Type 1 diabetes in the Maltese Islands

The prevalence of Type 1 diabetes in Malta was estimated by identifying all cases aged less than 32 years by the end of 1987 who had attended the island's principal diabetic clinic. The age-adjusted prevalence rate for 0-19 year olds was 110.3 per 100,000 (girls 126.2 (n = 65), boys 95.3 (n = 52]. The mean annual incidence, during the period 1980-1987, in 0-19 year olds was 13.3 per 100,000 (n = 113, girls 14.1 and boys 12.6). Males developed Type 1 diabetes 2.1 years later than females (13.7 +/- 6.9 (+/- SD) vs 11.6 +/- 6.7 years). The commonest age of onset was 10 to 14 years. The peak period of onset occurred during the cooler months of November to February. The incidence rates are close to those in Nordic countries and indicate that Type 1 diabetes in Malta is underestimated.     

The sexual behaviour of adolescents in sub‐Saharan Africa: patterns and trends from national surveys

Objectives To describe the sexual and reproductive behaviour of adolescents in sub‐Saharan Africa, particularly 15‐ to 19‐year‐olds. Methods Using DHS/AIS data (2000–2010), nine indicators of adolescent behaviour and one of adult attitudes towards condom education for adolescents were described for 24 countries. Indicators were disaggregated by gender, urban/rural residency and educational status, and time trends were described. Results Up to 25% of 15‐ to 19‐year‐olds reported sex before age 15; this proportion shrank over time in many countries. In most countries, ≥5% of females reported marriage before age 15, and >20% had commenced childbearing. Early sexual debut and childbearing were more common among the least educated and/or rural females. Reporting of multiple sexual partnerships was more common among males than among females, but decreases over time were more common among males. Urban males and females, and females with higher education, were more likely to report multiple partnerships. Urban youth and those with higher education also reported more condom use. Adult support for condom education for 12‐ to 14‐year‐olds has increased over time to 60–65%. Conclusions Many 15‐ to 19‐year‐olds are at risk of HIV/STIs and unplanned pregnancies because of multiple partnerships and insufficient condom and other contraceptive use. In many countries, trends are moving in a favourable direction. To better inform prevention programmes in this important area, we recommend routine collection of sexual and reproductive behaviour data for adolescents aged <15 years, expanding the data collected for 15‐ to 19‐year‐olds to include detailed information on sexual behaviour within partnerships, and disaggregating data according to sociodemographic variables.     

Prevalence and secular changes in abdominal obesity in Canadian adolescents and adults, 1981 to 2007–2009

The purposes of this study were to: (i) provide contemporary estimates of the prevalence of abdominal obesity, as assessed by waist circumference (WC), in Canadian adolescents and adults; (ii) provide estimates of the prevalence of abdominal obesity within normal weight, overweight and obese body mass index categories and (iii) examine secular changes in abdominal obesity. Data were based on three national health surveys conducted in 1981, 1988 and 2007–2009. WC was measured at the mid‐point between the last rib and iliac crest in all three surveys. The prevalence of Canadians with abdominal obesity increased with age and was higher in females than in males. In 12‐ to 19‐year‐old adolescents, the estimated prevalence of abdominal obesity was 1.8% in 1981, 2.4% in 1988 and 12.8% in 2007–2009. The corresponding values for 20‐ to 69‐year‐old adults were 11.4%, 14.2% and 35.6%. Between 1981 and 2007–2009, mean WC values increased by 4.2 cm in adolescent males, 6.7 cm in adolescent females, 6.5 cm in men and 10.6 cm in women. Within the 2007–2009 survey, 2.6% of normal weight adults had abdominal obesity, 35.3% of overweight adults had abdominal obesity and 93.0% of obese adults had abdominal obesity.     

