Use of medical identification jewellery in children and young adults with adrenal insufficiency in Australia

Chrisp, Georgina L; Quartararo, Maria; Torpy, David J.; Falhammar, Henrik; Rushworth, R. Louise

doi:10.1007/s12020-020-02595-9

Cited by 7 publications

(9 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While limitations in access to reliable data are considerable in this age group, indirect evidence on effectiveness of preventive interventions may be obtained from secondary data sources. One study used data on medical jewellery uptake in patients aged up to 24 years and found that subscriptions diminished among emerging adults, reflecting clinical experience which indicates that adherence to AC prevention recommendations diminishes in this age group [ 37 ].…”

Section: Ac Incidence Morbidity and Mortalitymentioning

confidence: 99%

Adrenal crises in adolescents and young adults

et al. 2022

Self Cite

View full text Add to dashboard Cite

Purpose Review the literature concerning adrenal insufficiency (AI) and adrenal crisis (AC) in adolescents and young adults. Methods Searches of PubMed identifying relevant reports up to March 2022. Results AI is rare disorder that requires lifelong glucocorticoid replacement therapy and is associated with substantial morbidity and occasional mortality among adolescents and young adults. Aetiologies in this age group are more commonly congenital, with acquired causes, resulting from tumours in the hypothalamic-pituitary area and autoimmune adrenalitis among others, increasing with age. All patients with AI are at risk of AC, which have an estimated incidence of 6 to 8 ACs/100 patient years. Prevention of ACs includes use of educational interventions to achieve competency in dose escalation and parenteral glucocorticoid administration during times of physiological stress, such as an intercurrent infection. While the incidence of AI/AC in young children and adults has been documented, there are few studies focussed on the AC occurrence in adolescents and young adults with AI. This is despite the range of developmental, psychosocial, and structural changes that can interfere with chronic disease management during this important period of growth and development. Conclusion In this review, we examine the current state of knowledge of AC epidemiology in emerging adults; examine the causes of ACs in this age group; and suggest areas for further investigation that are aimed at reducing the incidence and health impact of ACs in these patients.

show abstract

Section: Ac Incidence Morbidity and Mortalitymentioning

confidence: 99%

Adrenal crises in adolescents and young adults

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…The geographical variations in subscription rates may also re ect a local relationship between clinicians and the provider, as the head o ce was initially based in Western Australia and is now based in South Australia. Notably, a similar pattern of uptake in Western Australia and South Australia was found in both the adult and paediatric populations of people with adrenal insu ciency, emphasising the impact of local factors in uptake, irrespective of the disease [22,23]. It may be that variations in practice among diabetes physicians or diabetes educators between states underlie the very different rates of uptake and this is a factor that could be investigated.…”

Section: Discussionmentioning

confidence: 66%

“…The impact of social factors in determining usage of medical identi cation jewellery is emphasised by the similar uptake patterns found in children and adolescents with adrenal insu ciency, where usage was low in those aged under 4 years, increased with age, peaked in teenagers, and dropped off signi cantly in early adulthood [23].…”

Section: Discussionmentioning

confidence: 92%

“…It is underscored by the transition from paediatric to adult healthcare, which is a time where people with T1DM are at high risk for loss to follow-up, poor glycaemic control and increased hospitalisations [23,24]. Moreover, it is typically during these years that alcohol and other recreational substances become increasingly prevalent in social settings, which has been associated with impaired diabetes selfmanagement and hypoglycaemia [25,26].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An analysis of the utilisation of medical identification jewellery among children and young adults with type 1 diabetes mellitus in Australia

