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Background: Many obese children attending weight management interventions experience positive changes; however, not all are successful and little is known about what factors influence treatment outcome. The present study aimed to assess which baseline characteristics may predict unsuccessful treatment outcome in a weight management intervention for obese children. Methods: WATCH IT is a community weight management intervention for obese children and their families. Data collected during the pilot phase were visited retrospectively and secondary analysis was performed on the dataset. Inclusion criterion prioritised independent variables for the statistical model aiming to detect those that were exerting a significant effect. Logistic regression was used to assess the ability of these independent variables to predict unsuccessful treatment outcome. Results: Seventy-eight children (mean age 11.9 years) who attended the WATCH IT weight management intervention for at least 6 months were included in the analysis. Multivariable regression analysis showed that children from families where both parents reported having a weight problem were six times more likely to be unsuccessful compared to children from families where neither parent reported weight problems (odds ratio = 6.1; 95% confidence interval = 1.2-32.0; P = 0.032). Age, gender, severity of obesity and duration of previous weight management attempts were not predictive of treatment outcome. Conclusions: To increase the overall success rate of children's weight management interventions such as WATCH IT, current approaches to behaviour change may need to be adapted or tailored for those families who are less likely to be successful. Supporting overweight parents to make their own successful lifestyle changes may be one way of improving the child's likelihood of weight management success. [ABSTRACT FROM AUTHOR]

There is a paucity of population-based studies examining incidence and survival trends in childhood bone tumours. We used high quality data from four population-based registries in England. Incidence patterns and trends were described using Poisson regression. Survival trends were analysed using Cox regression. There were 374 cases of childhood (ages 0-14 years) bone tumours (206 osteosarcomas, 144 Ewing sarcomas, 16 chondrosarcomas, 8 other bone tumours) registered in the period 1981-2002. Overall incidence (per million person years) rates were 2.63 (95% confidence interval (CI) 2.27-2.99) for osteosarcoma, 1.90 (1.58-2.21) for Ewing sarcoma and 0.21 (0.11-0.31) for chondrosarcoma. Incidence of Ewing sarcoma declined at an average rate of 3.1% (95% CI 0.6-5.6) per annum (P=0.04), which may be due to tumour reclassification, but there was no change in osteosarcoma incidence. Survival showed marked improvement over the 20 years (1981-2000) for Ewing sarcoma (hazard ratio (HR) per annum=0.95 95% CI 0.91-0.99; P=0.02). However, no improvement was seen for osteosarcoma patients (HR per annum=1.02 95% CI 0.98-1.05; P=0.35) over this time period. Reasons for failure to improve survival including potential delays in diagnosis, accrual to trials, adherence to therapy and lack of improvement in treatment strategies all need to be considered. [ABSTRACT FROM AUTHOR]

We examined population-based information on relapsed childhood haematological cancers, investigating factors that might influence both overall survival and survival following relapse among the 1177 children (0-14 years) diagnosed with a haematological malignancy in Yorkshire from 1974 to 2003, of whom 342 (29%) relapsed at least once. Leukaemia patients from more deprived areas were significantly less likely to relapse (odds ratio=0.54, 95% confidence interval 0.32-0.93 for most deprived quintile vs least deprived quintile; P(trend)=0.06), especially those with acute myeloid leukaemia (P=0.04). Neither ethnic group nor distance to the main treatment centre was associated with risk of relapse. Overall, patients who relapsed at least once had 5-year survival rates of 46% (41-51%) compared with 79% (76-81%) of those who did not. Five-year survival rates from the time of first relapse increased from 20% in 1974-1983 to 45% in 1984-2003. Length of first remission was a strong predictor of survival for leukaemia with a 46% reduced risk of death for every additional year of event-free survival. Of children who experienced a relapse, 46% survived at least 5 years, whereas just under half of patients survived 5 years beyond disease recurrence. This provides a baseline for future comparisons and demonstrates that relapsed childhood cancer need not imply a poor outcome. [ABSTRACT FROM AUTHOR]

