Predictors of Unmet Healthcare Needs during Economic and Health Crisis in Greece

(1) Background: The aim of this study was to identify predictors of the unmet healthcare needs during the financial and recent health crisis in Greece. (2) Methods: Time series analysis was performed for the years 2008 through 2022 using the Eurostat database. The dependent variable was the percentage of people who reported unmet need for medical care. Demographic, socioeconomic, and health data, as well as health expenditures, were used as independent variables. Correlation analysis and simple linear regression models were conducted to analyze the results. (3) Results: Unmet health needs in Greece increased from the start of the crisis until 2016, as a gradual de-escalation of the crisis was observed. However, in 2019 the country recorded the second highest level of unmet needs for medical care before the health crisis. Limitations in usual activities, reporting bad/very bad health status, being unemployed, and having low income increased the likelihood of unmet needs. Health expenditures (public or private) were also significant determinants of unmet healthcare needs. (4) Conclusions: The increased unmet health needs widen inequalities in health and healthcare access. Therefore, health policies should eliminate barriers which restrict the access to health and enhance healthcare services, developing conditions for citizens' well-being.

Introduction of Alternative Proteins for Health Professionals' Diet: The Transtheoretical Model and Motivational Interviewing of Nutritional Interventions

The World Health Organization has documented the impact that a balanced diet has on disease prevention. Overconsumption of meat can lead to obesity, arteriosclerosis, thrombosis, type 2 diabetes and many life-threatening diseases. A new group of proteins has currently emerged in the scientific community of alternative nutrition called "alternative proteins". Several interventions have been introduced by a large number of healthcare providers in order to promote and enhance people's dietary habits. Two of the most prevalent models of health-related behaviour modification are the transtheoretical-stages of change-model (TM) and motivational interviewing (MI). The purpose of this study is to research and examine how the ΤΜ and MI could be effectively implemented in the diet of health professionals through alterations of eating habits. The population of the study is to comprise health professionals from «AΤΤΙΚOΝ» University General Hospital, Athens, Greece. The sample of participants is to be selected by the professional environment of the researcher. Participants, through random selection, are to be divided into two groups: the control group, consisting of 50 individuals, and the intervention group, consisting of 50 individuals. The duration of the study is to be from November 2022 to November 2024. The present study is concerned with productive mixed-quantitative and qualitative-evolutionary research along with the application testing of both the ΤΜ and the MI. It is to be conducted specifically on health professionals via self-administered questionnaires and semi-structured interviews.

Characterization and evaluation of Greek tomato landraces for productivity and fruit quality traits related to sustainable low-input farming systems

Tomato is one of the most important horticultural species all over the world, having high level of consumption and employing many people, both in the primary sector (farmers) and in the secondary sector (traders, seed companies and processors). Nowadays, the use of commercial tomato F1 hybrids tends to prevail because of high yield potential and homogeneity of fruits which are often characterized by lack of quality and sensory characteristics. In contrast, tomato landraces have outstanding quality traits, such as high concentration of antioxidants and organoleptic compounds, as well as often include desirable genes in their genome for adaptability, plasticity, response to low-input conditions, and high fruit nutritional value. Thus, they are appropriate material in the use of sustainable agricultural management systems or as gene donors for the development of new type of tomato cultivars suitable for low-input farming systems. The present experimental study refers to 22 Greek tomato landraces and two commercial cultivars (cv. Macedonia and the F1 hybrid Formula) used as controls, which were characterized by phenotypical markers and evaluated under low-input sustainable farming conditions. Specifically, during this research, measurements were taken regarding yield potential (early production, number of fruits per plant, fruit weight, total yield) and fruit quality traits, such as physicochemical characteristics (pH, acidity, and soluble solid components - Brix^ο) also according to nutritional value (content of ascorbic acid, lycopene, total carotenoids, and total phenolics) of tomato fruits. In the most promising landraces (cv. Milo Chalkidiki, cv. Eratiras, cv. Lotos, cv. Aspros lotos, cv. Pantaroza, cv. Karabola and cv. Kardia Vodiou), having comparable yield and fruit quality traits with commercial cultivars, intrapopulation "Pure line selection" method, under low-input farming conditions was applied for two years. Following this approach, we succeed to determine the level of yield potential and provide information for the nutritive value and utilization of typical tomato landraces, improving their yield and fruit quality traits, following a mild intrapopulation selection under low-input farming conditions. This data pipeline is expected to be of interest for organic farmers and processors of high nutritive tomato products, with low carbon footprint for the environment.

