A longitudinal observational study of insulin therapy and glycaemic control in Scottish children with Type 1 diabetes: DIABAUD 3

Objective/background Our objective was to investigate glycaemic control in children with Type 1 diabetes in Scotland and to analyse the effect of changing 'conventional' insulin regimen strategies on outcome. DIABAUD 2 ( 1997 - 1998) (D2) demonstrated that average glycaemic control in young people with Type 1 diabetes in Scotland was poor, with mean HbA(1c) of 9.0%. Over 90% were then treated with a twice-daily insulin regimen. The aim of DIABAUD 3 ( 2002 2004) (D3) was to determine if control had improved, and to examine changes in insulin regimen and effects on glycaemic control.

Infections and vaccinations as risk factors for childhood type I (insulin-dependent) diabetes mellitus: a multicentre case-control investigation.

AIMS/HYPOTHESIS: To determine if vaccinations and infections are associated with the subsequent risk of Type I (insulin-dependent) diabetes mellitus in childhood. METHOD: Seven centres in Europe with access to population-based registers of children with Type I diabetes diagnosed under 15 years of age participated in a case-control study of environmental risk factors. Control children were chosen at random in each centre either from population registers or from schools and policlinics. Data on maternal and neonatal infections, common childhood infections and vaccinations were obtained for 900 cases and 2302 control children from hospital and clinic records and from parental responses to a questionnaire or interview. RESULTS: Infections early in the child's life noted in the hospital record were found to be associated with an increased risk of diabetes, although the odds ratio of 1.61 (95% confidence limits 1.11, 2.33) was significant only after adjustment for confounding variables. None of the common childhood infectious diseases was found to be associated with diabetes and neither was there evidence that any common childhood vaccination modified the risk of diabetes. Pre-school day-care attendance, a proxy measure for total infectious disease exposure in early childhood, was found, however, to be inversely associated with diabetes, with a pooled odds ratio of 0.59 (95% confidence limits 0.46, 0.76) after adjustment for confounding variables. CONCLUSION/INTERPRETATION: It seems likely that the explanation for these contrasting findings of an increased risk associated with perinatal infections coupled with a protective effect of pre-school day care lies in the age-dependent modifying influence of infections on the developing immune system.

Action research and reflective practice: towards a holistic view

Two concepts that have captured the imagination of the educational community in the last 60 years have been those of ‘reflective practice’ and ‘action research’. Both, in their various forms, are considered to be critical dimensions of the professional development of teachers. However, whilst both were receiving academic attention during the 1930s and 1940s (Lewin, 1934, cited in Adelman, 1993; Lewin, 1946; Dewey, 1933), it was not until Stenhouse’s (1975) notion of the teacher-as-researcher that the two came most compellingly into relationship and educational action research as a process, which held at its centre different kinds of reflection, began to be reformulated in Britain (Carr, 1993). This article considers the important part played in teachers’ development by different kinds of action research. Its central thesis is that, although action research has a critical role to play not least as a means of building the capacity of teachers as researchers of their own practice, there has been insufficient attention given to both the nature of reflection in the action research process, and its relationship to the purposes, processes and outcomes. The article challenges the rational, cognitive models of reflection that are implicit in much of the action research literature. It suggests that more attention needs to be given to the importance of the role of emotion in understanding and developing the capacities for reflection which facilitates personal, professional and ultimately system change.