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The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. This study of a Barts Health NHS Trust cohort from 2008 to 2022 aims to elucidate the incidence, clinical outcomes, and complications associated with paediatric T2D. A retrospective analysis utilising electronic and paper records identified 40 patients with T2D. The incidence doubled from 2.6/year in 2008–2013 to 5.4/year in 2014–2018. Sixty-eight percent exhibited co-morbidities, notably learning disabilities. At diagnosis, the mean BMI was 32.4 ± 6.71 kg/m2, with no gender-based disparity and no significant change over a two-year follow-up. The initial HbA1c was 75.2 ± 21.0 mmol/mol, decreasing to 55.0 ± 17.4 mmol/mol after three months (p = 0.001) and then rising to 63.0 ± 25.5 mmol/mol at one year (p = 0.07). While 22/37 patients achieved HbA1c < 48 mmol/mol, only 9 maintained this for a year. Several metabolic and cardiovascular complications were observed at diagnosis and follow-up, with no significant change in frequency. In 2022, 15 patients transitioned to adult services. HbA1c at transition was 74.7 ± 27.6 mmol/mol, showing no change one year post-transition (71.9 ± 26.9 mmol/mol, p = 0.34). This study highlights substantial therapeutic failure, with current management falling short in achieving a sustained reduction in BMI or HbA1c. Novel treatment approaches are needed to improve clinical outcomes and address the high burden of co-morbidities and complications. [ABSTRACT FROM AUTHOR]

Background: Post-COVID services have been set up in England to treat children with ongoing symptoms of Long COVID. To date, the characteristics of children seeking treatment from these services has not been described. Purpose: (1) to describe the characteristics of children aged 11–17 referred to the Pan-London Post-COVID service and (2) to compare characteristics of these children with those taking part in the United Kingdom's largest research study of Long COVID in children (CLoCk). Design: Data from 95 children seeking treatment from the Post-COVID service between May 2021 and August 2022 were included in the study. Their demographic characteristics, symptom burden and the impact of infection are described and compared to children from CLoCk. Results: A high proportion of children from the Post-COVID service and CLoCk reported experiencing health problems prior to the pandemic. Almost all Post-COVID service children met the research Delphi definition of Long COVID (94.6%), having multiple symptoms that impacted their lives. Symptoms were notably more severe than the participants in CLoCk. Conclusions: This study describes the characteristics of children seeking treatment for Long COVID compared to those identified in the largest longitudinal observational study to date. Post-COVID service children have more symptoms and are more severely affected by their symptoms following infection with COVID-19 than children in the CLoCk study. Research to understand predisposing factors for severity and prognostic indicators is essential to prevent this debilitating condition. Evaluation of short- and long-term outcomes of interventions by clinical services can help direct future therapy for this group. [ABSTRACT FROM AUTHOR]

Background: While there is a substantial body of knowledge about acute COVID-19, less is known about long-COVID, where symptoms continue beyond 4 weeks. Aim: To describe longer-term effects of COVID-19 infection in children and young people (CYP) and identify their needs in relation to long-COVID. Design & setting: This study comprises an observational prospective cohort study and a linked qualitative study, identifying participants aged 8-17 years in the West Midlands of England. Method: CYP will be invited to complete online questionnaires to monitor incidences and symptoms of COVID-19 over a 12-month period. CYP who have experienced long-term effects of COVID will be invited to interview, and those currently experiencing symptoms will be asked to document their experiences in a diary. Professionals who work with CYP will be invited to explore the impact of long-COVID on the wider experiences of CYP, in a focus group. Descriptive statistics will be used to describe the incidence and rates of resolution of symptoms, and comparisons will be made between exposed and non-exposed groups. Logistic regression models will be used to estimate associations between candidate predictors and the development of long-COVID, and linear regression will be used to estimate associations between candidate predictors. Qualitative data will be analysed thematically using the constant comparison method. Conclusion: This study will describe features and symptoms of long-COVID and explore the impact of long-COVID within the lives of CYP and their families, to provide better understanding of long-COVID and inform clinical practice. [ABSTRACT FROM AUTHOR]