Leadership Development: Exploring Relational Leadership Implications in Healthcare Organizations

(1) Background: Relational Leadership Theory (RLT) has been gaining rising attention for the past 20 years with studies investigating multiple implications and practices of relationships within organizations. Yet, less attention has been given in healthcare settings. By virtue of the emerging need to move beyond exploring the quality of relationships and to move towards the exploitation of relational dynamics that influence leadership development in healthcare organizations, this study explores both the dyad relationships and the context in which those occur. With recent attention directed to the implementation of human-centered practices and the creation of effective networks to bring desired results, RLT is called on to advance this agenda within healthcare organizations. (2) Material and Methods: Research articles that examined leadership theories over the past thirty years were selected from computerized databases and manual searches. (3) Results: It is argued that the way and context in which relationships are formed between leaders and members is a social process that, in turn, shapes the effectiveness of the management of those organizations. Leadership is not rank-it is the relationship with the relational dynamics that play in the same context, creating evolutionary organizational processes. (4) Conclusions: This paper challenges leadership theory one step further. Exploring an organization through relational leadership theory is much like wearing the lens of 'cause and effect' in leadership behavioral studies. Therefore, this study contributes to this direction with a robust co-examination of relational dynamics that take place in the healthcare sector, showcasing a broader framework in which relational leadership is germinated and influences its outcomes.

The Economics of Shadow Economy in Health: The Case of Greek Physicians Sector

The article attempts to measure and report the extent and magnitude of shadow economy in Greek physicians’ sector. Tax evasion of self-employed doctors as well as informal payments to doctors in public health structures are identified as the two main parameters of shadow economy in this sector. This research attempts to create a standard multidimensional methodological model of approach and analysis of the shadow economy in physicians’ sector. This multidimensional model applied in Greece includes two phases of development of the research tools used. In the first phase, the level of tax evasion of self-employed doctors was assessed with a specific innovative methodology based on the following. Household expenditures for services of private doctors for the period 2011–2017 were analysed using data from the annual ‘Household Budget Survey-(HBS)’ of the Greek Statistical Authority and were compared with the financial data of the ‘Statistical Business Register-(SBR)’, which is updated with data from the Hellenic Tax Authority. In the second phase, the amount of ‘informal payments’ to doctors of the public sector was determined for the period 2011–2017. The survey made use of the HBS data on household expenditure for public care, which were compared with the revenue of public hospitals from private patients.

Assessment of Health Professionals' Attitudes on Radiation Protection Measures

(1) Background: Health professionals' knowledge, beliefs and perceptions concerning radiation protection may affect their behaviour during surgery and consequently influence the quality of health services. This study highlights the health professionals' average knowledge level and captures the beliefs, perceptions, and behaviours in a large public Greek hospital. (2) Materials and Methods: A cross-sectional study was carried out, including health professionals working in operating rooms. One hundred thirty-two staff members participated by responding to an original questionnaire. The sample consisted of nurses, radiographers and medical doctors of various specialties involved daily in surgical procedures where ionizing radiation is required. The survey was conducted from March to June 2021, and the response rate was 97%. (3) Results: The level of overall knowledge of health professionals regarding radiation protection safety was not satisfactory. Females and employees with a lower level of education had more misconceptions about radiation and radiation protection. Employees of younger ages and with less previous experience were more likely to have negative emotions towards radiation exposure. Finally, employees with fewer children tended to express physical complaints caused by their negative emotions due to radiation exposure. (4) Conclusions: Health professionals' lack of basic and specialized knowledge concerning radiation protection safety had a negative impact on the provision of health services. The continuing training of the staff seemed to be the only solution to reverse this trend. The training should highlight how radiation exposure can be minimized, safeguarding health professionals' trust and sense of security by significantly improving their working environment.

