Incidence of type 1 diabetes among children and adolescents during peace and war times in Yemen.

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.

Glucose control in Rwandan youth with type 1 diabetes following establishment of systematic, HbA1c based, care and education.

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.

USA endometrial cancer projections to 2030: should we be concerned?

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.

All-cause mortality in a population-based type 1 diabetes cohort in the U.S. Virgin Islands.

OBJECTIVE: Type 1 diabetes remains a significant source of premature mortality; however, its burden has not been assessed in the U.S. Virgin Islands (USVI). As such, the objective of this study was to estimate type 1 diabetes mortality in a population-based registry sample in the USVI. RESEARCH DESIGN AND METHODS: We report overall and 20-year mortality in the USVI Childhood (<19 years old) Diabetes Registry Cohort diagnosed 1979-2005. Recent data for non-Hispanic blacks from the Allegheny County, PA population-based type 1 diabetes registry were used to compare mortality in the USVI to the contiguous U.S. RESULTS: As of December 31, 2010, the vital status of 94 of 103 total cases was confirmed (91.3%) with mean diabetes duration 16.8 ± 7.0 years. No deaths were observed in the 2000-2005 cohort. The overall mortality rates for those diagnosed 1979-1989 and 1990-1999 were 1852 and 782 per 100,000 person-years, respectively. Overall cumulative survival for USVI was 98% (95% CI: 97-99) at 10 years, 92% (95% CI: 89-95) at 15 years and 73% (95% CI: 66-80) at 20 years. The overall SMR for non-Hispanic blacks in the USVI was 5.8 (95% CI: 2.7-8.8). Overall mortality and cumulative survival for non-Hispanic blacks did not differ between the USVI and Allegheny County, PA. CONCLUSIONS: This study, as the first type 1 diabetes mortality follow-up in the USVI, confirmed previous findings of poor disease outcomes in racial/ethnic minorities with type 1 diabetes.

Incidence of type 1 and type 2 diabetes in youth in the U.S. Virgin Islands, 2001-2010.

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.

Building research capacity in developing countries: cost-effectiveness of an epidemiology course taught by traditional and video-teleconferencing methods in Pakistan.

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.

Nurse educators establishing new venues in global nursing education.

Nurses represent the largest number of health care workers worldwide, but they are currently underutilized for global health practices. This may be due to the fact that global health programs are not incorporated in nursing education in many countries. The World Health organization (WHO) recognized the importance of building capacity and having well-prepared nurses who are able to exchange knowledge and expertise worldwide, but did not offer practical solutions. A nursing Super course recognizes the gap between what WHO advocates for and what needs to be done in nursing education to achieve well prepared nurses. A solution suggested is to develop well-structured contents that are applicable and can be shared among nursing programs worldwide. A nursing Supercourse is proposed to provide lectures prepared by expert nursing educators and researchers in global health. The nursing Supercourse has emerged from the parent Supercourse that is a virtual library of lectures developed by world experts in public health and medicine. It represents a global library of over 4,300 public health and medical lectures and a network of over 56,000 public health professionals in 174 countries of the world. These lectures are written in different languages, prepared in easy format, and can be accessed through the internet. In other words does not require the usage of any advanced technology. The Supercourse educational technology has been used successfully in Epidemiology education focusing on multiple topics in public health such as non- communicable disease prevention (NCD), chronic diseases, disaster preparedness, environmental health, and others. Training of nursing students in global health while there are attending nursing programs needs to be a part of the national and international health efforts for disease prevention and health promotion.

New directions in building a scientific social network: Experiences in the Supercourse project and application to Central Asia.

INTRODUCTION: Networking leaders in the field of public health and medicine is very important for improving health locally and globally, especially in times of disaster. METHODS: Fishing can best be defined as using an internet search engine to find the name and email address of the person or organization that is being sought. RESULTS: With over 500 hours of work, the group compiled a list of nearly 2,000 email addresses of Ministers of Health, deans of the 1,800 medical schools and schools of public health, and heads of medical and public health societies.

All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes: the Allegheny County type 1 diabetes registry.

OBJECTIVE: Although management of type 1 diabetes improved dramatically in the 1980s, the effect on mortality is not clear. RESEARCH DESIGN AND METHODS: We report trends in 30-year mortality using the Allegheny County (Pennsylvania) childhood-onset (age <18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965-1979, by dividing the cohort into three diagnosis year cohorts (1965-1969, 1970-1974, and 1975-1979). Local (Allegheny County) mortality data were used to calculate standardized mortality ratios (SMRs). RESULTS: As of 1 January 2008, vital status was ascertained for 97.0% of participants (n = 1,043) when mean age ± SD and duration of diabetes were 42.8 ± 8.0 and 32.0 ± 7.6 years, respectively. The 279 deaths (26.0%) observed were 7 times higher than expected (SMR 6.9 [95% CI 6.1-7.7]). An improving trend in SMR was seen by diagnosis cohort at 30 years of diabetes duration (9.3 [7.2-11.3], 7.5 [5.8-9.2], and 5.6 [4.0-7.2] for 1965-1969, 1970-1974, and 1975-1979, respectively). Although no sex difference in survival was observed (P = 0.27), female diabetic patients were 13 times more likely to die than age-matched women in the general population (SMR 13.2 [10.7-15.7]), much higher than the SMR for men (5.0 [4.0-6.0]). Conversely, whereas 30-year survival was significantly lower in African Americans than in Caucasians (57.2 vs. 82.7%, respectively; P < 0.001), no differences in SMR were seen by race. CONCLUSIONS: Although survival has clearly improved, those with diabetes diagnosed most recently (1975-1979) still had a mortality rate 5.6 times higher than that seen in the general population, revealing a continuing need for improvements in treatment and care, particularly for women and African Americans with type 1 diabetes.