Background The protective effect of community water fluoridation (CWF) against dental caries may be modified by secular changes in health behaviour. We aimed to determine the contemporary association between fluoride in public water supplies (PWS) and dental caries indicators and inequalities in England. Methods We estimated exposure to CWF and PWS fluoride concentrations from national monitoring data, using Geographic Information Systems and water supply boundaries, categorizing mean period exposure into <0.1, 0.1–<0.2, 0.2–<0.4, 0.4–<0.7 and ≥0.7 mg/l. We used area-level health outcome and confounder data in multivariable regression models to determine the association between fluoride and caries outcomes and calculated preventive fractions using these coefficients. Results The odds of caries and of severe caries in 5-year-olds fell with increasing fluoride concentration in all SES quintiles (P  < 0.001 to P  = 0.003). There was a negative trend between increasing fluoride concentration and dental extractions (P  < 0.001). Compared to PWS with <0.2 mg/l, CWF prevented 17% (95% confidence interval (CI): 5–27%) to 28% (95% CI: 24–32%) of caries (high-low SES) and 56% (95% CI: 25–74%) of dental extractions. The association between fluoride concentration and caries prevalence/severity varied by socioeconomic status (SES) (P  < 0.001). Conclusions Exposure to fluoride in PWS appears highly protective against dental caries and reduces oral health inequalities. [ABSTRACT FROM AUTHOR]

Introduction: The use of debating as an educational tool is increasing in popularity. Students who take part in debates can develop a range of skills such as confidence and communication as well as gaining a greater understanding of the topic discussed. Within this study we have evaluated an antibiotic-resistant debate kit, assessing the ability of the debate lesson to improve student knowledge and awareness around antibiotics. Methods: The debate lesson was delivered in seven schools across South West England to 235 students aged 13-16 years. Change in student knowledge was measured using before and after knowledge questionnaires. Student and teacher feedback and suggestions for improvements for the lesson were also collected through questionnaires and interviews. Results: Quantitative questionnaires found a significant improvement in knowledge for most areas covered in the debate, particularly around the use of antibiotics to treat colds and bacteria developing resistance. Teachers felt their students engaged well with the debate session and made suggestions for minor modifications that could improve the lesson. Conclusions: The results suggest that the e-Bug antibiotic resistant debate kit is able to improve knowledge in young people around antibiotics and antibiotic resistance. Furthermore, the lesson was enjoyed by students and therefore this resource should be promoted more widely to teachers and schools. [ABSTRACT FROM AUTHOR]

Aims: To explore adolescents’ experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care. Methods: In-depth semi-structured interviews with 27 adolescents (16 males; aged 14–17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis. Results: Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves. Conclusions: Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence. Trial registration: [ABSTRACT FROM AUTHOR]

