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1.
Pediatr Diabetes ; 23(3): 310-319, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35084809

RESUMO

AIM: To calculate a 30-year incidence rates of type 1 diabetes (T1D) in Sana'a city, Yemen during peace and wartimes. METHODS: A total of 461 patients aged between 8 months and 18 years with newly diagnosed diabetes were registered between 1989 and 2018. We used a standardized protocol for counting cases over time. The annual incidence rates (cases/100,000/year) were calculated from the number of new reported cases for each year divided by the estimated number of person-years "at risk" resident in Sana'a city, Yemen according to age and sex of the participants of that year. RESULTS: The mean annual incidence rate of T1D in children aged 0-14 years was 1.83/100,000/year. With the use of 3-year time-periods, the mean annual incidence rate was (5/100,000/year) in the first time-period, fluctuated between 1.2 and 2.3 during subsequent seven time-periods, and declined to (0.5/100,000/year) during the conflict years. The age-specific mean annual incidence rates for age-groups 0-4, 5-9, 10-14, and 15-18 years were 0.83, 1.82, 3.14, and 2.31/100,000/year, respectively. CONCLUSION: The mean annual incidence rate of T1D in children and adolescents over the observation period in Sana'a city was low. In children aged 0-14 years in particular, the incidence declined to a very low rate during wartime. Interpretation is partly limited by lack of recent census data, and the possibility of death from nondiagnosis at onset.


Assuntos
Diabetes Mellitus Tipo 1 , Adolescente , Criança , Diabetes Mellitus Tipo 1/epidemiologia , Humanos , Incidência , Lactente , Iêmen/epidemiologia
2.
BMC Pediatr ; 22(1): 613, 2022 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-36273121

RESUMO

BACKGROUND: Several individual studies from specific countries have reported rising numbers of pediatric COVID-19 cases with inconsistent reports on the clinical symptoms including respiratory and gastrointestinal symptoms as well as diverse reports on the mean age and household exposure in children. The epidemiological characteristics of COVID-19 in children are not fully understood, hence, comprehensive meta-analyses are needed to provide a better understanding of these characteristics. METHODS: This review was conducted in Medline, Scopus, Cochrane library, Embase, Web of Science, and published reports on COVID-19 in children. Data were extracted by two independent researchers and a third researcher resolved disputes. STATA software and the random-effect model were used in the synthesis of our data. For each model, the heterogeneity between studies was estimated using the Q Cochrane test. Heterogeneity and publication bias were calculated using the I2 statistic and Egger's/Begg's tests. RESULTS: The qualitative systematic review was performed on 32 articles. Furthermore, the meta-analysis estimated an overall rate of involvement at 12% (95% CI: 9-15%) among children, with an I2 of 98.36%. The proportion of household exposure was calculated to be 50.99% (95% CI: 20.80%-80.80%) and the proportion of admitted cases was calculated to be 45% (95% CI: 24%-67%). Additionally, the prevalence of cough, fatigue, fever and dyspnea was calculated to be 25% (95% CI: 0.16-0.36), 9% (95% CI: 0.03-0.18), 33% (95% CI: 0.21-0.47) and 9% (95% CI: 0.04-0.15), respectively. It is estimated that 4% (95% CI: 1-8%) of cases required intensive care unit admission. CONCLUSIONS: The pediatric clinical picture of COVID-19 is not simply a classic respiratory infection, but unusual presentations have been reported. Given the high incidence of household transmission and atypical clinical presentation in children, we strongly recommend their inclusion in research and population-based preventive measures like vaccination as well as clinical trials to ensure efficacy, safety, and tolerability in this age group.


Assuntos
COVID-19 , Humanos , Criança , COVID-19/epidemiologia , SARS-CoV-2 , Febre/complicações , Tosse/epidemiologia , Tosse/etiologia , Fadiga/etiologia
3.
Future Oncol ; 10(16): 2561-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25531045

RESUMO

AIM: As the incidence of endometrial cancer (EC) increased considerably since 2007, this study aimed to project the burden of EC to the year 2030. METHODS: Multivariate linear regression was used to project EC incidence by modeling trends in EC incidence from 1990 to 2013, while accounting for temporal changes in obesity, hysterectomy and smoking. RESULTS: The best-fitting model predicting EC rates included a time effect plus effects for hysterectomy (12-year lag), severe obesity (3-year lag) and smoking (9-year lag). The best-fitting model projected an increase to 42.13 EC cases per 100,000 by the year 2030, a 55% increase over 2010 EC rates. CONCLUSION: The projected increase of EC over next 16 years indicates the need for close monitoring of EC trends.


