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Background: The incidence of type 1 diabetes (T1D) among children and adolescents has been reported to be steadily increasing worldwide with considerable regional, national and ethnic differences. We aimed in this study to present a 30-year registry-based incidence data on T1D in Yemen, a low-income country, during peace and war times. Methods: A total of 461 children and adolescents aged more than 6 months to 18 years with newly-diagnosed diabetes were registered between1989-2018. We used a standardized registry protocol according to that established in the 155 center WHO Multinational (DiaMonod) Project for childhood diabetes. The registry as with other WHO DiaMond centers was primarily concerned with counting the frequency of new-onset cases of childhood diabetes over time across Sana’a city according to a standard set of specific criteria. Case reports registered were validated on the basis of a physician’s diagnosed diabetes in the records. Eligibility for registration was based on age < 19 years and permanent residence in Sana’a city. The annual incidence rates (cases/100,000 persons/year) were calculated from the numbers of new reported cases for each year (1989-2018) divided by the estimated numbers of person-years ‘at risk’ (population < 19 years) according to age and sex for that year. Completeness of case ascertainment for the identified number of cases was assessed with the use of the 2-source capture-recapture method throughout the study period. Findings: The mean annual incidence rate in children aged 0-14 years over the full observation period was 1.83/100,000/yr with 95% CI: (0.9, 2.74). With the use of 3-year time periods, the mean annual incidence rate was intermediate (5 per 100,000/yr) in the first time-period (1989-1991), low (1.56-2.3/100,000/yr) during subsequent 5 time-periods (1992-2006) and (1.2/100,000/yr) during the next 2 time-periods (2007-2012). Ultimately, there was a precipitous decline in incidence to a very low rate (0.5/100,000/yr) during the last two time-periods (2013-2018) which was the time when Yemen has experienced the conflict and war. The age-specific mean T1D annual incidence rates with the use of 3-year time periods for children aged 0-4 yr, 5-9 yr, 10-14 yr, and adolescents aged 15-18 yr over the full observation period (1989-2018) were 0.83, 1.82, 3.14, and 2.31/100,000/yr, respectively. On temporal trend analysis of incidence rates with the use of 3-years moving average, all trend curves indicated a decline for all participants aged 0-14 years and for other age groups, especially during the last 6 years of the observation period. The mean annual age-specific and sex-specific incidence rates over the full observation period were found to be increasing with increased age in both males and females, peaking at puberty (10-14 year old) with the associated gender effect. A seasonal trend in incidence of T1D was noted with more diagnoses of cases in the winter and autumn months and fewer in the summer months, a feature that was observed in both sexes and in all age groups. Interpretation: The mean incidence rate of T1D in children and adolescents in Sana’a city was found to be low. In children aged 0-14 years in particular, the rate was low during peace time, followed by a precipitous decline to a very low rate during the time of war. Economic destruction, poverty and shortage of food supply to a large sector of children and adolescents were likely associated with decreased incidence of childhood diabetes during war. Undernutrition and low standards of environmental hygiene with exposure to infections very early in childhood might have operated as a protective factor against pediatric-onset autoimmune diabetes. Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Declaration of Interests: None declared. Ethics Approval Statement: Patient consent for publication was obtained from patients’ families. Ethical approval statement: This work was approved by the Ethical Committee at the Faculty of Medicine and Health Sciences, University of Sana’a

Summary box 'Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world’, said Louis Pasteur. Over 200 years after this statement, scientists of various disciplines worldwide are today racing against time to understand a new infecting virus, SARS-CoV-2, in order to develop safe and effective interventions to control a raging pandemic. Scientists typically work quietly at a planned pace, but the COVID-19 pandemic altered the priority, methodology and speed by which science is conducted, communicated and translated.1 Haste to find answers could yield unusable or untrustworthy results, which is an early lesson of this paradigm shift.2 Paradoxically, the scientific and technological advancements of the 21st century offer assurance for a fast end to the pandemic, but on the other hand, the globalised communication infrastructure fosters anxiety in the population. Global transmission of SARS-CoV-2 was initially facilitated by fast transport movements, while high-speed internet enabling 24 hours live streaming of news and ubiquitous social media transmitted fear …

The natural history and mortality of type 1 diabetes in adolescents in Africa is not well characterized. Our aim is, therefore, to describe these characteristics for cases in the Rwanda Life For a Child (LFAC) program. Participants (≤25 years old) were the first 500 children and youth enrolled in the Rwanda LFAC program from 2004 to 2012. Clinical and demographic data were extracted from LFAC forms, and vital status was evaluated as of November 1, 2011. For the first 500 participants, 5-year survival was 93.8% while crude mortality was 13.9/1000 (95% CI 9.0–20.6/1000) person years of diabetes. However, since vital status is unknown for 134 participants, mortality could be as high as 40.2/1000 person years of diabetes if all missing cases died. Mortality was directly associated with age at diagnosis, and inversely to calendar year of first visit, BMI, and monitoring frequency. Hypertension prevalence reached 46% by 2012. Mortality rates associated with type 1 diabetes in Rwanda are similar to those in other African countries, but higher than rates in developed countries. Delayed diagnosis may contribute to excess mortality risk, but recent improvements in survival suggest that advancements are being made. Hypertension and loss to follow-up need to be addressed.