Prevalence of HIV and Chlamydia trachomatis infection in 15--19-year olds in rural Tanzania

OBJECTIVE: To estimate the prevalence of HIV and Chlamydia trachomatis (CT) infections amongst adolescents in rural Mwanza Region, Tanzania and their association with demographic variables. DESIGN: Population-based cross-sectional survey. METHODS: All 15--19-year olds living in households selected by random cluster sampling were invited to participate. After interview, urine was tested for HIV and CT. RESULTS: 9445 15--19-year olds were enrolled. HIV prevalence was 0.6% (95% CI: 0.4--0.8%) in males and 2.4% (95% CI: 2.0--2.8%) in females, and increased steeply with age (trend: P < 0.006 and P < 0.001, respectively). After adjustment for age, risk of HIV infection was significantly associated with female sex (OR=4.3), never having been to primary school in males (OR=2.7), and current symptoms of genital discharge (OR=2.3) or genital ulcer (OR=5.3) in females. The prevalence of CT was 1.0% (95% CI: 0.8--1.4%) in males and 2.4% (95% CI: 2.0-2.9%) in females. After adjustment for age, CT infection was associated with female sex (OR=2.4), reported current symptoms of STD (males OR=2.5, females OR=1.9) and positive leucocyte esterase (LE) test (males OR=3.1, females OR=2.6). Eighty-two percent of males and 79% of females with CT were asymptomatic. There was no association between CT and HIV infection in either sex. CONCLUSIONS: There is a high prevalence of HIV and CT amongst adolescents, especially young women, in this rural population, highlighting the need for effective interventions to improve adolescent reproductive health. The high rates of asymptomatic infection imply that innovative strategies are needed to reach and treat young people with STD.     

Incidence of Type 1 (insulin-dependent) diabetes mellitus in Catalonia, Spain

Summary The incidence of Type 1 (insulin-dependent) diabetes mellitus was prospectively evaluated in Catalonia, Spain in patients up to 30 years of age during the period 1987–1990. The population at risk (0–29 years) consisted of 2,690,394 inhabitants (total population of Catalonia 5,978,638). All the cases were independently identified from four sources: endocrinologists, sales of blood glucose monitors and insulin pen injectors, diabetes societies and diabetic summer camps. The degree of ascertainment was 90.1 %. The overall observed incidence rate was 10.7 per 100,000 per year, being 11.5 per 100,000 per year in the 0–14 age group. The incidence in males (12.0 per 100,000 per year) was higher than in females (9.3 per 100,000 per year), with a male/female ratio of 1.36/l. The sex differences were only present in cases over 14 years of age. Age specific incidence rates per 100,000 per year were 4.4 (confidence interval 95%: 3.2–5.7) in the age group 0–4, 9.9 (8.5–11.4) in 5–9, 17.5 (15.7–19.4) in 10–14, 11.4 (9.9–13.0) in 15–19, 11.3 (9.7–13.0) in 20–24 and 8.5 (7.2–9.9) in 25–29. There was a seasonal onset pattern, with the highest incidence in winter (December–February). We conclude that the incidence of Type 1 diabetes observed in Catalonia during the period 1987–1990 is higher than that recently reported in other Mediterranean countries. This study offers the first standardized data on Type 1 diabetes incidence in Catalonia, including cases up to 30 years, and contributes to the knowledge of the epidemiology of diabetes in South Europe.     

Tuberculosis burden in India and its control from 1990 to 2019: Evidence from global burden of disease study 2019