Chinese disasters and just-in-time education.

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.

Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes.

OBJECTIVE: Little is known concerning the primary cause(s) of mortality in type 1 diabetes responsible for the excess mortality seen in this population. RESEARCH DESIGN AND METHODS: The Allegheny County (Pennsylvania) childhood-onset (age < 18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965 to 1979 was used to explore patterns in cause-specific mortality. Cause of death was determined by a mortality classification committee of at least three physician epidemiologists, based on the death certificate and additional records surrounding the death. RESULTS: Vital status for 1,043 (97%) participants was ascertained as of 1 January 2008, revealing 279 (26.0%) deaths overall (141 females and 138 males). Within the first 10 years after diagnosis, the leading cause of death was acute diabetes complications (73.6%), while during the next 10 years, deaths were nearly evenly attributed to acute (15%), cardiovascular (22%), renal (20%), or infectious (18%) causes. After 20 years' duration, chronic diabetes complications (cardiovascular, renal, or infectious) accounted for >70% of all deaths, with cardiovascular disease as the leading cause of death (40%). Women (P < 0.05) and African Americans (P < 0.001) have significantly higher diabetes-related mortality rates than men and Caucasians, respectively. Standardized mortality ratios (SMRs) for non-diabetes-related causes do not significantly differ from the general population (violent deaths: SMR 1.2, 95% CI 0.6-1.8; cancer: SMR 1.2, 0.5-2.0). CONCLUSIONS: The excess mortality seen in type 1 diabetes is almost entirely related to diabetes and its comorbidities but varies by duration of diabetes and particularly affects women and African Americans.

Public awareness and disaster risk reduction: just-in-time networks and learning.

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.

Investigating socio-economic-demographic determinants of tobacco use in Rawalpindi, Pakistan.

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.

Ways to strengthen research capacity in developing countries: effectiveness of a research training workshop in Pakistan.

BACKGROUND: Developing countries are currently facing the burden of both communicable and non-communicable diseases. Physician-scientists, trained in patient care and research skills, are crucial in performing cutting-edge clinical research in developing countries. A major, unmet challenge has been lack of local expertise and the increasing problem of 'brain drain'. OBJECTIVE: The objective of this study was to present and assess a model of research training for healthcare professionals in Pakistan in order to increase research skills. METHODS: A 9-day research training workshop was offered to healthcare professionals in Pakistan using face-to-face (F2F) and video-teleconferencing (VTC) methods. In total, 38 F2F and 18 VTC participants were included in the workshop, which was conducted by research faculty from the University of Pittsburgh. The study measured short- and long-term effectiveness of research training. The training included courses in basic epidemiology, biostatistics, genetic epidemiology and international health. RESULTS: A significant improvement in post-test scores was seen in both the F2F and VTC groups (P<0.001). In the F2F group, mean scores increased from 11.13 (pre-test) to 15.08 (post-test 1), and in the VTC group, mean scores increased from 10.67 (pre-test) to 13.22 (post-test 1). Two-sample t-tests indicated that these results were statistically significant (P<0.001). Two-way repeated measure analysis of variance in both groups showed significant changes in mean scores over time (P<0.001). CONCLUSION: This model for training physicians in public health by providing in-house research training can be used to strengthen local capacity and reduce increasing problems of 'brain drain'.

Introducing a model for communicable diseases surveillance: cell phone surveillance (CPS).

BACKGROUND AND GOAL: Surveillance systems for communicable diseases are primarily passive in most countries, including Iran. Laboratory-based surveillance and use of cell phone surveillance may be a useful method. MATERIAL AND METHOD: We established a new model for gathering data directly from district laboratories to regional laboratories and from them to national manager of public health laboratories by using cell phone. We assessed the coverage of Mobile and Cell phone in the laboratory Technicians, and Directors of Public Health in 27 universities in Iran by a simple data collection form to evaluate the feasibility of this method. And then this method was piloted for the last Cholera outbreak in Iran in 2005. RESULT: From data of 27 universities with 184 cities, we gathered 769 data health directors' mobile, total mobile penetrating rate, SMS users, and SMS penetrating rate was 57.9%, 77.1%, and 44.6% between Directors in Medical Universities of Iran and 54.5%, 54.9% and 29.9% in Directors of Laboratory. In the Cholera epidemic in Iran in summer 2005, CDC of MOH registered near 900 cases of cholera from 70000 rectal soap's exam in whole of country. The median reporting interval was under one day. CONCLUSION: Although the advent of the cell phone will probably change the way in which surveillance is delivered by health system, further studies are warranted to evaluate this method for laboratory based surveillance of lethal infections.

Association between infectious diseases and type 1 diabetes: a case-crossover study.

BACKGROUND: To investigate the role of infectious diseases in the development of type 1 diabetes, this study estimated the relative risks of type 1 diabetes immediately after infectious diseases. RESEARCH DESIGN AND METHODS: A case-crossover design was employed. Information on infectious diseases during 407 d before the onset of type 1 diabetes was collected from medical records and parents' interviews for 260 patients in Chinese type 1 diabetes registry. The frequency of infectious diseases in 42 d before the onset of type 1 diabetes was compared with either the usual frequency of infectious diseases over the past year or the actual frequency of infectious diseases in a comparable 42-d control period. RESULTS: Forty-eight (18%) patients were reported to have infectious diseases during this period based on medical records and interviews with parents. The relative risk of type 1 diabetes onset was markedly elevated to 10.1 (5.6, 17.9) immediately after infectious diseases, suggesting the role of infections as a precipitator. The relative risk decreased gradually before and after 42 d and was similar between male and female patients. CONCLUSION: The results showed that infectious diseases are associated with a large and transient increase in the risk of type 1 diabetes during 42 d after the infection.