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Aims: To assess HbA1c values and hospitalization rates before, during and after continuous subcutaneous insulin infusion (CSII) therapy. Methods: Demographic and hospitalization data were extracted from 161 individuals with Type 1 diabetes who received continuous subcutaneous insulin infusion (CSII) therapy between 2002 and 2013 at the Leeds Children and Young People's Diabetes Service for those aged < 20 years. The median (range) age at CSII start was 11.9 (1.1–17.6) years. The median (range) follow‐up time was 2.3 (0–8.1) years. Random intercept models were used to compare HbA1c values before and during CSII initiation (and after CSII for those who discontinued it). Hospitalization rates were calculated for diabetic ketoacidosis and severe hypoglycaemia. Results: The mean HbA1c concentration decreased by 7 mmol/mol [95% CI 6–8; 0.6% (95% CI 0.5–0.7%)]. For the discontinued group (n=30), mean HbA1c decreased by 5 mmol/mol [95% CI 2–8; 0.4% (95% CI 0.2–0.7%)]. HbA1c returned to pre‐CSII start levels at the end of this therapy. Diabetic ketoacidosis admissions increased threefold during CSII compared with before CSII start [2.2 per 100 person‐years (95% CI 1.3 to 3.6) vs 7.4 per 100 person‐years (95% CI 5.1 to 10.8)] and was highest during the first year of CSII. No difference in severe hypoglycaemia incidence rate was found during CSII compared with the pre‐CSII period. Conclusions: Despite significant reductions in HbA1c levels for individuals treated with CSII, improvements are needed to reduce diabetic ketoacidosis hospitalizations for those new to the therapy. What's new?: Multi‐level modelling found that HbA1c values decreased with continuous subcutaneous insulin infusion (CSII) therapy, including in individuals who eventually discontinued CSII; however, these individuals returned to pre‐CSII start HbA1c levels after returning to multiple daily injections.HbA1c levels improved for up to 4 years of CSII therapy. For boys/men, this improvement was maintained for 6 years, compared with only 3 years in girls/women. Girls/women were also more likely to discontinue CSII therapy.Hospitalization rates increased for diabetic ketoacidosis in the first year of CSII therapy, but was no different from pre‐CSII rates thereafter. [ABSTRACT FROM AUTHOR]

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]

Diabet. Med. 28, 1508-1513 (2011) Abstract Aims Incidence of Type 1 diabetes in children is increasing worldwide. Earlier studies suggest that UK south Asian immigrants develop similar rates to the overall UK population, although incidence is lower in their country of origin. This study examines incidence rate trends of childhood Type 1 diabetes in Yorkshire 1978-2007, focusing on differences between south Asians and non-south Asians. Methods Data from the population-based Yorkshire Register of Diabetes in Children and Young People were used to estimate incidence (per 100 000 childhood population < 15 years per year) of Type 1 diabetes, stratified by sex, age and ethnicity validated using two name-recognition programs. Age-sex standardized rates were calculated for 1978-2007 and assessed by ethnic-group and deprivation for 1990-2007. We used Poisson regression to assess incidence trends and predict rates until 2020. Results From 1978-2007, 3912 children were diagnosed. Overall incidence was 18.1 per 100 000 childhood population (< 15 years) per year (95% CI17.6-18.7) and increased significantly over time: 13.2 (1978-1987) to 17.3 (1988-1997) to 24.2 (1998-2007). Average annual percentage change was 2.8% (2.5-3.2). Incidence for non-south Asians (21.5; 20.7-22.4) was significantly higher than for south Asians (14.7; 12.4-17.1). Average annual percentage change increased significantly over 18 years (1990-2007) in non-south Asians (3.4%; 2.7-4.2) compared with a non-significant rise of 1.5% (−1.5 to 4.6) in south Asians. Deprivation score did not affect overall incidence. Conclusions Type 1 diabetes incidence rose almost uniformly for non-south Asians, but not for south Asians, contrary to previous studies. Overall rates are predicted to rise by 52% from 2007 to 2020 to 39.0 per 100 000 per year. [ABSTRACT FROM AUTHOR]