Assuntos
Neoplasias do Endométrio/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Obesidade/complicações , Obesidade/patologia , Fumar/patologia , Estados Unidos
4.
Pediatr Diabetes ; 14(4): 280-7, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22925438

RESUMO

OBJECTIVE: To report the annual incidence of type 1 and type 2 diabetes among youth and to describe characteristics of youth diagnosed with diabetes in the U.S. Virgin Islands (USVI). RESEARCH DESIGN AND METHODS: All residents ≤19 years of age diagnosed with diabetes between January 2001 and December 2010 were identified from review of medical records of all hospitals and confirmed by physician query. RESULTS: A total of 82 eligible patients were identified and the registry ascertainment was estimated to be 98.7% complete. The overall age-adjusted annual incidence rates (per 100, 000) of type 1 and type 2 diabetes for the study period were 15.3 (95% CI: 11.3-20.1) and 9.6 (95% CI: 6.8-13.5), respectively. The incidence of type 1 diabetes increased significantly over the study period, with an epidemic-like threefold increase occurring from 2005 (8.7/100, 000) to 2006 (26.4/100, 000; p = 0.05). The incidence of type 1 diabetes was highest in the 10-19 age group in girls (25.6/100, 000), but no age difference was seen in boys, resulting from the lack of a pubertal peak in non-Hispanic Black boys. The incidence of type 2 diabetes rose significantly between 2001 (5.3/100, 000) and 2010 (12.5/100, 000; p = 0.03). CONCLUSIONS: The incidence of type 1 and type 2 diabetes in youth is increasing in the USVI, similar to global patterns. Further studies are needed to explore the missing pubertal rise in type 1 diabetes incidence in non-Hispanic Black boys and factors associated with the epidemic-like increases observed over the decade.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Ilhas Virgens Americanas/epidemiologia , População Branca/estatística & dados numéricos
5.
Telemed J E Health ; 18(8): 621-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23061643

RESUMO

BACKGROUND: Building research capacity in developing countries using cost-effective methods has been recognized as an important pillar for the production of a sound evidence base for decision-making in policy and practice. We assessed the effectiveness and cost-effectiveness of a research training course conducted using traditional methods as well as the video-teleconferencing (VTC) method in Pakistan. SUBJECTS AND METHODS: A 9-day epidemiology research training course was offered to physicians in Pakistan (92%) and Bangladesh (8%). The course was taught using (1) a traditional classroom face-to face (F2F) method at the Aga Khan University, Karachi, Pakistan, and (2) the VTC method at two medical institutions within Pakistan. In total, 40 participants were selected for the F2F group and 46 for the VTC group. Outcome parameters were assessed pre- and post-course (short-term) as well as after 1 year (long-term). Costs of conducting the training by both methods were also identified using cost-effectiveness analysis. RESULTS: The total study sample included 56 participants (F2F n =38, VTC n=18) for the short-term and 49 participants for the long-term assessment. After the end of the course (Day 9), mean post-test 1 scores showed significant improvement in both groups: 15.08 ± 1.75 in F2F (p=0.001) versus 13.122 ± 1.87 in VTC (p=0.001). Mean scores 1 year after the course (post-test 2) were lower than mean post-test 1 scores in both groups (13.42 ± 2.61 in F2F versus 12.31 ± 2.08 in VTC) but were higher than the baseline pretest scores. The total incremental cost per score gained was higher for the VTC group for both short-term (VTC incremental cost was $166/score gained) and long-term (VTC incremental cost was $458/ score gained) course effectiveness. CONCLUSIONS: The use of e-technologies in developing countries proves to be an effective way of building capacity and reducing the problems of brain drain. This initial study provides a foundation from which larger studies may be developed.


