Psychosocial family factors and glycemic control among children aged 1-15 years with type 1 diabetes: a population-based survey

Background: Being the parents of children with diabetes is demanding. Jay Belsky’s determinants of parenting model emphasizes both the personal psychological resources, the characteristics of the child and contextual sources such as parents’ work, marital relations and social network support as important determinants for parenting. To better understand the factors influencing parental functioning among parents of children with type 1 diabetes, we aimed to investigate associations between the children’s glycated hemoglobin (HbA1c) and 1) variables related to the parents’ psychological and contextual resources, and 2) frequency of blood glucose measurement as a marker for diabetes-related parenting behavior. Methods: Mothers (n = 103) and fathers (n = 97) of 115 children younger than 16 years old participated in a population-based survey. The questionnaire comprised the Life Orientation Test, the Oslo 3-item Social Support Scale, a single question regarding perceived social limitation because of the child’s diabetes, the Relationship Satisfaction Scale and demographic and clinical variables. We investigated associations by using regression analysis. Related to the second aim hypoglycemic events, child age, diabetes duration, insulin regimen and comorbid diseases were included as covariates. Results: The mean HbA1c was 8.1%, and 29% had HbA1c ≤ 7.5%. In multiple regression analysis, lower HbA1c was associated with higher education and stronger perceptions of social limitation among the mothers. A higher frequency of blood glucose measurement was significantly associated with lower HbA1c in bivariate analysis. Higher child age was significantly associated with higher HbA1c both in bivariate and multivariate analysis. A scatterplot indicated this association to be linear. Conclusions: Most families do not reach recommended treatment goals for their child with type 1 diabetes. Concerning contextual sources of stress and support, the families who successfully reached the treatment goals had mothers with higher education and experienced a higher degree of social limitations because of the child’s diabetes. The continuous increasing HbA1c by age, also during the years before puberty, may indicate a need for further exploring the associations between child characteristics, context-related variables and parenting behavior such as factors facilitating the transfer of parents’ responsibility and motivation for continued frequent treatment tasks to their growing children

Effect of predicted low suspend pump treatment on improving glycaemic control and quality of sleep in children with type 1 diabetes and their caregivers: the QUEST randomized crossover study.

BACKGROUND: In attempting to achieve optimal metabolic control, the day-to-day management is challenging for a child with type 1 diabetes (T1D) and his family and can have a major negative impact on their quality of life. Augmenting an insulin pump with glucose sensor information leads to improved outcomes: decreased haemoglobin A1c levels, increased time in glucose target and less hypoglycaemia. Fear of nocturnal hypoglycaemia remains pervasive amongst parents, leading to chronic sleep interruption and lack of sleep for the parents and their children. The QUEST study, an open-label, single-centre randomized crossover study, aims to evaluate the impact on time in target, in hypoglycaemia and hyperglycaemia and the effect on sleep and quality of life in children with T1D, comparing a sensor-augmented pump (SAP) with predictive low glucose suspend and alerts to the use of the same insulin pump with a flash glucose measurement (FGM) device not interacting with the pump. METHODS/DESIGN: Subjects meeting the inclusion criteria are randomized to treatment with the SAP or treatment with an insulin pump and independent FGM for 5 weeks. Following a 3-week washout period, the subjects cross over to the other study arm for 5 weeks. During the week before and in the last week of treatment, the subjects and one of their caregivers wear a sleep monitor in order to obtain sleep data. The primary endpoint is the between-arm difference in percentage of time in glucose target during the final 6 days of each treatment arm, measured by a blinded continuous glucose measurement (CGM). Additional endpoints include comparison of quantity and quality of sleep as well as quality of life perception of the subjects and one of their caregivers in the two different treatment arms. Recruitment started in February 2017. A total of 36 patients are planned to be randomized. The study recruitment was completed in April 2018. DISCUSSION: With this study we will provide more information on whether insulin pump treatment combined with more technology (SmartGuard® feature and alerts) leads to better metabolic control. The inclusion of indicators on quality of sleep with less sleep interruption, less lack of sleep and perception of quality of life in both children and their primary caregivers is essential for this study and might help to guide us to further treatment improvement. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03103867 . Registered on 6 April 2017

Survey of tourism trends in Wales 1994 Management summary

SIGLEAvailable from British Library Document Supply Centre- DSC:8551.5118(1994) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Survey of tourism trends in Wales 1996 Management summary

SIGLEAvailable from British Library Document Supply Centre-DSC:8551.5118(1996) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Welsh Health Survey, 2004-2005

Abstract copyright UK Data Service and data collection copyright owner.The Welsh Health Survey (WHS) collects information about the health of people living in Wales, the way they use health services, and the factors that can affect their health. The current WHS series was conducted for the first time in 2003-2004. It was commissioned by the Welsh Assembly Government (WAG), and carried out by a consortium comprising the National Centre for Social Research, Beaufort Research Limited, and the Department of Epidemiology and Public Health at University College London. The new WHS replaces two previous study series: the previous WHS, conducted in 1995 and 1998 (the 1998 WHS is held at the UK Data Archive under SN 4176), and the Health in Wales Survey which was conducted five times in 1985, 1988, 1990, 1993 and 1996 (none are currently held at the UKDA). Users should note that results from the new WHS survey are not comparable with those from the previous surveys, because of differences in the questionnaires and survey methodology. The new WHS is designed to: provide estimates of health status, health determinants and health service usecontribute to setting and monitoring targets and indicators in the health strategies and National Service Frameworksexamine differences between population sub-groups (such as sex, age, social class) and local areasprovide a direct measurement of need for health care for National Health Service resource allocation in Walesprovide local health board- and local authority-level information for the development of joint local health, social care and well-being strategiesThe WHS is based on a representative sample of adults aged 16 and over living in private households in Wales, and also collects a limited amount of information about children in those households. Further information about the WHS, including links to publications, may be found on the Welsh Assembly Government's WHS web pages. For the second edition (February 2011), the Welsh Health Survey All Waves User Guide was added to the study documentation. Main Topics:The main topics covered in the WHS for adults are health service use, health status, illnesses and other conditions, and health-related lifestyle (including smoking, alcohol, diet and exercise). Demographic characteristics and information on medical conditions for children in the same households are also collected