Smoking, use of smokeless tobacco, HLA genotypes and incidence of latent autoimmune diabetes in adults

Aims/hypotheses Smoking and use of smokeless tobacco (snus) are associated with an increased risk of type 2 diabetes. We investigated whether smoking and snus use increase the risk of latent autoimmune diabetes in adults (LADA) and elucidated potential interaction with HLA high-risk genotypes. Methods Analyses were based on Swedish case-control data (collected 2010-2019) with incident cases of LADA (n=593) and type 2 diabetes (n=2038), and 3036 controls, and Norwegian prospective data (collected 1984-2019) with incident cases of LADA (n=245) and type 2 diabetes (n=3726) during 1,696,503 person-years of follow-up. Pooled RRs with 95% CIs were estimated for smoking, and ORs for snus use (case-control data only). The interaction was assessed by attributable proportion (AP) due to interaction. A two-sample Mendelian randomisation (MR) study on smoking and LADA/type 2 diabetes was conducted based on summary statistics from genome-wide association studies. Results Smoking (RRpooled 1.30 [95% CI 1.06, 1.59] for current vs never) and snus use (OR 1.97 [95% CI 1.20, 3.24] for >= 15 box-years vs never use) were associated with an increased risk of LADA. Corresponding estimates for type 2 diabetes were 1.38 (95% CI 1.28, 1.49) and 1.92 (95% CI 1.27, 2.90), respectively. There was interaction between smoking and HLA high-risk genotypes (AP 0.27 [95% CI 0.01, 0.53]) in relation to LADA. The positive association between smoking and LADA/type 2 diabetes was confirmed by the MR study. Conclusions/interpretation Our findings suggest that tobacco use increases the risk of LADA and that smoking acts synergistically with genetic susceptibility in the promotion of LADA.Peer reviewe

Cooperation in Weal and Woe : Place perception, sense of self and project participation among women in rural Tanzania

Background: Tanzania is a country which faces several development challenges. The villages in this essay are located in a rural part of central Tanzania. The area experiences severe environmental conditions in addition to poverty and other related problems. Therefore, there are attempts to improve the situation by forming groups on local level. The two projects studied aim to improve the environment and the members’ economy by planting and selling trees. The participants are women only, except the supervisors who are men in both projects. Purpose and Question at Issue: The purpose is to examine if the project which the women participate in is affected by their sense of place. This is perceived through the examination of problems and possibilities faced by the women in their daily lives as well as in the project, and how these are managed and dealt with. The aim is to see if there is a correspondence between how different situations are dealt with by the individual and if this too can be related to the sense of place. Method: The majority of the material was gathered through field studies but additional information was achieved through literature studies, earlier research, observations in field and informal conversations. Interviews were carried out with participating women in the studied projects. The method followed the guidelines of grounded theory and the interviews were designed with Dolbeare’s and Schuman’s three-interview series in mind. A minor quantitative study was also carried out by handing out a questionnaire to the women in the projects. Theory: The theoretical framework builds on Tuan’s development of the meaning of sense of place, which is made up of people’s feelings, experiences and relations to a certain place. Closely related to sense of place is Bourdieu’s structural theory of habitus, why this is also considered a part of the theoretical framework. Analysis: The material gathered through the field studies is analyzed in relation to the purpose and question at issue. Sense of place is defined by using various categories of the concept, which aim to encompass several aspects and therefore give a more nuanced picture of the meaning of place for the individual. The women were found to relate the place first and foremost to their family, social bonds and daily chores and to a lesser extent with the environment

Associations between sleep and depressive symptoms : A cross-sectional study on working adults in Stockholm, Sweden

Background: Mental health disorders can be considered a public health problem and affect approximately one in ten people worldwide. It has profound negative effects on both the individual, the workplace and society. In the Swedish adult working population, diagnoses of mental health disorders is the most common reason for sick leaves among both men and women under the age of 50. Of these, depression and stress reactions are the primary diagnoses. Aim: To examine the relationship between sleep behaviour and depressive symptoms in a sample of working adults. Method: A cross-sectional design with data gathered through the use of actimetry, questionnaires and sleep diaries was employed. Analyses of correlation between sleep variables and depressive symptoms, analysis of variance to detect differences between groups and regression analyses to measure the predictive value of variables have been performed. Results: Depressive symptoms are positively associated with self-rated sleep measures. Self-rated sleepiness showed some explanatory value in predicting depressive symptoms but when adjusting for self-rated stress, sleepiness was no longer significant. Conclusion: Self-rated sleepiness only predicts depressive symptoms to a certain extent. Other factors such as self-rated stress seems to be a stronger indicator of depressive symptoms.

