A systematic review of publicity interventions to increase awareness amongst healthcare professionals and the public to promote earlier diagnosis of type 1 diabetes in children and young people

Read the full text ePDF PDF ePDFPDF PDF Tools Share Abstract Background Children with new onset type 1 diabetes (T1D) are at risk of developing the life‐threatening condition ketoacidosis if they have a delayed diagnosis. The rate of children presenting in ketoacidosis remains high in a number of countries worldwide. To ensure interventions to raise awareness of symptoms are effective a systematic review was conducted to evaluate previous publicity campaigns. Methods A range of databases was searched using search terms relating to T1D, publicity campaigns, and symptom awareness. Identified articles were checked against the inclusion criteria, ensuring interventions were designed to target individuals prior to diagnosis of T1D. Papers were independently assessed under the criteria specified within the Critical Appraisal Skills Programme checklist. Results The initial search retrieved 1537 papers and following screening 20 were identified for full consideration. Thirteen did not meet the inclusion criteria, leaving 7 to be assessed. Of these 7, 2 observational case‐control studies reported a reduction in the rate of ketoacidosis following a publicity campaign using posters and providing glucose testing equipment to primary healthcare professionals. Four observational cohort studies, utilized posters, and media campaigns; 2 reported a reduction in the rate of ketoacidosis and 2 reported no difference following their interventions. A feasibility study, not designed to evaluate effectiveness, reported some anecdotal evidence of a more timely diagnosis. Conclusion Due to the methodological limitations of the studies identified, it is not possible to make a definitive conclusion on the effectiveness of the interventions reported

Assessing the Risk of 100-year Freshwater Floods in the Lamprey River Watershed of New Hampshire Resulting from Changes in Climate and Land Use

What is the coastal resource issue the project sought to address? Both the magnitude and frequency of freshwater flooding is on the rise in seacoast NH and around much of New England. In the Great Bay watershed, this is the result of two primary causes: 1) increases in impervious surface stemming from a three-to-four fold increase in developed land since 1962; and 2) changing rainfall patterns in part exemplified by a doubling in the frequency of extreme weather events that drop more than 4 inches of precipitation in less than 48 hours (Wake et al., 2011) over the same time period. Moreover, the size of the 100-year precipitation event in this region has increased 26% from 6.3 inches to 8.5 inches from the mid 1950’s to 2010 (NRCC and NRCS, 2012). One consequence is the occurrence of three 100-year floods measured on the Lamprey River at Packers Falls since 1987, and a fourth if the three days of flooding in March of 2010 had occurred instead in two days (Figure 1). Flooding events are expected to continue to increase in magnitude and frequency as land in the watershed is further developed and climate continues to change in response to anthropogenic forcing (e.g., Hayhoe et el., 2007; IPCC, 2007; Karl et al., 2009). Land use management strategies, in particular low impact development (LID) zoning requirements, are one strategy that communities can employ for increased resiliency to flooding with the greatest influence in urban environments

Assessing the Risk of 100-year Freshwater Floods in the Lamprey River Watershed of New Hampshire Resulting from Changes in Climate and Land Use

What is the coastal resource issue the project sought to address? Both the magnitude and frequency of freshwater flooding is on the rise in seacoast NH and around much of New England. In the Great Bay watershed, this is the result of two primary causes: 1) increases in impervious surface stemming from a three-to-four fold increase in developed land since 1962; and 2) changing rainfall patterns in part exemplified by a doubling in the frequency of extreme weather events that drop more than 4 inches of precipitation in less than 48 hours (Wake et al., 2011) over the same time period. Moreover, the size of the 100-year precipitation event in this region has increased 26% from 6.3 inches to 8.5 inches from the mid 1950’s to 2010 (NRCC and NRCS, 2012). One consequence is the occurrence of three 100-year floods measured on the Lamprey River at Packers Falls since 1987, and a fourth if the three days of flooding in March of 2010 had occurred instead in two days (Figure 1). Flooding events are expected to continue to increase in magnitude and frequency as land in the watershed is further developed and climate continues to change in response to anthropogenic forcing (e.g., Hayhoe et el., 2007; IPCC, 2007; Karl et al., 2009). Land use management strategies, in particular low impact development (LID) zoning requirements, are one strategy that communities can employ for increased resiliency to flooding with the greatest influence in urban environments

Developing and evaluating a model of public involvement and engagement embedded in a national longitudinal study : HealthWise Wales

