Early vs late histological confirmation of coeliac disease in children with new-onset type 1 diabetes

AIM Screening for coeliac disease in asymptomatic children with new-onset type 1 diabetes is controversial. The aim of this study was to analyse whether the confirmation of coeliac disease in children with new-onset type 1 diabetes and positive screening results can be postponed. METHODS This was a multicentre population-based cohort study based on the German/Austrian/Swiss/Luxembourgian Prospective Diabetes Follow-up Registry (Diabetes Patienten Verlaufsdokumentation [DPV]). Participants aged ≤18 years diagnosed with type 1 diabetes between 1995 and June 2021 and with elevated IgA tissue transglutaminase antibodies (anti-tTGA) at diabetes onset on screening for coeliac disease were included. We compared outcomes of participants with a diabetes duration of more than 1 year between those in whom coeliac disease was confirmed histologically within the first 6 months and those in whom coeliac disease was confirmed between 6 and 36 months after diabetes diagnosis. RESULTS Of 92,278 children and adolescents with a diagnosis of type 1 diabetes, 26,952 (29.2%) had documented anti-tTGA data at diabetes onset. Of these, 2340 (8.7%) had an elevated anti-tTGA level. Individuals who screened positive were younger (median age 9.0 vs 9.8 years, p<0.001) and more often female (53.1% vs 44.4%, p<0.001). A total of 533 participants (22.8% of those who screened positive) had a documented biopsy, of whom 444 had documented histological confirmation of coeliac disease. Of 411 participants with biopsy-proven coeliac disease within the first 36 months of diabetes and follow-up data, histological confirmation was performed in 264 (64.2%) within the first 6 months and in 147 (35.8%) between 6 and 36 months after diabetes onset. At follow-up (median diabetes duration 5.3 years and 5.1 years, respectively), estimated median HbA1c levels (62.8 mmol/mol vs 62.2 mmol/mol [7.9% vs 7.8%]), cardiovascular risk markers (lipids, rate of microalbuminuria, blood pressure), rates of acute diabetes complications (diabetic ketoacidosis, severe hypoglycaemia) and the proportions of participants reaching anti-tTGA levels within the normal range did not differ between groups. Participants with delayed histological confirmation of coeliac disease showed no negative effects on growth or weight gain during the observation period. CONCLUSIONS Our study suggests that the histological confirmation of coeliac disease in asymptomatic individuals with new-onset type 1 diabetes could be postponed

Berufliche Rehabilitation: Fakten - Analysen - Entwicklungstendenzen; Evaluation von Leistungen zur Teilhabe behinderter Menschen am Arbeitsleben; Zwischenbericht

Die Leistungen zur Teilhabe behinderter Menschen am Arbeitsleben in den Bereichen der Arbeitsförderung und der Grundsicherung für Arbeitsuchende sind eine bedeutende Komponente der Arbeitsmarktpolitik. Mit der mehrstufig angelegten Evaluation von Leistungen zur Teilhabe behinderter Menschen am Arbeitsleben sollen Ansatzpunkte für die Optimierung der praktischen Umsetzung und die Fortentwicklung des rechtlichen Rahmens dieser Leistungen ermittelt werden. Bislang wurden drei Forschungsmodule durchgeführt. Deren Ergebnisse werden mit dem hier vorliegenden Bericht veröffentlicht. Inhaltsverzeichnis: Teil A: Basisstudie zur Evaluation von Leistungen zur Teilhabe behinderter Menschen am Arbeitsleben; Zusammenfassender Bericht. Teil B: Implementationsstudie 1 zur Evaluation von Leistungen zur Teilhabe behinderter Menschen am Arbeitsleben; Zusammenfassender Bericht. Teil C: Beratung zu wirkungsanalytischen Ansätzen für die Evaluation von Leistungen zur Teilhabe behinderter Menschen am Arbeitsleben: Zusammenfassender Bericht

Transition to suicide ideation and attempt among emergency room patients

Background Suicidal thoughts and behaviours (STB) represent a persistent and serious public health problem, and suicide is among the leading causes of death worldwide. We focus on predictors of transition rates and time courses through the STB spectrum among psychiatric emergency room (PER) patients. Aims We aimed to investigate (a) whether currently suicidal patients had prior referrals to the PER, (b) for which reason they were previously referred to the PER and (c) the timing of this referral. Method We performed a retrospective study spanning 20 years with 24 815 PER referrals. Descriptive statistics of patients’ sociodemographic and clinical characteristics are provided and expressed as weighted proportions and means. Logistic regression was used to identify risk profiles of patients who had a higher chance of being referred for reasons of STB given their PER history. Multiple imputation and data weighting techniques were implemented. Results STB among PER patients was persistent and led to repeated referrals (up to five times more likely), often within a short period (18% <1 month). Those previously referred for ideation/plan had 66% higher risk of making the transition to suicide attempt, with 25% making this transition within a month after previous referral. This is similar to the transition from depressed mood to suicide ideation/plan. Conclusions STBs in PER patients are persistent and lead to repeated referrals, often within a short period, including transitions to more severe forms of STB