Associations between sleep and depressive symptoms : A cross-sectional study on working adults in Stockholm, Sweden

Background: Mental health disorders can be considered a public health problem and affect approximately one in ten people worldwide. It has profound negative effects on both the individual, the workplace and society. In the Swedish adult working population, diagnoses of mental health disorders is the most common reason for sick leaves among both men and women under the age of 50. Of these, depression and stress reactions are the primary diagnoses. Aim: To examine the relationship between sleep behaviour and depressive symptoms in a sample of working adults. Method: A cross-sectional design with data gathered through the use of actimetry, questionnaires and sleep diaries was employed. Analyses of correlation between sleep variables and depressive symptoms, analysis of variance to detect differences between groups and regression analyses to measure the predictive value of variables have been performed. Results: Depressive symptoms are positively associated with self-rated sleep measures. Self-rated sleepiness showed some explanatory value in predicting depressive symptoms but when adjusting for self-rated stress, sleepiness was no longer significant. Conclusion: Self-rated sleepiness only predicts depressive symptoms to a certain extent. Other factors such as self-rated stress seems to be a stronger indicator of depressive symptoms.

Does a prior diagnosis of infectious disease confer an increased risk of latent autoimmune diabetes in adults?

AimsInfections are proposed risk factors for type 1 diabetes in children. We examined whether a diagnosis of infectious disease also confers an increased risk of latent autoimmune diabetes in adults (LADA).Materials and methodsWe used data from a population-based Swedish case-control study with incident cases of LADA (n = 597) and matched controls (n = 2386). The history of infectious disease was ascertained through national and regional patient registers. We estimated adjusted odds ratios (OR) with 95% confidence intervals for >= 1 respiratory (any/upper/lower), gastrointestinal, herpetic, other or any infectious disease episode, or separately, for 1 and >= 2 infectious disease episodes, within 0-1, 1-3, 3-5 and 5-10 years before LADA diagnosis/matching. Stratified analyses were performed on the basis of HLA risk genotypes and Glutamic acid decarboxylase antibodies (GADA) levels.ResultsIndividuals who developed LADA did not have a higher prevalence of infectious disease 1-10 years before diabetes diagnosis. For example, OR was estimated at 0.87 (0.66, 1.14) for any versus no respiratory infectious disease within 1-3 years. Similar results were seen for LADA with high-risk HLA genotypes (OR 0.95 [0.64, 1.42]) or high GADA levels (OR 1.10 [0.79, 1.55]), >= 2 episodes (OR 0.89 [0.56, 1.40]), and in infections treated using antibiotics (OR 1.03 [0.73, 1.45]). The only significant association was observed with lower respiratory disease the year preceding LADA diagnosis (OR 1.67 [1.06, 2.64]).ConclusionsOur findings do not support the idea that exposure to infections increases the risk of LADA. A higher prevalence of respiratory infection in the year before LADA diagnosis could reflect increased susceptibility to infections due to hyperglycemia.imagePeer reviewe

Incidence of lada and type 2 diabetes in relation to tobacco use and genetic susceptibility to type 2 diabetes and related traits : Findings from a swedish case-control study and the norwegian hunt study

OBJECTIVE Smoking and Swedish smokeless tobacco (snus) are associated with latent autoimmune diabetes in adults (LADA) and type 2 diabetes (T2D). Our aim was to investigate whether genetic susceptibility to T2D, insulin resistance (IR), and insulin secretion (IS) aggravate these associations. RESEARCH DESIGN AND METHODS We used data from two population-based Scandinavian studies with case subjects with LADA (n = 839) and T2D (n = 5,771), matched control subjects (n = 3,068), and 1,696,503 person-years at risk. Pooled, multivariate relative risks (RR) with 95% CI were estimated for smoking/genetic risk scores (T2D-GRS, IS-GRS, and IR-GRS), and ORs for snus or tobacco/GRS (case-control data). We estimated additive (proportion attributable to interaction [AP]) and multiplicative interaction between tobacco use and GRS. RESULTS The RR of LADA was elevated in high IR-GRS heavy smokers (‡15 pack-years; RR 2.01 [CI 1.30, 3.10]) and tobacco users (‡15 box/pack-years; RR 2.59 [CI 1.54, 4.35]) compared with low IR-GRS individuals without heavy use, with evidence of additive (AP 0.67 [CI 0.46, 0.89]; AP 0.52 [CI 0.21, 0.83]) and multiplicative (P = 0.003; P = 0.034) interaction. In heavy users, there was additive interaction between T2D-GRS and smoking, snus, and total tobacco use. The excess risk conferred by tobacco use did not differ across GRS categories in T2D. CONCLUSIONS Tobacco use may confer a higher risk of LADA in individuals with genetic susceptibility to T2D and insulin resistance, whereas genetic susceptibility does not seem to influence the increased T2D incidence associated with tobacco use