A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus.

BACKGROUND: Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. METHODS: Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. RESULTS AND DISCUSSION: Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. CONCLUSIONS: This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.

Adherence of backcountry winter recreationists to avalanche prevention and safety practices in northern Italy.

Backcountry recreationists account for a high percentage of avalanche fatalities, but the total number of recreationists and relative percentage of different recreation types are unknown. The aim of this study was to collect the first comprehensive survey of backcountry skiers and snowshoers in a region in the European Alps to quantify adherence to basic prevention and safety practices. Over a 1-week period in February 2011 in South Tyrol, Italy, 5576 individuals (77.7% skiers, 22.3% snowshoers) in 1927 groups were surveyed. Significantly more skiers than snowshoers could report the avalanche danger level (52.5% vs 28.0% of groups) and carried standard rescue equipment (transceiver, probe, and shovel) (80.6% vs 13.7% of individuals). Complete adherence to minimum advisable practices (i.e., an individual being in a group with one member correctly informed about the danger level and carrying personal standard rescue equipment) was 41.5%, but was significantly higher in skiers (51.1% vs 8.7% snowshoers) and in individuals who were younger, reported more tours per season, traveled in larger groups, and started earlier. A transnational survey over a complete winter season would be required to obtain total participation prevalence, detect regional differences, and assess the influence of prevention and safety practices on relative reduction in mortality.

A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service.

OBJECTIVE: Constipation and soiling is a relatively common condition in childhood and its course is often chronic. This study investigated long-term outcome of children with chronic constipation and soiling by following up a cohort of children 6 years after their presentation to a specialist paediatric gastroenterology clinic with chronic constipation and soiling. DESIGN: Retrospective postal survey. SETTING/SAMPLE: All children referred in 1991 to a specialist paediatric gastroenterology clinic accepting both secondary and tertiary referrals. MEASURES: A semi-structured postal questionnaire was sent to all families, and the Strengths and Difficulties Questionnaire (SDQ) was sent to a random sample. RESULTS: The response rate (of those who could be traced) was 89%. Of these, over a third (36%) still had a problem with constipation and soiling and 17% were using regular laxatives. Three people still having problems with constipation and soiling in the sample were aged over 18 years. No significant difference was found with regard to age, sex or age at referral between the group that improved and the group that did not. Both groups felt they had suffered a high degree of distress because of the problem, with parents highlighting their powerlessness to help their child and the child identifying the embarrassment caused by the problem. CONCLUSIONS: A significant number of children presenting to a specialist paediatric clinic continue to have problems for several years. Further research is needed to identify these cases and to identify which factors promote resolution of the problem.

The actual, but not labelled, fat content of a soup preload alters short-term appetite in healthy men.

The effects of the actual and labelled fat content of a soup preload on appetite at a test meal 30 min later were assessed in 16 healthy men. Each participant ate lunch on four occasions, combining two levels of fat energy (Low, 265 kJ or High, 1510 kJ) and two types of label (Low-fat or High-fat), presented as fictitious soup brand names. Preliminary work established that the Low-fat labels produced an expectation of reduced fat content and lower anticipated hedonic ratings, whereas the High-fat labels generated expectations of a high-fat content and above average hedonic ratings. These expectancies were confirmed in the main experiment, with the soups labelled as high fat rated as both more pleasant and creamy than those labelled low-fat, independent of actual fat content. However, intake at the test meal was unaffected by the preload label, but instead reflected the actual fat (hence, energy) content of the soup, with significantly lower food intake after the high-fat soup regardless of the food label. Rated hunger was lower, and fullness higher, at the start of the meal after the high-fat preloads regardless of how they were labelled, while the pattern of appetite change during the test meal was unaffected by preload. These results suggest that realistic food labels can modify the immediate experience of a consumed food, but do not alter appetite 30 min later in healthy men.

Physical model for photon beams used on the General Electric Target radiotherapy treatment planning system.

The tabulated measured data model for external photon beam planning used on the General Electric Target system is very powerful, allowing fast and accurate calculations and is extended to incorporate complex planning techniques. This approach is ideally suited for the incorporation of correction factors, defined at any point as the ratio of the dose in an inhomogeneous phantom to the dose in a homogeneous phantom. The correction factor can be determined using techniques such as a generalized Batho power law or the equivalent tissue air ratio method, and the dose in an homogeneous phantom is taken from the measured data tables. The use of tabulated data gives the benefits of very fast calculation times and, when required, the accuracy of sophisticated scatter corrections. The basic model and methods of correcting for inhomogeneities are described. The extension of the two-dimensional model to a three-dimensional model for non-coplanar treatment planning retains the basic principles of the 2D model.