Comparing the Effectiveness of Face-to-Face and Non-Face-to-Face Training on Oral and Dental Health Behaviors in Patients with Type 2 Diabetes: A Randomized Clinical Trial

Objective: Diabetes is closely related to oral and dental health. Several oral diseases and disorders are associated with diabetes. The present study was conducted to compare the effectiveness of face-to-face and non-face-to-face training of oral and dental health behaviors based on the Health Belief Model (HBM) in patients with type 2 diabetes. Materials and methods: This study was conducted among patients with type 2 diabetes referring to comprehensive health centers in Andimeshk in 2021. One hundred twenty patients with type 2 diabetes were randomly divided into two groups: a face-to-face (60 patients) training group and a non-face-to-face (60 patients) training group. For the face-to-face training group, training programs were conducted through lectures with questions and answers, group discussions, and videos in three 60-minute sessions; and for the other group through the presentation of patient education pamphlets. The results were collected in two stages before and two months after the intervention using a questionnaire. Then the data were analyzedusing a chi-squared test, t-test, and paired t-tests in SPSS Statistics 22.0. Results: A total of 120 patients participated in this study. The patients’ mean age was 51.5 ± 8.57 and 51.9 ± 10.1 years in the control and the intervention group, respectively. In both groups, 60% of the participants were female and 95% were married. The duration of diabetes in 57.5% of them was 5–10 years. After the implementation of the intervention, a significant increase was observed in the mean scores of all HBM constructs in the face-to-face training group (p < 0.001). However, there was no significant change in the mean scores of the HBM constructs in the non-face-to-face training group after the intervention (p > 0.05). Conclusions: This study showed that the design and implementation of an in-person training program had a positive effect on improving oral and dental health behaviors in patients with diabetes based on the HBM

The epidemiology of gastrointestinal cancers (Stomach, esophageal, colorectal) In Markazi province during 2005-2010

Introduction and Aims: Cancer is the third leading cause of death after Coronary Artery Disease and accidents in Iran. This Research has been carried out to Study the epidemiology of gastrointestinal cancers (Stomach, esophageal, colorectal) in Markazi province during 2005-2010.Methods: This is an analytical cross-sectional study that was carried out on cancer registry data collected from Markazi province between 2005-2010 years. Cancer incidence adjusted based on the age structure and agespecific incidence rates were calculated.Results: Most statistics on the Morbidity of gastric cancers in the study was 642 patients (51.2) that associated with gastric cancer and after which the CRC 444(35.4%) patients and esophageal numbers of 169 (13.5%) patients. in this study 61.8 % (801 patients) of cases in the age group 80-70 years, male, 387 cases (30.8%) and the highest 77.1% living in urban areas has been observed in terms of location. mean age at estimated time of diagnosis was 69 years. Rates age standardized incidence of digestive cancers in males and female was 141.04 and 73.39 respectively.Conclusion: Identification of risk factors and prevention of gastrointestinal cancers in Markazi province is required. Training programs related to the prevention of cancer in people at high risk should be presented.*Corresponding author: Assistant Professor, Department of Public Health, School of Public Health, University of Medical Sciences, Arak, Iran.Email: [email protected]

A comparison of serum and EDTA plasma in the measurement of glutamic acid decarboxylase autoantibodies (GADA) and autoantibodies to islet antigen-2 (IA-2A) using the RSR radioimmunoassay (RIA) and enzyme linked immunosorbent assay (ELISA) kits.

