East Scotland Research Articles

Multicentre open label randomised controlled trial of immediate enhanced ambulatory ECG monitoring versus standard monitoring in acute unexplained syncope patients: the ASPIRED study

IntroductionDiagnosing underlying arrhythmia in emergency department (ED) syncope patients is difficult. There is a evidence that diagnostic yield for detecting underlying arrhythmia is highest when cardiac monitoring devices are applied...

Environmental management on agricultural land: Cost benefit analysis of an integrated cropping system for provision of environmental public goods

Agricultural land covers a significant portion of the earths land surface. Although the predominant function of agricultural land is food production, environmental public goods, such as biodiversity or soil maintenance, are also essential for long-term sustainability. In arable farms the type of cropping system used has a major impact on delivery of these environmental goods. Low input, integrated and regenerative cropping systems aim to improve environmental outcomes of arable farming, with the goal of reducing external inputs by supporting internal regulation of system processes. However, the production of environmental goods does not have an immediate market value to the farmer, and often comes at a cost, particularly in the early stages of transition to a more sustainable system. We estimate the on-farm costs and benefits of an integrated cropping system during the first six years of transition from intensive conventional management at the Centre for Sustainable Cropping in north east Scotland. Although integrated cropping had better environmental outcomes, all crops had higher financial margins in the conventional system compared to the integrated system, which suffered a loss of over £500 per ha per year across the full rotation. This indicates that financial incentives are likely to be important to allow farmers to transition towards a more environmentally friendly cropping system.

Laying the foundations for hepatitis C elimination: evaluating the development and contribution of community care pathways to diagnostic efforts

BackgroundHepatitis C Virus (HCV) is a public health threat which contributes substantially to the global burden of liver disease. There is much debate about effective approaches to scaling up diagnosis of HCV among risk groups. Tayside, a region in the East of Scotland, developed low-threshold community pathways for HCV to lay the foundations of an elimination strategy. In this retrospective study, we sought to: quantify the contribution of community pathways to increasing HCV diagnosis; understand if shifting diagnosis to community settings led to a higher proportion of individuals tested for HCV being actively infected; and describe functional characteristics of the care pathways.MethodsDescriptive statistics were used to for analysis of routinely-collected HCV testing data from 1999 to 2017, and a review of the development of the care pathways was undertaken. Community-based testing was offered through general practices (GP); nurse outreach clinics; prisons; drug treatment services; needle and syringe provision (NSP) sites; community pharmacies; and mosques.ResultsAnti-HCV screening was undertaken on 109,430 samples, of which 5176 (4.7%) were reactive. Of all samples, 77,885 (71.2%) were taken in secondary care; 25,044 (22.9%) in GPs; 2970 (2.7%) in prisons; 2415 (2.2%) in drug services; 753 (0.7%) in NSPs; 193 (0.2%) pharmacies; and 170 (0.1%) in mosques. The highest prevalence of HCV infection among those tested was in NSP sites (26%), prisons (14%), and drug treatment centres (12%).ConclusionsDecentralised care pathways, particularly in harm reduction and other drug service settings, were key to increasing diagnosis of HCV in the region, but primary and secondary care remain central to elimination efforts.

Supporting victims of domestic violence in rural and island communities during COVID-19: the impact of the pandemic on service providers in North East Scotland and Orkney

We investigate the impact of the COVID-19 pandemic on domestic violence service providers in rural and island communities in North East Scotland and Orkney. Domestic abuse and violence in rural areas is typically underestimated and might be more hidden due to stigma, a surveillance culture, and the practical difficulties of accessing services. The geographical challenges of rural and remote areas in relation to domestic violence are, to some extent, further amplified in small island locations, given population sizes, terrain and separation by sea. In such communities, visits to a service organisation’s offices, or a visit by one of their staff, might publicly mark a service user out as a domestic abuse survivor. This article focuses on the move to digital and telephone provision of support in areas where broadband internet access is inconsistent and service users may live many miles from sources of support. At the same time, the move to online modes of communication was welcomed by staff in relation to offering opportunities for training and networking. There was also use of social and local media to raise awareness of the prevalence of domestic violence in these locations and to counter the myth of idyllic and abuse-free rural and island communities.

Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx (PHOENIx): a study protocol for a pilot randomised controlled trial

IntroductionThe number of people experiencing homelessness (PEH) is increasing worldwide. Systematic reviews show high levels of multimorbidity and mortality. Integrated health and social care outreach interventions may improve outcomes. No...

A new approach to characterising and predicting crop rotations using national-scale annual crop maps

Cropping decisions affect the nature, timing and intensity of agricultural management strategies. Specific crop rotations are associated with different environmental impacts, which can be beneficial or detrimental. The ability to map, characterise and accurately predict rotations enables targeting of mitigation measures where most needed and forecasting of potential environmental risks. Using six years of the national UKCEH Land Cover® plus: Crops maps (2015–2020), we extracted crop sequences for every agricultural field parcel in Great Britain (GB). Our aims were to first characterise spatial patterns in rotation properties over a national scale based on their length, type and structural diversity values, second, to test an approach to predicting the next crop in a rotation, using transition probability matrices, and third, to test these predictions at a range of spatial scales. Strict cyclical rotations only occupy 16 % of all agricultural land, whereas long-term grassland and complex-rotational agriculture each occupy over 40 %. Our rotation classifications display a variety of distinctive spatial patterns among rotation lengths, types and diversity values. Rotations are mostly 5 years in length, short mixed crops are the most abundant rotation type, and high structural diversity is concentrated in east Scotland. Predictions were most accurate when using the most local spatial approach (spatial scaling), 5-year rotations, and including long-term grassland. The prediction framework we built demonstrates that our crop predictions have an accuracy of 36–89 %, equivalent to classification accuracy of national crop and land cover mapping using earth observation, and we suggest this could be improved with additional contextual data. Our results emphasise that rotation complexity is multi-faceted, yet it can be mapped in different ways and forms the basis for further exploration in and beyond agronomy, ecology, and other disciplines.

Exploding silos: hacks in creating national simulation networks

Silos of work are a reality in virtually every large organisation and invariably create duplicated workloads, inefficiencies, and in some cases a sense of ‘tribalism’ which risks the integrity and effectiveness of teams [1]. As simulation-based education gains traction and momentum as a teaching approach across Scotland and the UK, silos of work have emerged and risk the effectiveness and efficiency of programme delivery. Our aim was to create an effective simulation user network across the 14 Health Boards of Scotland to eliminate silos and create a collaboration of work across the country. Thanks to an investment from NHS Education for Scotland (NES), insight from the NHS Scotland Academy, and the expertise of the Clinical Skills Managed Education Network (CSMEN), a team of regional Senior Educators were recruited to create a functional regional and national collaborative for simulation in Scotland. The story here is how the team have come together and the lessons learned in networking, negotiating, and establishing a new and growing sense of collegiately across the country. Starting in the East of Scotland, a questionnaire was designed and delivered across simulation teams and stakeholders across four Health Boards. The data collected was used to feed discussion at an East Scotland Simulation Collaborative scoping meeting which was attended by representatives of all four Health Boards and included medics, nurses, physiotherapists, and pharmacist teams delivering simulation to both undergraduate and postgraduate teams. An East Scotland Simulation Collaborative has been formally established with its inaugural meeting in Autumn 2023. An online space has been established to promote communication and the sharing of resources, and both a quarterly meeting and annual faculty development day designed for the group. Discussions are now ongoing for the development of an East Scotland Simulation Research group to develop new opportunities to conduct multisite studies for the first time. From a national perspective, North and West Scotland Simulation Collaborative groups are now in their formation stages. Like weeds in a garden, silos of work will grow all by itself. Like roses in a garden, an effective network takes both time and tending, but the investment pays dividends. 1. Beattie A. War and peace among the health tribes. 1995. In: Soothill K, Mackay L, Webb C (Eds). Interprofessional relations in health care. London: Edward Arnold.

