate the global history and causes of excess carbon dioxide emission, as well as the physical chemical mechanism of greenhouse effect. In detail, case analysis of excess carbon dioxide emission in China is provided with the relevant negative impact of climate change in China. According to the analysis, policies adopted by the Chinese government and their efficiencies and corresponding suggestions are also discussed in the meantime. Overall, these results shed light on guiding further exploration of carbon dioxide emission on climate change.

THE IMPACT OF DISRUPTIVE TECHNOLOGY ON BANKING UNDER SWITCHING VOLATILITY REGIMES

This paper uses the case of Spain to investigate whether and how disruptive technology impacts banking stock returns under a high volatility regime and a low volatility regime. For this purpose, a two-factor model with heteroscedastic Markov switching regimes has been applied. The results indicate that disruptive technologies have an impact on Spanish banking stock returns and that the effects are volatility regime dependent, having a relevant positive impact in high volatility regimes and a less relevant negative impact in low volatility regimes. These findings suggest that investors are informed about and acknowledge the advantages of disruptive technologies and will use their adoption as a business strategy to offset adverse market circumstances. During stable market conditions, on the other hand, Spanish banking seems to have less expectations about disruptive technology as a business strategy. To summarise, this paper provides insights into the role of the pricing of banking-related assets and has other relevant implications for investors that include disruptive technology or banking exposed investments in their portfolios.

Investigation of the effect of rifampicin resistance and risk factors on recovery rates after DAIR procedure in patients with prosthetic joint infection

BackgroundRifampicin plays a key role in the management of prosthetic joint infections (PJIs), however, the emergence of rifampicin resistance is associated with less favourable clinical outcomes. The purpose of this study was to investigate the impact of rifampicin resistance and other patient-related factors on recovery rates among patients with PJI undergoing debridement, antibiotics and implant retention (DAIR).MethodsWe reviewed medical records and microbiology reports of 67 patients (37 males and 30 females) undergoing DAIR due to PJI between 2014 and 2021. Patient-related factors, co-morbidities and microbiological reports were collected and reviewed. Forty-four patients had hip, 21 had knee, 1 had shoulder and 1 had elbow joint infection. Obtained data were statistically analysed with a logistic regression model.ResultsRifampicin-sensitive organism was isolated in 47 cases. Recovery rate was 72.3% in the sensitive and 76.9% in the resistant group. We found no significant effect of rifampicin resistance on the probability of recovery. Age and diabetes mellitus showed negative clinical impact on recovery. Staphylococcus aureus and coagulase-negative Staphylococci were predominant in the rifampicin-sensitive (66.6% of the isolates) and Gram-negative rods in the resistant group (65.2%).ConclusionsBased on our results, higher age and diabetes mellitus may have a clinically relevant negative impact on clinical outcome, however, this effect was not statistically significant. This may be due to the limited number of patients included in this study. We observed no clinically relevant effect of rifampicin-resistance, sex and body mass index (BMI) on recovery rates among patients undergoing DAIR due to PJI.

Tailored axillary surgery - A novel concept for clinically node positive breast cancer.

Axillary surgery in patients with breast cancer has been a history of de-escalation; however, surgery for clinically node-positive breast cancer remained at the dogmatic level of axillary lymph node dissection (ALND). In these patients, currently the only way to avoid ALND is neoadjuvant systemic treatment (NST) with nodal pathologic complete response (pCR) as diagnosed by selective lymph node removal. However, pCR rates are highly dependent on tumor biology, with luminal tumors being most present yet showing the lowest pCR rates. Therefore, the TAXIS trial is investigating whether in clinically node-positive patients, either with residual disease after NST or in the upfront surgical setting, ALND can be safely omitted. All patients undergo tailored axillary surgery (TAS), which includes removal of the biopsied and clipped node, the sentinel lymph nodes as well as all palpably suspicious nodes, turning a clinically positive axilla into a clinically negative. Feasibility of TAS was recently confirmed in the first pre-specified TAXIS substudy. TAS is followed by axillary radiotherapy to treat any remaining nodal disease. Disease-free survival is the primary endpoint of this non-inferiority trial, and morbidity as well as quality of life are the main secondary endpoints, with ALND being known for having a relevant negative impact on both. Currently, 663 of 1500 patients were randomized; accrual completion is projected for 2025. The TAXIS trial stands out in including clinically node-positive patients in both the neoadjuvant and upfront surgery setting, thereby investigating surgical de-escalation at the far-end of the risk spectrum of patients with breast cancer.

