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Objective: To estimate the incidence rates (IR) and analyse the trend in type 1 diabetes (T1D) among children aged 0-14 years in the West, South, and Tripoli regions of Libya. Methods: A retrospective study was conducted on Libyan children aged 0-14 years with a new diagnosis of T1D who were admitted and/or had their follow-up at Tripoli Children's Hospital during the period 2004 to 2018. The data were used to estimate the IR and the age-standardized IR per 100,000 population in the studied region for the years 2009-2018. The IRs by sex and age group (0-4, 5-9, 10-14 years) for every calendar year were assessed. Results: A total of 1,213 children were diagnosed during the study period (2004-2018), 49.1% were males with a male-to-female ratio of 1:1.03. The mean age (±standard deviation) at diagnosis was 6.3±3.8 years. The distribution of incident cases according to age group 0-4, 5-9, and 10-14 years was 38.2%, 37.8%, and 24.1%, respectively. Poisson regression modelling in the period 2009-2018 revealed an overall trend of a 2.1% increase per annum. In the period 2014-2018, the overall age-adjusted IR was 31.7 (95% confidence interval: 29.2-34.2) per 100,000 population, the IRs of age groups 0-4, 5-9, and 10-14 years were 36.0, 37.4, and 21.6 per 100,000, respectively. Conclusion: The incidence of T1D in Libyan children in the West, South, and Tripoli regions appears to be rising, with a higher rate in the 0-4 and 5-9 year age groups. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether there is an association between subgingival microbial diversity and reduced respiratory function. Materials and Methods: A group of dentate 58–72‐year‐old men in Northern Ireland had a comprehensive periodontal examination including subgingival plaque sampling. DNA was extracted from plaque samples and the V1–V3 regions of the 16S rRNA gene were analysed by high‐throughput sequencing and a microbial diversity index (MDI) was derived. Spirometry measurements were made using a wedge bellows spirometer. The primary outcome variable of interest was the percentage of predicted forced expiratory volume in 1 s (% predicted FEV1). Analysis included multiple linear regression with adjustment for various confounders. Results: Five‐hundred and seven men were included in the analysis. The mean age was 63.6 years (SD = 3.1). Of these, 304 (60.0%) men had no or mild periodontitis, 105 (20.7%) had moderate periodontitis and 98 (19.3%) had severe periodontitis. Multiple linear regression analysis showed that a one unit increase in MDI was associated with a 0.71% loss (95% confidence interval: 0.06%–1.35%; p =.03) in % predicted FEV1 after adjustment for all confounders. Conclusions: In this group of dentate men from Northern Ireland, subgingival microbial diversity was associated with reduced respiratory function. [ABSTRACT FROM AUTHOR]

Increased fruit and vegetable (FV) intake is associated with reduced blood pressure (BP). However, it is not clear whether the effect of FV on BP depends on the type of FV consumed. Furthermore, there is limited research regarding the comparative effect of juices or whole FV on BP. Baseline data from a prospective cohort study of 10 660 men aged 50–59 years examined not only the cross-sectional association between total FV intake but also specific types of FV and BP in France and Northern Ireland. BP was measured, and dietary intake assessed using FFQ. After adjusting for confounders, both systolic BP (SBP) and diastolic BP (DBP) were significantly inversely associated with total fruit, vegetable and fruit juice intake; however, when examined according to fruit or vegetable sub-type (citrus fruit, other fruit, fruit juices, cooked vegetables and raw vegetables), only the other fruit and raw vegetable categories were consistently associated with reduced SBP and DBP. In relation to the risk of hypertension based on SBP >140 mmHg, the OR for total fruit, vegetable and fruit juice intake (per fourth) was 0·95 (95 % CI 0·91, 1·00), with the same estimates being 0·98 (95 % CI 0·94, 1·02) for citrus fruit (per fourth), 1·02 (95 % CI 0·98, 1·06) for fruit juice (per fourth), 0·93 (95 % CI 0·89, 0·98) for other fruit (per fourth), 1·05 (95 % CI 0·99, 1·10) for cooked vegetable (per fourth) and 0·86 (95 % CI 0·80, 0·91) for raw vegetable intakes (per fourth). Similar results were obtained for DBP. In conclusion, a high overall intake of fruit, vegetables and fruit juice was inversely associated with SBP, DBP and risk of hypertension, but this differed by FV sub-type, suggesting that the strength of the association between FV sub-types and BP might be related to the type consumed, or to processing or cooking-related factors. [ABSTRACT FROM AUTHOR]