Background People with cerebral palsy (CP) experience increased muscle stiffness, muscle weakness, and reduced joint range of motion. This can lead to an abnormal pattern of gait, which can increase the energy cost of walking and contribute to reduced participation in physical activity. Objective The aim of the study was to examine associations between lower-body joint angles, moments, power, and walking efficiency in adolescents with CP. Design This was a cross-sectional study. Methods Sixty-four adolescents aged 10 to 19 years with CP were recruited. Walking efficiency was measured as the net nondimensional oxygen cost (NNcost) during 6 minutes of overground walking at self-selected speed. Lower-body kinematics and kinetics during walking were collected with 3-dimensional motion analysis, synchronized with a treadmill with integrated force plates. The associations between the kinematics, kinetics, and NNcost were examined with multivariable linear regression. Results After adjusting for age, sex, and Gross Motor Function Classification System level, maximum knee extension angle (β = −0.006), hip angle at midstance (β = −0.007), and maximum hip extension (β = −0.008) were associated with NNcost. Age was a significant modifier of the association between the NNcost and a number of kinematic variables. Limitations This study examined kinetic and kinematic variables in the sagittal plane only. A high interindividual variation in gait pattern could have influenced the results. Conclusions Reduced knee and hip joint extension are associated with gait inefficiency in adolescents with CP. Age is a significant factor influencing associations between ankle, knee, and hip joint kinematics and gait efficiency. Therapeutic interventions should investigate ways to increase knee and hip joint extension in adolescents with CP. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is sexually transmitted and has been conclusively linked to cervical cancer and genital warts. Cervical cancer is attributed to approximately 1100 deaths annually in UK, and is the second most common female cancer globally. It has been suggested that black African women are more predisposed to HPV infection and cervical cancer. A vaccine has been developed to reduce HPV infection, and in the UK, has been offered to 12-13 year old adolescent girls through schools as part of their childhood immunization programme since 2008. Upon programme initiation, it was noted that vaccine uptake was lower in schools where girls from ethnic minority groups were proportionately higher. The study's objectives were to explore factors influencing UK based African parents' acceptance or decline of the HPV vaccine, whether fathers and mothers share similar views pertaining to vaccination and any interfamily tensions resulting from differing views. Methods: A qualitative study was conducted with five African couples residing in north England. Face to face semi- structured interviews were carried out. Participants were parents to at least one daughter aged between 8 and 14 years. Recruitment was done through purposive sampling using snowballing. Results: HPV and cervical cancer awareness was generally low, with awareness lower in fathers. HPV vaccination was generally unacceptable among the participants, with fear of promiscuity, infertility and concerns that it'ss t i l lan e w vaccine with yet unknown side effects cited as reasons for vaccine decline. There was HPV risk denial as religion and good cultural upbringing seemed to result in low risk perceptions, with HPV and cervical cancer generally perceived as a white person's disease. Religious values and cultural norms influenced vaccine decision-making, with fathers acting as the ultimate decision makers. Current information about why the vaccine is necessary was generally misunderstood. Conclusion: Tailored information addressing religious and cultural concerns may improve vaccine acceptability in African parents. [ABSTRACT FROM AUTHOR]

Introduction: Contemporary adolescents are deemed inactive, especially girls, but whether for biological reasons associated with their maturation, changes in their behavior or because of environmental constraints, is uncertain. We examined the trends in physical activity (PA) in relation to both biological and environmental factors in an attempt to establish what drives activity patterns from childhood through adolescence. Methods: Physical activity (7-d Actigraph accelerometry) was measured annually from 5 to 15 yr in a single cohort of some 300 UK children. Total PA (TPA; in-school and out-of-school separately and combined as whole day) and intensity-specific PA (sedentary, light, and moderate-and-vigorous [MVPA]) were analyzed. Biological age (years before/after measured peak height velocity) and pubertal stage (self-reported pubic hair development-Tanner staging) were also measured as was socioeconomic status (postcode-derived index of multiple deprivation [IMD]). Results: Total PA was stable from 5 to 8 yr (trend P = 0.10) but fell progressively from 9 to 15 yr (by approximately 30% in girls and approximately 20% in boys, both P < 0.001; sex interaction, P < 0.01). Half of this fall was attributable to light intensity PA and only a quarter to MVPA. The decline in PA was related similarly to chronological and biological age, whereas pubertal stage explained the more rapid PA decline in girls (puberty-adjusted sex interaction, P = 0.51). Total PA fell to the same extent for in-school and out-of-school settings (both P < 0.001), and for lower and higher IMD areas (both P < 0.001). Total PA tracked moderately to strongly from childhood into adolescence (r = 0.58; P G 0.001). Conclusions: The adolescent decline in PA is consistent across different environmental settings, attributable to falls in light-intensity/habitual activity and influenced by puberty, suggesting that the inactivity of adolescence may, in part, be under biological control [ABSTRACT FROM AUTHOR]