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Musculoskeletal injuries (MSIs) result in the most medical encounters, lost duty days, and permanent disability. Women are at greater risk of injury than men and physical training is the leading cause of injury. The purpose of this study was to investigate the demographic, body composition, fitness, and physical training risk factors for injuries in female Soldiers serving in garrison Army units over the past 12 months. Self-report survey was collected from 625 women. The ankle was the most frequently injured body region, 13%. Running was the activity most often associated with injury, 34%. In univariate analysis lower rank, older age, history of deployment, no unit runs, weekly frequency of personal resistance training, and history of injury were all associated with injury. In multivariate analysis rank, history of injury, weekly frequency of unit runs, and weekly frequency of personal resistance training were the best combination of predictors of injury. Running once or twice a week with the unit protected against MSIs, whereas participating in personal resistance training sessions once or twice a week increased the risk of MSIs. With more emphasis on running and resistance training, the U.S. Army could reduce injuries and save billions of dollars in training and health care costs.

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.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.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.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.

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 methodResults. 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.

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 US 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.

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 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.

During the past decade, a new model of health research and care has taken hold, that of translational research. However, translational research has many different nuances and it is difficult to have an umbrella definition. Our focus has been the translation of research to the classroom. The focus of translational research has been little investigated, but is fundamental to all of science and health. At the University of Pittsburgh, we have been developing systems to translate science into the classroom using a model called the Supercourse. Supercourse is a library of over 4100 lectures on public health and medicine shared for free by more than 65,000 members of the Global Health Network from over 170 countries. Translation of knowledge into the classrooms is done via the transfer of PowerPoint modules around the world. We have been particularly concerned with the lack of training of medical, public health and nursing schools for global health and prevention. The Library of Alexandria, the World Health Organization in Geneva, and our WHO Collaborating Center at the University of Pittsburgh have been distributing Supercourse DVDs to address the lack of preventive training in both developed and developing countries.

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'.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.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.A significant improvement in post-test scores was seen in both the F2F and VTC groups (P0.001). 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 (P0.001). Two-way repeated measure analysis of variance in both groups showed significant changes in mean scores over time (P0.001).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'.

Maternal and child health (MCH) is a growing concern among the countries of the Former Soviet Union (FSU) where economic issues and changing infrastructures are seriously deteriorating the public health system. Moreover, in the past decade, lack of primary prevention programs coupled with a shortage of well-trained public health professionals are having an increasingly negative impact on MCH outcomes. In this article, we provide a brief overview of the current state of MCH, health care and public health education in the FSU. We suggest that indices could be improved by developing new inexpensive information exchange systems, and that system is Supercourse (accessible at www.pitt.edu/ approximately super1). Supercourse is an Internet-based library of public health lectures in PowerPoint format that are accessible, free of charge to anyone, anywhere, who has Internet access including scientists, doctors, and, specifically, educators. As of April 2007, Supercourse has more than 3,200 public health lectures, a network of more than 42,000 faculty members across 151 countries, with Nobel Prize winners and the former head of the CDC being among the lectures' authors. Supercourse lectures are aimed at the educator with the goal of improving public health training through timely and customizable lectures. The distinguishing features of Supercourse are ease of access in low-bandwidth lecture, minimal cost, a distribution system for lectures in CD format, high-quality content, and the capacity to create and sustain a global network of public health professionals. Additionally, statistical process control procedures for industry developed by W. Edwards Deming are utilized to ensure the quality of Supercourse lectures. Papers on Supercourse already have been published in the British Medical Journal, Nature, and Lancet, and are having a wide impact in the field of public health. Currently, an increasing number of lectures in the Supercourse library are dedicated to the theme of MCH. Low cost, high impact projects such as Supercourse are needed to improve and deploy MCH education worldwide.

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.

ABSTRACT 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.