Diabetes summer camps provide children and adolescents with type 1 diabetes opportunities to learn about the disease and its management in a supportive environment to help improve glycemic control, self‐reliance, and quality of life. The objective of this quantitative review was to assess the advantages of attending summer camps and study any adverse psychological effects. Studies with a pre/post study design in children and adolescents attending summer camp were systematically reviewed. Five bibliographic databases were searched and relevant data extracted. Random effects meta‐analyses were used to combine the individual study results to derive pooled estimates and meta‐regression was used to explore between‐study heterogeneity. Studies in the literature report short‐term improvements in the glycemic control, diabetes knowledge (DK), quality of life (QOL) anxiety, diabetes self‐management, and self‐esteem. Thirty‐three studies were identified, and those outcomes reported in five or more studies were included in meta‐analyses. There were significant benefits with a pooled mean change for glycated hemoglobin (95% CI) of −0.59(−0.95,‐0.23)% (−6.4[−10.4,‐2.5]mmol/mol), and for standardized DK score of 1.99(1.28,2.70) but corresponding changes for QOL 0.17(−0.06,0.39) and for anxiety −0.32(−0.70, 0.06) were not significant. However, all outcomes showed considerable between‐study heterogeneity little of which was explained by study characteristics. The findings suggest short‐term benefits of camp on metabolic control, DK, QOL and anxiety in T1D children and adolescents, although the latter two were not statistically significant. Further research is warranted with more methodological rigor and longer‐term follow‐up to determine if there are long‐term benefits associated with camp attendance. [ABSTRACT FROM AUTHOR]

Objective: To investigate periodontitis as a risk factor for prevalent and incident coronary heart disease (CHD) in a group of middle‐aged men from Northern Ireland. Methods: A representative sample of 1400 dentate men had a comprehensive periodontal examination between 2001 and 2003. Prevalent and incident CHD events were validated by independent cardiologists. Logistic regression was used to assess the cross‐sectional relationship between periodontitis and prevalent CHD and Cox's proportional hazards analysis to assess the longitudinal relationship between periodontitis and incident CHD. Results: The mean age of the men at baseline was 63.7 (SD 3.0) years. Of the 1400 men examined, 126 (9%) had prevalent CHD. After adjusting for confounding variables, men with highest mean CAL (Q4) had an odds ratio of 2.15 (95% CI 1.15–4.02), p = 0.02 for prevalent CHD in comparison to men with the lowest CAL (Q1). During a median follow‐up of 12.7 years, 137 (10.8%) of the 1274 men free of CHD at baseline had an incident CHD event. After adjusting for confounding variables, the hazard ratio for incident CHD in men in Q4 versus Q1 CAL categories was 1.36 (95% CI 0.81–2.29), p = 0.24. Conclusions: In this group of dentate men, periodontitis was associated with prevalent CHD. However, there was no association with incident CHD. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether there was an association between chronic periodontitis (CP) and reduced respiratory function. Methods: A group of dentate 58‐ to 72‐year‐old men in Northern Ireland had a comprehensive periodontal examination. Parallel to the periodontal examination, participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Fasting blood samples were obtained and analysed for high‐sensitivity C‐reactive protein (hs‐CRP). Spirometry measures were performed using a wedge bellows spirometer (Vitalograph S Model). The primary outcome variable of interest was the percentage predicted forced expiratory volume in one‐second (% predicted FEV1). Analysis included multiple linear regression with adjustment for various confounders and a regression‐based mediation analysis. Results: A total of 1,380 men were included in the analysis. The mean age was 63.7 years (SD 3.0). Multiple linear regression analysis showed that a doubling in mean clinical attachment loss (CAL) equated to a −3.33% (95% CI: −4.80, −1.86), p < 0.001 change in % predicted FEV1 after adjustment for all other potential confounding variables. Systemic inflammation, as measured by hs‐CRP, only accounted for a minor mediating pathway effect (9%). Conclusions: In this homogenous group of dentate men, CP was significantly associated with a reduced respiratory function. [ABSTRACT FROM AUTHOR]