Background: The Daily MileTM is a free school-based active mile intervention. Its main features include that children run or jog for 15 minutes at least 3 times a week (3x/wk) during school hours. The Daily Mile Foundation recommends 10 principles for successful implementation. These are it is (1) quick (15 minutes), (2) fun, (3) whole school participates, (4) it takes place in all weathers, (5) 3x/wk in addition to curricular lessons (not during PE, breaks, before/after school), (6) ideally in the school playground, (7) safe, (8) simple (no equipment), (9) children go at their own pace and (10) no change of clothes or shoes is needed. The aim of this study was to identify how many Greater London primary schools adopting The Daily Mile implement its 10 principles. Methods: In September 2020, we sent all state-funded primary schools (n = 1721) in every Greater London borough (n = 32) a survey to find out if and how they implemented The Daily Mile. Results: By June 2021, 368 (21%) schools responded to our survey (at least one from every London borough). Of these, 195 (53%) schools adopted The Daily Mile of which only 7 (4%) reported implementing all 10 principles; a median 7 (IQR: 6,8) principles were reported implemented. Whole school participation was reported by 93 (48%) Daily Mile schools, 104 (53%) reported implementing The Daily Mile for 15 minutes, 127 (65%) implemented it at least 3x/wk, and 149 (76%) schools reported that the children ran or jogged during The Daily Mile. A large proportion of schools reported implementing The Daily Mile in the school playground and that it was done simply (both n = 171, 88%), but only 85 (44%) schools reported implementing it during lessons. Conclusions: Daily Mile schools in Greater London implement 7/10 principles on average. Whether implementing all the principles limits the success of its desired effect is unclear. Studies assessing effects of The Daily Mile should consider its implementation when reporting results. Key messages: Of The Daily Mile’s 10 principles, an average of 7 are implemented in London schools. Studies examining The Daily Mile should consider implementation which may impact its desired effect. [ABSTRACT FROM AUTHOR]

Background The prevalence of autistic spectrum disorder (ASD) in children in UK is ∼1 in 100. There is emerging evidence that dysregulation of the immune system may be an underlying cause of ASD. The CARRA registry from the USA reported a frequency of 0.3% co-morbidity of autism in children with JIA. There is a paucity of data from the UK reporting this association. Methods The department's database of all patients that attended the local paediatric rheumatology clinic was reviewed over a 12-month period from April 2018 to April 2019. Diagnoses were grouped broadly into inflammatory (JIA, systemic disease, non-JIA uveitis) and non-inflammatory (mechanical, bone and collagen disorder and other). Those with a co-morbidity of autism were also identified within inflammatory and non-inflammatory groups. Results There were 196 individual patients within the cohort of paediatric rheumatology patients seen in Bradford in April 2018 to April 2019. These were subcategorised into JIA (N = 79,40%), mechanical (N = 56, 29%), systemic rheumatological disease (N = 31, 16%), bone and collagen disorders (N = 12, 6%), other non-inflammatory diagnoses (N = 11, 6%), non-JIA associated uveitis (N = 7, 3%). This cohort was divided into 117 patients with inflammatory paediatric rheumatological conditions and 79 patients with non-inflammatory causes for joint pain. Nine children (see Table 1) had a co-morbidity of autism, of which 6 children had an inflammatory diagnosis and 3 a non-inflammatory cause for joint pain. The prevalence of autism in our cohort of children with paediatric rheumatological disease was 5%, which is higher than expected from a UK prevalence of autism of 1%. P16 Table 1: Patients with Autism in Paediatric Rheumatology cohort. Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  P16 Table 1: Patients with Autism in Paediatric Rheumatology cohort. Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  Conclusion In this cohort of paediatric rheumatology patients there was a higher prevalence of autism than the UK average. Two of these patients were diagnosed with autism after presenting to our service. This association is compatible with the emerging recognition of dysregulation of the immune system as a potential underlying cause of ASD. It is important to consider the co-morbidity of autism in children presenting to paediatric rheumatology clinic and potentially paediatric rheumatological conditions in children already diagnosed with autism, where there may be a delay in their presentation due to communication difficulties. There is the need for a larger UK study to review this association further. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]