Aims: Determine incidence, prevalence and mortality of Type 1 diabetes (T1D) in children and youth <25 years (y) in Mali during the first 10 years of the Santé Diabète/Life for a Child program. Methods: Data were collected from the prospective program register. Diagnosis of T1D was clinical, based on presentation, clinical features, immediate requirement for insulin, and no suggestion of other diabetes types.Results: Total of 460 cases were diagnosed with T1D <25 years in 2007-2016.
Introduction Extraction of decayed teeth is the most common reason for UK children aged 5-9 years to receive a general anaesthetic. Inequalities in oral health are well recognised, but is under-explored in dental general anaesthesia (DGA).Methods Secondary analysis of routinely collected data from three local authorities in South West England was used to assess: 1) dental activities recorded for children <18 years attending NHS general dental practitioners (GDP); 2) the incidence rate of DGA and disease severity among <16-year-olds; and 3) individual and neighbourhood factors associated with higher rates of child DGA, and greater severity of disease.Results Among 208,533 GDP appointments, rates of preventive action were low where 1/7 included fluoride varnish but 1/5 included permanent fillings. The incidence rate of DGA was 6.6 admissions for every 1,000 children, rising to 12.4/1,000 among 5-9-year-olds. A total of 86 (7.6%) children had previously received a DGA at the same hospital. Area deprivation was strongly associated with higher rates of DGA, but rates of DGA remained high in less deprived areas. No associations were observed between number of teeth removed and socio-economic status.Conclusion Too many children are receiving DGA, and too few preventive actions are recorded by GDPs. Area-based inequalities in DGA were apparent, but wealthy areas also experienced substantial childhood dental decay.
Most patients attained the RDI benchmark; however dose intensity reducing events occurred frequently. Despite contrary recommendations in the literature, BSA capping and dose reduction due to patient choice were common. Implementation of focused patient and physician education strategies may improve these results, as could measures directed as supporting those at risk (i.e. elderly or obese).
X-linked hypophosphataemia (XLH), the most common inherited form of rickets, is caused by a PHEX gene mutation that leads to excessive serum levels of fibroblast growth factor 23 (FGF23). This leads to clinical manifestations such as rickets, osteomalacia, pain, lower limb deformity and overall diminished quality of life. The overarching aims in the management of children with XLH are to improve quality of life by reducing overall burden of disease, optimise an individual's participation in daily activities and promote normal physical and psychological development. Burosumab, a monoclonal antibody targeting FGF23, has been shown to improve biochemistry, pain, function and radiological features of rickets in children with XLH and has transformed management of XLH around the world. Burosumab has been recently approved for clinical use in children with XLH in Australia. This manuscript outlines a clinical practice guideline for the use of burosumab in children with XLH to assist local clinicians, encourage consistency of management across Australia and suggest future directions for management and research. This guideline also strongly advocates for all patients with XLH to have multidisciplinary team involvement to ensure optimal care outcomes and highlights the need to consider other aspects of care for XLH in the era of burosumab, including transition to adult care and the effective coordination of care between local health-care providers and specialist services.
Aim
To determine patient/carer expectations of continuous glucose monitoring (CGM) and short‐term satisfaction, to assess the efficacy of CGM in improving: fear of hypoglycaemia and glycaemic control (HbA1c, ketosis, hypoglycaemia) and to determine time requirements of diabetes clinic staff in commencing and administering CGM.
Methods
We assessed CGM‐naïve patients starting on CGM at a Sydney Diabetes Centre following the introduction of a nationwide government subsidy for CGM. A standardised questionnaire was administered collecting demographic and glycaemic information in addition to Likert scale assessment of expectations and satisfaction. Clinic staff reported time dedicated to CGM education, commencement and follow‐up.
Results
A total of 55 patients or parents/carers completed baseline questionnaires, with 37 completing a 3‐month follow‐up questionnaire. There were high expectations of CGM prior to commencement and high satisfaction ratings on follow‐up. CGM improved fear of hypoglycaemia, and total daily insulin dose increased after commencement of CGM. There was a trend towards lower HbA1c that was not statistically significant and no statistically significant reduction in ketosis or hypoglycaemia. Comments were mostly positive, with some concern raised regarding technical issues and a lack of subsidy after 21 years of age. Staff time requirements were substantial, with an estimated average of 7.7 h per patient per year.
Conclusions
Patients and families have high expectations of CGM, and satisfaction levels are high in the short term. Total insulin delivery increased after CGM commencement. Time requirements by staff are substantial but are worthwhile if families' overall satisfaction levels are high.
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