Ten Key Steps to Writing a Protocol for a Qualitative Research Study: A Guide for Nurses and Health Professionals

Writing a well-structured research protocol is a critical component of any research activity. It is a demanding task that requires rigor and strenuous effort especially for the novice researchers in all disciplines. The aims of the present paper are a) to demonstrate the key steps required towriting a protocol for a qualitative research study b) to assist nurses and other health professionals in effectively developing protocols on qualitative research. For this purpose, an example qualitative research protocol was used entitled “Investigating nurses’ views on care of mentally ill patients with skin injuries”. This protocol was chosen because it provides a reasonable model of proposing a qualitative research design within the field of nursing. Results of this process led to the development of a 10 key-step guide to writing a protocol for a qualitative research study. A thorough analysis of how each step of the protocol must be undertaken and accomplished is presented and supported by the relevant literature. This paper provides an informative guide for novice researchers and/or nurse students, on how to develop successful protocols on qualitative research studies that guide research and decision making in naturalistic settings.

Beliefs and behaviours of radiographers and other health professionals concerning radiation protection safety in a high-volume Greek public hospital. Development of a new measuring instrument

INTRODUCTION

The use of fluoroscopy-assisted surgical procedures has been increasing recently. The extensive use of fluoroscopy, combined with the lack of knowledge about radiation risks among operating room (OR) personnel (surgeons, anaesthetists, nurses, and radiographers), may lead to misconceptions. The perceptions and beliefs of any health professional concerning radiation protection safety (RPS) may affect their behaviour during surgery, leading to negative outcomes. The aim of this study was to construct a new, original, reliable, and valid instrument to record the beliefs, perceptions, and behaviours of health professionals during surgery, which reflects the established culture of RPS.

METHODS

A questionnaire was designed, consisting of 95 questions grouped into six coherent sections. The study was performed at a Greek public hospital with a high workload in terms of fluoroscopically guided surgical operations.

RESULTS

It was distributed among 136 people, and 132 completed questionnaires were collected (response rate 97%). Exploratory factor analysis was performed separately for each scale studied and Cronbach's Alpha reliability analysis was also performed. The reliability of the greater part of the new measurement tool ranged from very good to acceptable.

CONCLUSION

The questionnaire developed in this study is a valid and reliable option for recording health professionals' perceptions, beliefs, and behaviours concerning the RPS culture.

IMPLICATIONS FOR PRACTICE

This study helps clinical radiographers to understand a possible knowledge gap about RPS and locates the specific fields that the OR personnel misunderstand. It also can support and establish local learning organisations with regular targeted staff training for health professionals, thereby leading to a generally improved RPS culture.

Differences of mentally ill patients' satisfaction degree during their involuntary or voluntary stay in a psychiatric clinic

BACKGROUND

Mental health illness is not considered as a private matter, as it affects not only the mental patient's life and those who are considered his/her immediate family, but also the society as a whole. The involuntary examination and/or hospitalization in the field of mental health as the basic first-line therapeutic solution in Greece, calls for an immediate intervention, which is supposed to counterbalance the need for therapy and patient's rights of personal freedom and safety.

DESIGN AND METHODS

A research using questionnaire was realized, consisting of 100 hospitalized patients in psychiatric clinics (50 voluntarily and 50 involuntarily hospitalized) at the Psychiatric Hospital of Attica. The sampling scheme was the stratified sampling and the level of statistical significance was set to α=0.05.

RESULTS

The results have shown that involuntarily and voluntarily hospitalized mental patients did not differ significantly with almost the entirety of the questionnaire; however, the involuntary patients were significantly more satisfied with the conditions of hospitalization as well as assessing the overall quality of the services provided during their hospitalization.

CONCLUSIONS

For mentally ill patients, greater importance and stronger correlation with gratification, does not constitute the admission procedure to the psychiatric clinic but the development of effective communication and therapeutic relationship with the staff, full knowledge and update about patient's health condition, medication, participation in therapeutic planning and hospitalization in a regime of autonomy and respect for their rights.