OBJECTIVES: To determine the frequency of the metabolic syndrome (MS) among four subpopulations in the United States Virgin Islands and to estimate the risk for the MS that is associated with waist circumference cutpoints among overweight and obese individuals. METHODS: In a study undertaken from 1995 to 1999, data on demographic characteristics, anthropometric measurements, blood pressure measurements, and a blood sample were obtained from a population-based cohort of 893 Caribbean-born persons from four population subgroups who were living on Saint Croix (the largest island of the U.S. Virgin Islands) and who did not have a history of diagnosed diabetes. The four subpopulations were: (1) Hispanic white, (2) Hispanic black, (3) non-Hispanic black born in the U.S. Virgin Islands, and (4) non-Hispanic black born elsewhere in the Caribbean. Fasting blood samples were analyzed for glucose, insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C). National Cholesterol Education Program Adult Treatment Panel III guidelines were used to identify the MS. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR) method. RESULTS: The overall prevalence of the MS in the sample was 20.5% (95% confidence interval (CI) = 15.3%-25.7%). Persons who had classified themselves as both Hispanic and black had the highest frequency (27.8% (95% CI = 16.3%-39.3%)) of the MS and the highest HOMA-IR scores. After controlling for lifestyle factors and HOMA-IR, Hispanic ethnicity was independently associated with an increased risk of having the MS (odds ratio (OR) = 1.82, (95% CI = 1.07-3.07)), high triglycerides (OR = 3.66 (95% CI = 2.18-6.15)), and low HDL-C (OR = 1.60 (95% CI = 1.04-2.45)). A waist circumference of > 88 cm was associated with an increased risk of metabolic abnormalities among overweight and obese women. CONCLUSIONS: The frequency of the MS among Caribbean-born persons in the U.S. Virgin Islands is comparable to the frequency of the MS among the general population on the mainland of the United States. Among Caribbean-born persons living in the U.S. Virgin Islands, those who are Hispanic blacks may have a greater risk of cardiovascular disease than do other groups.OBJETIVOS: Determinar la frecuencia del síndrome metabólico (SM) en cuatro subpoblaciones de residentes de las Islas Vírgenes estadounidenses y calcular el riesgo de sufrir SM asociado con una circunferencia abdominal superior a determinados puntos de corte en personas con sobrepeso y obesidad. MÉTODOS: En un estudio realizado entre 1995 y 1999 se obtuvieron las características demográficas, medidas antropométricas, presión arterial y muestras de sangre de miembros de una cohorte poblacional de 893 personas que pertenecían a cuatro subgrupos poblacionales en Saint Croix (la mayor de las Islas Vírgenes estadounidenses) y que nunca habían recibido un diagnóstico de diabetes. Las cuatro subpoblaciones fueron: 1) hispanos de raza blanca; 2) hispanos de raza negra; 3) personas no hispanas de raza negra nacidas en las Islas Vírgenes estadounidenses y 4) personas no hispanas de raza negra nacidas en otras partes del Caribe. A las muestras de sangre en ayunas se les midieron las concentraciones de glucosa, insulina, triglicéridos y colesterol transportado por lipoproteínas de alta densidad (HDLc). Para identificar el SM se aplicaron las pautas generadas por el Panel III en torno al Tratamiento de Adultos, del Programa Educativo Nacional sobre el Colesterol [National Cholesterol Education Program Adult Treatment Panel III]. La resistencia a la insulina se calculó mediante la valoración de un modelo homeostásico (HOMA-IR). RESULTADOS: La prevalencia general de síndrome metabólico en la muestra fue de 20,5% (intervalo de confianza de 95% [IC95%]: 15,3% a 25,7%). Las personas que se habían clasificado a sí mismas como hispanas y de raza negra tuvieron la frecuencia más alta (27,8% (IC95% = 16,3% a 39,3%)) de SM y los puntajes más altos en el HOMA-IR. Después de hacer ajustes en función de los factores asociados con el estilo de vida y el HOMA-IR, la etnia hispana mostró una asociación independiente con un mayor riesgo de tener SM (razón de posibilidades [RP] = 1,82 (IC95%: 1,07 a 3,07)), triglicéridos séricos elevados (RP = 3,66 (IC95% = 2,18 a 6,15)) y concentraciones séricas bajas de HDLc (RP = 1,60 (IC 95% = 1,04 a 2,45)). Una circunferencia abdominal > 88 cm se asoció con un mayor riesgo de anomalías metabólicas en mujeres con sobrepeso y obesidad. CONCLUSIONES: La frecuencia de SM en personas nacidas en el Caribe con residencia en las Islas Vírgenes estadounidenses se asemeja a la observada en el territorio continental de los Estados Unidos. Dentro de esa misma categoría de personas, las de origen hispano y raza negra podrían tener un mayor riesgo de sufrir enfermedades cardiovasculares que las pertenecientes a otros grupos.

The discovery of islet cell antibodies (ICAs) was the prelude to the understanding that type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease. The issue regarding whether or not the measurement of ICAs should be completely replaced by biochemical markers detecting islet autoantibodies (AAs) for the prediction of T1DM has been the subject of endless international debates. In light of this controversy, we assessed the current role of ICAs as a predictive marker for T1DM progression. We examined a cohort of 1484 first-degree relatives (FDRs) of T1DM probands from the Children's Hospital of Pittsburgh Registry. These relatives were consecutively enrolled between 1979 through 1984 and followed up to 22 yr. Serum obtained at the time of enrollment was assayed for ICAs, glutamic acid decarboxylase (GAD)65, insulin A (IA)-2 AA, and insulin AAs (IAAs). In FDRs who had ICAs in addition to GAD65 and IA-2 AAs, the cumulative risk of developing insulin-requiring diabetes was 80% at 6.7 yr of follow-up, whereas this risk in those with GAD65 and IA-2 AAs without ICAs was only 14% at 10 yr of follow-up (log rank: P

Objective: The aim of this study was to search for the seasonal and geographic variations in epidemics of type 1 diabetes in China. Research design and methods: Incidence data from 22 type 1 diabetes registration centers across China were analyzed. A Poisson regression model with a sine wave function was applied to evaluate the seasonal trends. A scan statistic was used to examine the occurrence of an epidemic. Results: There was a significant cyclic trend of incidence of type 1 diabetes in China. The northern area had a higher incidence rate than the southern area. Epidemics were discovered in Dalian and Shenyang from late 1992 to late 1993. Conclusions: There was a strong association of climate and incidence of type 1 diabetes in China, whereby the incidence was higher in the colder areas and in the winter months. Evidence of epidemics existed in two centers in 1992–1993. It is critical to identify the epidemics early and determine the causes of epidemics.

