Introduction of paediatric laparoscopic cholecystectomy in Scotland: a national review of incidence, outcomes and training implications

BACKGROUND

We present a national data series to determine the incidence, outcomes and training opportunities for laparoscopic cholecystectomy among children <16yrs in Scotland as performed by paediatric surgeons.

METHODS

A retrospective cohort study was performed reviewing laparoscopic cholecystectomy performed at the three children's hospitals in Scotland. Using the National Records Scotland Database mid-year population estimates; age and sex specific annual incidence rates of laparoscopic cholecystectomy were calculated between 1998-2015. Trends in the observed case mix were tested using univariate linear regression and students t-test.

RESULTS

Between 1998-2015; 141 paediatric laparoscopic cholecystectomies were performed. The annual rate of cholecystectomy increased from 0.10/100,000 to 0.88/100,000 (p = 0.069). Sex specific incidences were identified; 0.00-0.90/100,000 (p = 0.098) in girls and 0.20-0.86/100,000 in boys (p = 0.28). Cholecystectomy was more frequent in girls (63%; p = 0.04). No major complications, defined as common bile duct injury or mortality were identified. Overall; 75% of cases were performed by consultants (n = 17 consultants, median = 5 cases, p < 0.05) and 25% by trainees.

CONCLUSION

We have demonstrated that despite a low national case load (8 laparoscopic cholecystectomies per year) paediatric surgeons have been able to perform laparoscopic cholecystectomy safely without major morbidity.

TLR2-mediated activation of innate responses in the upper airways confers antiviral protection of the lungs

The impact of respiratory virus infections on global health is felt not just during a pandemic, but endemic seasonal infections pose an equal and ongoing risk of severe disease. Moreover, vaccines and antiviral drugs are not always effective or available for many respiratory viruses. We investigated how induction of effective and appropriate antigen-independent innate immunity in the upper airways can prevent the spread of respiratory virus infection to the vulnerable lower airways. Activation of TLR2, when restricted to the nasal turbinates, resulted in prompt induction of innate immune-driven antiviral responses through action of cytokines, chemokines, and cellular activity in the upper but not the lower airways. We have defined how nasal epithelial cells and recruitment of macrophages work in concert and play pivotal roles to limit progression of influenza virus to the lungs and sustain protection for up to 7 days. These results reveal underlying mechanisms of how control of viral infection in the upper airways can occur and support the implementation of strategies that can activate TLR2 in nasal passages to provide rapid protection, especially for at-risk populations, against severe respiratory infection when vaccines and antiviral drugs are not always effective or available.

Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta-analysis

BACKGROUND

The outcome of vital pulp treatment after carious pulp exposure is multifactorial and related to the procedure, biomaterial and pre-operative pulpal diagnosis.

OBJECTIVES

To conduct a systematic review and meta-analysis determining the outcome of direct pulp capping (DPC) in mature permanent teeth with a cariously exposed pulp and a clinical diagnosis of reversible pulpitis, and ascertain whether the capping material influences the outcome.

METHODS

Sources: MEDLINE Ovid-SP, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Embase and Web of Science until April 2020. Inclusion: Prospective, retrospective cohort studies and randomized trials investigating DPC outcome or comparing different capping materials after carious pulp exposure. Exclusion: Primary teeth, mechanical, traumatic or not specified pulp exposure, teeth with irreversible pulpitis or no pulpal diagnosis. Risk of bias assessed using Cochrane and modified Downs and Black quality assessment checklist. Meta-analysis on combined clinical/radiographic outcome was performed using a random effect model. Success was defined as absence of signs and symptoms of irreversible pulpitis, apical periodontitis or loss of pulp vitality.

RESULTS

Quality assessment highlighted four non-randomized studies to be of fair and five of poor quality. Four randomized trials had a high risk of bias. The pooled success rate differed based on material and follow-up. Calcium hydroxide success rate was 74% at 6-months, 65% at 1-year, 59% at 2-3 years and 56% at 4-5 years. Mineral trioxide aggregate (MTA) success was 91%, 86%, 84% and 81% at the same time points. Biodentine success was 96% at 6-months, 86% at 1 year and 86% at 2-3 years. The meta-analysis revealed MTA had better success than calcium hydroxide at 1-year (OR 2.66, 95% CI; 1.46- 4.84, P = 0.001) and 2- to 3-year follow-up (OR 2.21, 95% CI; 1.42-3.44, P = 0.0004). There was no difference between MTA and Biodentine.