BACKGROUND: Glutamic acid decarboxylase antibodies (GADA) and tyrosine phosphatase antibodies (islet antigen-2 antibodies; IA-2A) are used in clinical practise to identify type 1 diabetes. METHODS: GADA and IA-2A were measured with RSR-ELISA kits in samples from 76 newly diagnosed type 1 diabetic children and 120 healthy controls. The aim was to evaluate performance of RSR-ELISA kits for GADA and IA-2A when serum and Ca2+ treated plasma were used. RESULTS: GADA achieved high area under the curve (AUC) both for serum 0.95 (95% CI 0.90-0.99) and for Ca2+ treated plasma 0.95 (95% CI 0.91-0.99). At specificity 98%, sensitivity was 84% for serum and 87% for Ca2+ treated plasma. IA-2A achieved AUC 0.92 (95% CI 0.87-0.97) for serum and 0.94 (95% CI 0.90-0.98) for Ca2+ treated plasma. Using the lowest standard (15 WHO-Units/ml) as cut-off, specificity for serum was 100% and for Ca2+ treated plasma 99% with sensitivity 74% in both cases. Sensitivity was higher in ELISA compared to RIA (74%; p = 0.0080) for GADA measurement and similar for ELISA and RIA IA-2A measurements (76%; p = 0.50). CONCLUSION: Both RSR-ELISAs, GADA and IA-2A showed excellent performance for serum as well as for Ca2+ treated plasma

The Environmental Determinants of Diabetes in the Young (TEDDY) Study

The etiology of type 1 diabetes (T1D) remains unknown, but a growing body of evidence points to infectious agents and/or components of early childhood diet. The National Institutes of Health has established the TEDDY Study consortium of six clinical centers in the United States and Europe and a data coordinating center to identify environmental factors predisposing to, or protective against, islet autoimmunity and T1D. From 2004-2009, TEDDY will screen more than 360,000 newborns from both the general population and families already affected by T1D to identify an estimated 17,804 children with high-risk HLA-DR,DQ genotypes. Of those, 7,801 (788 first-degree relatives and 7,013 newborns with no family history of T1D) will be enrolled in prospective follow-up beginning before the age of 4.5 months. As of May 2008, TEDDY has screened more than 250,000 newborns and enrolled nearly 5,000 infants--approximately 70% of the final cohort. Participants are seen every 3 months up to 4 years of age, with subsequent visits every 6 months until the subject is 15 years of age. Blood samples are collected at each visit for detection of candidate infectious agents and nutritional biomarkers; monthly stool samples are collected for infectious agents. These samples are saved in a central repository. Primary endpoints include (1) appearance of one or more islet autoantibodies (to insulin, GAD65 or IA-2) confirmed at two consecutive visits; (2) development of T1D. By age 15, an estimated 800 children will develop islet autoimmunity and 400 will progress to T1D; 67 and 27 children have already reached these endpoints

Metabolite-related dietary patterns and the development of islet autoimmunity

The role of diet in type 1 diabetes development is poorly understood. Metabolites, which reflect dietary response, may help elucidate this role. We explored metabolomics and lipidomics differences between 352 cases of islet autoimmunity (IA) and controls in the TEDDY (The Environmental Determinants of Diabetes in the Young) study. We created dietary patterns reflecting pre-IA metabolite differences between groups and examined their association with IA. Secondary outcomes included IA cases positive for multiple autoantibodies (mAb+). The association of 853 plasma metabolites with outcomes was tested at seroconversion to IA, just prior to seroconversion, and during infancy. Key compounds in enriched metabolite sets were used to create dietary patterns reflecting metabolite composition, which were then tested for association with outcomes in the nested case-control subset and the full TEDDY cohort. Unsaturated phosphatidylcholines, sphingomyelins, phosphatidylethanolamines, glucosylceramides, and phospholipid ethers in infancy were inversely associated with mAb+ risk, while dicarboxylic acids were associated with an increased risk. An infancy dietary pattern representing higher levels of unsaturated phosphatidylcholines and phospholipid ethers, and lower sphingomyelins was protective for mAb+ in the nested case-control study only. Characterization of this high-risk infant metabolomics profile may help shape the future of early diagnosis or prevention efforts. © 2019, The Author(s)

