The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990-2019: Results From the Global Burden of Disease Study 2019.

Objectives: As little is known about the burden of type 1 (T1DM) and type 2 diabetes (T2DM) in adolescents in Western Europe (WE), we aimed to explore their epidemiology among 10-24 year-olds. Methods: Estimates were retrieved from the Global Burden of Diseases Study (GBD) 2019. We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for prevalence, incidence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. Results: In 2019, prevalence and disability estimates were higher for T1DM than T2DM among 10-24 years old adolescents in WE. However, T2DM showed a greater increase in prevalence and disability than T1DM in the 30 years observation period in all WE countries. Prevalence increased with age, while only minor differences were observed between sexes. Conclusion: Our findings highlight the substantial burden posed by DM in WE among adolescents. Health system responses are needed for transition services, data collection systems, education, and obesity prevention.

Validity and reliability study of clinician attitude towards rural health extension program in Ethiopia: exploratory and confirmatory factor analysis.

BACKGROUND: The Ethiopian health extension program (HEP) is an innovative community-based strategy aimed at disease prevention and health promotion. While health extension workers (HEWs) are its front-line workers, the involvement of clinicians remains an integral part. The goals of this study were to: (1) assess the correlation of clinician attitude with predictors and (2) assess the reliability and validity of the survey instrument. METHODS: A cross-sectional study design was utilized to collect data from a sample of 1239 clinicians using 28 items of attitude questions. Exploratory factor analysis (EFA) was applied to create the latent variables. Oblique Promax type rotation with factor loading (> 0.5) was used. Cronbach's alpha was used to assess reliability, with a level of > 0.7 suggesting good reliability. Confirmatory factor analysis (CFA) was undertaken, with the values of Root Mean Square Error Administration (RMSEA) < 0.08, Standardized Root Mean Square Residual (SRMR) < 0.05, comparative fit index (CFI) 0.9-0.95, and Tucker-Lewis index (TLI) 0.9-0.95 suggesting acceptable model fit. A linear regression analysis was conducted. RESULTS: EFA produced two latent variables which explained 93.2% of the total variance. The latent variables were labeled as perceived attitude towards the skill of HEWs (F1), and perceived attitude towards the impact of HEP (F2). Internal reliability for the 28 items was reported with a Cronbach's alpha of 0.94, and for F1 and F2 it was 0.91 and 0.90, respectively. CFA was done and RMSEA was reported at 0.04, SRMR was 0.03, and CFI and TLI were each 0.97. The value of clinician attitude increased by 3.5, 95% CI (1.5, 5.3), P-value < 0.001 for those who have been exposed to the HEP program than non-exposed. Similarly, clinician attitude was lower for degree holders compared to those with diplomas by - 2.7, 95% CI (- 4.4, - 0.94), P-value < 0.002. CONCLUSION: Clinician attitude increased as exposure to HEP increased. Clinician attitude towards HEP has two latent variables. Furthermore, the assessment tool demonstrated good reliability and validity. In conclusion, it is worthy valued for clinicians to receive orientation about HEP, and researchers and program evaluators can use this assessment tool.