Aim To investigate associations between periodontal disease pathogens and levels of systemic inflammation measured by C-reactive protein ( CRP). Methods A representative sample of dentate 60-70-year-old men in Northern Ireland had a comprehensive periodontal examination. Men taking statins were excluded. Subgingival plaque samples were analysed by quantitative real time PCR to identify the presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia. High-sensitivity CRP (mg/l) was measured from fasting blood samples. Multiple linear regression analysis was performed using log-transformed CRP concentration as the dependent variable, with the presence of each periodontal pathogen as predictor variables, with adjustment for various potential confounders. Results A total of 518 men (mean age 63.6 SD 3.0 years) were included in the analysis. Multiple regression analysis showed that body mass index ( p < 0.001), current smoking ( p < 0.01), the detectable presence of P. gingivalis ( p < 0.01) and hypertension ( p = 0.01), were independently associated with an increased CRP. The detectable presence of P. gingivalis was associated with a 20% (95% confidence interval 4-35%) increase in CRP (mg/l) after adjustment for all other predictor variables. Conclusion In these 60-70-year-old dentate men, the presence of P. gingivalis in subgingival plaque was significantly associated with a raised level of C-reactive protein. [ABSTRACT FROM AUTHOR]

Background: We evaluated the effectiveness and cost-effectiveness of a loyalty scheme based intervention involving rewards for increasing physical activity in public sector employees. Methods: A cluster randomised wait-list controlled trial in public sector organisations in Northern Ireland. We randomly assigned clusters (1:1) using a computer generated random sequence. Researchers were masked to allocation, but participants were not. Employees aged 18–65 years with no self-reported medical contraindications to physical activity were included. The Physical Activity Loyalty Scheme (PAL) intervention was based on high-street loyalty cards where participants earned points for minutes of activity that could be redeemed for rewards, complemented by evidence-based behaviour change techniques. The primary outcome was objectively measured mean steps/day at 6 months using a validated pedometer (Yamax Digi-Walker CW-701) over 7 days, assessed with intention to treat analysis. Secondary outcomes included health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Cost-effectiveness, cost-benefit and mediation analyses were conducted. Trial registered with Current Controlled Trials, number ISRCTN17975376. Results: Between September 2014 and October 2015, we recruited and randomly assigned 37 clusters (from nine organisations; mean clusters per organisation = four) and 853 participants to the intervention (n = 19 with 457 participants) or control group (n = 18 with 396 participants). Primary outcome data were available for 249 (54·4%) intervention and 236 (59·6%) control participants. Mean steps/day were significantly lower in the intervention vs control group (adjusted mean difference = − 336, 95% CI: -612 to − 60, p = 0·02) at 6 months. Participants redeemed only 39% (SD 43%) of their earned points. Using the Quality Adjusted Life Year outcome, the intervention was not cost effective from an NHS/PSS perspective. A net cost analysis from an employer perspective demonstrated the intervention group was associated with a mean of 2·97 h less absenteeism over a 4 week period (p = 0·62), which could result in net savings ranging from £66 to £735 depending on the wage rate employed. At 4-weeks post-baseline there were significant increases in identified regulation, integrated regulation, intrinsic motivation, social norms and intentions in intervention compared to control participants. Conclusions: Our mixed results pose challenges that are too infrequently exposed in public heath intervention trials. Although the intervention successfully altered several hypothesised mediating constructs it did not translate into long-term behaviour change. Our incentive level may have been too low to incentivise change, despite being designed a priori by a Contingent Valuation Survey. There were also major re-structuring of several organisations which presented significant implementation challenges, and technical limitations. Trial registration: ISRCTN17975376 (Registered 19/09/2014). [ABSTRACT FROM AUTHOR]