Infant milk and food introduction may be linked to type 1 diabetes risk in high incidence populations. Dietary data through age 12 months was collected for 247 type 1 diabetic cases and 443 controls in China, a low incidence population, to determine if milk and solid food intake differed. Age range at introduction to milk and formulas was similar in cases and controls but solid food introduction more often occurred before age 3 months in cases. Logistic regression analyses showed soy milk formula consumption at 4-6 (OR = 2.0; 95% CI: 1.1-3.4) and 7-12 months of age (OR = 1.5; 95% CI: 1.0-2.1) was associated with a twofold higher risk of type 1 diabetes, while steamed bread consumption (4-6 months, OR = 0.44; 95% CI: 0.28-0.68; 7-12 months, OR = 0.48; 95% CI: 0.34-0.69) and higher SES (4-6 months, OR = 0.55; 95% CI: 0.39-0.78; 7-12 months, OR = 0.57; 95% CI: 0.40-0.83) were negatively associated. Drinking cow's milk at 7-12 months (OR = 0.60; 95% CI: 0.43-0.85) was negatively associated with type 1 diabetes while consuming vegetables at 4-6 months (OR = 1.5; 95% CI: 1.0-2.2) was positively associated. Results suggest that infant milk and solid food intake are associated with type 1 diabetes in China. Prospective studies may determine how these dietary factors impact disease etiology, particularly for at-risk-populations.

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 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 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.

OBJECTIVE—We have previously reported differences in the prevalence of β-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 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.

Scientific communication is in the process of metamorphosis. Will it change into a dung beetle or into a beautiful butterfly? Here is one possibility that some might argue is as frightening as Kafka's story > “As Gregor Samsa awoke from unsettling dreams one morning, he found himself transformed in his bed into a monstrous bug.” > > Kafka, Metamorphosis In 1995 we questioned the hallowed tenets of paper journals. We wrote a series of articles, beginning with “The death of biomedical journals,” suggesting the death knell for paper journals.1–3 Delamothe echoed our conclusions that “The burgeoning world wide web … makes it inevitable that new systems of disseminating research will replace or at least supplement journals.”4 #### Summary points Traditional peer reviewed journals are becoming obsolete We are experiencing a dramatic metamorphosis of the tools of scientific communication The prima lingua of scientific communication is PowerPoint Our search for the optimal information exchange method in science leads to P2P The response was Kafkaesque, reminding us of the quote from Penal Colony “It is an exceptional apparatus” so do not question it. The “journal” apparatus shows that little of the fibre of journals has been scientifically evaluated. Are journals an efficient, scientific, “just in time” process? It is impossible to answer. For 300 years there has been no evidence based evaluation of the journal process. For example, there is virtually no research on the quality of learning from journals, whether IMRD (introduction, methods, results, discussion) optimises learning, or if traditional peer review is the best system. To quote Goldbeck-Wood, “But if peer review is so central to the process by which scientific knowledge become canonised, it is ironic that science has little to say as to whether it works.”5 This applies to all phases of the journal process. Is a metamorphosis in …

Most Caucasians with Type I (insulin-dependent) diabetes mellitus develop an autoimmune form of diabetes known as Type IA diabetes, based on the presence of humoral responses to islet autoantigens. Alleles at the HLA locus account for the strongest susceptibility to this form of diabetes, which requires insulin therapy. Because a number of patients who develop insulin-requiring diabetes are islet autoantibody negative, the HLA class II haplotypes, DQA1*0501-DQB1*0201 and DQA1*0301-DQB1*0302, were evaluated to assess whether they are an independent risk factor for progression to insulin requirement in first-degree relatives of Type I diabetic patients.Both HLA-DQ genotyping and islet cell autoantibody assessment (insulin, GAD65, IA-2 autoantibodies and cytoplasmic islet cell antibodies) were evaluated prospectively in 74 relatives of Type I diabetic patients who developed diabetes treated with insulin (prediabetics) and in 426 control subjects who did not develop insulin-requiring diabetes. Based on the presence of DQA1*0501-DQB1*0201 and/or DQA1*0301-DQB1*0302, the number of HLA-DQ high-risk haplotypes was assigned as 0, 1 or 2.A higher prevalence of 2 HLA-DQ high-risk haplotypes was present in seronegative prediabetic subjects as compared to non-diabetic autoantibody negative first-degree relatives (33.3 % vs 10.1 % respectively; p0.05). Moreover, in seronegative relatives who developed insulin-requiring diabetes, the presence of 2 HLA-DQ high-risk haplotypes conferred an increased cumulative risk of developing insulin requirement of 27 % at 12.5 years of follow-up, compared to a risk of 6 % for non-diabetic relatives who were antibody-negative and had 0 or 1 HLA-DQ high-risk haplotypes (Log rank p = 0.01).These data provide evidence for a phenotype, which is associated with the absence of conventional islet autoantibodies at initial screening, while usually remaining seronegative, and the presence of 2 HLA-DQ high-risk haplotypes with progression to clinical Type I diabetes after a prolonged follow-up. Given the fact that in humans the highest risk-conferring locus associated and linked to the disease is the HLA cluster, and that HLA-DQ molecules play a key role in the development of autoimmune diabetes, our observations imply that as yet unidentified immunologic abnormalities could well exist in seronegative relatives at risk of developing clinical diabetes and carrying 2 HLA-DQ high-risk haplotypes.

To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined.A 1-2 year follow-up of 214 members of the Rwanda Life for a Child program (aged26 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.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.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.