Psychological manifestations of celiac disease autoimmunity in young children

BACKGROUND AND OBJECTIVES: Psychological symptoms can be associated with celiac disease; abstract however, this association has not been studied prospectively in a pediatric cohort. We examined mother report of psychological functioning in children persistently positive for tissue transglutaminase autoantibodies (tTGA), defined as celiac disease autoimmunity (CDA), compared with children without CDA in a screening population of genetically at-risk children. We also investigated differences in psychological symptoms based on mothers' awareness of their child's CDA status. METHODS: The Environmental Determinants of Diabetes in the Young study followed 8676 children to identify triggers of type 1 diabetes and celiac disease. Children were tested for tTGA beginning at 2 years of age. The Achenbach Child Behavior Checklist assessed child psychological functioning at 3.5 and 4.5 years of age. RESULTS: At 3.5 years, 66 mothers unaware their child had CDA reported more child anxiety and depression, aggressive behavior, and sleep problems than 3651 mothers of children without CDA (all Ps ≤ .03). Unaware-CDA mothers also reported more child anxiety and depression, withdrawn behavior, aggressive behavior, and sleep problems than 440 mothers aware of their child's CDA status (all Ps ≤.04). At 4.5 years, there were no differences. CONCLUSIONS: In 3.5-year-old children, CDA is associated with increased reports of child depression and anxiety, aggressive behavior, and sleep problems when mothers are unaware of their child's CDA status. Mothers' knowledge of their child's CDA status is associated with fewer reports of psychological symptoms, suggesting that awareness of the child's tTGA test results affects reporting of symptoms

Complement gene variants in relation to autoantibodies to beta cell specific antigens and type 1 diabetes in the TEDDY Study

A total of 15 SNPs within complement genes and present on the ImmunoChip were analyzed in The Environmental Determinants of Diabetes in the Young (TEDDY) study. A total of 5474 subjects were followed from three months of age until islet autoimmunity (IA: n = 413) and the subsequent onset of type 1 diabetes (n = 115) for a median of 73 months (IQR 54-91). Three SNPs within ITGAM were nominally associated (p < 0.05) with IA: rs1143678 [Hazard ratio; HR 0.80; 95% CI 0.66-0.98; p = 0.032], rs1143683 [HR 0.80; 95% CI 0.65-0.98; p = 0.030] and rs4597342 [HR 1.16; 95% CI 1.01-1.32; p = 0.041]. When type 1 diabetes was the outcome, in DR3/4 subjects, there was nominal significance for two SNPs: rs17615 in CD21 [HR 1.52; 95% CI 1.05-2.20; p = 0.025] and rs4844573 in C4BPA [HR 0.63; 95% CI 0.43-0.92; p = 0.017]. Among DR4/4 subjects, rs2230199 in C3 was significantly associated [HR 3.20; 95% CI 1.75-5.85; p = 0.0002, uncorrected] a significance that withstood Bonferroni correction since it was less than 0.000833 (0.05/60) in the HLA-specific analyses. SNPs within the complement genes may contribute to IA, the first step to type 1 diabetes, with at least one SNP in C3 significantly associated with clinically diagnosed type 1 diabetes

A Comparison of Rule-based Analysis with Regression Methods in Understanding the Risk Factors for Study Withdrawal in a Pediatric Study

Regression models are extensively used in many epidemiological studies to understand the linkage between specific outcomes of interest and their risk factors. However, regression models in general examine the average effects of the risk factors and ignore subgroups with different risk profiles. As a result, interventions are often geared towards the average member of the population, without consideration of the special health needs of different subgroups within the population. This paper demonstrates the value of using rule-based analysis methods that can identify subgroups with heterogeneous risk profiles in a population without imposing assumptions on the subgroups or method. The rules define the risk pattern of subsets of individuals by not only considering the interactions between the risk factors but also their ranges. We compared the rule-based analysis results with the results from a logistic regression model in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Both methods detected a similar suite of risk factors, but the rule-based analysis was superior at detecting multiple interactions between the risk factors that characterize the subgroups. A further investigation of the particular characteristics of each subgroup may detect the special health needs of the subgroup and lead to tailored interventions

Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity

Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection