Therapeutic controversy: prevention and treatment of diabetes in children.
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Biomedical subjects
Publications and source records attributed to R E Laporte.
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To investigate the epidemiological characteristics of childhood type 1 diabetes mellitus in China, newly diagnosed cases of type 1 diabetes with an onset age under 15 years were retrospectively registered by 23 local centers in China following a standardized protocol on the basis of the nationwide registry established by the WHO DiaMond Project China Participating Center, Chinese Academy of Preventive Medicine (CAPM). A population of about 24 million children were covered in the defined areas. A two-sample capture-recapture method was used to estimate case ascertainment. Between 1988 and 1996, 903 diabetic cases were registered in 9 ethnic groups. The overall ascertainment corrected incidence rate (IR) was 0.59 per 100,000 person-year. The IR was 0.52/100,000 (95% CI: 0.50-0.54) for males and 0.66/100,000 (95% CI: 0.64-0.68) for females. The standardized ascertainment corrected IR by the national age-specific population in 1990 was 0.57 per 100,000 person-year. The incidence among various ethnic groups ranged from 0.25/100,000 to 3. 06/100,000. The IRs increased with northern latitude, and the IR of Han population was significantly higher in North China compared with South China (0.67 versus 0.53 per 100,000 respectively, P < 0.01). A correlation model of incidence and calendar time showed that the IR increased significantly between 1988 and 1996 (r = 0.86, P = 0.0027). The relative risk (RR) of type 1 diabetes mellitus for different age-groups estimated by a Poisson regression model showed that taking RR as 1.00 for age-group from 0 to 4 years, the RR for age-group from 5 to 9 year and from 10 to 14 year was 2.30 and 3.60 respectively. The standardized ascertainment corrected IR of childhood type 1 diabetes mellitus in China in much lower than in other countries. The geographic and ethnic variability of the incidence suggests that both genetic and environmental factors play a role in the development of childhood diabetes in China.
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Epidemiology and public health need to change for the upcoming problems of the 21st century and beyond. We outline a four-point approach to produce this change. The first one is to take a systems approach to disease. The second approach discussed is the use of new techniques to "count" disease using capture-recapture. The third represents the application of telecommunications, especially the Internet, to public health. The fourth and final component represents the application, at the local health department level, of a total quality approach, as espoused by Deming, for the prevention of disease.
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The association of physical activity to the initiation of health risk behaviors was examined in a 3-yr prospective study of a population-based cohort of 1245 adolescents aged 12-16 yr. Four hundred thirty-seven students (35% of the cohort) were identified at baseline via self-report survey as never having smoked cigarettes, consumed alcohol, used marijuana, or carried a weapon. Three measures of physical activity were obtained at baseline: leisure-time physical activity (LTPA), level of aerobic fitness (AF), and participation in competitive athletics. Significant associations, with notable gender differences, were observed between physical activity and the initiation of cigarette smoking and alcohol use. The cumulative proportion of male students initiating alcohol use was 48%, 42%, and 24% for high, moderate, and low LTPA, respectively (P < 0.01). Males who participated in competitive athletics were significantly more likely than nonathletes to initiate alcohol use (44% vs 17%, P < 0.01). The cumulative proportion of female students initiating cigarette use was 10%, 23%, and 22% for high, moderate, and low LTPA, respectively (P < 0.05) and 7%, 28%, and 16% for high, moderate, and low AF, respectively (P < 0.05). No association was found between physical activity and weapon carrying. These results indicate that in this cohort of adolescents, the most active or most fit females were less likely to initiate cigarette smoking. In contrast, the most active males or males who participated in competitive athletics appeared more at-risk for initiating alcohol consumption than their less active counterparts.
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We have compared the incidence of Type 1 diabetes in childhood between two predominantly Russian populations from the former Soviet Union--the non-Estonians living in Estonia and the inhabitants of the district of Novosibirsk. The study period covered the years 1980-1989 for the non-Estonians and 1983-1989 for the district of Novosibirsk. The mean annual incidence of Type 1 diabetes was significantly higher in the non-Estonian population, 7.8 per 100,000 (95% confidence interval (CI): 6.3-9.6) than in Novosibirsk where it was 4.7 per 100,000 (95% CI: 4.1-5.4). The highest incidence in females from Estonia was in the age group 5-9 years and in Novosibirsk 10-14 years. In the youngest age group of 0-4 years there was no difference in the incidence between non-Estonians in Estonia and the population of Novosibirsk, or males and females in either population. There was no difference in the incidence between the 0-4 and 5-9 year age groups in Novosibirsk males. No time trend was seen in the incidence over the study period in either population. The annual incidence in Novosibirsk was fairly stable, while in the non-Estonians it showed two distinct peaks. The most likely reason for the observed phenomena is a different pattern and higher prevalence of environmental causal agents in the Baltic country of Estonia.
A cohort of 1245 adolescents, 12-16 yr old and participating in a prospective study of risk factors for injury, were surveyed annually to assess past year leisure physical activity. This report describes the development and reproducibility of the questionnaire and provides the descriptive epidemiology of leisure physical activity in adolescents. The questionnaire was self-administered twice, a year apart, and had a 1 yr test-retest rank order correlation of 0.55. The past year estimate of leisure activity was also shown to be related to fitness (rho = -0.37), which was defined as the time needed to complete a 1-mile run. Males reported significantly more activity than females (P < 0.05) and whites reported more activity than nonwhites (P < 0.05). However, socioeconomic status was not found to be a determinant of activity levels in either males or females. In females, a negative association between activity and age was found (P < 0.05); however, this association was not evident in males. In summary, an activity questionnaire has been developed and was shown to be both reproducible and feasible. Therefore, it was used to examine habitual leisure physical activity patterns of adolescents.
During the past twenty years there has been a rapid rise in the numbers of papers evaluating the incidence of childhood diabetes. Childhood diabetes has emerged as the non-communicable disease with the largest geographic coverage across the world. The incidence data are employed to forecast into the future. It is evident that both the United States and Europe will be confronted with an ever increasing burden of diabetes. It is argued that the monitoring of childhood diabetes should move into the public health sphere by making it a reportable disease. This would set the stage for public health surveillance of not only childhood diabetes but of all non-communicable diseases in the 21st century. The current paper overviews where we have come in the area of insulin-dependent diabetes mellitus epidemiology. Moreover, it projects into the future as to where Type 1 diabetes epidemiology can head. It is argued that Type 1 diabetes epidemiology can become the model disease to transform the current global approaches to health.
Serious injury from sport and recreation is a leading cause of morbidity and mortality in the United States. Historically, occurrences of diseases with substantial public health impact have been monitored via surveillance systems in order to obtain information concerning the frequency with which the diseases occur. Surveillance leads to efforts that identify risk factors, and eventually, control measures to reduce the incidence of disease. Currently, the surveillance of sports injury represents only limited coverage in the U.S. It is important to begin discussions regarding approaches toward the development of surveillance of these injuries. Methods based upon the communicable disease surveillance model could potentially be used to monitor serious sports injuries. One method of surveillance, using the statistical approach of capture-mark-recapture, is presented as an example by which a national system of surveillance of serious sports injury could be established.