The WHO Collaborating Center at the University of Pittsburgh, USA partnering with Nazarbayev University, developed the Central Asian Journal of Global Health (CAJGH, cajgh.pitt.edu) in order to increase scientific productivity in Kazakhstan and Central Asia. Scientists in this region often have difficulty publishing in upper tier English language scientific journals due to language barriers, high publication fees, and a lack of access to mentoring services. CAJGH seeks to help scientists overcome these challenges by providing peer-reviewed publication free of change with English and research mentoring services available to selected authors.CAJGH began as a way to expand the Supercourse scientific network (www.pitt.edu/~super1) in the Central Asian region in order to rapidly disseminate educational materials. The network began with approximately 60 individuals in five Central Asian countries and has grown to over 1,300 in a few short years. The CAJGH website receives nearly 900 visits per month.The University of Pittsburgh's “open access publishing system” was utilized to create CAJGH in 2012. There are two branches of the CAJGH editorial board: Astana (at the Center for Life Sciences, Nazarbayev University) and Pittsburgh (WHO Collaborating Center). Both are comprised of leading scientists and expert staff who work together throughout the review and publication process. Two complete issues have been published since 2012 and a third is now underway. Even though CAJGH is a new journal, the editorial board uses a rigorous review process; fewer than 50% of all submitted articles are forwarded to peer review or accepted for publication. Furthermore, in 2014, CAJGH will apply to be cross referenced in PubMed and Scopes.CAJGH is one of the first English language journals in the Central Asian region that reaches a large number of scientists. This journal fills a unique niche that will assist scientists in Kazakhstan and Central Asia publish their research findings and share their knowledge with others around the region and the world.

Objective. To estimate rates of lower extremity amputations (LEAs) in persons with peripheral vascular disease, diabetes mellitus, trauma, neoplasm, osteomyelitis, or emphysematous gangrene. Methods. Regional amputee registries were used to estimate the rate of lower extremity amputations with the capture-recapture (CR) technique. Data were extracted from three amputee registries in Rio de Janeiro: source 1, with 1 191 cases from 23 hospitals; source 2, with 157 cases from a limb-fitting center; and source 3, with 34 cases from a rehabilitation center. Amputee death certificates from source 1 identified 257 deaths from 1992 to 1994. Three CR models were evaluated using sources 2 and 3. In order to avoid an overestimation of the rate of LEAs, two models were applied for the data analysis: in one case, deceased patients listed in source 1 were excluded from the model, and in the other case, deceased patients were included as well. Results. Excluding the 257 deaths, the estimated number of amputations in the municipality of Rio de Janeiro from 1992 to 1994 was 3 954, for a mean annual incidence rate of 13.9 per 100 000 inhabitants. Among persons with diabetes, the annual incidence rate of lower extremity amputations was substantially higher (180.6 per 100 000 persons per year), representing 13 times the risk of individuals without diabetes. The yearly rate of LEAs according to the routine surveillance system was estimated at 5.4 and 96.9 per 100 000 in the general population and in diabetics, respectively. If data from the three registries are added, 1 382 patients with LEAs were identified, with the reasons for the amputations distributed as follows: peripheral vascular disease = 804 (58.1%); diabetes mellitus = 379 (27.4%); trauma = 103 (7.4%); osteomyelitis = 44 (3.1%); gangrene = 36 (2.6%), and neoplasm = 16 (1.1%). Conclusions. These findings show a high incidence of LEAs in Brazil, when compared to countries such as Spain, that is attributable mainly to peripheral vascular disease and diabetes mellitus.Objetivos. Estimar las tasas de amputación del miembro inferior (AMI) en individuos con vasculopatías periféricas, diabetes sacarina, traumatismos, neoplasias, osteomielitis o gangrena enfisematosa. Métodos. Se utilizaron los registros regionales de amputados para estimar la tasa de AMI con el método de captura-recaptura (CR). Los datos se obtuvieron a partir de tres registros de amputados de Río de Janeiro: la fuente 1, con 1 191 casos de 23 hospitales; la fuente 2, con 157 casos de un centro de miembros artificiales, y la fuente 3, con 34 casos de un centro de rehabilitación. Los certificados de defunción de los amputados de la fuente 1 identificaron 257 muertes entre 1992 y 1994. Se investigaron dos modelos de CR utilizando las fuentes 2 y 3. Con el fin de evitar la sobreestimación de la tasa de AMI, en el análisis de los datos se aplicaron dos modelos: en uno se excluyeron los pacientes fallecidos que figuraban en la fuente 1, y en el otro se incluyeron. Resultados. Excluyendo las 257 muertes, el número estimado de amputaciones en el municipio de Río de Janeiro entre 1992 y 1994 fue de 3 954, lo cual representa una incidencia anual media de 13,9 por 100 000 habitantes. En los pacientes diabéticos, la incidencia anual de AMI fue considerablemente mayor (180,6 por 100 000), lo cual representa un riesgo 13 veces mayor que en individuos sin diabetes. De acuerdo con el sistema de vigilancia habitual, las correspondientes tasas anuales de AMI fueron de 5,4 y 96,9, respectivamente. Combinando los datos de los tres registros, se identificaron 1 382 pacientes con AMI, cuyas causas se distribuyeron del siguiente modo: vasculopatías periféricas, 804 (58,1%); diabetes sacarina, 379 (27,4%); traumatismos, 103 (7,4%); osteomielitis, 44 (3,1%); gangrena, 36 (2,6%), y neoplasias, 16 (1,1%). Conclusiones. En comparación con otros países, como España, estos resultados muestran una alta incidencia de AMI en Brasil, atribuible principalmente a las vasculopatías periféricas y a la diabetes sacarina.