Assuntos
Pesquisa Biomédica/organização & administração , Fortalecimento Institucional/economia , Países em Desenvolvimento/economia , Epidemiologia/educação , Ensino/métodos , Telemedicina/organização & administração , Adulto , Pesquisa Biomédica/economia , Fortalecimento Institucional/métodos , Fortalecimento Institucional/organização & administração , Análise Custo-Benefício , Currículo , Educação a Distância , Escolaridade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Paquistão , Estatística como Assunto , Telemedicina/economia , Comunicação por Videoconferência/economia , Comunicação por Videoconferência/organização & administração
6.
Prehosp Disaster Med ; 25(5): 477-81, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21053199

RESUMO

Just-in-time ( JIT) Educational Strategy has been applied successfully to share scientific knowledge about disasters in several countries. This strategy was introduced to China in 2008 with the hopes to quickly disseminate accurate scientific data to the population, and it was applied during the Sichuan Earthquake and Influenza A (H1N1) outbreak. Implementation of this strategy likely educated between 10,000 and 20,000,000 people. The efforts demonstrated that an effective JIT strategy impacted millions of people in China after a disaster occurs as a disaster mitigation education method. This paper describes the Chinese JIT approach, and discusses methodologies for implementing JIT lectures in the context of China's medical and public health system.


Assuntos
Desastres , Disseminação de Informação , Ensino/métodos , China , Humanos , Desenvolvimento de Programas
7.
J Cancer Educ ; 25(4): 478-83, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20300911

RESUMO

Cancer-related presentations are rapidly communicated through thousands of Websites, chat rooms, newsgroups, list servers, newsletters, YouTube, and e-mails, with no specific attention to the validity of the reported findings. Quality control (QC) of cancer education lectures on the Web is an important concern, just like the quality assessment of all information found on the Web. This paper discusses the Supercourse, a global library of 3,600 online lectures available at www.pitt.edu/~super1 and several alternative quality control approaches that are being developed as part of this global effort. Peer review may not be optimal for the review of online lectures because it is labor-intensive and has low throughput. To our knowledge, we are among the first to begin a multilayer and multimetric evaluation approach toward QC (MQC) of PowerPoint lectures on the Web. We hope that future scientific research on peer review as well as on emerging multilayer QC methodologies will help us to determine best measures of QC, especially in the field of rapidly developing cancer education.


Assuntos
Internet/normas , Saúde Pública/educação , Controle de Qualidade , Correio Eletrônico , Humanos , Bibliotecas , Revisão por Pares
8.
Nutr Health ; 20(1): 31-40, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19326718

RESUMO

Epidemiologic research has demonstrated that fish is an important component of human nutrition. Existing information for the public about the benefits vs dangers of fish consumption is often contradictory and unclear. Education in the field of human nutrition, especially in the area of fish consumption could be markedly enhanced if there were better mechanisms for the development of customized high quality, low cost educational lectures Researchers from the Department of Epidemiology, University of Pittsburgh, in collaboration with the members of the Global Health Network Supercourse project are developing a library of lectures on nutrition, environmental health, and fisheries, for the use and share among the scientists of the world. With the growing demand for environmental health/nutrition awareness, there is an escalating demand for easily accessible and inexpensive teaching materials on nutritional information, including fish and fisheries. The Supercourse has a network of 45,000 faculty members from 171 countries who have contributed more than 3400 public health lectures, providing forum for sharing the latest research developments in the areas of nutrition. This article outlines the importance of creating easily accessible educational modules on the issues of nutrition, environmental health challenges, and fisheries.


Assuntos
Alimentos Orgânicos , Neoplasias/prevenção & controle , Ciências da Nutrição/educação , Saúde Pública/educação , Animais , Doença Crônica/prevenção & controle , Pesqueiros , Saúde Global , Humanos , Alimentos Marinhos , Materiais de Ensino
9.
BMC Public Health ; 8: 50, 2008 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-18254981