Acknowledgements: We acknowledge and thank the contribution of all the HWW Champion and Supporters who provided input to the protocol, collaborated with the research team and attended the events. We also thank Ameeta Richardson who helped facilitate the HWW Champion model. Funding HWW is funded by Health and Care Research Wales.Peer reviewedPublisher PD

Demographic and socioeconomic patterns in the risk of alcohol-related hospital admission in children and young adults with childhood onset type-1 diabetes from a record-linked longitudinal population cohort study in Wales

Acknowledgements AG was funded by the National Centre for Population Health and Wellbeing Research Wales (WCPHWR), and SP, DF, and JG are members of the NCPHWR team in Cardiff University. We would like to thank the Brecon Group (which comprises all paediatricians and paediatric diabetes healthcare staff in Wales with an interest in Diabetes and endocrinology). The Brecon Group was supported initially by grants from NovoNordisk and subsequently the Welsh Government. Funds from the Economic and Social Research Council, the Medical Research Council, and Alcohol Research UK supported the establishment of the ELASTiC data platform.This study used anonymised data held in the Secure Anonymised Information Linkage (SAIL) Databank. We would like to acknowledge all the data providers who enable SAIL to make anonymised data available for research. Data sharing The datasets used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP gives careful consideration to each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy-protecting safe haven and remote access system referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process. Funding information: Alcohol Research UK; Medical Research Council; Economic and Social Research Council; Welsh Government; Novo Nordisk; Brecon Group; National Centre for Population Health and Wellbeing Research WalesPeer reviewedPostprintPublisher PD

Cost-effectiveness of home versus hospital management of children at onset of Type 1 Diabetes: The DECIDE randomised controlled trial

Objective The aim of this economic evaluation was to assess whether home management could represent a cost-effective strategy in the patient pathway of Type 1 diabetes (T1D). This is based on the DECIDE trial (ISRCTN78114042), which compared home versus hospital management from diagnosis in childhood diabetes and found no statistically significant difference in glycaemic control at 24 months. Design Cost-effectiveness analysis alongside a randomised controlled trial. Setting Eight paediatric diabetes centres in England, Wales and Northern Ireland. Participants 203 clinically well children aged under 17 years, with newly diagnosed type 1 diabetes and their carers. Outcome measures The base case analysis adopted an NHS perspective. A scenario analysis assessed costs from a broader societal perspective. The incremental cost-effectiveness ratio (ICER) expressed as cost per mmol/mol reduction in HbA1c, was based on the mean difference in costs between the home and hospital groups, divided by mean differences in effectiveness (HbA1c). Uncertainty was considered in terms of the probability of cost-effectiveness. Results At 24 months post-intervention, the base case analysis showed a difference in costs between home and hospital, in favour of home management (mean difference -£2,217; 95% CI -£2,825 to -£1,609; p<0.001). Home care dominated, with an ICER of £7,434 (saved) per mmol/mol reduction of HbA1c. The results of the scenario analysis also favoured home management. The greatest driver of cost differences was hospitalisation during the initiation period. Conclusions Home management from diagnosis of children with T1D who are medically stable represents a less costly approach for the NHS in the UK, without impacting clinical effectiveness

Presentation to primary care during the prodrome of type 1 diabetes in childhood: A case-control study using record data linkage

Objective To evaluate primary care presentations during the prodrome (12 months prior to onset type‐1 diabetes (T1D), with or without diabetic ketoacidosis [DKA]), to identify opportunities for earlier diagnosis. Methods This was a case‐control study, linking 16 years of data from children (≤15 years) registered at diagnosis of T1D, and routinely collected primary care records in Wales (United Kingdom). Controls (without T1D) were matched on a 3:1 ratio. Conditional logistic regression modeling was used to compare characteristics occurring in cases (children with T1D) and controls; and cases that presented with/without DKA. Results A total of 1345 children with T1D (19% DKA) and 4035 controls were identified. During the 12 months prior to diagnosis, cases were 6.5 times more likely to have at least one primary care contact (P < 0.001). One to 30 days prior to diagnosis, contacts relating to blood tests, fungal conditions, respiratory tract infections (RTIs), urinary conditions, vomiting, and weight were independently associated with T1D, as were contacts relating to blood tests, between 91 and 180 days prior to diagnosis. Children with a contact up to a month prior to diagnosis, relating to RTIs, antibiotic prescriptions, and vomiting, were more likely to present in DKA, as were boys (P = 0.047). Conclusion There are opportunities in primary care for an earlier diagnosis of T1D in childhood. These data could be used to create a predictive diagnostic tool, as a potential aid for primary care health professionals, to prevent presentation in DKA