Using Data to Improve the Management of Diabetes: The Tayside Experience.

Tayside is a region in the East of Scotland and forms one of nine local government regions in the country. It is home to approximately 416,000 individuals who fall under the National Health Service (NHS) Tayside health board, which provides health care services to the population. In Tayside, Scotland, a comprehensive informatics network for diabetes care and research has been established for over 25 years. This has expanded more recently to a comprehensive Scotland-wide clinical care system, Scottish Care Information - Diabetes (SCI-Diabetes). This has enabled improved diabetes screening and integrated management of diabetic retinopathy, neuropathy, nephropathy, cardiovascular health, and other comorbidities. The regional health informatics network links all of these specialized services with comprehensive laboratory testing, prescribing records, general practitioner records, and hospitalization records. Not only do patients benefit from the seamless interconnectedness of these data, but also the Tayside bioresource has enabled considerable research opportunities and the creation of biobanks. In this article we describe how health informatics has been used to improve care of people with diabetes in Tayside and Scotland and, through anonymized data linkage, our understanding of the phenotypic and genotypic etiology of diabetes and associated complications and comorbidities.

Short Report: Exploring the extent to which Intellectual Disability is undiagnosed within children attending developmental paediatric clinics

Intellectual Disability is under-ascertained worldwide and is associated with greater physical and mental health difficulties. This research aimed to identify clinical features and characteristics of children with Intellectual Disability in a population of 126 6–18 year olds in mainstream school, attending paediatric developmental clinics. Intellectual Disability was defined according to the DSM-5 (deficits in intellectual and adaptive functioning, present during childhood). Measures used to assess this were WISC-IV IQ (score <70) and ABAS adaptive behaviour (score =<70). Clinical features were compared from a structured clinical records investigation and logistic regression explored which factors were associated with Intellectual Disability. Twenty-eight children (22%) met the criteria for Intellectual Disability. Five variables were associated with higher odds of having Intellectual Disability: no other neurodevelopmental diagnosis, multiple other health problems, prior genetic testing, maternal smoking during pregnancy, and parental unemployment. Routinely-collected paediatric data only predicted Intellectual Disability correctly in two out of five cases. Further research is needed to verify these findings and improve identification. What this paper adds?Many children with Intellectual Disability, particularly a milder version, still reach adulthood without a diagnosis, despite evidence indicating that diagnosis is generally well received by children and families, and that early intervention leads to improvements in outcomes. This short report, based on a small sample of 126 children aged 6–18 in mainstream school who attended a paediatric development clinic in South East Scotland, provides tentative data on the clinical features and characteristics which are associated with Intellectual Disability. This tentative evidence suggests that the combination of a) having multiple concerns and investigations, alongside b) one or both parents being out of work (which may be related to familial undiagnosed Intellectual Disability), should raise a flag for paediatricians to further investigate the possibility of an Intellectual Disability diagnosis among these children and young people. Further research with larger samples is needed to explore this more robustly, with the potential to create an algorithm to highlight to paediatricians cases requiring formal screening for Intellectual Disability.

