Is twelve years old an acceptable age at which to begin Diabetic Retinopathy Screening?

Introduction: The English National Screening Programme for diabetic retinopathy (ENSPDR) states that “all people with diabetes aged 12 years and over should be offered screening” Purpose: The audit aims to assess whether the current guideline is suitable and whether diabetes duration should be taken into account when deciding at what age to start screening patients. Method: Retrospective analysis of 143 randomly selected patients aged twelve years or younger who have attended diabetic retinopathy (DR) screening in the Birmingham and Black Country Screening Programme. Results: 98% had Type 1 diabetes and mean visual acuity (VA) was 6/5 (6/4-6/36). 73 were under 12 with 7 the youngest age and 70 were aged 12. Both groups had mean diabetes duration of 5 years (1month-11years). For those under 12, 7/73 (9.6%) had background DR, of these mean diabetes duration was 7 years (6-8) and the youngest aged 8. In those aged 12, 5/70 (7.1%) had background DR; of these mean diabetes duration was 8 years (6-11). In total 12 (8.4%) patients aged 12 years or under developed DR. No patients had retinopathy worse than background changes. One patient was referred to ophthalmology for VAs of 6/12, 6/18 and was diagnosed with optic atrophy so returned to annual screening. Conclusion: The results suggest that the current guideline on when to begin screening should be readdressed as more patients under twelve developed DR than those aged 12. Diabetes duration may help when deciding what age to start screening adolescent patients as DR was not seen in those with disease duration.

Language change in young Panjabi/English children: implications for bilingual language assessment

This paper reports some of the more frequent language changes in Panjabi, the first language of bilingual Panjabi/English children in the West Midlands, UK. Spontaneous spoken data were collected in schools across both languages in three formatted elicitation procedures from 50 bilingual Panjabi/English-speaking children, aged 6–7 years old. Panjabi data from the children is analysed for lexical borrowings and code-switching with English. Several changes of vocabulary and word grammar patterns in Panjabi are identified, many due to interaction with English, and some due to developmental features of Panjabi. There is also evidence of pervasive changes of word order, suggesting a shift in Panjabi word order to that of English. Lexical choice is discussed in terms of language change rather than language deficit. The implications of a normative framework for comparison are explored. A psycholinguistic model interprets grammatical changes in Panjabi.