The Potential of Structural Batteries for Commuter Aircraft Hybridization

Electric or hybrid electric propulsion systems have received a great deal of attention in recent years in various branches of transportation including aviation. Europe is committed to the ambitious goals of reducing CO2 emissions by 75%, NOx emissions by 90% and perceived noise by two-thirds by the year 2050 compared to the average new aircraft of the year 2000. The main barrier of the electric propulsion is bound to the battery limits in terms of energy and power densities, thus determining a relevant negative impact on payload or aircraft size. It is possible to design and fly an electrically propelled aircraft, as testified by some existing examples, both prototypical and production models, in the categories of ultralight and general aviation aircraft. A novel technology, which allows the electrification process toward heavier categories of aircraft, is constituted by structural batteries. These are similar in structure to carbon fiber composites, where the matrix features dielectric characteristics, making the structure capable of storing electric energy while retaining the capability to withstand mechanical loads. Despite that, it raises relevant issues concerning aircraft sizing procedures that need to be conceived considering the specific characteristics of such multifunctional technology. This research work aims to evaluate the potential benefits the structural batteries have on the fuel burn for a 11-seater commuter aircraft. According to the envisaged technologies (structural batteries), this work will focus on the determination of the best hybridization factors determining the energy requirements for the typical mission of a commuter aircraft.

Impact of atrial fibrillation on outcome of percutaneous mitral valve repair (PMVR) procedure

Abstract Background Limited evidence exists regarding the impact of atrial fibrillation (AF) on outcomes after percutaneous mitral valve repair (PMVR). The aim of the present study was to compare 1-year clinical outcomes following PMVR in patients with and without AF. Methods 426 patients with PMVR for severe MR were included in the COburg MItraclip (COMI) registry between 2016 and 2021. Patients were divided into an AF group (group A, n=284) and a non-AF group (group B, n=142). Clinical profiles, PMVR procedure characteristics and the clinical follow-up were compared between the two groups. Results Patients with AF were older (79.3±6.3 [AF] vs. 77.8±8 years [non-AF], p=0.03), had higher N-terminal B-type natriuretic peptide levels (NT-pro BNP: 5675±5544.2 vs 8516±11184.5, p=0.004), more often a coronary artery disease (62% vs 38%, p=0.03) and had a lower stroke risk (CHA2DS2-VASc score: 4.6±1.2 vs 4.9±1.3, p=0.01). There were no significant differences between groups with regard to the gender, logistic Euroscore or prevalence of chronic heart failure, hypertension, diabetes mellitus or severe mitral regurgitation. Acute procedural success (post-procedural 2. MR, 95.1% vs. 94.4%; p=0.76) and procedure-related major complications were similar. There were no significant differences in 1-year MACCE (death, MI, stroke, bleeding), health-related quality of life or clinical improvement. Conclusion In patients with mitral regurgitation who underwent PMVR, AF is common and appears not to have a relevant negative impact on the clinical outcome at 1 year compared to patients with sinus rhythm. Funding Acknowledgement Type of funding sources: None.

Residual flexion deformity after scaphoid nonunion surgery: 7-year follow-up study.

The clinical implication of a residual flexion deformity following surgery for scaphoid nonunion is unclear. Sixty-three patients who underwent scaphoid nonunion surgery were assessed after a mean of 7 years (range 5-10) to analyse the outcomes based on the presence of residual scaphoid deformity. Primary outcome was Disabilities of the Arm, Shoulder and Hand score. Secondary outcomes were Patient-Rated Wrist Evaluation score, wrist range of motion and strength. Patients were dichotomized to residual deformity or no deformity. Scaphoid deformity was calculated from CT scans based on the median difference between the height-length ratio of the operated versus the uninjured scaphoid. There were no differences between residual deformity (n = 33) and no deformity (n = 30) in any outcome variables, except for wrist extension which was slightly worse in the deformity group. The deformity group had a greater number of radiographic osteoarthritis, but all cases were mild, and osteoarthritis did not correlate to a worse outcome. We conclude that residual scaphoid deformity has no relevant negative impact on mid-term wrist function.Level of evidence: IV.

Impact of irradiation on metabolomics profile of ground meat and its implications toward food safety

Irradiation is a reputed efficient sterilizing method that demonstrated valuable effects on meat preservation. This research, based on qualitative untargeted HPLC-Orbitrap metabolomics approach, was intended to estimate the variations in global metabolome profile of irradiated chicken, turkey, and mixed (chicken, turkey, and pork) ground meat to assess the possible presence of a food safety issue concerning the metabolome alteration. Overall, 402 metabolites were identified, and all three matrices exhibited a specific metabolome profile that was not influenced remarkably by the application of five different levels of irradiation intensity. In particular, all three meat categories displayed the following common features: 1) free amino acids pool remained unaffected by irradiation 2) taurine appeared as the most important differentiator for all three category 3) amount of glutathione decreased 4) characteristic although minor, oxidative modifications of polyunsaturated free fatty acids occurred 5) intensified adenosine nucleotide degradation. The presented analytical approach highlighted the usefulness of meat metabolome profiling in distinction of irradiated meat from non-treated one. Metabolomics analysis did not diagnose any relevant negative impact of irradiation on meat safety issues, but contemporary has demonstrated alternations in few metabolic pathways.

