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M Rewers

Publications and source records attributed to M Rewers.

65 records · Page 4Linked to original sources
PubMed1991

Diabetes in adults is now a Third World problem. The WHO Ad Hoc Diabetes Reporting Group.

Since 1988, WHO has been collecting standardized information on the prevalence of diabetes mellitus and impaired glucose tolerance (IGT) in adult communities worldwide. Within the age range 30-64 years, diabetes and IGT were found to be absent or rare in some traditional communities in Melanesia, East Africa and South America. In communities of European origin, the prevalences of diabetes and IGT were in the range of 3-10% and 3-15% respectively, but migrant Indian, Chinese and Hispanic American groups were at higher risk (15-20%). The highest risk was found in the Pima Indians of Arizona and in the urbanized Micronesians of Nauru, where up to one-half of the population in the age range 30-64 years had diabetes. The prevalence of total glucose intolerance (diabetes and IGT combined) was greater than 10% in almost all populations, and was within the range 11-20% for European and U. S. white populations. However, the prevalence of total glucose intolerance reached almost 30% in Arab Omanis and in U. S. blacks and affected one-third of all adult Chinese Mauritians, migrant Indians, urban Micronesians and lower-income urban U. S. Hispanics. In Nauruans and Pima Indians, approximately two-thirds of all adults in the age range were affected. These results lead to three important conclusions. (1) An apparent epidemic of diabetes has occurred--or is occurring--in adult people throughout the world. (2) This trend appears to be strongly related to life-style and socioeconomic change. (3) It is the populations in developing countries, and the minority or disadvantaged communities in the industrialized countries who now face the greatest risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The Swedish childhood diabetes study. An analysis of the temporal variation in diabetes incidence 1978-1987.

The Swedish Childhood Diabetes Register combines continuous prospective reporting on incident cases and regular retrospective review of hospital records in all paediatric departments in the country and has, from 1978 to 1987, compiled 3838 cases. A validity test using an independent source has revealed a degree of ascertainment of 100%. When fitting a linear regression model to the natural logarithm of the yearly incidence rates, a significant increase over time was found for girls and for both sexes combined. To analyse the time trend with respect to age, sex, calendar year and birth cohort and their interactions, Poisson regression modelling was used. There was a significant age effect and interaction between age and sex. When these age and sex effects were taken into account a significant increase over time was found. Calendar period had a significant effect when adjusted for cohort effects whereas cohort did not add significantly to the explanation of the variance. There was no significant interaction between sex and calendar period indicating similar time variations for both sexes. The temporal variability was also apparently similar among different age groups. The observed increase of childhood insulin-dependent diabetes mellitus (IDDM) affecting both sexes and all age groups, strongly supports the importance of environmental factors in the aetiology of IDDM.

Adolescent↗
PubMed1989

Poisson regression modeling of temporal variation in incidence of childhood insulin-dependent diabetes mellitus in Allegheny County, Pennsylvania, and Wielkopolska, Poland, 1970-1985.

Contradictory observations have accumulated regarding a secular trend and/or an epidemic pattern in the incidence of insulin-dependent diabetes mellitus. In this study, insulin-dependent diabetes mellitus incidence below age 15 years was examined in Allegheny County, Pennsylvania, and in Wielkopolska, Poland, two areas diverse in terms of their geography and average risk for this disease. Numerator data were extracted from individual patient records, and annual denominator data were available for the years 1970-1985. Poisson regression models were used to disentangle the contributions of country, race, sex, age, period, and cohort effects to the observed variation in incidence. Poles and Allegheny County nonwhites were at greatly and moderately reduced risk, respectively, relative to Allegheny County whites. An increase in risk with age was significant and proportional in all three groups. There was significant time variability in Wielkopolska, where an epidemic began in 1982 and continued through 1985. This was a period rather than a cohort phenomenon and was a result of a recent outbreak of the disease rather than a long-term trend. In Allegheny County, changes in risk over the 16-year period were insignificant, although incidence doubled among whites aged 0-9 years during 1982-1983. The Poisson regression modeling provided a quantification and formal comparison of determinants of the incidence of insulin-dependent diabetes mellitus.

Adolescent↗
PubMed1989

Clustering of premature mortality in 1,761 insulin-dependent diabetics and their family members.

The clustering of premature mortality was investigated in 1,761 insulin-dependent diabetics and their family members from the Children's Hospital of Pittsburgh Insulin-Dependent Diabetes Mellitus Registry from 1950-1981. At follow-up, 5% of the mothers and 13% of the fathers were deceased. Life table analyses revealed that fathers of deceased diabetics were significantly more likely to die prematurely than fathers of living diabetics (18% vs. 8% at age 55 years; p = 0.02). A father-diabetic son concordance of mortality appeared to be responsible for this effect. A similar overall trend was observed for maternal mortality, although the difference was not statistically significant. Cause-specific analyses revealed that the increased paternal mortality was primarily the result of cardiovascular disease. Overall mortality rates of parents of deceased diabetics were higher than those of the general population, reaching statistical significance in the age group 35-44 years (p less than 0.05). Mortality among diabetic siblings was also examined. Diabetic siblings of deceased diabetics had a markedly increased risk of dying compared with diabetic siblings of living diabetics (p = 0.001). These findings indicate that premature mortality among both diabetic and nondiabetic relatives of diabetics clusters in families in which there is a deceased insulin-dependent diabetic, and suggest that the marked increase in mortality among persons with insulin-dependent diabetes may be partly under familial control.