OBJECTIVE: To assess mortality of population-based cohorts of childhood-onset type 1 diabetic patients from the Eastern European countries of Estonia and Lithuania and compare this information with recent data from Finland. RESEARCH DESIGN AND METHODS: Estonian (n = 518) and Finnish (n = 5,156) type 1 diabetic cohorts were diagnosed between 1980 and 1994, and the Lithuanian (n = 698) cohort was diagnosed between 1983 and 1994. The mortality of these cohorts was determined in 1995. Life-table analysis, Cox survival analysis with covariates, and standardized mortality ratios (SMRs) were used. Causes of death were analyzed. RESULTS: Survival after 10 years duration of type 1 diabetes was similar in Estonia (94.3%) and Lithuania (94.0%), but much higher in Finland (99.1%). In the Cox survival analysis with covariates, the country of origin and age at diagnosis were found to be significant predictors of mortality. The SMR for the Estonian cohort was 4.35 (95% CI 2.25-7.61), the highest for the Lithuanian cohort was 7.55 (4.89-11.15), and the lowest for the Finnish cohort was 1.62 (1.10-2.28). The most common cause of death in Estonia and Lithuania was diabetic ketoacidosis (DKA), and in Finland, it was violent causes. No deaths from late complications of diabetes have been documented so far in any of the three countries. CONCLUSIONS: Our results demonstrate a high rate of short-term deaths due to DKA and inferior survival of childhood-onset type 1 diabetic patients in Estonia and Lithuania compared with Finland. In Finland, the survival of childhood-onset type 1 diabetic patients has improved and is only slightly inferior to that of the background population.

Capture-recapture analysis is an analytical tool being used in epidemiological research to estimate incidence rates for missing cases and unreliable reporting. Its contribution to batterer program evaluations is examined through a capture-recapture analysis of a multisite evaluation of batterer programs (n = 853). Capture-recapture analysis is applied to various subsamples of the multisite study and to different outcomes (i.e., any reassault, “severe” reassault) to explore the utility of capture-recapture. Finally, the capture-recapture estimates are compared to only the women’s reports and to adjusted women’s reports (women’s reports supplemented with arrest records and men’s reports), which are the basis of existing batterer program evaluation. The capture-recapture reassault estimate for the 15-month follow-up is equal to the adjusted women’s reports (39%), but is 7% greater than the women reports. The subsample estimates for the individual sites appear to vary as a result of unreliable or unavailable arrest records.

Background/Purpose: Although fertility is decreased after cryptorchidism, the importance of risk factors, including parencymal testicular suture, is unknown. The aim of this study was to examine the relationship between parencymal testicular suture and failure to conceive a child for 1 year or longer among formerly cryptorchid men. Methods: Men who underwent orchidopexy between 1955 and 1972 at the Children's Hospital of Pittsburgh (n = 619) were surveyed by questionnaire and their medical records reviewed. Only the men who attempted to conceive a child (n = 387) are included. Results: Logistic regression analysis determined significant risk factors for infertility. Testicular suture was strongly related to infertility (RR, 7.56; 95% Cl, 1.66, 34.39) as were bilateral cryptorchidism (RR, 5.51; 95% Cl, 1.58, 19.24), varicocele (RR, 4.72; 95% Cl, 1.42, 15.75), hormone treatment before surgery (RR, 3.69; 95% Cl, 1.22, 11.11), and partner conception problem (RR, 3.32; 95% Cl, 1.11, 9.90). Conclusions: Testicular suture was a potent independent determinant of infertility among formerly cryptorchid men who have orchidopexy. Bilateral cryptorchidism, hormone treatment, varicocele, and partner conception problems also were associated with increased infertility.

The purpose of this study was to determine how well men recall reproductive information. By using a questionnaire, the authors surveyed men who had undergone orchiopexy for undescended testes and a group of matched control men, all of whom had had surgery at the Children's Hospital of Pittsburgh in Pittsburgh, Pennsylvania (n = 77), and their spouses. Subjects were a random subset of a larger (n = 1,212) male fertility study, which has been ongoing since 1992. In 1994, the spouses of men who participated in the study completed a short telephone survey that contained questions previously asked of their partners. Pearson correlations and kappa statistics were calculated to evaluate the accuracy of male recall of reproductive information. For the continuous measures, such as time to conception and frequency of intercourse, the correlations were high to moderate (r = 0.84 (p < 0.001) and r = 0.45 (p < 0.001), respectively). Agreement between the men and their spouses on the majority of bivariate (yes/no) questions, such as those concerning the use of birth control, as measured by the kappa statistic, was moderate to very good (K ranged from 0.14 to 0.69). Statistics were similar for formerly cryptorchid and control men. Male participants' responses to questions about their reproductive histories were accurate as compared with the responses given by their spouses. In this sample from a large cohort study, men appeared to recall reproductive information with acceptable accuracy.