Editorial introductions.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of anesthesiology is divided into 16 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Anthony AbsalomAnthony AbsalomProf. Anthony Absalom studied medicine at the University of Cape Town, South Africa, and underwent specialist training in East Anglia and Scotland in the UK. He is currently Professor of Anaesthesiology at the University Medical Center Groningen, Netherlands. His clinical interests are procedural sedation, anaesthesia for neurosurgery, and intravenous anaesthesia techniques. His research interests are mostly in the domains of pharmacology and neuroscience. He is an editor of the British Journal of Anaesthesia, past President of the Society for Intravenous Anaesthesia, and a former vice-president of the World Society for Intravenous Anaesthesia. He is currently Chairman of the Neuroanaesthesia Section of the Dutch Association of Anaesthetists and past-Chair of the General Anaesthesia Scientific Sub-committee of the European Society of Anesthesiology. Ellen SoffinEllen SoffinEllen M. Soffin, MD, PhD is an Associate Professor of Anesthesiology, Weill Cornell Medical College, New York, USA and an anesthesiologist at Hospital for Special Surgery, New York, USA. She is the Director of the Anesthesia-Spine Service, and Co-Director of the Hospital for Special Surgery's interdisciplinary spine research program. Dr Soffin earned her medical degree at King's College Medical School, London, UK and PhD in neuroscience at Edinburgh University, Edinburgh, UK, before moving to the United States. She completed residency training in anesthesiology at The Johns Hopkins Hospital, Baltimore, Maryland, USA and a fellowship in regional anesthesia and acute pain medicine at Hospital for Special Surgery. Dr Soffin's research interests include evaluating the role and value of field and fascial plane blocks for the spine surgery patient; optimizing surgical outcomes using enhanced recovery pathways for total joint arthroplasty and spine surgery; and implementation of regulatory, institutional, and clinical strategies for opioid stewardship programs. She has published extensively on outcomes related to pathway-based care, regional analgesia techniques, and opioid-minimizing approaches to the perioperative care of the orthopedic surgery patient. Dr Soffin serves on the editorial board of Regional Anesthesia & Pain Medicine and is the Section Editor, Acute Pain and Perioperative Care, for Journal of Pain Research. She is an active faculty member of American Society of Regional Anesthesia & Pain Medicine, the American Academy of Pain Medicine, and the Society of Anesthesia & Sleep Medicine, where she is the co-chair of the research committee.

The Impact of the COVID-19 Pandemic on Hernia Surgery: The South-East Scotland Experience.

AimThe coronavirus disease 2019 (COVID-19) pandemic resulted in a lockdown in South East Scotland on 23 March 2020. This had an impact on the volume of benign elective surgery able to be undertaken. The degree to which this reduced hernia surgery was unknown. The aim of this study was to review the hernia surgery workload in the Lothian region of Scotland and assess the impact of COVID-19 on hernia surgery.MethodsThe Lothian Surgical Audit database was used to identify all elective and emergency hernia operations over a six-month period from 23 March 2020 and for the same time period in 2019. Data were collected on age, gender, anatomical location of the hernia, hernia repair technique, and whether elective or emergency operation. Statistical analysis was performed using the chi-squared test in R-Studio, with a p-value of <0.05 accepted as statistically significant.ResultsThe total number of hernia repairs reduced considerably between 2019 and 2020 (570 vs 149). The majority of this can be explained by a decrease in elective operating (488 vs 87), with the percentage of elective repairs reducing significantly from 85.6% to 58.4% (p<0.001). The inguinal hernia subgroup had a 24% rise in emergency operations from 21 to 26 operations, despite a reduction from 270 to 84 total inguinal repairs. There were just two elective hernia repairs carried out in the first three months of the 2020 study period (5.6% of all operations for April-June) compared to 265 (87.7%) for the same period in 2019 (p<0.001). No statistically significant differences were observed in the rates of laparoscopic versus open operating techniques across the two study periods on any analysis. The age and gender of the patients were similar over the two time periods.ConclusionThe COVID-19 pandemic led to a marked reduction in the number of elective hernia repairs (especially incisional hernia surgery), with the effect most pronounced over the first three months of lockdown. Despite an overall reduction in total emergency operative figures, possibly due to more widespread use of non-operative strategies, there was still an increase in emergency inguinal hernia repairs during the lockdown. Further studies are needed to evaluate if the delays to elective operating will result in a long-term increase in the rates of emergency presentation.