BackgroundTuberculosis is still a major public health problem in India. This study aims to assess trends in the burden of tuberculosis from 1990 to 2019 for tracking success of tuberculosis control programme in India.MethodsIn this study, the 2019 global burden of disease study data were used to measure the incidence, prevalence, mortality, and disability-adjusted life years lost (DALY)rates of Tuberculosis during 1990–2019 for India and its states. Age and gender-specific rates were also analyzed for India. All rates were age-standardized and 95% uncertainty intervals (UIs) were computed.ResultOverall incidence, prevalence, death and DALY of TB decreased in India from 1990 to 2019. Tuberculosis morbidity and mortality was higher in males as compared to females. Incidence of TB was low in children up to 14 years of age. Prevalence of TB was higher in females as compared to males till 29 years of age, whereas higher prevalence was reported in males as compared to females in adults aged 30 years and more. Death rate of TB was low in children and young adults up to 29 years of age.ConclusionThis study shows that overall incidence, prevalence, death and DALY of tuberculosis decreased from 1990 to 2019 in India. The burden of TB was higher among males as compared to females during study period. TB affects all the age groups but deaths were higher in older age groups.     

Childhood-onset Diabetes in the White and South Asian Population in Leicestershire,UK

The prevalence of childhood-onset Type 1 diabetes mellitus is important for determining health care provisions. In Leicestershire 13.5% of the childhood population (0–14 years) is of South Asian origin (census 1991). This study determined the prevalence of Type 1 diabetes in Whites and South Asians in Leicestershire, using a capture/recapture method to coincide with the 1991 Census day. Children (0–14 years) with Type 1 diabetes were captured from the central diabetic register. The health visitor and consultant records were used to recapture the cases. Total ascertainment of cases was 95–100%. The prevalence of Type 1 diabetes in White children (107 cases) was 0.75/1000 children (95% CI 0.61–0.89) compared with the South Asian prevalence (18 cases) of 0.77/1000 (95% CI 0.41–1.13). The overall prevalence in White males was 0.82/1000 (0.61–1.03) compared with 0.68/1000 (0.48–0.87) in females. In South Asian males it was 0.59/1000 (0.15–1.03) compared with 0.96/1000 (0.39–1.53) in females. The prevalence of Type 1 diabetes in children of South Asian migrants to the United Kingdom cannot be said to be different from White children.     

Incidence of new diabetic patients on dialysis in Piedmont,Italy: Major changes recorded over a 10-year period

Different incidence rates of new diabetic patients on dialysis are reported in various settings; although prevalence of this disease is often considered a marker of acceptance policy, rates are thought to be influenced also by genetic, epidemiological and other characteristics of a population (genetic composition, age distribution, lifestyle). Moreover, since features of a general population are often not stable (as in the setting analysed) changes at this level may have important reflections in the incidence of diabetics with end-stage renal disease (ESRD). In the region studied (Piedmont, northern Italy, about 4400 000 inhabitants, 20 dialysis centres, open acceptance since the mid-1970s, yearly information on 100% of patients, gathered by a Dialysis and Transplantation Registry) the incidence of diabetic patients with ESRD (389 cases recorded 1981–1990: 222 males, 167 females: mean age at start increasing from 55.5 years in 1981–1985 to 58.7 years in 1986–1990) differs according to age and sex. Incidence was higher in males, and rose from 6.23/year patients per million population (p.m.p.) in 1981–1982 to 12.88/year p.m.p. in 1989–1990, with a peak at age 60–69 (from 18.46/year p.m.p. in 1981–1982, to 46.12/year p.m.p. in 1989–1990). While relatively stable in the younger age groups from 1981 to 1990, incidence increased in the elderly (males age 70–79: 7.12/year p.m.p. in 1981–1982, 26.08/year p.m.p. in 1989–1990). As regards clinical and metabolic patterns, at the first update, in 1986–1990, 88.3% of diabetic patients were hypertensive or taking hypotensive drugs; albumin levels were below the normal range (<3.5 g/dl) in 30.3%; cholesterol levels were below the normal range (<150 mg/dl) in 16.15%. As regards entry criteria, creatinine clearances ranged from <1 to 14 ml/min (mean values at first update: 3.45±2.76 ml/min). In conclusion, presentation of diabetic patients with ESRD is changing. The stability of incidence in the younger age groups confirms the appropriateness of an open acceptance policy, at least for these ages. The increase in the elderly probably reflects the longer lifespan of diabetic patients in the overall population, while the influence of a hidden preselection must be further assessed. Since this cohort increasingly requires in-hospital high-tolerance treatment, future provision of dialysis needs must take into account the trend towards an increase in this high-risk elderly population.     