RESUMO

BACKGROUND: To investigate the socio-economic and demographic determinants of tobacco use in Rawalpindi, Pakistan. METHODS: Cross sectional survey of households (population based) with 2018 respondent (1038 Rural; 980 Urban) was carried out in Rawalpindi (Pakistan) and included males and females 18-65 years of age. Main outcome measure was self reported daily tobacco use. RESULTS: Overall 16.5% of the study population (33% men and 4.7% women) used tobacco on a daily basis. Modes of tobacco use included cigarette smoking (68.5%), oral tobacco (13.5%), hukka (12%) and cigarette smoking plus oral tobacco (6%). Among those not using tobacco products, 56% were exposed to Environmental tobacco smoke. The adjusted odds ratio of tobacco use for rural residence compared to urban residence was 1.49 (95% CI 1.1 2.0, p value 0.01) and being male as compared to female 12.6 (8.8 18.0, p value 0.001). Illiteracy was significantly associated with tobacco use. Population attributable percentage of tobacco use increases steadily as the gap between no formal Education and level of education widens. CONCLUSION: There was a positive association between tobacco use and rural area of residence, male gender and low education levels. Low education could be a proxy for low awareness and consumer information on tobacco products. As Public health practitioners we should inform the general public especially the illiterate about the adverse health consequences of tobacco use. Counter advertisement for tobacco use, through mass media particularly radio and television, emphasizing the harmful effects of tobacco on human health is very much needed.


Assuntos
Escolaridade , População Rural/estatística & dados numéricos , Fumar/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Atitude Frente a Saúde , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Renda , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Prevalência , Fatores Sexuais , Fumar/economia , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/estatística & dados numéricos
10.
Prehosp Disaster Med ; 23(3): 286-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18702277

RESUMO

Improving public awareness through education has been recognized widely as a basis for reducing the risk of disasters. Some of the first disaster just-in-time (JIT) education modules were built within 3-6 days after the south Asia tsunami, Hurricane Katrina, and the Bam, Pakistan, and Indonesia earthquakes through a Supercourse. Web monitoring showed that visitors represented a wide spectrum of disciplines and educational levels from 120 developed and developing countries. Building disaster networks using an educational strategy seizes the opportunity of increased public interest to teach and find national and global expertise in hazard and risk information. To be effective, an expert network and a template for the delivery of JIT education must be prepared before an event occurs, focusing on developing core materials that could be customized rapidly, and then be based on the information received from a recent disaster. The recyclable process of the materials would help to improve the quality of the teaching, and decrease the time required for preparation. The core materials can be prepared for disasters resulting from events such as earthquakes, hurricanes, tsunamis, floods, and bioterrorism.


Assuntos
Planejamento em Desastres , Educação a Distância/organização & administração , Comportamento de Redução do Risco , Desastres , Eficiência Organizacional , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet
11.
Croat Med J ; 48(2): 249-55, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17436390

RESUMO

AIM: To examine the feasibility of using peer review for the quality control of online materials. METHODS: We analyzed the inter-rater agreement on the quality of epidemiological lectures online, based on the Global Health Network Supercourse lecture library. We examined the agreement among reviewers by looking at kappa statistics and intraclass correlations. Seven expert reviewers examined and rated a random sample of 100 Supercourse lectures. Their reviews were compared with the reviews of the lay Supercourse reviewers. RESULTS: Both expert and non-expert reviewers rated lectures very highly, with a mean overall score of 4 out of 5. Kappa (Kappa) statistic and intraclass correlations indicated that inter-rater agreement for experts and non-experts was surprisingly low (below 0.4). CONCLUSIONS: To our knowledge, this was the first time that poor inter-rater agreement was demonstrated for the Internet lectures. Future research studies need to evaluate the alternatives to the peer review system, especially for online materials.


Assuntos
Instrução por Computador/estatística & dados numéricos , Educação Médica Continuada/estatística & dados numéricos , Epidemiologia/educação , Internet , Revisão por Pares/métodos , Instrução por Computador/normas , Educação Médica Continuada/normas , Humanos , Variações Dependentes do Observador , Controle de Qualidade
13.
Cent Asian J Glob Health ; 5(1): 261, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29138734