Public Hospital Quality Assessment. Evidence from Greek Health Setting Using SERVQUAL Model

(1) Background: Health care service quality has been equated with preparedness to provide, accessibility, suitability, adequacy, friendliness and ongoing support and has been connected to service excellence. The main aim of this study was to investigate patients' perceptions and expectations regarding the quality of health services. (2) Materials and Methods: A cross-sectional analysis was carried out in 5 public general hospitals and convenience sampling was used as the sampling technique. Questionnaires were distributed to inpatients and outpatients and 700 valid questionnaires were returned. The SERVQUAL questionnaire was used for data collection in this survey. (3) Results: Overall, in this study, it became apparent that patients' expectations as regarding the quality of the provided services were not met. All of the five quality dimensions had a negative gap between patients' expectations and perceptions. (4) Conclusions: The findings suggested that hospital managers and health care professionals should be interested about patient expectations and subsequently they should search out ways and means to meet them. Open communication with patients, individualized attention, as well as responsiveness to their requirements, polite behavior, trustful atmosphere across the hospital and better physical facilities are the key elements that determine the patient's judgment about quality.

Learning Organizational Culture in Greek Public Hospitals

(1) Background: A learning organizational culture is crucial to the safety of patients and the quality of public health care. The aim of this study was to assess the learning organizational culture and capacity of Greek public hospitals. (2) Materials and Methods: A cross-sectional analysis was carried out in six public general hospitals and stratified sampling was used as the sampling technique. A total of 480 questionnaires were distributed to health care professionals and 380 valid questionnaires were returned (78% response rate). The comprehensive form of the Dimensions of Learning Organization Questionnaire (DLOQ), which was adapted and translated into Greek, was used for data collection in this survey. (3) Results: The level of learning organizational culture and capacity in the health units are very low. All seven dimensions of the learning organizational instrument are lower than the theoretically neutral median (3.0). Health care employees believe that the hospital’s existing culture and management practices do not foster and contribute to continuing learning, which is the fundamental aspect of self-development, department development and performance improvement. (4) Conclusions: Greek public hospitals need to adopt different types of leadership practices and culture in order to be able to facilitate organizational learning. Organizational learning (OL) is based on collaborative working, a culture that encompasses learning as participation in the organizational work practice. This transformation of culture should take place at all levels of learning to enhance results.

Assessment of Nursing Workload as a Mortality Predictor in Intensive Care Units (ICU) Using the Nursing Activities Score (NAS) Scale

Introduction: Nursing activities score scales are valuable instruments for assessing the quality of nursing care provided in critically ill patients and easy to use in validating nurse staffing. The aim of this study was the assessment of nursing workload (NW) as a predictive factor of mortality by using the nursing activities score (NAS) scale. Materials and Methods: In this cross-sectional study of 91 days during 2019, convenience sampling was employed to recruit 82 registered nurses (RN) from three intensive care units (ICUs) of two public hospitals with 41 beds in total. Data were collected using the NAS scale, the researcher’s observation, the information given by the staff, and the nursing care reports. Descriptive and inductive statistics were used with significance level α = 0.05. The Statistical Package for Social Sciences (SPSS 25.0) was used for analyzing the data. Results: Females were the majority of the sample (84.1%), with a mean age of 38.9 (7.7) years, 87.8% had a nursing degree from a technological educational institute (T.E.I), the average working experience was 14 (8.1) years and the ICU experience was 12.9 (8.5) years. There were 3764 daily records of NAS with an average of 54.81 (2.34) and total NAS of 756.51 (150.27). The NW of the first day’s admission in the ICU was 65.15 (13.05), NW was 13.15 h/day and the NW of patients who died was 57.37 (4.06). The optimal nurse/patient ratio (NPR) was 1:1.82, while the existing NPR was 1:2.86. The mortality rate was 28.7%. Conclusion: Although the study results did not demonstrate a significant correlation between NW and mortality, the NW in ICU appeared to be relatively higher for patients who died than for those who survived. This result may serve as an indication for a positive correlation between these two variables. In addition, NW was found to be moderate, while one ICU nurse can take care of more than one patient.

Advanced Therapy Medicinal Products Challenges and Perspectives in Regenerative Medicine

Recently, the design and development of a modern health policy in the field of regenerative medicine leads to the formation of a new and integrated cognitive field, which requires systematic research and study in order to produce innovative answers and best practices. Advanced therapy medicinal products (ATMPs) is a new product category, which is at the heart of concern since it has to deal with diseases in which traditional medicine has proven to be ineffective so far. The aim of this review is to provide evidence for the state of the art ATMPs and their modern applications in the field of regenerative medicine. The ATMPs are characterized by a great heterogeneity and variation in methods of isolation, which cover the entire spectrum from a single intravenous injection to a surgical placement. Clinical development of ATMP encounters specific challenges due to the nature of the product and the limited availability of non-clinical data. The gold standard of a controlled, randomized, clinical trial may not be feasible or ethically justified for all indications, particularly in life-threatening diseases, where there is no satisfactory standard of care. Therefore, the European Commission (EC) took initiatives in order to set standards and operating rules concerning authorization and supervision of ATMPs and on pharmacovigilance in relation to them. The European Union (EU) Regulation 1394/2007 provides the possibility of exceptions. In particular, the “hospital exemption” allows for the administration of an ATMP without a license on certain conditions. Although the Regulation 1394/2007 has led to the commercial exploitation of ATMPs, the reality today, 11 years after its first implementation, is completely different. While the Committee for Advanced Therapies (CAT) has already registered 285 products as ATMPs, only 10 licenses were granted which only remained six (the rest related to products withdrawn). The key players in the development and delivery of ATMPs still remain the academic/research centers and small and medium-sized enterprises; while the involvement of pharmaceutical companies is focusing on recent developments in the treatment of oncological incidents with in vitro modified cytotoxic T lymphocytes, and chimeric antigen receptor (CAR)-T cells.

Validation of Dimensions of Learning Organization Questionnaire (DLOQ) in health care setting in Greece

Background: In health care systems the organizational learning is a continuous process to improve actions through better knowledge and detect or correct errors. This study examines the validity and reliability of the Dimensions of Learning Organization Questionnaire in addition to the applicability of the instrument in a Greek health care cultural context. Design and methods: A cross-sectional study was carried out in 6 general hospitals of Attica and the sampling scheme was the stratified sampling. Questionnaires were distributed to 487 healthcare professionals and 380 valid questionnaires were returned. The research tool used in this survey is the extensive form of DLOQ, which has been adapted and translated into Greek language. Data analysis was carried out with SPSS 25. Results: Three leading experts of the health sector examined the face validity assessment of the translated DLOQ and stated that it is characterized by high face validity. As regard construct validity of the DOLQ throughout Multitrait-Multimethod Matrix, was proved that all the variables of the same factors are statistically significantly correlated (p<0.001), and their correlation coefficients have moderate to high power ranging between 0.563 and 0.798. Moreover, the discriminant validity was demonstrated as certain correlation coefficients between variables of different factors were found to be higher than of certain correlation coefficients between variables of the same factors. The internal consistency among the items of the DOLQ range between 0.842 and 0.977 and they are considered to be good to excellent. Conclusions: Our results confirmed that DLOQ is a valuable tool in measuring Learning Organizational in Greek public hospitals.

Public Health Policies in European Union: An Innovation Strategy—Horizon 2020

Health planning and policy seek to create a group of mutually interacting bodies to produce goods and services to meet the health needs of a population. Recent developments in the health status of the population are characterized by continuous improvement in life expectancy, chronic diseases which absorb 90% of total health care expenditure, differences in the causes of mortality (more than 70% mortality from cancer, heart and brain, and external causes). The new trends in health indicators define the current health policies and lead to the necessity of adapting the health system so as to meet the changing health needs of the population. Especially in the context of the changes in the epidemiological spectrum and the variability in the indices of morbidity and mortality, the focus is not only to further prolong life expectancy but also to improve life expectancy without chronic diseases and without disabilities and to reduce the avoidable mortality, the potential years of life lost before the age of 65 years. According to this approach, the main strategic priorities of health policy in the European Union for the period 2014–2020 are: (1) Prevention and health promotion (to combat diseases associated with the modern way of life), (2) Protection from cross-border threats (to address the external impact from cross-border relations, combating epidemics, pandemics), (3) Viability (to address the lack of resources by adopting innovation), (4) Accessibility (to assure the access to medical expertise).Therefore, the key priorities are the prevention of disease and the improvement of life in good health, the patient safety and quality of health services, and the readiness to manage crises and health risks.