The prevalence of insulin autoantibodies at the onset of Type 1 diabetes is higher in males than females during adolescence

Aims/hypothesis The incidence of Type 1 diabetes shows little sex bias up to age 15 years, but more males are diagnosed in early adult life. Humoral responses to the beta cell antigen insulin could help to reveal the mechanism underlying this difference. We therefore determined the influence of sex on the prevalence of insulin autoantibodies (IAA) at diagnosis.Methods IAA were measured by radiobinding assay in 598 patients with newly diagnosed Type 1 diabetes (aged 10.5, range 0.8–20.7 years, 333 male), and analysed according to age, sex and HLA class II genotype.Results Overall, 74% of males and 65% of females had IAA above the 97.5^th centile of 2860 schoolchildren (p=0.028). IAA prevalence was similar in males and females under the age of 15 (0–4 yr, 95% vs 88%; 5–9 yr, 76% vs 73%; 10–14 yr, 67% vs 58%), but male excess was seen between 15 and 21 years (66% vs. 32%, p_corr=0.016). HLA class II genotype was available for 426 patients. IAA prevalence in DR4 homozygous patients was 87%, in DR4 heterozygous patients 72% and in DR4 negative patients 55% (p<0.001). Multivariate analysis showed independent association of IAA with age (p<0.001), number of DR4 alleles (p<0.001) and male sex (p=0.002).Conclusions/interpretation The prevalence of IAA in patients with newly diagnosed Type 1 diabetes is higher in males than females between 15 and 21 years of age. The lower prevalence of IAA in adolescent females implies sex-specific modulation of the autoimmune process during puberty.Abbreviations IAA Insulin autoantibodies - IA-2 protein tyrosine phosphatase IA-2 - ICA islet cell antibodies     

Changes in Indices of Airway Hyperresponsiveness During One Year of Treatment with Inhaled Corticosteroids in Patients with Asthma

Background. Mortality from asthma increased during the last decades but is now declining in some countries. Little is known about this trend in Brazil. Objective. The objective of the study was to determine the trends in asthma mortality in Southern Brazil. Methods. We reviewed death certificates of 566 people in the state of Rio Grande do Sul, Brazil, between 5 and 39 years of age in whom asthma was reported to be the underlying cause of death during the period of 1981-2003. Population data were available in 5-year age groups. Mortality rates were submitted to linear and quadratic regression procedures. Results. Among children and teenagers (5–19 years), there were 170 asthma deaths, ranging from 4 to 13 deaths each year with rates of 0.154/100,000 to 0.481/100,000. In young adults (20–39 years), 396 asthma deaths occurred, ranging from 9 to 32 each year, with rates from 0.276/100,000 to 1.034/100,000. There was an initial increase in rates, with later stabilization, and then the start of a decline beginning in the late 1990s and the early part of this decade. This trend occurred in both age subgroups examined but was more evident in males. Conclusions. Asthma mortality in southern Brazil remains low and appears to be decreasing after reaching a peak in the mid-1990s. The reason for these trends remains unknown.     