Actuarial Analysis↗
PubMed1988

Telecommunication and international health research.

Telecommunication will revolutionize how international medical research is completed. It is faster, more accurate, less expensive, and potentially more accessible than all other existing modes of communication. It is time for medical scientists to come into the age of electronic communication.

International Cooperation↗
PubMed1988

Trends in the prevalence and incidence of diabetes: insulin-dependent diabetes mellitus in childhood.

The results of this international collaboration emphasize the importance of population-based incidence registries which, similarly to cancer research, became an indispensable tool in etiological investigation and health-delivery planning in the area of insulin-dependent diabetes mellitus (IDDM). Future collaboration within the DERI project will help to monitor the geographical and temporal variability of IDDM incidence. This collaborative effort may provide a frame for more detailed international studies of etiology and natural history of the disease, as well as for evaluation of the costs of IDDM and future prevention programmes.

Adolescent↗
PubMed1987

Apparent epidemic of insulin-dependent diabetes mellitus in Midwestern Poland.

There is no information concerning the risk of developing insulin-dependent diabetes mellitus (IDDM) in eastern Europe. An IDDM registry has been developed in Midwest Poland for 1970-1984. The risk of developing IDDM in Polish children was determined through utilization of the registry. The incidence of IDDM in Polish children was very low compared with other Caucasian populations. There was a major increase in risk beginning in 1982; the incidence almost doubled from 3.5/100,000 in 1970-1981 to 6.6/100,000 in 1982-1984. The pattern of IDDM in the high-risk period was different from that in the low-risk period, with an altered seasonal pattern and unusual increased incidence in younger children. The rapid increase in incidence as well as altered epidemiologic patterns during this period suggest that major alterations of environmental factors were responsible for the change in risk.

Adolescent↗
PubMed1987

The epidemiology and genetics of insulin-dependent diabetes mellitus.

The epidemiologic study of insulin-dependent diabetes mellitus (IDDM) has provided evidence for both a genetic and an environmental component in the etiology of the disease. The characteristics of IDDM, such as incidence and prevalence, and the worldwide variations therein, have prompted research into the areas of both environmental and genetic influences. While animal studies have strongly implicated an environmental agent, such as a virus, as the initiator of the disease process, it appears that such an agent needs a genetically susceptible individual in order to be effective. A coexisting approach to the study of the environmental etiology of IDDM involves immunogenetics. Recent technological advances in the study of the human genome have prompted research particularly in the HLA region of chromosome 6, where an IDDM susceptibility gene or genes are thought to lie. The combined knowledge regarding the environmental and genetic roles and their probable interaction will be helpful in understanding the etiology of the disease, if not directly leading to a mode of prevention of the disorder.

Age Factors↗
PubMedDate not supplied

The epidemiology of diabetes in childhood with special reference to the Orient: implications for mechanism of beta cell damage.

Epidemiologic studies are providing important new insights into the etiology and clinical course of IDDM as well as providing critically needed data on the magnitude of the problem in different parts of the world. The development of national IDDM registries have documented extraordinary differences in diabetes incidence and prevalence, with the highest incidence figures in Finland (greater than 30/100,000/yr) and the lowest in the Orient with Korea reporting incidence rates below 1 and Japan between 1.0-2.4/100,000/yr. The great geographic variation in expression of diabetes in childhood is strongly supportive of environmental factors playing a major role in the etiology of disease. Our studies document a linear correlation between IDDM incidence and distance from the equator and a similar but inverse correlation with mean annual environmental temperature. Other workers find a direct correlation with dairy product consumption. Factors that may play a role in beta cell damage include viral infections, environmental toxins, nutrients and stress factors. Because of the low incidence of IDDM among children living in Asia it is most important to expand the current national registries in the Asian countries and begin a careful study of the environmental differences within Asian countries as well as comparison of studies between countries with very high incidence rates and those with the lowest rates.

Child↗
PubMedDate not supplied

Serum pancreatic polypeptide and glucagon immunoreactivity in fasting healthy and diabetic children.

Serum pancreatic polypeptide (hPP) concentrations ranged in normal children from 45 pg/ml to 525 pg/ml with mean value at 185 +/- 49 pg/ml. Both hPP and glucagon immunoreactivity (IRG) levels showed age-dependent decrease during childhood. In diabetic children plasma IRG concentrations were significantly increased in comparison with the healthy subjects while hPP concentrations were only slightly elevated. The age dependence of the hormones levels was completely effaced in diabetics. No significant serum hPP norm IRG values dependence on the duration of diabetes was found. IRG/hPP relations correlated with age in healthy children despite those in diabetic ones.

Adolescent↗