DISCUSSION

These results were based on poor methodological quality studies. The effect size for of MTA vs Ca(OH)2, although modest, was consistent with narrow CI.

CONCLUSIONS

Low-quality evidence suggests a high success rate for direct pulp capping in teeth with cariously exposed pulps with better long-term outcomes for MTA and Biodentine compared with calcium hydroxide.

The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence

BACKGROUND

Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set (COS) to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the informed consent process.

METHODS

This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies.

RESULTS

Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making.

CONCLUSIONS

This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery.

REGISTRATION

The study protocol was registered on the international prospective register for systematic reviews (PROSPERO ID: CRD42017077101).

Seasonality of births in affective disorder in an Irish population

Seasonal variation in the births of patients with schizophrenia is a consistently replicated epidemiological finding. Few studies have investigated this phenomenon among patients with a diagnosis of affective disorder. The majority of season of birth studies have employed the chi square test for statistical analysis, a method that has been subject to some criticism. Using a Kolgomorov-Smirnov type statistic, the quarterly birth distribution of 6,646 patients with an ICD 9/10 diagnosis of affective disorder were compared to the general population. Only the births of those individuals with unipolar forms of affective disorder (n = 4,393) differed significantly from the general population, with significant excesses and deficits in the second quarter and fourth quarter respectively. These results were not altered by application of the displacement test. © 1998 Elsevier, Paris

The relationship between insight and neurological dysfunction in first-episode psychosis

Purpose

Impaired insight is commonly seen in psychosis and some studies have proposed that is a biologically based deficit. Support for this view comes from the excess of neurological soft signs (NSS) observed in patients with psychoses and their neural correlates which demonstrate a degree of overlap with the regions of interest implicated in neuroimaging studies of insight. The aim was to examine the relationship between NSS and insight in a sample of 241 first-episode psychosis patients.

Method

Total scores and subscale scores from three insight measures and two NSS scales were correlated in addition to factors representing overall insight and NSS which we created using principal component analysis.

Results

There were only four significant associations when we controlled for symptoms. “Softer” Condensed Neurological Evaluation (CNE) signs were associated with our overall insight factor (r = 0.19, P = 0.02), with total Birchwood (r = −0.24, P<0.01), and the Birchwood subscales; recognition of mental illness (r = −0.24, P<0.01) and need for treatment (r = −0.18, P = 0.02). Total Neurological Evaluation Scale (NES) and recognition of the achieved effects of medication were also weakly correlated (r = 0.14, P = 0.04).

Conclusion

This study does not support a direct link between neurological dysfunction and insight in psychosis. Our understanding of insight as a concept remains in its infancy.

A review of the current public health practice for contact tracing in relation to laryngeal TB in England 2012-2016

OBJECTIVES

Contact tracing following identification of tuberculosis (TB) is well established. However, evaluation of this activity, particularly for laryngeal TB, is limited. We compare contact tracing and outcomes in response to laryngeal TB with sputum-smear-positive pulmonary TB (ss + pTB) and consider the public health response in light of our findings.

STUDY DESIGN

This study is a comparative secondary analysis of retrospective data, extracted from TB surveillance systems, to determine differences in contact tracing process and outcomes between two groups.

METHODS

Cases of laryngeal TB (without ss + pTB) notified in England between 2012 and 2016 were selected and matched to ss + pTB controls. Number of contacts identified and screened, along with screening outcomes were gathered from local databases.

RESULTS

There were 44 laryngeal TB cases who met inclusion criteria. The median number of contacts identified per case was 3 and 4 for controls (P = 0.04). Median number of contacts screened was 3 for cases and 4 for controls. The percentage of contacts with TB was 9.7 for cases and 20.3 for controls (P < 0.01).

CONCLUSION

We observed a small difference, between case and control groups, in number of contacts identified but not number screened, indicative of a broadly similar approach to contact tracing. Conversely, the difference in screening outcomes between the groups was significant. These findings highlight a potential need to further understand infectivity of laryngeal TB; and consider possible implications for public health practice.

Knowledge and Uptake of Voting Rights By Psychiatric Inpatients in Westminster, London During the 2015 Uk General Election

Introduction

Being able to vote empowers people with mental illness to have a political voice and promotes social inclusion. Evidence shows that patients with mental illness are less likely to vote compared to the general population.

Objective

This study explores the knowledge and uptake of the voting rights of adult patients in a psychiatric hospital in the 2015 UK general election.