Heath

Torpy

Rushworth

2022

Preprint

View full text Add to dashboard Cite

Aims People with type 1 diabetes mellitus (T1DM) are at risk of life-threatening illness. Medical jewellery is recommended for emergencies, but its uptake is unknown. This study assessed the use of medical jewellery among people with T1DM aged 0–24 years in Australia. Methods A cross sectional analysis of subscription data to the largest medical identification jewellery service in Australia was analysed by age, sex and geographic location using Australian population data from 2018. Results There were 1599 people with T1DM aged 0–24 in the database, but only 1061 had an active subscription, corresponding to an active subscription rate of 13.28/100,000 population or approximately 5% of the estimated patient population. Half of the active subscribers were male (543/1061, 51/3%). The average age of active subscribers was 17; very few (n = 12, 1.1%) were aged less than 5; and the highest number (n = 141, 39%) was in the 20–24 age group. Active subscription rates varied significantly by geographic location. 88.4% of active subscribers had a diagnosis of T1DM or equivalent inscribed on their emblem, while engraved instructions for management in an emergency were only included in 1.8% of records (n = 19). Conclusions Medical jewellery subscription rates were lower than expected; increased with age; and varied significantly by state/territory. The use of medical identification jewellery may be limited by the lack of suitable engraved instructions for use in an emergency. Factors leading to low use should be addressed.

show abstract

“…In Australia, this typically occurs after 18 years of age, when young people are required to move from the paediatric environment to the less well-defined setting of adult healthcare services. Accessing developmentally appropriate support for these patients may be difficult, particularly in non-urban areas, and financial burdens may lead to lower levels of engagement with healthcare services and lower levels of use of appropriate management and AC preventative strategies in this age group ( 28 ). It is likely that these vulnerabilities vary between individuals, and that other factors, such as use of recreational drugs and alcohol, would also affect treatment adherence and increase AC risk ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

et al. 2022

Self Cite

View full text Add to dashboard Cite

BackgroundVery little is known about the epidemiology of adrenal crises (AC) and adrenal insufficiency (AI) in adolescents and young adults.MethodsData on all admissions to Australian hospitals between 2000/1 to 2019/20 for a principal diagnosis of AI (including AC) in 10-24 year olds were extracted from a national repository. Age and sex-specific rates and age-adjusted rates were compared.FindingsOver the study, there were 3386 admissions for a principal diagnosis of AI; 24.0% (n=812) were for an AC and 50·7% (n=1718) were for secondary AI. Age-adjusted AI admissions increased from 31·70/million in 2000/1 to 54·68/million in 2019/20 (p<0·0001). Age-adjusted AC admissions also increased, most notably in the second decade (from 5·80/million in 2010/11 to 15·75/million in 2019/20) (p<0·00001). Average AI and AC admission rates were comparable between the sexes, but rates increased significantly in females, especially in those aged 20 to 24 years, whose AC rate in 2019/20 (39·65/million) was significantly higher than the corresponding rate in 2000/1 (3·15/million) (p<0·00001). Average age-adjusted SAI admission rates were higher in males (23·92/million) than females (15·47/million) (p<0·00001). However, SAI admission rates increased only among females (from 11·81/million to 22·12/million in 2019/20), with an increase in 20-24 year old females in the second decade from 5·07/million in 2010 to 20·42/million (p<0·00001). Age adjusted admissions for congenital adrenal hyperplasia, primary AI (PAI) and drug-induced AI did not change significantly over the study.InterpretationAC/AI admissions increased over the first two decades of this century in the emerging adult population, particularly among females who also experienced a marked increase in AC admission rates, most evident in the second decade. Although uncertain, possible explanations include: dose of glucocorticoid replacement; non-adherence to therapy; psychosocial factors; and difficulty in transition to adult services. Admissions for SAI also increased, while rates of PAI and CAH remained constant.

show abstract

Use of medical identification jewellery in children and young adults with adrenal insufficiency in Australia

Cited by 7 publications

References 22 publications

Adrenal crises in adolescents and young adults

Adrenal crises in adolescents and young adults

An analysis of the utilisation of medical identification jewellery among children and young adults with type 1 diabetes mellitus in Australia

Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

Contact Info

Product

Resources

About