Increasing prevalence of Type II diabetes in American Indian children

Summary Until recently, Type II diabetes was considered rare in children. The disease is, however, increasing among children in populations with high rates of Type II diabetes in adults. The prevalence of Type II diabetes was determined in 5274 Pima Indian children between 1967 and 1996 in three 10-year time periods, for age groups 5–9, 10–14 and 15–19 years. Diabetes was diagnosed using World Health Organisation criteria, based on an oral glucose tolerance test. The prevalence of diabetes increased over time in children aged 10 years and over: in boys from 0 % in 1967–1976 to 1.4 % in 1987–1996 in the 10–14 year old age group, and from 2.43 % to 3.78 % for age group 15–19 and in girls from 0.72 % in 1967–1976 to 2.88 % in 1987–1996 in the 10–14 year old age group, and from 2.73 % to 5.31 % for age group 15–19 years. Along with the increase in the prevalence of Type II diabetes (p < 0.0001), there was an increase in weight (calculated as percentage of relative weight, p < 0.0001), and in frequency of exposure to diabetes in utero (p < 0.0001). The increasing weight and increasing frequency of exposure to diabetes in utero accounted for most of the increase in diabetes prevalence in Pima Indian children over the past 30 years. Type II diabetes is now a common disease in American Indian children aged 10 or more years and has increased dramatically over time, along with increasing weight. A vicious cycle related to an increase in the frequency of exposure to diabetes in utero appears to be an important feature of this epidemic. [Diabetologia (1998) 41: 904–910] Received: 30 January 1998 and in revised form: 18 April 1998     

Teenage pregnancies in Mozambique: the experience of “Servicios Amigos dos Adolescentes” clinics in Beira

The purpose of this article is to provide insights into the demand for pregnancy-related health services by adolescent girls and young women in Mozambique. We analysed the patient registers for the first year of operation (2014) of the Servicios Amigos dos Adolescentes (SAAJ) [Friendly Services for Adolescents] clinics in Beira, Mozambique. These registers provide details of the service demands of, and services provided to the 8 290 adolescent girls and young women who accessed the 6 SAAJ clinics in 2014. Analysis of that record, with disaggregation of the patients according to age (9 years or less; 10–14; 15–19; 20–24; 25 and older), show that 3 021 (36%) were pregnant or had previously been pregnant; most being girls in the 15–19 age band (59%). Being pregnant or having been pregnant previously was associated with dropping out of school. Of all the girls and women, 60% agreed to HIV testing and counselling; the HIV prevalence rate amongst this group was 4–5% amongst adolescents and 25% amongst women 25 years and older. A minority of the girls and women who were pregnant or had been pregnant previously agreed to HIV testing and counselling. Notwithstanding the limitations for analysis, the results were alarming: substantially high HIV prevalence rates were indicated (2% amongst 10–14 year old girls; 8% amongst 15–19 year olds; 10% amongst 20–24 year olds; and 28% amongst >24 year olds). The data from the SAAJ clinics and results pertain only to conditions in Beira. However, as the first empirical assessment of pregnancy-related service demand amongst adolescent girls and young women in the country and involving a relatively large sample, we contend that this study affirms the need for expansion of sexual and reproductive health (SRH) services, including HIV services, for adolescent girls and young women in Mozambique.     

An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya.