OBJECTIVE To investigate the impact of age at onset on the prognosis of childhood IDDM in Japan. RESEARCH DESIGN AND METHODS The study population consisted of 987 prepubertal-onset and 345 pubertal-onset IDDM cases who were registered by two nationwide surveys and who were diagnosed between 1965 and 1979. The living status was identified as of 1 January 1990 with the ascertainment rate of 96.5%. Prognosis was evaluated by cause- and agespecific mortality rates and life-table analyses; in addition, an attained-age-matched case-control study was analyzed by conditional logistic regression. RESULTS The adjusted mortality rates per 100,000 person-years for the pubertal-onset cases were significantly higher than those of the prepubertal-onset cases (835 [95% CI 573–1,168] vs. 391 [283–526]). Life-table analyses revealed that the survival rate of the pubertal-onset cases was lower than that of the prepubertal-onset cases for each observation period. Life-table analyses after the age of 15 years indicated that the prognosis of pubertal cases was almost the same as that of the prepubertal cases despite having a shorter duration of diabetes. The attained-age–matched case-control study indicated that the pubertal onset was a potent determinant of death. CONCLUSIONS The prognosis of pubertal-onset IDDM was considerably poorer than that of prepubertal-onset IDDM.

OBJECTIVE To determine the incidence of IDDM in children aged < 20 years at diagnosis in Allegheny County, Pennsylvania, for the period from 1 January 1990 to 31 December 1994 and to compare the incidence between whites and nonwhites in the same area and for the same time period. RESEARCH DESIGN AND METHODS All new patients diagnosed between January 1990 and December 1994 who were aged < 20 years, on insulin, and residents of Allegheny County at diagnosis were identified from medical records of 23 hospitals in the Allegheny County area. To verify the completeness of the hospitals using the capture-recapture method, pediatricians and diabetologists were used as a secondary source. RESULTS A total number of 257 patients were identified. The overall age-standardized incidence rate was 16.7/100,000. Nonwhites had a slightly higher incidence (17.6/100,000) than whites (16.5/100,000). In the 15–19 years age-group, the incidence in nonwhites (30.4/100,000) was almost three times higher than that in white (11.2/100,000) and more than two times higher than that in the previous period (from 1985 to 1989) (13.8/100,000). CONCLUSIONS For the first time in the Allegheny County registry, and in any other registry, nonwhites showed a higher incidence of IDDM than whites. The high incidence in the 15–19 years age-group was responsible for this phenomenon. This epidemic of diabetes in adolescent nonwhites may be the result of a rising incidence of classical IDDM or another type of diabetes. Further studies using population-based registries are needed to determine whether this increase is being seen in other areas and other ethnic groups and to clarify the reasons for the increase in IDDM among blacks.

‘The strongest arguments prove nothing so long as the conclusions are not verified by experience. Experimental science is the queen of sciences and the goal of all speculation.’(R Bacon)

A new era of public health is emerging, with the use of the Internet at the forefront. Improving the efficiency of information transfer through the use of new telecommunications tools, such as the Internet, will lead to advances in health worldwide. To describe the current status of Internet connectivity within the U.S. public health system, state health departments were surveyed by telephone. A total of 47 state health departments participated in the survey. The results indicate that 92 percent were connected to the Internet in some way; however, 74 percent of those connected had personnel restrictions on usage and/or limited access to the Internet. Only 6.4 percent of the states indicated that all of their local health departments were connected. The results of this survey reveal that despite the widespread use of the Internet, the public health system in the United States has limited connectivity with respect to the number of personnel who can access the Internet and the Internet services they are able to use. It is important for the future of public health to establish a network linking the public health departments in the United States.

A population based comparative study of head injury in Taiwan was conducted from January to December 1993. Taipei City was selected to represent an urban population and Hualien County its rural counterpart. A total of 4955 cases of head injury in Taipei and 1069 cases in Hualien were studied. The head injury incidence rate in Hualien is about two times that of Taipei. Traffic accident related head injuries, especially motorcycle accidents, accounted for a larger percentage of cases in Hualien than in Taipei. In terms of mortality rate, the injuries tended to be more fatal in Hualien. The preliminary data clearly show that there exist major geographical differences of head injury patterns in urban and rural areas in a developing country. Preventative measures, specifically focusing on motorcycle accident related head injury, need to be adopted to deal with this serious problem.

The aim of this study was to evaluate the geographic variation in mortality among individuals with youth-onset insulin-dependent diabetes mellitus (IDDM) across the world. The study was based on the currently available IDDM incidence and mortality data. Mortality data for diabetes in the 0-24 year age group were obtained from the World Health Organization (WHO) statistics. The mortality rates were adjusted for the frequency of occurrence of IDDM and dividing the mortality rates by the IDDM incidence rates which were obtained from the WHO DiaMond project. There was a more than 10-fold geographic variation in mortality between the developed countries and Eastern European populations. The areas with the highest mortality rates were located in Japan, Eastern Europe and Russia. The areas having the best outcome associated with IDDM were Northern Europe, Central Europe, and Canada. An ecological study demonstrated a relationship between the incidence-adjusted mortality (estimated case-fatality) with IDDM incidence itself (Spearman's correlation coefficient = 0.45) as well as infant mortality and life expectancy at birth. These data demonstrated the possibility of an enormous geographic variation in mortality of youth-onset diabetic patients even in developed countries. It is important to note that these excess deaths are potentially preventable. The ecological study also suggested that the mortality differences may be in part related to overall and diabetes related care.