Genetic Characterization of Pathogenic Escherichia Coli Isolated from Smallholding Dairy Buffaloes, their Products, and Some Environmental Sources

This study was conducted to evaluate the potential existence of pathogenicEscherichia coli in smallholding dairy buffaloes, their products as well as in some environmental sources. In total, 150 samples including an equal sample size (n = 25) of raw milk, Kareish cheese, water, feed, udder and rectal swabs were examined. Phenotypic and genotypic procedures were used to characterize the bacterial population. Twenty-eight isolates were confirmed as E. coli from the examined samples (18.66%). The recovered isolates were categorized as Enterohemorrhagic E. coli (n=11),Enteropathogenic E. coli(n=9), Enterotoxigenic E. coli(n= 5)and Enteroinvasive E. coli (n=3). All isolates were resistant to erythromycin followed by oxacillin (89.28%), and nalidixic acid (67.85%), while 96% of the recovered strains displayed high sensitivity to imipenem. A great proportion of the recovered E. coli (67.9%) exhibited multidrug resistance. The majority of isolates (92.9%) harbored stx1either alone or in association with stx2 which present in 60.7% (17/28) while eaeA genes were detected in 50% among the recovered isolates in association with stx1 or combined with stx2 (n =11). Twelve isolates (42.86%) expressed all the examined beta lactamase encoding genes; while only 25% of the isolates harbored all tested beta lactamase genes in common with stx1, stx2 and eaeA genes.The results herein indicated that the pathogenicE. coli could be present in the examined samples which pose a relevant threat and negative impact on animal as well as consumer health. The study emphasizes the necessity of developing long-term strategies to assure dairy food safety.

Impact of COVID-19 on Infertility Treatments: Not Even a Global Pandemic Was Strong Enough to Hamper Successful Pregnancies.

The COVID-19 global pandemic has meant a sanitary and social threat at every level and it was not any different for the assisted reproduction industry. This retrospective two-arm study aims to describe its impact on infertility treatments performed in our clinics (IVI Spain, Rome, and Lisbon) regarding: (1) assessment of COVID-19 impact in the amount, type, and success of infertility treatments performed during 2020 compared to 2019; and (2) description of the psychological status of women who got pregnant during the first months of the pandemic and its correlation with their final pregnancy outcome. On the one hand, this pandemic has led to a significant reduction in the total number of treatments performed, even though the proportion of the different types was almost unaltered. Additionally, its impact on pregnancy rates was not clinically relevant. On the other hand, the psychological status of pregnant women did not seem to affect their final pregnancy outcome. These results suggest that, even in the event of a negatively affected psychological status in our study population, it was not translated into an impaired pregnancy outcome. Hence, the COVID-19 global pandemic, although devastating, might not have exerted a clinically relevant negative impact on the overall pregnancy outcome in our clinics.

Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board.

Pancreatic cancer represents a very challenging disease, with an increasing incidence and an extremely poor prognosis. Peculiar features of this tumor entity are represented by pancreatic exocrine insufficiency and an early and intense nutritional imbalance, leading to the highly prevalent and multifactorial syndrome known as cancer cachexia. Recently, also the concept of sarcopenic obesity has emerged, making the concept of pancreatic cancer malnutrition even more multifaceted and complex. Overall, these nutritional derangements play a pivotal role in contributing to the dismal course of this malignancy. However, their relevance is often underrated and their assessment is rarely applied in clinical daily practice with relevant negative impact for patients’ outcome in neoadjuvant, surgical, and metastatic settings. The proper detection and management of pancreatic cancer-related malnutrition syndromes are of primary importance and deserve a specific and multidisciplinary (clinical nutrition, oncology, etc.) approach to improve survival, but also the quality of life. In this context, the introduction of a “Nutritional Oncology Board” in routine daily practice, aimed at assessing an early systematic screening of patients and at implementing nutritional support from the time of disease diagnosis onward seems to be the right path to take.

Psychological Wellbeing of Parents with Infants Admitted to the Neonatal Intensive Care Unit during SARS-CoV-2 Pandemic.

The current SARS-CoV-2 disease (COVID-19) pandemic is a sudden major stressor superimposed on pre-existing high distress in parents of infants admitted to the neonatal intensive care unit (NICU). This study aimed to investigate the psychological wellbeing of NICU parents during the COVID-19 pandemic. Forty-four parents of 25 inpatients of the Padua University Hospital NICU were included from June 2020 to February 2021. At 7–14 days postpartum parents completed the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Parental Stressor Scale: NICU (PSS:NICU) and an ad-hoc questionnaire measuring parental COVID-19 related stress. About one third of parents reported extreme/high stress and a relevant negative impact on parenthood experience. Less time (82%) and less physical contact (73%) with infants due to COVID-19 preventive measures were the most frequent negative factors. Higher COVID-19 related parental stress was positively associated with anxiety, depression, NICU parental stress, stress related to NICU environment, and parental role alterations. Depression symptoms, stress related to infant condition and parental role alterations were higher in mothers. The pandemic affected parental emotional and relational wellbeing directly through additional stress due to COVID-19 concerns and indirectly through the impact of restrictions on the experience of becoming parents.