A prevalence study of abdominal cystic echinococcosis (CE) was undertaken in the northwest, north-central, and northeast regions of Libya. A total of 36 villages along the coast were included, in which 20,220 people were screened by portable ultrasound. Three hundred thirty-nine (1.7%) were diagnosed with CE. There was no significant difference between CE prevalence rates in the three regions of Libya (mean = 1.6%); however, intervillage rates were variable, ranging from 0% to 4.5%. The prevalence of CE increased significantly with age (P < 0.0001) and females were significantly more affected (2%) than males (1.3%) (P < 0.0001). Cases of CE were distributed among 3.2% of housewives, 2.6% of farmers, 2.3% of male civil servants, 1.3% of female students, and 1.1% of male students. Housewives (P < 0.0001) and students (P < 0.0001) were significantly more at risk for CE. A statistically significant proportion (62% [210 of 339]) of CE cases kept dogs (P < 0.0001). Of the ultrasound-positive CE cases 69% (233 of 339) were antibody seropositive by ELISA using Echinococcus granulosus hydatid cyst fluid antigen B. Blood samples (n = 10,096) collected onto filter papers were taken randomly from ultrasound-negative people who entered the study, of which 11.2% were found to be seropositive. Seropositivity increased with age (P < 0.0001), with females exhibiting higher seroprevalence than males for all age groups (P < 0.0001). Seroprevalence was distributed occupationally among 17.3% of female students, 11.2% of male students, 8.3% of housewives, 7.3% of farmers, and 6.4% of male civil servants. Housewives and students were more likely to be seropositive (P < 0.0001). Forty-seven percent (526) of the seroreactors kept dogs. All liver hydatid cysts detected by ultrasound during community screening were classified according to morphology and size into six types. Type I (17.5% of all cases) were small univesicular cysts less than 50 mm in diameter with no laminations or daughter cysts. Type II (34%) were univesicular cysts with only laminations. Type IIIa (8.5%) were univesicular cysts with the appearance of laminations and daughter cysts. Type IIIb (13%) were univesicular with laminations and less prominent daughter cysts. Type IV (5.6%) presented as a solid mass. Type V were degenerated calcified or partially calcified cysts (13.2%). Type VI presented as multiple cysts (8% of all cases). The CE cases that exhibited Types II, IIIa, IIIb, IV or VI cysts showed the highest seropositivity (86%, 96%, 95%, 100%, and 96%, respectively), while Types I and V were the least seroreactive (38% and 22%, respectively). Cases of CE occurred in 311 families, with 93% having only one member as a CE case while 7% of the families had two or more cases. However, 25% of the ultrasound-negative persons belonging to families with an index CE case were seropositive for antibodies to Echinococcus. These results confirm the importance of human CE in Libya. They also confirm the usefulness of ultrasound combined with serology as a mass screening approach for CE in north African communities.     

Frequency and Symptoms of Hypoglycaemia Experienced by Patients with Type 2 Diabetes Treated with Insulin

This study ascertained the prevalence of severe hypoglycaemia and loss of awareness of hypoglycaemia in patients with Type 2 diabetes treated with insulin. One hundred and four sequentially selected Type 2 diabetic patients were compared with 104 patients with Type 1 diabetes who were matched for duration of insulin therapy. The patients were interviewed using a standardized questionnaire. During treatment with insulin, 18 Type 2 patients had experienced fewer than two episodes of hypoglycaemia, while 86 had experienced two or more episodes; 80 (93%) reported normal awareness, six (7%) reported partial awareness, and none had absent awareness of hypoglycaemia. All 86 Type 1 diabetic patients matched to the 86 Type 2 patients had experienced multiple episodes of hypoglycaemia; 71 (83%) had normal awareness, 14 (16%) had partial awareness and one patient (1%) reported absent awareness of hypoglycaemia. The Type 1 patients who had altered awareness of hypoglycaemia had longer duration of diabetes and insulin therapy (normal awareness: 5 (1–17) years (median (range)) vs partial awareness: 9 (3–18) years, p < 0.01). Similarly, Type 2 patients with altered awareness had longer duration of diabetes (normal awareness: 11 (2–25) years vs partial awareness: 19 (8–24) years, p < 0.02) and had received insulin for longer (normal awareness: 3 (1–18) years vs partial awareness: 12 (6–17) years, p < 0.001). Severe hypoglycaemia in the preceding year had occurred with a similar prevalence in the Type 2 patients (9 (10%)) and Type 1 patients (14 (16%)), but was more frequent in those patients with partial awareness both in Type 1 patients (normal awareness: 3 (4%) vs partial awareness: 11 (73%), p < 0.001) and in Type 2 patients (normal awareness: 3 (4%) vs partial awareness: 6 (100%), p < 0.001). Although the symptoms of hypoglycaemia were idiosyncratic in individual Type 2 patients, the range and prevalence of specific symptoms were similar to those described by the patients with Type 1 diabetes.     

