Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: a population-based cohort study.

AIMS/HYPOTHESIS: The aim of this study was to investigate psychiatric morbidity following childhood onset of type 1 diabetes. METHODS: In a matched, population-based cohort study based on Danish national registers, we identified children and adolescents who had been diagnosed as an in- or outpatient with type 1 diabetes before the age of 18, and afterwards diagnosed with a psychiatric disorder (n = 5084). Control individuals were matched according to sex and date of birth (n = 35,588). The Cox proportional hazards model was used to assess associations between type 1 diabetes and the incidence of psychiatric disorders as well as the effects of age at onset and duration of type 1 diabetes on the risk of subsequently developing psychiatric morbidities. RESULTS: An increased risk of being diagnosed with mood disorders and anxiety, dissociative, eating, stress-related and somatoform disorders was observed in both sexes in the years following type 1 diabetes onset, with the highest risk observed five years or more after onset (HR 1.55 [95% CI 1.38, 1.74]). The risk of psychoactive substance-misuse disorders increased significantly only in boys, and the risk of personality disorders increased only in girls. CONCLUSIONS/INTERPRETATION: In the years following type 1 diabetes onset, an increased risk of eating disorders, anxiety and mood disorders, substance misuse, and personality disorders was found. These findings highlight a clinical need to monitor the mental health of children and adolescents in the years following type 1 diabetes onset to identify and treat psychiatric problems associated with type 1 diabetes.

Validity of parent-reported weight and length of infants.

INTRODUCTION: Anthropometric data are key to evaluating infant health. This study assessed the validity of parent-reported infant weight and length, and their reliability to categorise children by BMI z-score, as compared to clinical measurements. METHODS: From a cohort of 4,262 infants, parent-reported and clinically measured anthropometric data were obtained and compared at three months and one year of age. RESULTS: Parent-reported and clinically measured data generally correlated well. Mean differences at three months and at one year, respectively, were 0.08 kg (95% confidence interval (CI): 0.07-0.09 kg) and 0.10 kg (95% CI: 0.08-0.12 kg) for weight, 0.8 cm (95% CI: 0.8-0.9 cm) and 1.0 cm (95% CI: 0.9-1.1 cm) for length and -0.16 kg/m2 (95% CI: -0.20--0.12 kg/m2) and -0.22 kg/m2 (95% CI: -0.27--0.18 kg/m2) for BMI. Effect sizes were negligible to small. Bland-Altman plots showed clinically insignificant bias, but 95% limits of agreement were wide enough to be significant. Comparing categorisation of BMI z-score showed only fair agreement. CONCLUSION: Parents' reports of measured infant weight and length are reliable at a population level in a setting with routine preventive care. Parent-reported data should not be used for assessment of individual infants, particularly not if a health condition is suspected. BMI calculated from parent-reported anthropometrics is not reliable. FUNDING: None. TRIAL REGISTRATION: This study was registered with www. CLINICALTRIALS: gov, registration number NCT01694108.

The role of play in hospitals.

Play is a non-invasive, safe, and inexpensive intervention that can help children and adolescents better manage difficult aspects of hospitalisation. Play has existed in hospitals for decades but is emerging as an interdisciplinary scientific field. The field concerns all medical specialties and healthcare professionals working with children. In this review, we describe play within different clinical contexts and recommend that directed and non-directed play activities should be prioritised in future paediatric departments. We also emphasise the need for professionalisation and research in the area.

Play interventions for paediatric patients in hospital: a scoping review.

OBJECTIVE: Play is a non-invasive, safe and inexpensive intervention that can help paediatric patients and their families manage difficult aspects of being ill or hospitalised. Although play has existed in hospitals for decades, research on hospital play interventions is scarce. This review aimed to categorise and synthesise the last 20 years of research on hospital play interventions. DESIGN: Scoping review. DATA SOURCES: PubMed, CINAHL, CENTRAL, ERIC and PsycINFO (1 January 2000- 9 September 2020). STUDY SELECTION AND DATA EXTRACTION: We systematically searched for original peer-reviewed articles, written in English, on hospital play interventions in paediatric patients (0-18 years) in non-psychiatric settings. Two reviewers independently screened titles and abstracts, reviewed full text of relevant articles and extracted data. We thematically synthesised the data from the included studies, and a descriptive analysis, based on a developed framework, is presented. RESULTS: Of the 297 included articles, 78% came from high-income countries and 56% were published within the last 5 years. Play interventions were carried out across all ages by various healthcare professionals. Play interventions served different roles within four clinical contexts: A) procedures and diagnostic tests, B) patient education, C) treatment and recovery and D) adaptation. Across these contexts, play interventions were generally facilitated and purpose-oriented and had positive reported effects on pain, stress, and anxiety. CONCLUSIONS: Play in hospitals is an emerging interdisciplinary research area with a significant potential benefit for child and family health. Future research should further describe principles for play in hospitals. High-quality studies investigating short-term and long-term effects are needed to guide when and how to best integrate play in hospitals.

Language barriers and use of interpreters in two Danish paediatric emergency units.

INTRODUCTION: Paediatric consultations require safe and unambiguous communication. For children and adolescents of foreign ethnic and language backgrounds, professional interpretation may be crucial to avoid misunderstandings and malpractice. Knowledge about language barriers in paediatric consultations in the Danish healthcare is sparse. METHODS: The study was based on questionnaires completed by medical professionals at two paediatric emergency units in Copenhagen from March through June 2018. Questionnaire A, completed by doctors, addressed all patients aged 0-18 years regardless of the parents' first language and, if foreign, the presence of language barriers, whether clinical management was affected and use of professional interpretation. All doctors and nurses were asked to complete questionnaire B addressing their knowledge, experiences and practices with language barriers in their clinical work. RESULTS: Language barriers were present in 37% of 136 non-native-Danish consultations. In 44% of these, clinical management was affected. Professional interpretation was not used in any consultations. Almost half of the medical professionals reported insufficient communication opportunities with non-native-Danish-speaking patients (48%). CONCLUSIONS: Language barriers frequently affected communication and clinical decision-making in the two Danish paediatric emergency units studied. Even so, professional interpretation was not used. Further studies are needed to explore whether language is a barrier to equal health. FUNDING: none. TRIAL REGISTRATION: not relevant.