Objective To analyse the putative association between incidence of primary bone cancer diagnosed in 0–49 year olds in Great Britain (GB) in 1980–2005 and fluoride in drinking water. The analyses focussed on osteosarcoma and Ewing sarcoma. Design The study accessed multiple data sources including population census, digital boundary, postcode directory and fluoride monitoring at water supply zone level data. Incidence data from all 10 regional cancer registries were accessed and analysed by census ward. Residential postcode was used as a proxy for population distribution and the basis for making all census data compatible with 2001 census geography. Postcode distributions were also used to link water supply zones to census wards for England and Wales and postcode sectors for Scotland and enabled a fluoride level to be assigned to each census small-area in GB. Setting GB. Participants Data from patients (0 to 49 years) diagnosed with a primary bone cancer between 1980 and 2005 and registered with one of the 10 regional cancer registries in GB. Main outcome measure Negative binomial regression was used to examine the relationship between incidence rates and census small-area fluoride levels. These models were fitted to census small-area data aggregated into four age bands (0–14; 15–29; 30–49 and 0–49 years) and by gender with the logarithm of the “at risk” population as an offset. Results There were a total of 2566 osteosarcoma cases aged 0–49 years; 817 aged 0–14 years; 1315 aged 15–29 years and 434 aged 30–49 years. For Ewing sarcoma there were a total of 1650 cases aged 0–49 years; 659 aged 0–14 years; 800 aged 15–29 years and 191 aged 30–49 years. After adjustment for age and gender, no statistically significant association was found between osteosarcoma or Ewing sarcoma and fluoride levels in drinking water. For example, for osteosarcoma the RR for 1 ppm increase in fluoride level 0.993; 95% CI 0.843 to to 1.171 and for Ewing sarcoma RR 0.860; 95% CI 0.696 to to 1.064. Conclusion This is the first time the relationship between fluoride and bone cancer has been studied across the whole of GB at census ward level. No statistically significant associations between Ewing sarcoma or osteosarcoma and fluoride in drinking water were found. [ABSTRACT FROM PUBLISHER]

Objective To examine geographical patterning in the incidence of primary bone cancers diagnosed in 0–49 year olds in Great Britain (GB) during the period 1980–2005. The analyses focussed on the two most common types in this age range, osteosarcoma and Ewing sarcoma. We specifically aimed to analyse putative associations with area characteristics including deprivation and population density. Design The study accessed multiple data sources including population census, digital boundary, postcode directories and time series of Townsend deprivation scores. Incidence data from the 10 regional cancer registries in GB were accessed and analysed by census small-area level (census ward level for England and Wales; postcode sector level for Scotland). Setting GB. Participants Data from patients (0 to 49 years) diagnosed with a primary bone cancer between 1st January 1980 and 31st December 2005 and registered with one of the 10 regional cancer registries in GB. Main outcome measure Negative binomial regression was used to examine the relationship between incidence rates and population density, Townsend deprivation index (and its components). The models were fitted to small-area level data and aggregated to four age bands (0–14 years; 15–29 yrs; 30–49 years and 0–49 years) and by gender with the logarithm of the “at risk” population as an offset. Results The study analysed 2566 cases of osteosarcoma and 1650 cases of Ewing sarcoma. After adjustment for age and gender there was a statistically significant negative association for the incidence of osteosarcoma with area-level Townsend deprivation score (RR for one unit increase in level of deprivation 0.975; 95% CI 0.963 to to 0.986). For Ewing sarcoma, after adjustment for age and gender, there was a statistically significant negative association for incidence with population density (RR for an increase of one person per hectare 0.981; 95% CI 0.972 to to 0.989) and also with non-car ownership (RR for an increase of one percent in non-car ownership 0.996; 95% CI 0.993 to to 1.000). Conclusion Higher deprivation appears to have a protective effect on the incidence of osteosarcoma. Higher incidence of Ewing sarcoma was associated with living in less densely populated areas and greater levels of car ownership, both of which are characteristic of rural areas. This study contributes to the growing body of evidence linking risk of Ewing sarcoma to some aspect of agriculture and suggests further study of environmental exposures or land use may be informative. [ABSTRACT FROM PUBLISHER]

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]