Is childhood type 1 diabetes a wealth-related disease? An ecological analysis of European incidence rates

Aims/Hypothesis: To describe the epidemiology of childhood-onset Type 1 (insulin-dependent) diabetes in Europe, the EURODIAB collaborative group has established prospective, geographically-defined registers of children diagnosed under 15 years. A total of 16,362 cases were registered by 44 centres during the period 1989-1994. The registers cover a population of approximately 28 million children with most European countries represented. Methods In most centres a primary and a secondary source of ascertainment were used so that the completeness of registration could be assessed by the capture-recapture method. Ecological correlation and regression analyses were used to study the relationship between incidence and various environmental, health and economic indicators. Findings: The standardised average annual incidence rate during the period 1989-94 ranged from 3.2 cases per 100,000 per annum in the Former Yugoslavian Republic of Macedonia to 40.2 cases per 100,000 per annum in Finland. Indicators of national prosperity such as infant mortality (r= -0.64) and gross domestic product (r= 0.58) were most strongly and significantly correlated with incidence rate, and previously-reported associations with coffee consumption (r= 0.51), milk consumption (r= 0.58) and latitude (r= 0.40) were also observed. Conclusion/Interpretation: The wide variation in childhood type 1 diabetes incidence rates within Europe could be partially explained by indicators of national prosperity. These indicators could reflect differences in environmental risk factors such as nutrition or lifestyle that are important in determining a country's incidence rate.

Decision making in childhood asthma exacerbation – a clinical judgement analysis

Background: Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors on the basis of their knowledge and experience. These include administration of systemic corticosteroids (CS), oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making. Methods: Stepwise linear regression was used to select clinical cues based on visual analogue scale assessments of the propensity of 62 clinicians to prescribe a short course of oral CS (decision 1), a course of antibiotics (decision 2), and/or admit to hospital (decision 3) for 60 â??paperâ?? patients. Results:When compared by specialty, paediatriciansâ?? models for decision 1 were more likely to include as a cue level of alertness (54% v. 16%); for decision 2 presence of crepitations (49% v. 16%), and less likely to include inhaled CS (8% v. 40%), respiratory rate (0% v. 24%), and air entry (70% v. 100%). When compared to other grades, the models derived for decision 3 by consultants/general practitioners were more likely to include wheeze severity as a cue (39% v. 6%). Conclusions: Clinicians differed in their use of individual cues and the number included in their models. Patient safety and quality of care will benefit from clarification of decision making strategies as general learning points during medical training, in the development of guidelines and care pathways, and by clinicians developing self-awareness of their own preferences.

Widening our knowledge concerning young looked after children: the case for research using sociological models of childhood

The Assessment and Action framework for looked after children, designed to improve outcomes for all children in public care and those at home on care orders, is now well established in the UK. This paper offers a critical evaluation of the framework by examining the model of childhood upon which it is premised and by exploring its relationship to children's rights as conceptualized in the United Nations Convention on the Rights of the Child (1989). It will be argued that the particular child development model which underpins the framework addresses the rights of looked after children to protection and provision but does not allow for their participation rights to be sufficiently addressed. A critical review of the research concerning the education and health of looked after children is used to illustrate these points. It will be argued that what are missing are the detailed accounts of looked after children themselves. It is concluded that there is a need for the development of additional research approaches premised upon sociological models of childhood. These would allow for a greater engagement with the participation rights of this group of children and complement the pre-existing research agenda

Rates of childhood trauma in a sample of patients with schizophrenia as compared with a sample of patients with non-psychotic psychiatric diagnoses