How the Citizen Science Platform iSpot Ensures Data Accuracy During and After Collection

How the Citizen Science Platform iSpot Ensures Data Accuracy During and After Collection

947 COVID19 and Its Impact on the North and East of Scotland Orthopaedic Trainees

Abstract Aim We conducted a trainee survey at the first peak of the pandemic to investigate the impact of COVID-19 on the North of Scotland (NoS) and East of Scotland (EoS) orthopaedic trainees. Method An online survey was distributed to all NoS and EoS orthopaedic trainees. All data collection was anonymous. Results Across both Scottish deaneries, 28 trainees had responded: 39% from EoS and 61% from NoS. Trainees at all stages of training responded to the survey, with the most responses received from specialist trainees in third year of training (ST3) (25%). In response to the pandemic, 18% of trainees had been redeployed and they were from NoS. Since the reconfiguration of service, 18% of trainees had done &amp;gt;20 operations in a month and they were senior trainees. If COVID-19 outbreak is likely going to reduce operating opportunities for a long period, only 36% of trainees would be open to the idea of making standard surgical specialty training longer whereas 57% of trainees would be open to longer working hours to achieve certification in Trauma and Orthopaedic surgery within 96 months. Conclusion The outbreak of COVID-19 has impacted both deaneries orthopaedic training and urgent restoration of surgical training is essential for individual trainees. Changes in working practices necessitated by COVID-19 have known to impact theatre efficiency. Actions should be taken to improve the theatre efficiency while prioritizing training opportunities.

Socioeconomic deprivation is associated with reduced efficacy of an insulin adjustment education program for people with type 1 diabetes.

The Dose Adjustment for Normal Eating (DAFNE) course teaches insulin dose adjustment to match dietary carbohydrates and improve glycaemic control in participants with type 1 diabetes mellitus (T1DM). We investigated the association between socioeconomic deprivation and reduction in HbA1c as a marker of sustained glycaemic control, after attending DAFNE education. This retrospective observational study identified adults with T1DM who attended DAFNE training in NHS Lothian, South East Scotland. We extracted age, sex, postcode-based Scottish Index of Multiple Deprivation (SIMD) quintiles and annual HbA1c measurements available four years before and after course attendance. We calculated mean HbA1c before (baseline) and after attendance at DAFNE, across four annual measurements. Change in mean HbA1c (mmol/mol) was categorised into three groups: decrease (≥ - 2.5), no change (<±2.5), increase (≥ + 2.5). We used multivariable ordinal logistic regression, with baseline mean HbA1c as a covariate, to investigate the association of SIMD quintile with reduction in mean HbA1c. 335 participants were included. Age and sex distribution were similar across SIMD quintiles (Mean age=45, range 21-91, 59% women). Lower SIMD quintiles (greater deprivation) had higher baseline mean HbA1c (SIMD 1: 76.0, SIMD 5: 69.0). Higher SIMD quintiles (lower deprivation) were associated with lower odds of no change/increase in mean HbA1c (SIMD 5, odds ratio=0.25, 95% confidence interval 0.10, 0.58, p=0.001, multivariable analysis). Socioeconomic deprivation was associated with higher baseline mean HbA1c and lower reduction in HbA1c following DAFNE education. Future research could explore causes and how best to support participants from deprived areas. This work has not been previously submitted to a journal. This work was presented as a poster at The ABCD Conference 2021 and the abstract (of no more than 300 words) from the meeting has been published: Innes CWD, Henshall DE, Wilson B, Poon M, Morley SD, Ritchie SA. Socioeconomic deprivation is associated with reduced efficacy of an insulin adjustment education programme for people with type 1 diabetes. Br J Diabetes. 2021; 21: 293-296.

What patient assessment skills do pharmacist independent prescribers require to prescribe immunomodulators in myeloma?

To gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing immunomodulators in myeloma across National Health Service Scotland. This was a two-phase study which used nominal group technique to gain local consensus followed by a two-round eDelphi questionnaire to gain national consensus across all cancer networks. This project was conducted across the three cancer networks within NHS Scotland: South East Scotland Cancer Network; West of Scotland Cancer Network and North Cancer Alliance. Participants were invited from each cancer network (South East Scotland Cancer Network, West of Scotland Cancer Network and North Cancer Alliance) and included haematology consultants, haematology specialist registrars, haematology advanced nurse practitioners and haematology pharmacists. There were five participants in the nominal group technique. Twenty-two out of 31 patient assessment skills gained local consensus, seven patient assessment skills did not gain consensus and two patient assessment skills were deemed irrelevant. There were 12 and 14 participants in round one and two of the eDelphi questionnaire, respectively. Twenty-nine patient assessment skills were included in the first-round questionnaire and 21 gained consensus. The remaining eight patient assessment skills were included in round two where seven did not achieve consensus and one achieved disagreement consensus. This research outlines 21 patient assessment skills required for pharmacist independent prescribers to prescribe immunomodulators for myeloma patients according to haematology specialists in Scotland. Discussion on patient assessment skills without consensus showed that the pharmacist independent prescribers would have a shared responsibility with the consultant. This work should inform the development of a competency framework to allow training of pharmacist independent prescribers in Scotland. Some patient assessment skills could be transferrable for pharmacist independent prescribers prescribing systemic anti-cancer therapy for other haematological malignancies.

Long-term trends in incidence and prevalence of severe sight impairment due to diabetes in South East Scotland before and after implementation of diabetic retinopathy screening

The study set out to examine the impact of the introduction of a national diabetic retinopathy screening programme in Scotland in 2006 on incidence and trends in severe sight impairment (SSI) certification due to diabetes over three decades. We analysed SSI certification due to diabetic eye disease in Fife, Scotland, between 2010 and 2019 and compared it to previously published estimates from 1990 onwards. Population estimates of the general population and those with diabetes were obtained from the National Records of Scotland and the National Diabetes Register, NHS SCI Diabetes, respectively. Mean annual incidence of SSI in the population with diabetes, 1990–2019, before and after the introduction of diabetic retinopathy screening was compared using a Mann–Whitney U Test. Mean incidence in 2007–2019 was 19.8/100,000 and was significantly less than the period before the systematic screening, 1990–2006 (57.5/100,000, p &lt; .001). Mean SSI incidence due to diabetes in Fife between 2010 and 2019 was significantly lower than in the previous decades ( p &lt; .001) at 16.4 per 100,000 for the population with diabetes, per year ( SD 10.0; 95% confidence interval: [9.2, 23.5]) compared to 42.7 per 100,000 in 2000–2009 and 64.3 per 100,000 in 1990–1999. This study demonstrates a significant reduction in the annual incidence of SSI due to diabetes before and after the introduction of the screening programme provides evidence for the benefit of systematic diabetic retinopathy screening programmes. Other factors including improved management of diabetes and risk factors will have also had an impact emphasizing the importance of a multidisciplinary approach to the prevention of sight loss in diabetes.

Cottage Gardens and Gardeners in the East of Scotland 1750–1914. By CatherineRice. Boydell and Brewer, 2021. xiii‐241 pp. £37.50.

Cottage Gardens and Gardeners in the East of Scotland 1750–1914. By CatherineRice. Boydell and Brewer, 2021. xiii‐241 pp. £37.50.

Evaluation of a whole system approach to diet and healthy weight in the east of Scotland: Study protocol.

Obesity is a global epidemic affecting all age groups, populations and income levels across continents. The causes of obesity are complex and are routed in health behaviours, environmental factors, government policy and the cultural and built environment. Consequently, a Whole System Approach (WSA) which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live in is required. This protocol describes a programme of research that will: critically evaluate the evidence for WSAs; assess longitudinally the implementation of a WSA to diet and healthy weight to explore the range of levers (drivers) and opportunities to influence relevant partnerships and interventions to target obesity in East Scotland. The programme consists of four workstreams within a mixed methods framework: 1) Systematic review of reviews of WSAs to diet and healthy weight; 2) Longitudinal qualitative process evaluation of implementing two WSAs in Scotland; 3) Quantitative and Qualitative momentary analysis evaluation of a WSA; and 4) the application of System Dynamics Modelling (SDM) methodology to two council areas in Scotland. A Public Involvement in Research group (PIRg) have informed each stage of the research process. The research programme's breadth and its novel nature, mean that it will provide valuable findings for the increasing numbers who commission, deliver, support and evaluate WSAs to diet and healthy weight nationally and internationally.