Aims

To understand patients’ eligibility and intentions to vote during the 2015 UK general election. To establish what assistance patients may require in order to vote.

Methods

A staff-assisted survey was undertaken in all mental health wards in the Gordon Hospital, Westminster prior to the general election in May 2015.

Results

A total of 51 surveys were returned. Seventy-five percent thought they were eligible to vote, and 47% had already registered. Of those that had not yet registered, 37% wanted staff support to do so. Fifty-seven percent of the respondents intended to vote and of those 9 out of 10 intended to vote in person. Twenty-six percent of those intending to vote identified needing assistance in this process.

Conclusions

The majority of inpatients were aware of their eligibility to vote. Over half of the respondents planned to vote, which is lower than the UK average. As 1 in 4 patients intending to vote requested support, this suggests potential barriers impacting on their ability to exercise their right.

Multidisciplinary teams can provide valuable assistance to patients in the voting process in many ways, including information provision, organisation of leave and providing staff escort.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Changes in soluble tumor necrosis factor receptor type 1 levels and early renal function decline in patients with diabetes

The relationship between serial changes in soluble tumor necrosis factor receptor type 1 (TNFR1) levels and an early decline in estimated glomerular filtration rate (eGFR) decline remains to be defined. We found that in patients with an early decline in renal function (n = 30), soluble TNFR1 values increased (2,595 ± 683 vs 3,596 ± 1,203 pg/mL, P < 0.001) as eGFR decreased (89 ± 1 vs 51 ± 2 mL/min/1.73m2 , P < 0.001) over an 8-year period. In contrast, there were no significant changes in soluble TNFR1 levels in patients with stable renal function (n = 17). In a multilevel mixed effects regression model, changes in soluble TNFR1 levels were found to be independently associated with eGFR decline (Z = -4.31, P < 0.001). An early decline in eGFR is associated with an increase in soluble TNFR levels; however, the factors driving this increase and the possible pathological role that soluble TNFR1 plays in progressive diabetic kidney disease remain to be determined.

Three Dimensional Glomerular Reconstruction: A Novel Approach to Evaluate Renal Microanatomy in Diabetic Kidney Disease

Mesangial metrics reflect glomerular filtration surface area in diabetes. The point-sampled intercept (PSI) method is the conventional method to calculate these parameters. However, this is time consuming and subject to underestimation. We introduce a novel three-dimensional (3D) reconstruction method applicable to light microscopy to measure mesangial metrics. Transmission electron microscopy (TEM), PSI and our new 3D imaging methods were used to quantify mesangial metrics from 22 patients with type 2 diabetes, normo-, micro- and macroalbuminuria and an estimated glomerular filtration rate of <60 mL/min/1.73 m². Repeated-measures ANOVA test was used to test the equality of the measurement means from the three methods and the degree of inter method variability. Repeated-measures and post-estimation ANOVA tests together with correlation coefficient measurements were used to compare the methods with TEM as reference. There was a statistically significant difference in mesangial volume measurements (F(2, 16) = 15.53, p = 0.0002). The PSI method underestimated measurements compared to TEM and 3D methods by 30% (p = 0.001) and 15%, respectively (p < 0.001). 3D and TEM measurements did not differ significantly. 3D reconstruction is a reliable and time efficient method for calculating mesangial metrics. It may prove to be a useful tool in clinical and experimental diabetic kidney disease.

Giri-nya-la-nha (talk together) to explore acceptability of targeted smoking cessation resources with Australian Aboriginal women

OBJECTIVES

To engage with health providers and Aboriginal women to understand what educational resources they want and need to support quit smoking attempts during pregnancy in order to develop a comprehensive evidence-based intervention.

STUDY DESIGN

Resources were developed in partnership with Aboriginal people, communities and academics with the aim to be inclusive of diverse communities. We then recruited Aboriginal women of various ages for yarning circles (focus groups) held in three Australian states to explore the acceptability of the resources and seeking further guidance as to the needs of Aboriginal women to support smoking cessation during pregnancy.

METHODS

Yarning circles were recorded and transcribed, and data were analysed independently by two researchers. Responses were coded using predetermined themes and further general inductive analysis for emergent themes.

RESULTS

Twenty-four Aboriginal women reflected on the resources they included: one pregnant woman, 15 mothers and eight elders. Predetermined themes of attraction, comprehension, cultural acceptability, graphics and layout, persuasion and self-efficacy were explored. Women suggested the following: resources need to be visually attractive and interactive to enhance self-efficacy; additional scientific content on health consequences of smoking and combining with non-pharmacological approaches to quitting.