Despite strong evidence of high rates of childhood and adult trauma in schizophrenia, the area remains under-researched. Our objectives in the study were first, to examine the rates of exposure to childhood, adult and lifetime (child plus adult) trauma in a population with schizophrenia and a population with non-psychotic psychiatric diagnoses and second, to examine the effect of trauma on the symptoms of schizophrenia. Two groups, those with schizophrenia (n = 40), and those with a non-psychotic diagnosis (n = 30), were recruited. Data were collected for demographic, psychiatric and trauma histories for all participants and on psychosocial functioning and psychiatric symptomatology for the patients with schizophrenia. Childhood exposure to trauma was significantly more common in the schizophrenia group (t = 5.196, df = 68, p <0.001, Eta squared = 0.28), with the strongest relationship being childhood physical assault. In the schizophrenia group a history of trauma was significantly related to poor communication skills (r = -0.529, p <0.001) and depressive symptoms (r = 0.443, p = 0.004). Evidence that childhood exposure to trauma is more common in a population with schizophrenia is consistent with other studies and raises the possibility that such trauma is of etiological importance. Further research is required to replicate those findings, to elucidate possible pathways by which the experience of trauma may contribute to the development of schizophrenia, and to explore the relationship between a history of childhood trauma and the experience of depressive symptoms in schizophrenia.

A meta-analysis of the association between Caesarean section and childhood asthma

Background: Children born by Caesarean section have modified intestinal bacterial colonization and consequently may have an increased risk of developing asthma under the hygiene hypothesis. The results of previous studies that have investigated the association between Caesarean section and asthma have been conflicting.

Objective: To review published literature and perform a meta-analysis summarizing the evidence in support of an association between children born by Caesarean section and asthma.

Methods: MEDLINE, Web Science, Google Scholar and PubMed were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated for each study from the reported prevalence of asthma in children born by Caesarean section and in control children. Meta-analysis was then used to derive a combined OR and test for heterogeneity in the findings between studies.

Results: Twenty-three studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by Caesarean section (OR=1.22, 95% CI 1.14, 1.29). However, in this analysis, there was evidence of heterogeneity (I2=46%) that was statistically significant (P<0.001). Restricting the analysis to childhood studies, this heterogeneity was markedly decreased (I2=32%) and no longer attained statistical significance (P=0.08). In these studies, there was also evidence of an increase (P<0.001) in the risk of asthma after Caesarean section (OR=1.20, 95% CI 1.14, 12.6).

Conclusion: In this meta-analysis, we found a 20% increase in the subsequent risk of asthma in children who had been delivered by Caesarean section.

Prevalence of childhood abuse in mothers taking part in a study of parenting their own children.

This paper describes the incidence of maltreatment histories in a community sample of mothers of one-year old infants in Northern Ireland. The occurrence of five subsets of childhood maltreatment is examined: emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse. Of the 201 women who completed the Childhood Trauma Questionnaire (CTQ), 70 mothers (35%) reported experiencing one or more types of maltreatment during childhood. Forty-eight mothers (24%) gave a history of being emotionally abused, 43 (21%) of emotional neglect, 27 (13%) of physical abuse, 20 (10%) of sexual abuse, and 19 (10%) of physical neglect. Physical abuse was the only type of maltreatment which showed an association with maternal socio-economic status, with higher incidence reported amongst Occupational Classes 4 and 5 (lower supervisory and technical occupations and semi-routine and routine groups). More than half of those with a history of abuse experienced more than one type of maltreatment (42 mothers or 60% of those reporting maltreatment). Differences in rates of incidence to more recent studies on younger adults are discussed, as well as implications for prevention and intervention.

A Longitudinal Study of the Effects of Childhood Trauma on Symptoms and Functioning of People with Severe Mental Health Problems

This study examines the relationship between childhood trauma and the psychiatric symptoms and psychosocial functioning of adults with severe mental health problems. Participants (n = 31) were recruited from the caseloads of community mental health services in Northern Ireland and assessed at baseline, 9 months, and 18 months. More than half had a history of childhood trauma (n = 17). There were no differences between the no childhood trauma (n = 14) and childhood trauma groups on psychiatric symptoms, but a significant relationship was found between trauma history and all aspects of social functioning. Those with no history of trauma showed improved psychosocial functioning over time, whereas those with a history of trauma deteriorated. These findings have implications for current service provision.