Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort

Background: Global incidence of type 1 diabetes (T1D) is rising and nearly half occurred in adults. However, it is unclear if certain early-life childhood T1D risk factors were also associated with adult-onset T1D. This study aimed to assess associations between birth order, delivery mode or daycare attendance and type 1 diabetes (T1D) risk in a population-based cohort and whether these were similar for childhood- and adult-onset T1D (cut-off age 15); (2) Methods: Data were obtained from the German National Cohort (NAKO Gesundheitsstudie) baseline assessment. Self-reported diabetes was classified as T1D if: diagnosis age ≤ 40 years and has been receiving insulin treatment since less than one year after diagnosis. Cox regression was applied for T1D risk analysis; (3) Results: Analyses included 101,411 participants (100 childhood- and 271 adult-onset T1D cases). Compared to “only-children”, HRs for second- or later-born individuals were 0.70 (95% CI = 0.50–0.96) and 0.65 (95% CI = 0.45–0.94), respectively, regardless of parental diabetes, migration background, birth year and perinatal factors. In further analyses, higher birth order reduced T1D risk in children and adults born in recent decades. Caesarean section and daycare attendance showed no clear associations with T1D risk; (4) Conclusions: Birth order should be considered in both children and adults’ T1D risk assessment for early detection

Hepatitis B and C Screening Practices among At Risk Population Groups in6 European Countries: A Survey of Experts in Hungary, Germany, Italy,Spain, The Netherlands, and The United Kingdom

Background: The national low prevalence of hepatitis B and C reported in a number of European countries is not entirely accurate. Higher rates are found among individuals in the population identified as at-risk groups. Early discovery through screening in these groups is essential in alleviating the potential burden due to complications of chronic hepatitis B and C. Not much is known on current practices of hepatitis B and C screening in Europe, despite existing international or national policies and guidelines on viral hepatitis management in most countries. This study is designed to fulfill that information gap and provide an overview of such practices in Europe. Method: The countries included in the study were Germany, Hungary, Italy, Spain, the Netherlands, and the UK. Questionnaires on hepatitis B and C screening recommendations to specified at-risk groups were developed and translated into five other main languages. Questions were tailored to different fields of expertise as follows: general viral hepatitis care, general practitioners, sexual health services providers, antenatal care providers, and asylum seekers’ care providers. The questionnaires were made available on an online platform (LIME survey). Potential respondents were selected based on their involvement in viral hepatitis care. Direct personalized links were disseminated per email, and answers were descriptively analyzed with SPSS 19. Results: The survey yielded 286 completed questionnaires. The response rates from the surveyed six countries varied considerably (UK: 19.0%, Germany: 14.8%, Netherlands: 53.8%, Hungary: 27.7%, Italy: 35.7% and Spain: 32.5%). Total responses in each field of expertise also varied extensively, with the most coming from antenatal care providers (81 respondents) and the least from asylum seekers’ care providers (18 respondents) across the six countries. The results show varying practices in recommending hepatitis B and C screening to all at-risk groups, except in hepatitis B screening among pregnant women. This variety demonstrates a lack of consensus among experts in screening recommendation standards within their knowledge or services, albeit recommendations in available policies or guidelines. Regional differences in standard practices were also suggested in antenatal care for hepatitis C and in asylum seekers’ care in most study countries