Satisfaction degree evaluation of Elena Venizelou-Alexandra's Maternity Clinic patients

The concept of health care users' satisfaction is a complicated issue that is constantly differentiated and adapted. Aim of this study is to evaluate the satisfaction degree of the patients of Alexandra Maternity Clinic and to determine their total perception concerning the quality of health services it offers. A suitably designed questionnaire was used so as to collect all the necessary information. Although the patients seem to be satisfied with the quality of health services in total, some organizational issues, such as bureaucracy, need to be solved.

Glucose metabolism, insulin secretion and insulin sensitivity in juvenile hemochromatosis. A case report and review of the literature

Among specific diabetes subtypes secondary to pancreatopathies, hereditary hemochromatosis is an inherited disorder of iron metabolism resulting in excessive iron overload and tissue damage in various organs. We here report the case of a man with the young-onset form of the disease and describe his glycaemic status before and during venesection therapy. A 25-year old man visited our clinic in Athens, Greece, with hypogonadotropic hypogonadism due to hereditary hemochromatosis. Genetic analysis revealed that he was suffering from the juvenile aggressive form and treatment was initiated with frequent phlebotomies in conjunction with androgen substitution. Within 18 months of therapy ferritin level was normalized and hypogonadism was fully restored. Despite severe iron overload, glucose tolerance remained normal during the various stages of the disease, although alterations in both insulin secretion and sensitivity were detected. Present data indicate that in juvenile hemochromatosis, the efficacy of the chelation therapy and probably the chronic interval required to restore normal iron concentration both play important roles in the formation of glucose metabolism characteristics.

Sporadic Hypoparathyroidism Treated with Teriparatide: A Case Report and Literature Review

Herein we describe the case of a 64-year-old woman with hypoparathyroidism diagnosed at the age of 40, after an acute episode of tetany and seizures due to severe hypocalcemia. She was treated for more than 20 years with calcitriol and calcium supplementation but she presented with marked hypercalciuria and recently nephrolithiasis, although serum calcium was maintained at levels below normal range. Provided that any attempt to increase the recommended dose of calcitriol was leading to an exacerbation of hypercalciuria, we decided to enroll an alternative tool in the treatment strategy. In order to avoid further deterioration of renal function she was administered once-daily a subcutaneous (sc) injection of synthetic human parathyroid hormone (PTH 1-34) while doses of calcium and calcitriol were gradually decreased depending on the response of calcium metabolism in serum and urine samples taken periodically. Within two months of administration, PTH (1-34) significantly reduced the level of urine calcium excretion compared with calcitriol therapy and maintained serum calcium in the normal range. The relevant literature is reviewed in light of this alternative therapeutic approach in long-standing hypoparathyroidism, illustrating the potential benefits and the unresolved issues in parathyroid hormone replacement.

Effect of age on pupillary light reflex: evaluation of pupil mobility for clinical practice and research

PURPOSE

The aim of this study was to provide a data base for the measurement of various parameters of the pupil light reflex in normal subjects using a fast video pupillometry device (262 frames/sec).

METHOD

One hundred healthy subjects took part in the study aged 44.31+/-18.11 years. Subjects were divided in two (2) groups according to age: 18-50 years of age (group 1) and 51-81 years of age (group 2). All subjects were examined between 09.00 and 15.00 and the re-test examination was repeated exactly 24 hours later. All variables showed satisfactory test-retest reliability (Pearson test-retest showed values over 0. 70 for all parameters besides Time for Maximum Constriction (T3. 0.62) and Recovery (R%: 0.57)).