OBJECTIVE To examine the influence of diabetes on the employment patterns of parents of children living with diabetes. STUDY DESIGN A case-control study of 197 families with an IDDM child and 142 control families without IDDM children was conducted. Case families were identified from a population-based diabetes registry. Brothers and sisters of the parents in the IDDM families were asked to participate as controls. Employment rates, absenteeism related to child care, and changes in work status were assessed by means of a questionnaire. Surveys were obtained from 85% of the families (172 case; 118 control). RESULTS No difference was found between the IDDM and control families in the overall rate of employment and changes in work patterns. However, IDDM families were more likely to report absences from work related to child care (58% vs. 45%, P < 0.05). This impact was greatest for the working mothers. The greatest impact of IDDM on employment may be faced by single parents, who reported lower rates of employment and higher rates of absenteeism and changes in work patterns. CONCLUSIONS Families face decisions regarding employment and the appropriate level of care for children with diabetes. These data illustrate that most families with an IDDM child have employment experiences similar to those of families without diabetic children. Larger sample sizes of single parent families are necessary to confirm these findings.

Now that many laboratories have access to the Internet, employees can use it in a variety of ways. Improved information transfer has an enormous potential for improving all areas of clinical laboratory science. It was with this goal in mind that we developed a Global Health Network for clinical laboratory science on the Internet ( ). The principles of the Global Health Network include connectivity, monitoring, global education and training, networking, and information servers. These principles, when applied, will improve the transfer of information among individuals, laboratories, and organizations.

BACKGROUND: The success of the Supercourse showed that the effort was needed in Latin America. But would a Spanish language version be better for the region?METHODS: Google Analytics was used to determine website usage. A custom evaluation form was created to get user feedback on the usefulness of both the English language and Spanish language Supercouse lectures.RESULTS: Over a year's span from June 2009 to June 2010 there were 257,403 unique visits and 448,939 page views. The overall average rating of lectures was 4.87 with the Spanish language lectures getting even higher ratings.CONCLUSION: Supercourse lectures in Spanish were a great success in Latin America. This success shows the need for this information and similar success could be found in Central Asia.

Objective. To determine if paternity is decreased among formerly unilateral cryptorchid men compared with a control group of men. Subjects and Methods. Formerly unilateral cryptorchid men who had orchiopexy between 1955 and 1971 at the Children's Hospital of Pittsburgh and a group of control men have had their medical records reviewed and have been surveyed by questionnaire. Results. Among the men who had ever married and had attempted paternity, significantly more of the unilateral cryptorchid men had been unable to father children (10.5%) than among the control group (5.4%). No difference was found when the groups were compared for the duration of regular intercourse without contraception to conception of their first child. There was no relationship between the age of orchiopexy or lifestyle factors and paternity or between the age of orchiopexy and months of regular unprotected intercourse to conception. Paternity among both groups was related to femalerelated infertility factors and to the presence of vericoceles. Conclusion. When compared with a control group, paternity was compromised after unilateral cryptorchidism. Infertility is about twice as frequent among the unilateral group. There was no evidence of subfertility requiring a longer exposure of regular intercourse without contraception among the fertile subgroup. No correlation was found between age of orchiopexy and paternity.

This study applied a Cox proportional hazard model to investigate the calendar time trends of insulin-dependent diabetes mellitus (IDDM) mortality. The study population was the IDDM patients who were diagnosed in the period 1965-1979, less than or equal to 19 years of age at diagnosis, and were residents of Allegheny County, PA. The mortality follow-up for each individual was recorded from the diagnosis of IDDM and till 31 December 1990. There were 999 individuals in this study, and 68 deaths (6.8%) occurred during this 26-year investigation period. Overall, for the patients with the same IDDM duration, non-whites were 1.7 times more likely to die than white group; female IDDM patients had a higher risk of death than male IDDM patients (1.27:1); and the risk of mortality increased as the age at diagnosis increased. When controlling for the gender, ethnic groups and age at onset effect, the risk of dying in different calendar years appeared to be a quadratic form. The highest mortality appeared in the late 60's, and the lowest was in the period of 1975-1979. Disappointingly the mortality has begun to rise again in the latest time frame.

OBJECTIVE To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children aged 0–14 years in Kuwait, as part of the World Health Organization Multinational Collaborative Study (DIAMOND), and to determine if the incidence rates have increased. RESEARCH DESIGN AND METHODS All cases of IDDM diagnosed before the child's 15th birthday between 1 January 1992 and 31 December 1993 were recorded. Prospective notification of all children with newly diagnosed diabetes who were admitted to hospitals and periodic review of hospital medical records provided the primary source; notification by physicians working in diabetic clinics, in which registry of all new cases is mandatory, provided the secondary source of ascertainment. RESULTS The degree of ascertainment was 92.2%. The annual incidence of IDDM for children aged 0–14 years over the 2-year period was 15.4/100,000 (95% confidence interval, 12.4–19), with a male:female ratio of 1.2:1. The age-specific annual incidence rates for the age-groups 0–4, 5–9, and 10–14 years were 12.8, 15.1, and 18.3/100,000, respectively, with a male:female ratio of 1.45:1 in the 0- to 4-year-old age-group and an equal sex ratio in the 5- to 9- and 10- to 14-year-old age-groups. No significant difference was detected between incidence rates of IDDM in boys and girls in the three age-groups. There was no significant linear trend toward an increase in IDDM incidence rates as age advanced. Compared with a previous study by Taha et al. (Taha T, Moussa M, Rashed A, Fenech F: Diabetes mellitus in Kuwait: incidence in the first 29 years of life. Diabetologia 25:306–308, 1983), there was a nearly fourfold increase of IDDM in the age-group 0–14 years, mainly in those children < 5 years old, suggesting a rapid increase in a short period of time. CONCLUSIONS Kuwait has the highest incidence of IDDM in children in the region, and an apparently increasing incidence has been demonstrated over the last decade.