TY  - JOUR
A1  - Drozd, Valentina M.
A1  - Saenko, Vladimir A.
A1  - Brenner, Alina V.
A1  - Drozdovitch, Vladimir
A1  - Pashkevich, Vasilii I.
A1  - Kudelsky, Anatoliy V.
A1  - Demidchik, Yuri E.
A1  - Branovan, Igor
A1  - Shiglik, Nikolay
T1  - Major Factors Affecting Incidence of Childhood Thyroid Cancer in Belarus after the Chernobyl Accident: Do Nitrates in Drinking Water Play a Role?
JF  - PLoS One
N2  - One of the major health consequences of the Chernobyl Nuclear Power Plant accident in 1986 was a dramatic increase in incidence of thyroid cancer among those who were aged less than 18 years at the time of the accident. This increase has been directly linked in several analytic epidemiological studies to iodine-131 (I-131) thyroid doses received from the accident. However, there remains limited understanding of factors that modify the I-131-related risk. Focusing on post-Chernobyl pediatric thyroid cancer in Belarus, we reviewed evidence of the effects of radiation, thyroid screening, and iodine deficiency on regional differences in incidence rates of thyroid cancer. We also reviewed current evidence on content of nitrate in groundwater and thyroid cancer risk drawing attention to high levels of nitrates in open well water in several contaminated regions of Belarus, i.e. Gomel and Brest, related to the usage of nitrogen fertilizers. In this hypothesis generating study, based on ecological data and biological plausibility, we suggest that nitrate pollution may modify the radiation-related risk of thyroid cancer contributing to regional differences in rates of pediatric thyroid cancer in Belarus. Analytic epidemiological studies designed to evaluate joint effect of nitrate content in groundwater and radiation present a promising avenue of research and may provide useful insights into etiology of thyroid cancer.
KW  - analysis
KW  - areas
KW  - power-station accident
KW  - iodine nutrition
KW  - skin hemagioma
KW  - pooled
KW  - risk
KW  - children
KW  - radiation
KW  - exposure
KW  - radiotherapy
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-141863
VL  - 10
IS  - 9
ER  - 
TY  - JOUR
A1  - Gabriel, Katharina M. A.
A1  - Jírů-Hillmann, Steffi
A1  - Kraft, Peter
A1  - Selig, Udo
A1  - Rücker, Victoria
A1  - Mühler, Johannes
A1  - Dötter, Klaus
A1  - Keidel, Matthias
A1  - Soda, Hassan
A1  - Rascher, Alexandra
A1  - Schneider, Rolf
A1  - Pfau, Mathias
A1  - Hoffmann, Roy
A1  - Stenzel, Joachim
A1  - Benghebrid, Mohamed
A1  - Goebel, Tobias
A1  - Doerck, Sebastian
A1  - Kramer, Daniela
A1  - Haeusler, Karl Georg
A1  - Volkmann, Jens
A1  - Heuschmann, Peter U.
A1  - Fluri, Felix
T1  - Two years' experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)
JF  - BMC Neurology
N2  - Background 
Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. 

Methods 
The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals. 

Results 
Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. 

Conclusion 
The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.
KW  - pilot project
KW  - care tempis
KW  - ischemic stroke
KW  - thrombolysis
KW  - areas
KW  - time
KW  - hospitals
KW  - mortality
KW  - outcomes
KW  - quality
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229214
VL  - 20
ER  -