RESUMO
Objective: To investigate the clinical incidence and characteristics of type 1 diabetes mellitus (T1DM) of children and adolescents at the time of initial diagnosis in China. Methods: Data on all pediatric patients with newly diagnosed T1DM were retrospectively collected from 34 medical centers in 25 major cities in China from January 2015 to January 2020. Patients were classified into three age groups: <5 years, 5 to <10 years, and ≥10 years of age. The same patient population was also categorized into diabetic ketoacidosis (DKA) and non-DKA groups based on clinical criteria. Results: The mean annual clinical incidence of T1DM was 3.16/100,000 from the years 2015 to 2019. A total of 6,544 patients with newly diagnosed T1DM aged 0-16 years (median 7.84 ± 3.8) were studied [ages <5 years (29.3%), 5 to <10 years (38.7%), and ≥10 years (32%)], 52.4% of them were women. In total, 90.5% of the cases were occurred in individuals without a family history. Patients had lower C-peptide (CP) and body mass index (BMI) z scores when compared with healthy children, 41.8% of them had measurable T1DM-related antibodies and 52.7% had DKA. Among all three age groups, the <5 years group had the lowest BMI z score, CP, and glycated hemoglobin (HbA1c) on average, while it had the highest incidence rate of DKA (56.9%). Compared to the non-DKA group, the DKA group was significantly younger, with a lower BMI z score and CP, higher antibody positive rate, HbA1c, and the rate of insulin pump therapy. Conclusion: The clinical incidence of T1DM in children and adolescents in China was 3.16/100,000. Patients with DKA at the first diagnosis of T1DM have a worse ß-cell function. Public health measures for the prevention and treatment of T1DM should focus on preschoolers (aged <5 years) in particular, considering the severity and the highest frequency of DKA in this age group. More efforts should be dedicated to early screening and diagnosis of the T1DM.
RESUMO
Resumo O objetivo do estudo é investigar, da perspectiva do institucionalismo histórico, a evolução histórica e a configuração atual do Serviço de Acolhimento Institucional para Crianças e Adolescentes em situação de risco. Argumenta-se que decisões prévias, por favorecerem o desenvolvimento de certas capacidades estatais em detrimento de outras, influenciam decisões correntes, explicando a dificuldade de mudança no curso das políticas. A análise mostra que escolhas feitas na Era Vargas prejudicaram a implementação de inovações do Código de Menores de 1979 e do Estatuto da Criança e do Adolescente (ECA), de 1990, até meados da década de 2000, quando a burocracia estatal na área da assistência foi fortalecida. A empiria utilizada são os dados do Censo Suas 2014 e as normativas que têm estruturado, desde o início do século XX, as políticas de assistência social e de atenção à criança e ao adolescente.
Resumen El objetivo del estudio es investigar, de la perspectiva del institucionalismo histórico, el desarrollo histórico y la configuración actual del Servicio de Acogimiento Institucional para los Niños y Adolescentes en situación de riesgo. Se argumenta que, al favorecer el desarrollo de ciertas habilidades a expensas de la otra, las decisiones anteriores influyen en las decisiones actuales, lo que explica la dificultad de cambio en el curso de la política. El análisis muestra que las decisiones tomadas en el estado Vargas minaron la aplicación de las innovaciones establecidas por el Código de Menores de 1979 y el Estatuto da Criança e do Adolescente (ECA), de 1990, hasta mediados de 2000, cuando se fortalece la burocracia estatal de asistencia social. El empírica utilizada son los registros del Censo Suas 2014 y las normas que se estructuran a partir de principios del siglo XX, las políticas de asistencia social y la atención a los niños y adolescentes.
Abstract The objective of the study is to investigate, through a historical and institutional perspective, the historical development and current configuration of the Institutional Care Service for Children and Adolescents at risk. It is argued that, by favoring the development of certain skills at the expense of others, previous decisions have influenced current decisions, explaining the difficulty of changing the course of policy. The analysis shows that choices made in the Vargas Era undermined the implementation of innovations established by the Código de 1979 and the Estatuto da Criança e do Adolescente (ECA) (1990) up until the mid-2000s when the bureaucracy of state social assistance was strengthened. The empirical data used are found in the Censo Suas 2014 and the regulations that, from the early twentieth century, have been structured in child and adolescent social assistance policies.