RESUMO

INTRODUCTION: Despite the significant number of research institutions and rich scientific heritage, published research from Central Asia (Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan, and Turkmenistan) is traditionally underrepresented in international scientific literature. The goal of this paper was to analyze publication patterns in Central Asian countries, and to explore the factors that contributed to the publication productivity in Kazakhstan. METHODS: Publication productivity was evaluated using data generated by the SCImago Journal & Country Rank over the period of 1996-2014 for all of the 15 former Soviet Union Republics for all subject categories. Country specific data, including total population, gross domestic product (GDP) per capita, research and development (R&D) expenditure (% of GDP), number of reserchers (per million people), was abstracted from World Bank data. ANOVA and ANCOVA analyses compared the mean number of publications among Central Asian countries. Separate analyses was done for publication patterns in the health sciences. Multiple comparisons were performed using Tukey method. RESULTS: The analysis of publication productivity showed significant discrepancies in the number of published documents among the Central Asian countries. Kazakhstan demonstrated a significant increase in the number of published documents in the period of 1996-2014, mainly in the areas of natural and multidisciplinary sciences. Our analyses also showed that the number of publications are siginicantly associated with GDP and population size. CONCLUSIONS: We identified large gaps in publication productivity among the Central Asian countries. The association between publication rate with GDP and population size indicates there is a need to adjust for these factors when planning research policy.

15.
Ethn Dis ; 15(3): 429-35, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16108303

RESUMO

OBJECTIVE: We assessed the distribution of coronary artery disease (CAD) and its association with the major biological risk factors and behaviors among Pakistanis presenting at a tertiary care hospital in Karachi, Pakistan. METHOD: An epidemiologic cross-sectional study was conducted at the Aga Khan University Hospital (a teaching hospital) in Karachi, Pakistan. A total of 600 adult (> or =18 years of age) patients visiting family practice clinics for general check-up were included. The association of biological risk factors with CAD (smoking, obesity [body mass index (BMI)], hypertension, family history of ischemic heart diseases [IHD], sedentary lifestyle, diabetes mellitus, total cholesterol, low density lipoprotein [LDL] levels, high density lipoprotein [HDL] levels, and triglycerides) were assessed. RESULTS: On univariate analysis, age > or =40 years, early menopause, BMI > or =29.9 kg/m2, diabetes, high cholesterol, and positive family history of IHD were independently associated with CAD. We found age > or =40 years, diabetes, and positive family history of IHD strongly related with CAD on multivariate analysis. CONCLUSION: Looking at the strong association of major risk factors with CAD, the unique characteristics of Pakistanis must be studied in depth, with focus on high-risk groups.


Assuntos
Doença das Coronárias/epidemiologia , Adulto , Idoso , Estudos Transversais , Países em Desenvolvimento , Saúde da Família , Feminino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paquistão/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , População Urbana
17.
J R Soc Med ; 98(11): 487-91, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16260795

RESUMO

Brain drain is defined as the migration of health personnel in search of the better standard of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. This migration of health professionals for better opportunities, both within countries and across international borders, is of growing concern worldwide because of its impact on health systems in developing countries. Why do talented people leave their countries and go abroad? What are the consequences of such migrations especially on the educational sector? What policies can be adopted to stem such movements from developing countries to developed countries? This article seeks to raise questions, identify key issues and provide solutions which would enable immigrant health professionals to share their knowledge, skills and innovative capacities and thereby enhancing the economic development of their countries.


Assuntos
Países em Desenvolvimento , Emigração e Imigração , Pessoal Profissional Estrangeiro/provisão & distribuição , Mão de Obra em Saúde , Competência Clínica , Educação de Pós-Graduação em Medicina , Humanos , Cooperação Internacional
18.
Diabetes Care ; 26(10): 2871-5, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14514594

