The epidemic increase in type 2 diabetes can be prevented only if markers of risk can be identified and used for early intervention. We examined the clinical phenotype of individuals characterized by normal or low IRS-1 protein expression in fat cells as well as the potential molecular mechanisms related to the adipose tissue. Twenty-five non-obese individuals with low or normal IRS-1 expression in subcutaneous abdominal fat cells were extensively characterized and the results compared with 71 carefully matched subjects with or without a known genetic predisposition for type 2 diabetes. In contrast to the commonly used risk marker, known heredity for diabetes, low cellular IRS-1 identified individuals who were markedly insulin resistant, had high proinsulin and insulin levels, and exhibited evidence of early atherosclerosis measured as increased intima media thickness in the carotid artery bulb. Circulating levels of adiponectin were also significantly reduced. Gene analyses of fat cells in a parallel study showed attenuated expression of several genes related to fat cell differentiation (adiponectin, aP2, PPARgamma, and lipoprotein lipase) in the group of individuals characterized by a low IRS-1 expression and insulin resistance. A low IRS-1 expression in fat cells is a marker of insulin resistance and risk for type 2 diabetes and is associated with evidence of early vascular complications. Impaired adipocyte differentiation, including low gene expression and circulating levels of adiponectin, can provide a link between the cellular marker and the in vivo phenotype.

In many ways our sexual and reproductive health reflects our way of life and living conditions. In a long-term perspective, advances in welfare combined with a well-developed health and medical care system, have meant that by international standards it is now rare for mothers to die during delivery and infant mortality continues to decline to new record lows. Pregnancy and childbirth, however, continue to be a time in a woman's life associated with many health problems, and absence from work due to illness is common. The age of parents at the birth of their first child is no longer rising; it has remained the same for women and men since 2004. The fact that more and more people are having children later in life means many people are compelled for a long time beforehand to take precautions to avoid unwanted pregnancies and sexually transmitted infections (STIs) that can put fertility at risk. This has been accompanied by a parallel trend: an increasingly liberal view of sex as an activity independent of permanent relationships. As a result of these developments, young people in particular tend to have more sexual partners than formerly. In addition, condom use has not increased, resulting in a rise in the number of unprotected encounters. The incidence of chlamydia, the most common notifiable sexually transmitted disease, has risen very rapidly in the last decade. In 2011, 37,000 cases were reported, most of them (86 %) among young men and women (15-29 years) irrespective of sexual orientation. Sweden, along with Finland, has one of the lowest percentages of HIV-infected people in Western Europe. Despite this, there are grounds for continued vigilance. The domestic spread of the disease among men who have sex with men climbed sharply in 2007. Another factor was a sudden outbreak of HIV among intravenous drug users. However, statistics from 2010 and 2011 shows a significant decline in notified cases among intravenous drug users after 2007 and a decreasing trend also among MSM. A sustained picture of the HIV epidemic in Sweden is that more than half (ca 55 %) the present incidence has been observed among migrants and ethnic groups closely connected to countries where there are generalised epidemics. This, combined with the growing trend towards unprotected sex, points to a risk of further transmission, even outside high risk groups. Cervical cancer is caused by a group of sexually transmitted viruses-collectively the human papillomavirus (HPV). At present there are vaccines against some types of HPV. A general vaccination programme for 12-year old girls has just started. Pap tests 1 will also continue to be needed to prevent cervical cancer since the vaccine does not cover all potential carcinogenic viruses. Involuntary childlessness affects an estimated 10-15 per cent of all couples. Women's fertility declines sharply at around the age of 35. Couples planning to have children do not appear to be sufficiently aware of this and thus risk being over-optimistic about the number of children they intend to have. The grow...

Sexual risk behaviour increased significantly for 16-24 year olds, and particularly young women, during the study period. To reduce the risk of uncontrollable spread of sexually transmitted infections in this age group, it is imperative that condom use in risky sexual contact is encouraged.

No abstract