Objective: To investigate long‐term mortality rates and causes of death in individuals diagnosed with type 1 diabetes before the age of 15 years during the period 1989‐2012 or known to paediatric diabetes teams in 1989, in Northern Ireland. Methods: A cohort of 3129 patients from the Northern Ireland Childhood Diabetes Register was linked to death registrations and underlying causes, coded according to ICD‐9 or ICD‐10. Standardized mortality ratios (SMRs) were calculated as the ratio of observed to expected deaths by sex, attained age, time since diagnosis, calendar period, and cause of death. Results: Subjects were followed to December 31, 2012 giving 39 764 person‐years of follow‐up (median 12.1 years). In total, 59 subjects had died (1.5 per 1000 person‐years) compared with 19.9 deaths expected, an SMR of 296 (95% confidence interval (CI) 229‐382). Women had a significantly higher excess risk of mortality than men with SMRs of 535 (95% CI 361‐764) and 203 (95% CI 136‐291), respectively. Over half of the deaths (56%) were judged to be related or possibly related to diabetes with most of these due to acute (n = 24) or late (n = 6) complications. Conclusions: Subjects with type 1 diabetes diagnosed less than 15 years of age had 3 times the mortality risk of the general population. Over half of the deaths were related to acute or chronic complications of diabetes. [ABSTRACT FROM AUTHOR]

Background Physical activity (PA) interventions are generally effective in supporting short-term behaviour change, but increases are not always maintained. This review examined the effectiveness of PA interventions for behaviour change maintenance in young and middle–aged adults, and investigated which Behaviour Change Techniques (BCTs) and other intervention features were associated with maintenance. Methods Six databases (Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Web of Science) were systematically searched. Eligibility criteria were controlled trials investigating the effectiveness of PA interventions with adult (mean age 18–64 years) non-clinical populations using validated measures of PA behaviour at baseline and ≥six months’ post-baseline. Results were pooled in meta-analyses using standardised mean differences (SMD) at five time intervals (6–9, 9–15, 15–21, 21–24, >24 months). Moderator analyses investigated the influence of sample and intervention characteristics on PA maintenance at 6–9 months. Results Sixty-two studies were included. PA interventions had a significant effect on behaviour maintenance 6–15 months post-baseline relative to controls. Interventions had a larger effect on maintenance at 6–9 months (SMD = 0.28; 95% CI : 0.20, 0.35; I 2 = 73%) compared to 9–15 months (SMD = 0.20; 95% CI : 0.13, 0.26; I 2 = 70%). Beyond 15 months, PA measurements were infrequent with little evidence supporting maintenance. Moderator analyses showed some BCTs and intervention settings moderated PA outcomes at 6–9 months. A multivariable meta-regression model showed interventions using the BCTs ‘Prompt self-monitoring of behavioural outcome’ ( b = 1.46, p < 0.01) and ‘Use of follow-up prompts’ ( b = 0.38, p < 0.01) demonstrated greater effectiveness at promoting PA maintenance at 6–9 months. Interventions implemented in primary care (versus community or workplace/university) settings ( b = −0.13, p = 0.10) tended to demonstrate less effectiveness. Conclusions This review provides evidence of some effective BCTs for maintaining behaviour to 15 months. Greater consideration must be given to how future interventions encourage and measure maintenance of changes, and investigate broader psychological, social and environmental influences of PA behaviour. PROSPERO registration PROSPERO 2015:CRD42015025462. [ABSTRACT FROM AUTHOR]