Proximal humerus fractures in adolescents: Experience from East of Scotland

BackgroundThe management of proximal humerus fractures (PHF) in adolescent has not been agreed upon. We aim to investigate the outcomes of PHF managed conservatively in adolescents. MethodsAll shoulder radiographs performed in patients aged from 10 to 18 years and from 2008 to 2015 were reviewed. The radiological parameters, including anatomical side, Neer and Horwitz displacement grade, angulation and any residual deformities were recorded. Mail questionnaires based on the modified 15-Upper Extremities Functional Index (15-UEFI), with a maximum of 59 points, were sent out. The return of the completed anonymized questionnaire was considered as implied consent. Results118 patients with a median age of 12 at the time of fracture were identified. The majority of the fractures were Neer and Horwitz grade I displacement and 3 children had Neer and Horwitz grade III and IV displacement. The median angulation was 25°. The median follow-up length was 26 days. 55 patients had residual angulation and 25 patients had worsened angulation. No non-union was identified. No patients underwent subsequent corrective surgeries. 35 patients responded to the questionnaire. The median 15-UEFI was 59 points. None of the patients have contacted the research or clinical team regarding any concerns. ConclusionThe vast majority of non-displaced and minimally displaced PHF in adolescent were managed conservatively in our unit. The functional outcomes for this cohort remain excellent even for those with residual deformities in the follow-up radiographs. Further large prospective multicenter studies on adolescent cohort with significantly displaced PHF are warranted.

Young-onset diabetes in Asian Indians is associated with lower measured and genetically determined beta cell function

Aims/hypothesisSouth Asians in general, and Asian Indians in particular, have higher risk of type 2 diabetes compared with white Europeans, and a younger age of onset. The reasons for the younger age of onset in relation to obesity, beta cell function and insulin sensitivity are under-explored.MethodsTwo cohorts of Asian Indians, the ICMR-INDIAB cohort (Indian Council of Medical Research-India Diabetes Study) and the DMDSC cohort (Dr Mohan’s Diabetes Specialties Centre), and one of white Europeans, the ESDC (East Scotland Diabetes Cohort), were used. Using a cross-sectional design, we examined the comparative prevalence of healthy, overweight and obese participants with young-onset diabetes, classified according to their BMI. We explored the role of clinically measured beta cell function in diabetes onset in Asian Indians. Finally, the comparative distribution of a partitioned polygenic score (pPS) for risk of diabetes due to poor beta cell function was examined. Replication of the genetic findings was sought using data from the UK Biobank.ResultsThe prevalence of young-onset diabetes with normal BMI was 9.3% amongst white Europeans and 24–39% amongst Asian Indians. In Asian Indians with young-onset diabetes, after adjustment for family history of type 2 diabetes, sex, insulin sensitivity and HDL-cholesterol, stimulated C-peptide was 492 pmol/ml (IQR 353–616, p<0.0001) lower in lean compared with obese individuals. Asian Indians in our study, and South Asians from the UK Biobank, had a higher number of risk alleles than white Europeans. After weighting the pPS for beta cell function, Asian Indians have lower genetically determined beta cell function than white Europeans (p<0.0001). The pPS was associated with age of diagnosis in Asian Indians but not in white Europeans. The pPS explained 2% of the variation in clinically measured beta cell function, and 1.2%, 0.97%, and 0.36% of variance in age of diabetes amongst Asian Indians with normal BMI, or classified as overweight and obese BMI, respectively.Conclusions/interpretationThe prevalence of lean BMI in young-onset diabetes is over two times higher in Asian Indians compared with white Europeans. This phenotype of lean, young-onset diabetes appears driven in part by lower beta cell function. We demonstrate that Asian Indians with diabetes also have lower genetically determined beta cell function.Graphical abstract