This review updates earlier work by including prospective studies published within the past five years and extends earlier work by inclusion of studies with late follow-up. Addition of some recent large studies to this review brings the combined number of participants in the meta-analysis to more than five times higher than in the latest review (Smid et al, 2009).Affiliation:
OBJECTIVEType 1 diabetes is associated with an increased risk of psychiatric morbidities. We investigated predictors and diabetes outcomes in a pediatric population with and without psychiatric comorbidities. RESEARCH DESIGN AND METHODSData from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) and National Patient Register were collected (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) for this population-based study. We used Kaplan-Meier plots to investigate whether age at type 1 diabetes onset and average glycated hemoglobin (HbA 1c ) levels during the first 2 years after onset of type 1 diabetes (excluding HbA 1c at debut) were associated with the risk of being diagnosed with a psychiatric disorder. Mixed-effects linear and logistic regression models were used to analyze HbA 1c , BMI, severe hypoglycemia (SH), or ketoacidosis as outcomes, with psychiatric comorbidities as explanatory factor. RESULTSAmong 4,725 children and adolescents with type 1 diabetes identified in both registers, 1,035 were diagnosed with at least one psychiatric disorder. High average HbA 1c levels during the first 2 years predicted higher risk of psychiatric diagnoses. Patients with psychiatric comorbidity had higher HbA 1c levels (0.22% [95% CI 0.15; 0.29]; 2.40 mmol/mol [1.62; 3.18]; P < 0.001) and an increased risk of hospitalization with diabetic ketoacidosis (1.80 [1.18; 2.76]; P = 0.006). We found no associations with BMI or SH. CONCLUSIONSHigh average HbA 1c levels during the first 2 years after onset of type 1 diabetes might indicate later psychiatric comorbidities. Psychiatric comorbidity in children and adolescents with type 1 diabetes increases the risk of poor metabolic outcomes. Early focus on the disease burden might improve outcomes.Type 1 diabetes in childhood has been found to be associated with an increased risk of psychiatric comorbidities (1-3), which might intensify the burden of disease and accelerate metabolic deterioration (4-6), subsequently increasing the risk of mortality and long-term complications such as retinopathy, nephropathy, and neuropathy (7-9).
Organizational change, psychosocial work environment, and non-disability early retirement: a prospective study among senior public employees by Breinegaard N, Jensen JH, Bonde JP To date, this is the most exhaustive study to examine voluntary early retirement behavior among senior public service employees exposed to organizational change and subsequent assessment of the psychosocial work environment on the work-unit level. Decision-makers should consider the impact of organizational change and the psychosocial work environment in strategies to maintain senior public employees in the labor market. Original article Scand J Work Environ Health. 2017;43(3):234-240. doi:10.5271/sjweh.3624 Organizational change, psychosocial work environment, and non-disability early retirement: a prospective study among senior public employees Objective This study examines the impact of organizational change and psychosocial work environment on non-disability early retirement among senior public service employees. AffiliationMethods In January and February 2011, Danish senior public service employees aged 58-64 years (N=3254) from the Capital Region of Denmark responded to a survey assessing psychosocial work environment (ie, social capital, organizational justice, and quality of management). Work-unit organizational changes (ie, change of management, merging, demerging, and relocation) were recorded from January 2009 to March 2011. Weekly data on non-disability early retirement transfer were obtained from the DREAM register database, which holds weekly information about all public benefit payments in Denmark. Hazard ratios (HR) for early retirement following employees' 60 th birthday were estimated with Cox regression adjusted for age, gender, and socioeconomic status. Conclusion Organizational change and poor psychosocial work environment contribute to non-disability early retirement among senior public service employees, measured at work-unit level. Results
The communication mode at home proved essential to speech and language outcome, as children exposed to spoken language had markedly better odds of performing well in all tests, compared with children exposed to a mixture of spoken language and sign support, or sign language.
Objectives: To investigate the trajectory in glycemic control following episodes of severe hypoglycemia (SH) among children and adolescents with type 1 diabetes (T1D). Methods:A Danish national population-based study comprising data from 2008-17. SH was defined according to the 2014 ISPAD guidelines. A mixed model was applied with HbA1c as outcome and SH episodes and time since first episode as explanatory variables. Data were adjusted for age, gender and diabetes duration.Results: A total of 4,244 children (51.6% boys) with 18,793 annual outpatient visits were included. Mean (SD) age at diabetes onset was 9.0 (4.1) years. Median diabetes duration at inclusion in the study was 1.2 (Q1=0.9, Q3=3.0) years, and median diabetes duration at last visit was 5.0 (Q1=2.7, Q3=8.1) years. A total of 506 children experienced at least one episode of SH during the nine-year follow-up; 294 children experienced one episode, 115 two episodes and 97 three or more episodes of SH. HbA1c increased with episodes of SH and in the years following the first episode. The glycemic trajectory peaked 2-3 years after an SH episode. The accumulated deterioration in glycemic control was in the range of 5% in patients with two or more episodes equivalent to an increase in HbA1c of 4 mmol/mol (HbA1c ~ 0,4%). Conclusion:Severe hypoglycemia was followed by a progressive and lasting increase in HbA1c among Danish children and adolescents with T1D. Thus, in addition to the known risk of new episodes of hypoglycemia and cognitive impairment, SH contributes to long-term diabetes complications.
Generalized linear mixed models for longitudinal data assume that responses at different occasions are conditionally independent, given the random effects and covariates. Although this assumption is pivotal for consistent estimation, violation due to serial dependence is hard to assess by model elaboration. We therefore propose a targeted diagnostic test for serial dependence, called the transition model test (TMT), that is straightforward and computationally efficient to implement in standard software. The TMT is shown to have larger power than general misspecification tests. We also propose the targeted root mean squared error of approximation (TRSMEA) as a measure of the population misfit due to serial dependence.
Maximum likelihood estimation of models for binary longitudinal data is typically inconsistent if the dependence structure is misspecified. Unfortunately, diagnostics specifically designed for detecting such misspecifications are scant. We develop residuals and diagnostic tests based on comparing observed and expected frequencies of response patterns over time in the presence of arbitrary time-varying and time-invariant covariates. To overcome the sparseness problem, we use lower-order marginal tables, such as two-way tables for pairs of time-points, aggregated over covariate patterns. Our proposed pairwise concordance residuals are valuable for exploratory diagnostics and for constructing both generic tests for misspecified dependence structure as well as targeted adjacent pair concordance tests for excess serial dependence. The proposed methods are straightforward to implement and work well for general situations, regardless of the number of time-points and the number and types of covariates.
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