RESULTS

The Latency of pupil reaction to light (Ti) was not affected by Age. Baseline Pupil Radius (RI) after 2 min of dark adaptation was statistically smaller in the elderly group p < 0.001; Maximum Constriction Velocity (VCmax), Maximum Constriction Acceleration (ACmax) and Amplitude (AMP) were significantly smaller in the elderly group (p < 0.001) when compared to group 1. When all parameters were studied their correlation showed a statistical significant difference for R1, R2, VCmax, ACmax and AMP when related to Age. However when Age was taken into account through the use of partial correlation, the relation between R1, R2 and AMP remained unaltered, but the relations between R1 and VCmax and ACmax were dramatically reduced from -0.39 to -0.21 and from -0.45 to -0.09 respectively indicating that the relation observed between Ri and VCmax and ACmax was due mainly to the Age of the subjects.

CONCLUSION

The results suggest that age influences Baseline Pupil Size, Maximum Constriction Velocity (VCmax) and Acceleration (ACmax), while the Latency of the light reflex remains unaltered.

Reduced insulin secretion in normoglycaemic patients with beta-thalassaemia major

AIMS

To assess insulin sensitivity and secretion in the fasting state in regularly transfused patients with beta-thalassaemia major with normal glucose response during an oral glucose tolerance test and to estimate its possible relation to iron overload.

METHODS

We measured fasting glucose, insulin and C-peptide levels in 24 patients with beta-thalassaemia major and 18 control subjects matched for age and body mass index. Insulin sensitivity and insulin release index were calculated according to the homeostasis model assessment (HOMA). Correlations with age, body mass index and serum ferritin were also calculated.

RESULTS

Fasting glucose levels in patients were increased compared with control subjects (5.5 +/- 0.12 vs. 4.7 +/- 0.13 mmol/l, mean +/- SEM, P < 0.001). Pancreatic B-cell insulin secretion in the fasting state (estimated by SC(HOMA)) was lower in thalassaemic patients (SC(HOMA) 88.5 +/- 11.11 vs. 184.3 +/- 23.72 in control subjects, P < 0.001). Patients were then divided into those with impaired (IFG) and normal (NFG) fasting glucose. SC(HOMA) was higher in the patients with NFG compared with those with IFG patients (110.6 +/- 17.63 vs. 66.3 +/- 10.88, respectively, P < 0.05) but estimated insulin sensitivity (ISI(HOMA)) was similar. Plasma values of C-peptide correlated positively with ferritin (r = 0.42, P = 0.04) and SC(HOMA) (r = 0.45, P = 0.02) and negatively with ISI(HOMA) (r = -0.43, P = 0.03).

CONCLUSIONS

These results support the concept that impaired B-cell function, as reflected by a reduction in the insulin secretion index, is present in beta-thalassaemic patients with normoglycaemia before changes in oral glucose tolerance tests are apparent.

The role of luteinizing hormone activity in controlled ovarian stimulation

The role of LH in the natural menstrual cycle is undisputed. The active participation of LH in both steroidogenesis and ovulation is well established, but its potential effect on oocyte maturation in the issue of assisted reproduction protocols remains a topic of debate. Although several studies have added to our understanding of the specific actions of androgens in human follicular development, some discrepancies persist regarding their role in oocyte atresia. Clinical situations, where LH is either decreased or absent (e.g. in women with hypogonadotrophic hypogonadism or LH-receptor gene mutations), provide important data supporting the necessity for a minimal amount of LH to evoke ovulation. Recent use of GnRH antagonists, which results in profound suppression of LH concentration, in combination with the pharmacological production of recombinant gonadotrophins, has attracted the attention of investigators. Identification of sub-fertilized women, in whom LH administration could be beneficial and should be indicated, is arousing ever more interest. Based on the available data in the literature, the aims of this review are to assess the role of both endogenous and exogenous LH activity in stimulated cycles, and to evaluate the effects of recombinant human LH supplementation on the ovarian hormonal milieu and on the main outcomes of controlled stimulated cycles.