Prevalent obstacles and predictors for people living with type 2 diabetes.

Background. Type 2 diabetes (T2DM) is a chronic, progressive disease with serious micro- and macrovascular complications. A person affected by T2DM should learn to accept the new restricted lifestyle. Aims. The aim of the study was to identify the prevalence of obstacles in coping with daily life for people with T2DM and the magnitude of the relationships of the obstacles with various patient characteristics. Methods. Participants were recruited from randomly selected GPs' lists in Estonia. Respondents completed the Estonian version of the Diabetes Obstacles Questionnaire (DOQ). The statements were assessed on a 5-point scale. Biomedical and clinical variables were measured. The central tendency statistics and skewness and kurtosis for all statements were computed to find out those that reflect obstacles. Then obstacles of the DOQ were stratified. Multinomial logistic regression (MLR) was computed to estimate the influences of descriptive variables on the statements. Results and Conclusions. Altogether, 138 diabetic patients were enrolled in the study. Fourteen statements were identified as obstacles. Variables such as age, type of diabetes treatment, and BMI had significant effects on five of them. Younger age, BMI, and insulin nonuse were revealed as the strongest predictive characteristics for perceiving obstacles more often in coping with daily life.

Family doctors' assessment of patient- and health care system-related factors contributing to non-adherence to diabetes mellitus guidelines.

OBJECTIVE: The aim of this study was to assess family doctors' opinions on the patient- and health care system-related factors contributing to non-adherence to diabetes mellitus clinical practice guidelines (CPG) in Estonia. RESEARCH DESIGN AND METHODS: Descriptive postal survey using a self-administered questionnaire. RESULTS: Of the 354 doctors who received the questionnaire 46% (n=163) responded. Seventy-six percent of them have type 2 diabetes guidelines. Low awareness of diabetes and its complications as well as patients' low motivation to change their lifestyle were considered to be the biggest difficulties in managing individual patients. In addition to the most often listed problems non-compliance with medical regimen, patients' financial problems and their nonattendance were mentioned. The greatest health care system-related barriers to practices providing desirable care were the lack of special diabetes education for nurses and underfunding, and an inadequate number of patients' educational materials. The patient-related issues were regarded as problems in 96% of the cases and health care system-related factors were mentioned in 79% of the cases. CONCLUSIONS: Family doctors in Estonia consider patient-related factors to be key issues in non-adherence to diabetes mellitus clinical practice guidelines.

Toxicological Investigation of Soils with the Solid-phase Flash Assay: Comparison with Other Ecotoxicological Tests.

A new direct-contact toxicity test, the solid-phase flash assay, which utilises photobacteria in direct contact with soil particles during the exposure, was evaluated on four soil samples. Samples HTNT1 and HTNT2 originated from former military sites in Germany, and were highly contaminated with nitroaromatics (approximately 20g/kg), lead and polycyclic aromatic hydrocarbons. Samples LMKW1 and LMKW2, from bioremediation stacks in Germany, were mainly contaminated with mineral oils. The solid-phase flash assay was applied to soil-water slurries, and the results were compared with the toxicity data for soil-water extracts obtained by using various conventional ecotoxicological tests, in which photobacteria, crustaceans, protozoa and algae were used as test organisms. The LMKW1 and LMKW2 samples were not toxic (EC20 > 12.5%) according to all the tests applied, except for the Photobacterium phosphoreum conventional luminescence-inhibition test for LMKW1 (15-minute EC20 = 5.4%(. The HTNT1 and HTNT2 samples were toxic according to all the tests applied, with the majority of EC20 values being lower than 1%. The solid-phase flash assay (1 minute of extraction and 30 seconds of exposure time) gave comparable results to the conventional tests. Therefore, this flash assay could be applied as a fast screening test in parallel with conventional toxicity tests that use soil 24-hour extracts. The flash assay results will be ready by the start of the conventional assays, and could serve as range-finders for these slower and more expensive tests.

Predicting the Toxicity of Oil-shale Industry Wastewater by its Phenolic Composition.

The chemical composition and toxicity of five phenolic wastewater samples collected from the Kohtla-Järve (Estonia) oil-shale industry region were analysed. The total phenolic contents (HPLC data) of these samples ranged from 0.7mg/l to 195mg/l. A total of 11 phenolic compounds were found in the wastewater samples, the most abundant being phenol (up to 84mg/l) and p-cresol (up to 74mg/l). Artificial phenolic mixtures were also composed, to mimic the content of phenolic compounds in the wastewater samples. The theoretical toxicities of these artificial mixtures were calculated by using the toxicities of the individual phenolic constituents to photobacteria (the BioTox™ test) and were assumed to have an additive mode of action. From the BioTox data, the additive toxic effects of phenolic compounds in the artificial mixtures were confirmed to be highly probable. The toxicities of the wastewater samples and their artificial phenolic analogues (mixtures) were studied by using a battery of Toxkit microbiotests (Daphtoxkit F™ magna, Thamnotoxkit F™, Protoxkit F™ and Rotoxkit F™) and three photobacterial tests (Microtox™, BioTox™ and Vibrio fischeri 1500). The wastewaters were classified as toxic (two samples), very toxic (two samples) and extremely toxic (one sample). Comparison of the test battery responses showed that the industrial wastewaters were 2-28-fold more toxic than the respective artificial phenolic mixtures. The photobacterial tests proved to be the most appropriate for screening purposes. This was the first attempt to use a test battery approach in the toxicity testing of Estonian wastewaters. The study showed that the toxicity of oil-shale industry wastewaters could not be predicted solely on the basis of their phenolic composition, since only 7-50% of their toxicity was shown to be due to phenolic compounds. It is true, to a certain extent, that the majority of environmental samples are usually very complex and contain various types of pollutants. As even a full chemical analysis (which is very expensive) can easily miss the constituent(s) with the greatest toxic effect(s), the use of toxicity tests in parallel to chemical analysis should be encouraged.

The efficiency of different phenol-degrading bacteria and activated sludges in detoxification of phenolic leachates.

Phenolic composition, toxicity and biodegradability of three different phenolic leachates/samples was studied. Samples A and C were the leachates from the oil-shale industry spent shale dumps at Kohtla-Järve, Estonia. Sample B was a laboratory-prepared synthetic mixture of 7 phenolic compounds mimmicking the phenolic composition of the leachate A. Toxicity of these 3 samples was analyzed using two photobacterial test (BioTox and Microtox), Daphnia test (DAPHTOXKIT F pulex) and rotifiers' test (ROTOXKIT F). All the LC50 values were in the range of 1-10%, leachate A being the most toxic. The growth and detoxifying potential (toxicity of the growth medium was measured using photobacterial tests) of 3 different phenol-utilizing bacteria and acclimated activated sludges was studied in shake-flask cultures. 30% leachate A (altogether 0.6 mM total phenolic compounds) was too toxic to rhodococci and they did not grow. Cell number of Kurthia sp. and Pseudomonas sp. in 30% leachate A increased by 2 orders of magnitude but despite of the growth of bacteria the toxicity of the leachate did not decrease even by 7 weeks of cultivation. However, if the activated sludge was used instead of pure bacterial cultures the toxicity of the 30% leachate A was eliminated already after 3 days of incubation. 30% samples B and C were detoxified by activated sludge even more rapidly, within 2 days. As the biodegradable part of samples A and B should be identical, the detoxification of leachate A compared to that of sample B was most probably inhibited by inorganic (e.g. sulphuric) compounds present in the leachate A. Also, the presence of toxic recalcitrant organic compounds in the leachate A (missed by chemical analysis) that were not readily biodegradable even by activated sludge consortium should not be excluded.