CONCLUSION

Indigenous peoples prefer culturally targeted messages. However, developing effective Aboriginal health promotion requires more than a 'culturally appropriate' adaptation of mainstream resources. Consideration needs to be given to the diversity of Aboriginal communities when developing effective, evidence-based interventions. Aboriginal women are calling for innovative and interactive resources that enhance self-efficacy; the use of videos to explain medical and informational brochure content is well received. Requests for non-pharmacological cessation options were reported in New South Wales and Queensland and should be further explored.

31 A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

Background

Constipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.

Methods

A multi-site retrospective case-note review was conducted consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.

Results

A physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%) involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently with sodium docusate or senna as the preferred laxatives across all sites however 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstruction

Conclusion

Assessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.

References

. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&A?N=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 21 August 2017]

. Gilbert EH, et al. Chart reviews in emergency medicine research: Where are the methods?Annals of Emergency Medicine1996;27(3):305–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8599488 [Accessed: 17 May 2018]

. National Clinical Effectiveness Committee. Management of constipation in adult patients receiving palliative care national clinical guideline No. 10November 2015.

. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 21 August 2017]

. Wickson-griffiths A, et al.Revisiting retrospective chart review: An evaluation of nursing home palliative and end-of-life care research. Palliative Medicine Care2014;1(2):8. Available at: www.symbiosisonlinepublishing.com [Accessed: 23 November 2017]

32 Examining the key factors impacting on the implementation of an educational program on constipation in specialist palliative care

Introduction

Constipation is one of the most common symptoms in patients in specialist palliative care (SPC) settings and can cause considerable physical psychological and social suffering for the patient and their family. Due to the high variability in constipation assessment and management in SPC settings questions exist around how to implement an educational program in practice to address this clinical gap.

Aim

To develop and test the feasibility and acceptability of a novel educational intervention for HCPs to manage constipation experienced by people in SPC settings.

Method

Using the MRC framework for complex interventions and guided by the consolidated framework for implementation research an online resource was developed considering the content context and processes for implementation.

Results

Assessment prevention and management were identified as the core aspects. Six sessions with theoretical content application to practice and reflection through interacting with colleagues were developed in line with the best available evidence. Incentives including an educational bursary and alignment with revalidation and support from senior management champions and the research team were identified as key elements needed successful implementation. Funding IT infrastructure and attitudes to the content have been flagged as potential barriers to success.

Conclusion

A six week blended program covering the key concepts for assessment and management of constipation in palliative care has been created. Content evidence from the literature and empirical data on the preferred structure and method of delivery as well as key considerations of the contextual factors have been identified as key factors for implementation.

References

. Craig P, et al.Developing and evaluating complex interventions: The new medical research council guidance. BMJ Clinical Research Ed2008;337(October):a1655. Available at: http://discovery.ucl.ac.uk/168426/

. Damschroder LJ, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science2009;4(50).

. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&AN=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 2017 August 21]

. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 2017 August 21]

Childhood psychotic experiences are associated with poorer global functioning throughout adolescence and into early adulthood

BACKGROUND

Psychotic experiences (PEs) are common in childhood and have been associated with concurrent mental disorder and poorer global functioning. Little is known about the effects of childhood PEs on future functioning. We investigated the effects of childhood PEs on global functioning from childhood into early adulthood.

METHOD

Fifty-six participants from a community sample completed all three waves of the Adolescent Brain Development study (T1x¯ Age: 11.69, T2x¯ Age: 15.80 T3x¯Age: 18.80). At each phase, participants completed a clinical interview assessing for PEs, mental disorder and global function. Repeated measures models, adjusted for mental disorder and gender, were used to compare current (C-GAF) and most severe past (MSP-GAF) functioning in participants who had reported PEs in childhood and controls.

RESULTS

Participants with a history of PEs had significantly poorer C-GAF (P < 0.001) and MSP-GAF scores (P < 0.001). Poorer functioning was evident in childhood (C-GAF: P = 0.001; MSP-GAF: P < 0.001), adolescence (C-GAF: P < 0.001; MSP-GAF: P = 0.004) and early adulthood (C-GAF: P = 0.001; MSP-GAF: P = 0.076).

DISCUSSION

Children who report PEs have persistently poorer functioning through to early adulthood. The longitudinal association between childhood PEs and global functioning highlights the underlying global vulnerability in children reporting PEs, beyond what can be explained by mental disorder.