The epidemiology of cannabis use and cannabis‐related harm in Australia 1993–2007

Aims To examine trends in patterns of cannabis use and related harm in the Australian population between 1993 and 2007. Design Analysis of prospectively collected data from: (1) the National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS); (2) the National Hospital Morbidity Database (NHMD); and (3) the Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS‐NMDS). Participants Australians aged 14 years and over from the general population; students aged 12–17 years; public and private hospital in‐patients; public and private in‐patients and out‐patients attending for drug treatment. Measurement Prevalence of 12‐month cannabis use among the general population and secondary students. Proportions in the general population by age group reporting: daily cannabis use; difficulties in controlling cannabis use; and heavy cannabis use on each occasion. Number of hospital and treatment presentations for cannabis‐related problems. Findings Prevalence of past‐year cannabis use has declined in the Australian population since the late 1990s. Among those reporting past‐year use, daily use is prevalent among 40–49‐year‐olds, while heavy patterns of use are prevalent among 14–19‐year‐olds. Hospital presentations for cannabis‐related problems reflect similar trends. Past‐year cannabis use has decreased among the 10–19‐year age group, but those who are daily users in this age group report using large quantities of cannabis. Conclusions Despite declines in the prevalence of cannabis use, continued public health campaigns warning of the harms associated with cannabis use are essential, aimed particularly at users who are already experiencing problems. The increasing demand for treatment for cannabis problems in Australia suggests the need for more accessible and more effective interventions for cannabis use disorders.     

Increasing prevalence and incidence of thyroid disease in Tayside, Scotland: the Thyroid Epidemiology Audit and Research Study (TEARS)

Objective We aimed to describe the changing incidence of thyroid disease in a population‐based study in Tayside, Scotland (population 390 000) between 1994 and 2001. Design A retrospective, data‐linkage, population‐based study measuring the incidence and prevalence of thyroid disease. Patients All patients with newly diagnosed, treated and stable thyroid disease in Tayside were identified by electronic linkage of six datasets, including all regional biochemistry data, hospital admissions, deaths and a thyroid follow‐up register. Results The overall prevalence of thyroid dysfunction has increased from 2·3% to 3·8% (1994–2001). The prevalence of ever having had hyperthyroidism increased from 0·86% to 1·26% in females and 0·17% to 0·24% in males (P < 0·0001 for both). The standardized incidence of hyperthyroidism increased from 0·68 to 0·87 per 1000 females/year, representing a 6·3% annual increase (P < 0·0001). The prevalence of primary hypothyroidism increased from 3·12% to 5·14% in females and 0·51% to 0·88% in males (P < 0·0001 for both). The standardized incidence of primary hypothyroidism did not change and varied between 3·90 and 4·89 per 1000 females/year over the 8 years. Incidence of hypothyroidism in males increased from 0·65 to 1·01 per 1000 males/year (P = 0·0017). Mean age at diagnosis of primary hypothyroidism declined in females from 1994 to 2001. Conclusions The prevalence of primary hypothyroidism and previous hyperthyroidism has increased in Tayside, Scotland. This is partly due to an increasing incidence of disease, increased ascertainment and earlier diagnosis of disease. This will result in an increased workload for endocrinologists and general practitioners.     

Diurnal Variation of Blood Pressure in Adolescents with Type 1 Diabetes: Dippers and Non-dippers

The study aimed to determine the prevalence of impaired nocturnal BP fall in adolescents with Type 1 diabetes. Thirty-six normoalbuminuric normotensive adolescents with Type 1 diabetes (19 males, 17 females) aged 14.4 ± 2.1 years (mean ± SD) with duration of 4.0 (2.6–7.5) years (median (25–75th percentile)) and 23 controls (11 males, 12 females) aged 15.0 ± 1.6 years were studied. Day/night BP variation was examined using Ambulatory Accutracker II Monitor (Raleigh, NC). Recordings were made at 30 min intervals during the day and 60 min intervals during the night. Time records were set according to individual diaries. There was no significant difference in day and night systolic or diastolic BP or in mean day/night BP variability between patients with Type 1 diabetes and control subjects. 15/36 patients compared to 3/23 controls (chi squared = 5.43, p < 0.02) were non-dippers defined as a nocturnal fall in either systolic (13/36) or diastolic (6/36) BP or both (4/36) of less than 10 %. These non-dippers had normal day–night ratio of heart rate when compared with the remainder of the patients or controls. In conclusion a significant number of young normotensive normoalbuminuric patients with Type 1 diabetes show an impaired fall in blood pressure at night, predominantly in systolic BP. These changes may be relevant to the long-term development of macrovascular or microvascular disease.     