Objective: To investigate the duration of postictal impairment of consciousness and the factors that affect it. Patients and methods: 90 children aged 1-16 years (37 male, 53 female, median age 6 years), attending the accident and emergency department, and inpatients of Leeds General Infirmary, Leeds, UK, who had experienced seizures involving impairment of consciousness. Interventions-hourly modified paediatric coma scores were determined, until a coma score of 15 was obtained. Linear regression analysis was used to determine the factors influencing recovery time. Results: 49 children were excluded owing to incomplete coma scoring, lost notes and refusal of consent. Median time for full recovery of consciousness was 38 mm (0.63 h, range 0.05-17 h). Median recovery time was 1 8 mm (0.3 h, range 0.05-9 h) from febrile seizures, which was significantly shorter than for seizures of other aetiologies (p<0.05), 1.35 h (range 0.07-13.13 h) from idiopathic seizures, 1.25 h (0.07-12.1 h) from remote symptomatic seizures and 4.57 h (0.25-17 h) from acute symptomatic seizures. Median recovery time after the use of benzodiazepines was 3.46 h (range 0.08-14.25 h), and was significantly longer (p<0.05) than for seizures not treated with benzodiazepines (median 0.47 h, range 0.05-17 h). Age, sex, seizure type and duration did not significantly affect recovery time. Conclusions: Most children experiencing febrile seizures recover within 30 mm. An acute symptomatic aetiology should be considered if recovery takes >1 h. [ABSTRACT FROM AUTHOR]

Aims Primary Care Trusts (PCTs) are now responsible for the planning and delivery of health-care services throughout England and Wales. As the 25 PCTs throughout Yorkshire are representative of the national distribution in terms of population structure and socio-economic status, we aimed to address the paucity of information describing the burden of childhood diabetes in primary care and to evaluate the cost implications of insulin pump therapy on individual PCTs. Methods We extracted information from a population-based register in Yorkshire, including 1952 patients diagnosed under the age of 15 years from 1990 to 2003. Each patient's postcode was linked to an individual PCT. Incidence rates (per 100 000 patient years) were derived and assessed for evidence of heterogeneity across PCTs and within Strategic Health Authorities (SHAs). Results Incidence rates were lower in West Yorkshire (19.1, 95% CI 18.0–20.2) than North-east Yorkshire (20.3, 18.9–21.6), although this difference was not significant ( P = 0.20). No significant evidence of heterogeneity in incidence rates was observed across PCTs ( P = 0.46). Ninety per cent of all PCTs would expect four to seven newly diagnosed children per year, corresponding to a single general practitioner (GP) referring an individual for diagnosis once every 15 years on average. Assuming 1% of current patients under the age of 15 years with diabetes were to move onto insulin pump therapy, this would impose an additional cost of £400–1300 per year for each PCT. The average cost was 15% lower for PCTs in West Yorkshire than North and East Yorkshire. Conclusions The additional resources required to pay for insulin pump therapy for a small proportion of the diabetes population would be minimal given the potential benefits to these patients of improved control and anticipated reduction in long-term morbidity. [ABSTRACT FROM AUTHOR]

Objective To examine incidence rates and trends of childhood Type 1 diabetes in Yorkshire from 1978 to 2007. Methods Data from the population-based Yorkshire Register of Diabetes in Children and Young People was used to analyse the incidence of Type 1 diabetes in children aged <15 years diagnosed in the former Yorkshire Regional Health Authority. Incidence rates (per 100 000 per year) were estimated using mid-year population estimates stratified by sex, age and ethnicity: south Asian (Indian, Pakistani, Bangladeshi) or non-south Asian (all other ethnicities). Ethnicity was assigned using two name recognition programs (Nam Pehchan and SANGRA) and a local expert. Age-sex standardised rates were calculated between 1978 and 2007 and by ethnic-group between 1990 and 2007. Poisson regression was used to assess incidence trends and estimate predicted rates up to 2020. Goodness-of-fit, AIC and likelihood-ratio tests were used to assess model fit. Results 3896 children were diagnosed in Yorkshire between 1978 and 2007. Overall incidence was 18.1 (95% CI 17.5 to to 18.6), increasing from 13.3 (1978 to 1987) to 16.9 (1988 to 1997) to 24.1 (1998 to 2007). Incidence increased significantly over time: average annual percentage change (AAPC) was 2.8% (1.8 to 3.8). The inclusion of an age-sex interaction term provided evidence for differences in trends between sexes depending on age, with females having higher incidence and AAPC than males for those aged 5–9. Overall incidence for non-south Asians (21.4; 20.6 to 22.3) was significantly higher than that of south Asians (14.6; 12.3 to 17.0) over the entire study period. A significant increasing trend in incidence was observed for non-south Asians of 3.3% (1.3 to 5.2) compared to a non-significant trend seen in south Asians (1.9%; –0.4 to 4.3). Overall forecasted incidence for 2020 is 38.3 per 100 000. Conclusions Type 1 diabetes incidence rates have risen almost uniformly for non-south Asians of all ages but not for south Asians, contrary to findings in the Bradford area of Yorkshire between 1978 and 1998. Overall incidence increased most quickly in the 5–9 age-group. Incidence doubled from 12.5 to 25.2 between 1978 and 2007. If current trends continue, rates will rise by 52% to 38.3 between 2007 and 2020. [ABSTRACT FROM PUBLISHER]