Linking Inuit Knowledge and Public Health for Improved Child and Youth Oral Health in NunatuKavut

The oral health of Inuit children in Canada has been identified as a public health crisis. Although efforts are being made to identify and address ways to deal with this crisis, current policy and program approaches are largely entrenched within the prevailing paradigm of dental science to the exclusion of Indigenous people's understandings of health. This article reports qualitative findings of a larger study aimed at identifying, understanding, and addressing rates of oral disease among children living in NunatuKavut, a cluster of small, coastal Inuit communities located in southern Labrador, Canada. Through 18 focus groups with youth (n = 86), caregivers (n = 22), and interviews with key informant (n = 13), this study begins to elucidate southern Inuit understandings of oral health. Theorized using Two-Eyed Seeing, an Indigenous approach to balancing both Indigenous and non-Indigenous understandings of the world, the findings reported here reveal 3 themes, each of which is crosscut by historical and contemporary dimensions: 1) (w)holistic conceptualizations of health are essential to good oral health, 2) achieving optimal oral health is prohibitive for Inuit communities, and 3) community-engaged oral health service delivery is needed. Our recommendations have implications for improved oral public health service delivery for Inuit communities, in that the inclusion of Inuit perspectives on oral health should form an instrumental element of oral public health service delivery. Knowledge Transfer Statement: The results of this study may be used by clinicians and oral health educators to inform approaches to oral health service delivery within the context of Indigenous communities. It may also be used by policymakers to recognize how historical and contemporary issues of colonization relate to the formation of oral health-related policies.

Use of Readily Accessible Inflammatory Markers to Predict Diabetic Kidney Disease

Diabetic kidney disease is a common complication of type 1 and type 2 diabetes and is the primary cause of end-stage renal disease in developed countries. Early detection of diabetic kidney disease will facilitate early intervention aimed at reducing the rate of progression to end-stage renal disease. Diabetic kidney disease has been traditionally classified based on the presence of albuminuria. More recently estimated glomerular filtration rate has also been incorporated into the staging of diabetic kidney disease. While albuminuric diabetic kidney disease is well described, the phenotype of non-albuminuric diabetic kidney disease is now widely accepted. An association between markers of inflammation and diabetic kidney disease has previously been demonstrated. Effector molecules of the innate immune system including C-reactive protein, interleukin-6, and tumor necrosis factor-α are increased in patients with diabetic kidney disease. Furthermore, renal infiltration of neutrophils, macrophages, and lymphocytes are observed in renal biopsies of patients with diabetic kidney disease. Similarly high serum neutrophil and low serum lymphocyte counts have been shown to be associated with diabetic kidney disease. The neutrophil-lymphocyte ratio is considered a robust measure of systemic inflammation and is associated with the presence of inflammatory conditions including the metabolic syndrome and insulin resistance. Cross-sectional studies have demonstrated a link between high levels of the above inflammatory biomarkers and diabetic kidney disease. Further longitudinal studies will be required to determine if these readily available inflammatory biomarkers can accurately predict the presence and prognosis of diabetic kidney disease, above and beyond albuminuria, and estimated glomerular filtration rate.

Disordered eating behaviour in young adults with type 1 diabetes mellitus

BACKGROUND

The combination of eating disorders and diabetes is associated with increased risk of morbidity and mortality. The aim of this study is to compare the prevalence of disordered eating behaviour (DEB) in young adults with type 1 diabetes mellitus to a sample of non-diabetic controls, and to examine the relationship of DEB to glycaemic control.

METHODS

The Eating Disorder Examination Questionnaire (EDE-Q) was administered to 51 individuals aged 18-30 years attending an outpatient diabetic clinic in a large university teaching hospital. Glycaemic control was assessed by the glycosylated haemoglobin (HbA1c). The control group comprised a consecutive sample of 236 male and female students aged 18-30 years attending a university primary health care service.

RESULTS

The mean global EDE-Q score for the diabetes group was 0.82 ± 1.1 (mean ± SD) and the mean for the control group was 1.4 ± 1.3 (mean ± SD). The diabetes group was significantly more likely to have a lower global EDE-Q score compared to the control group. There was no association between the global EDE-Q score of the diabetes group and HbA1c level.

CONCLUSIONS

We did not find increased levels of disordered eating behavior (DEB) in young adults with type 1 diabetes mellitus compared to a non-diabetic control sample.