Type 1 (insulin-dependent) diabetes in Tasmania: prevalence and apparent regional differences

Summary The results of a cross-sectional study of Type 1 (insulin-dependent) diabetes in the total population of Tasmania are described. Tasmanians, predominantly of British origin, live in a temperate island situated to the south-east of mainland Australia. For males and females respectively, prevalence in 1984 was 1.1±0.1 and 0.9±0.1 per 1,000 at all ages, 0.6±0.2 and 0.5±0.2 per 1,000 in subjects aged 0–14 years, rising to 1.2±0.2 and 1.1±0.2 per 1,000 in those aged 0–29 years. Prevalence in the 0–19 year age range was 0.8±0.2 per 1,000 in both sexes. Prevalence fell in both sexes from the third decade of life. A statistically significant excess in prevalence was found in the urban, as compared with the rural, sector of the community. The urban relative risk was greatest in subjects aged 10–19 years. According to reported month of onset (commencement of insulin treatment) there was a suggestion of seasonal trend in the rural, but not in the urban subjects. Longitudinal studies of Type 1 diabetes in Tasmania are now required if these findings are to be confirmed, and their possible aetiological implications explored.     

Incidence and prevalence of Type 1 (insulin-dependent) diabetes in Estonia in 1988

Summary The objective of this study was to determine the incidence and prevalence of Type 1 (insulin-dependent) diabetes in Estonia in different sex and age groups. The data collection was based on a centralized retrospective registration of all cases of Type 1 diabetes nationwide using the records of all hospitals and polyclinics where diabetic patients are treated. In 1988, 35 new cases of Type 1 diabetes were diagnosed among children aged 0–14 years (10.3 per 100,000) and 131 among the population over 15 years. The highest incidence of Type 1 diabetes (39.9 per 100,000) was found in the age group 15–19 years. The total number of patients with Type 1 diabetes in Estonia was 2,719 in 1988. The overall prevalence was 1.72 per 1,000. It was highest in the age group 40–49 years (3.04 in males and 2.77 in females). In children under 15 years 204 cases of Type 1 diabetes were identified at the end of 1988. These data suggest that the risk of Type 1 diabetes in Estonia is not low, but is certainly not as high as in Finland where the population is ethnically and linguistically similar and where the highest incidence of Type 1 diabetes is found.     

From Coitus to Concurrency: Sexual Partnership Characteristics and Risk Behaviors of 15–19 Year Old Men Recruited from Urban Venues in Tanzania

Understanding the uptake and patterns of sexual partnerships of adolescent males reveals their risky behaviors that could persist into adulthood. Using venue-based sampling, we surveyed 671 male youth ages 15–19 from an urban Tanzanian neighborhood about their sexual partnerships during the past 6 months. The proportion of males who had ever had sex increased with age (21 % at age 15; 70 % at age 17; 94 % at age 19), as did the proportion who engaged in concurrency (5 % at age 15; 28 % at age 17; 44 % at age 19). Attendance at ≥2 social venues per day and meeting a sexual partner at a venue was associated with concurrency. Concurrency was associated with alcohol consumption before sex among 18–19 year olds and with not being in school among 15–17 year olds. We find that concurrency becomes normative over male adolescence. Venue-based sampling may reach youth vulnerable to developing risky sexual partnership patterns.