Conjugate heat transfer modeling of a turbine vane endwall with thermal barrier coatings

ABSTRACTAdvanced cooling techniques involving internal enhanced heat transfer and external film cooling and thermal barrier coatings (TBCs) are employed for gas turbine hot components to reduce metal temperatures and to extend their lifetime. A deeper understanding of the interaction mechanism of these thermal protection methods and the conjugate thermal behaviours of the turbine parts provides valuable guideline for the design stage. In this study, a conjugate heat transfer model of a turbine vane endwall with internal impingement and external film cooling is constructed to document the effects of TBCs on the overall cooling effectiveness using numerical simulations. Experiments on the same model with no TBCs are performed to validate the computational methods. Round and crater holes due to the inclusion of TBCs are investigated as well to address how film-cooling configurations affect the aero-thermal performance of the endwall. Results show that the TBCs have a profound effect in reducing the endwall metal temperatures for both cases. The TBC thermal protection for the endwall is shown to be more significant than the effect of increasing coolant mass flow rate. Although the crater holes have better film cooling performance than the traditional round holes, a slight decrement of overall cooling effectiveness is found for the crater configuration due to more endwall metal surfaces directly exposed to external mainstream flows. Energy loss coefficients at the vane passage exit show a relevant negative impact of adding TBCs on the cascade aerodynamic performance, particularly for the round hole case.

Influence of specific osteoporosis drugs on fracture healing

For the treatment of disturbed fracture healing, drugs could be given in addition to surgical procedures. Specific osteoporosis drugs affect the bone metabolism and are used to treat osteoporosis, particularly after afragility fracture has occurred. Therefore, their use would be conceivable to improve adisturbed fracture healing. This article presents the available and upcoming specific osteoporosis drugs and investigates whether these substances affect fracture healing in the context of osteoporosis. Furthermore, it is discussed whether disturbed fracture healing can be improved by the use of these substances. Aliterature search (PubMed) was conducted using key terms. Preclinical studies, clinical studies, reviews and meta-analyses were considered in order to present the current knowledge in aclinically relevant context. Preclinical and clinical studies show that specific osteoporosis drugs have no relevant negative impact on the healing of fragility fractures. Atendency to improve adisturbed fracture healing was attributed to bone anabolic substances; however, studies are inconsistent and there is no approval for this application. Following afragility fracture, osteoporosis should be diagnosed according to the guidelines and, if necessary, treated with specific osteoporosis drugs, since in principle they do not impair fracture healing but significantly reduce the risk of subsequent fractures. Approval to improve fracture healing requires further investigations.

Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes. Results of the Hypos-1 observational study

Background and aimsHypoglycemia represents a relevant burden in people with diabetes. Consequences of hypoglycemia/fear of hypoglycemia on quality of life (QoL) and behaviors of patients with T1DM and T2DM were assessed. Methods and resultsHYPOS-1 was an observational retrospective study. Fear of hypoglycemia (Fear of Hypoglycemia Questionnaire, FHQ), general health status (visual analog scale of EuroQol questionnaire, EQ5D-VAS) psychological well-being (WHO-5 well being index, WHO-5), diabetes related distress (Problem Areas in Diabetes 5, PAID-5), and corrective/preventive behaviors following hypoglycemia were compared between people with and without previous experience of severe and symptomatic hypoglycemia and by tertiles of FHQ scores. A multivariate analysis was performed to identify factors associated with the likelihood of being in the third tertile of FHQ score. Overall, 2229 patients were involved. Severe hypoglycemia had statistically significant and clinically relevant (measured as effect sizes) negative impact on EQ5D-VAS, WHO-5, PAID-5, and FHQ both in T1DM and T2DM. In T2DM, symptomatic episodes had similar impact of severe hypoglycemia. Moving from the first to the third FHQ tertile, lower scores of EQ-5D VAS and WHO-5, and higher levels of PAID-5 were found. Patients in the third tertile performed more frequently corrective/preventive actions that negatively impact on metabolic control. Previous hypoglycemia, insulin treatment, female gender, age, and school education were the independent factors associated with increased likelihood to be in the third tertile. ConclusionNot only severe but also symptomatic hypoglycemia negatively affect patient QoL, especially in T2DM. Addressing fear of hypoglycemia should be a goal of diabetes education.