RESUMO

OBJECTIVE: The aim of this study was to compare the prevalence of being overweight in black and white children and adolescents at onset of insulin-treated diabetes during two time periods: 1979-1989 (period I) and 1990-1998 (period II). RESEARCH DESIGN AND METHODS: All black children <19 years of age diagnosed with diabetes and treated with insulin at onset admitted to the Children's Hospital of Pittsburgh between January 1979 and December 1998 were matched with white children by sex, age at onset, and year of diagnosis. Data were obtained from a review of medical records. Overweight was defined as BMI >or=85th percentile for age and sex. Islet cell autoantibodies were measured. RESULTS: The prevalence of being overweight increased from 12.6% (period I) to 36.8% (period II) (P = 0.0003); in whites from 2.9 to 16.6% (P = 0.04) and in blacks from 22 to 55% (P = 0.001); and in the age-group <11 years from 7.3 to 22.2% (P = 0.04) and age 11-18 years from 20 to 50% (P = 0.006). In children with at least one antibody, the prevalence of being overweight increased from 5.1 to 24.4% (P = 0.001). In the multivariate logistic regression, period of diagnosis (period II), race (black), age at onset (>or=11 years old), and absence of autoimmunity were associated with being overweight. CONCLUSIONS: At onset of the disease, the prevalence of being overweight has tripled from the 1980s to the 1990s, following the trend in the general population. Weight gain may be an accelerating factor for onset of insulin-treated diabetes and may have contributed to the increased incidence of diabetes in youth seen in some populations.


Assuntos
Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus/etnologia , Obesidade , Adolescente , Autoanticorpos/sangue , População Negra/estatística & dados numéricos , Criança , Diabetes Mellitus/imunologia , Diabetes Mellitus Tipo 1/imunologia , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Pennsylvania/epidemiologia , Prevalência , Sistema de Registros , População Branca/estatística & dados numéricos
19.
Diabetes Care ; 26(10): 2876-82, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14514595

RESUMO

OBJECTIVE: We have previously reported differences in the prevalence of beta-cell autoantibodies (AAs) in black and white children with insulin-treated diabetes, suggesting that the disease pathogenesis may be more heterogeneous among racial groups than previously thought. To further explore this issue, we compared clinical, biochemical, and autoimmune characteristics at disease diagnosis and follow-up treatment in an expanded number of black and white children with and without the presence of AAs. RESEARCH DESIGN AND METHODS: The study cohort of 130 black children and adolescents, aged <19 years, diagnosed with diabetes and treated with insulin at time of diagnosis (January 1979 to December 1998) were matched with an equal number of white children by age at onset, sex, and year of diagnosis. RESULTS: The black children had a higher prevalence of obesity (43 vs. 11%) and acanthosis nigricans (21 vs. 1%) than white children and a lower prevalence of AAs. Compared with black children who had AAs, those with no AAs were older and had a higher prevalence of obesity, acanthosis nigricans, and parental diabetes. However, one of four of the black children with AAs was obese and/or had acanthosis nigricans. Among white children, the absence of AAs was not associated with any differences in terms of obesity or acanthosis nigricans compared with those with AAs. Similar to their black counterparts, white children without antibodies were older and had a higher prevalence of parental diabetes. Although treatment with an insulin sensitizer was used, insulin therapy was rarely discontinued on follow-up. CONCLUSIONS: These pediatric subjects, irrespective of autoimmunity, often showed characteristics associated with type 2 diabetes. These characteristics were more frequently displayed in black than in white children. Our data suggest that childhood diabetes may constitute a spectrum of pathogenic mechanisms that may overlap, including those typically associated with both type 1 and type 2 diabetes. This finding could have therapeutic implications.


Assuntos
Autoanticorpos/sangue , População Negra/estatística & dados numéricos , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/etiologia , População Branca/estatística & dados numéricos , Adolescente , Criança , Diabetes Mellitus/etnologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/imunologia , Feminino , Seguimentos , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Obesidade , Prevalência , Estudos Soroepidemiológicos
20.
Diabetes Res Clin Pract ; 107(1): 113-22, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25458328

RESUMO

AIMS: To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined. METHODS: A 1-2 year follow-up of 214 members of the Rwanda Life for a Child program (aged <26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (<18 years, ≥18 years). Trajectory analysis was performed to identify trends in HbA1c. RESULTS: Mean overall HbA1c decreased significantly from baseline (11.2 ± 2.7%; 99 ± 30 mmol/mol) to one- (10.2 ± 2.6%; 88 ± 28 mmol/mol) and two- (9.8 ± 26%; 84 ± 25 mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week. CONCLUSIONS: The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/terapia , Hemoglobinas Glicadas/metabolismo , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Glicemia/análise , Criança , Estudos de Coortes , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipertensão/complicações , Masculino , Prevalência , Ruanda/epidemiologia , Adulto Jovem
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