A review of interventions to prevent Type 2 Diabetes after Gestational Diabetes

BackgroundGestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type 2 Diabetes (T2DM) within 15 years, and prevention programmes have been problematic.QuestionThe aim of the study is to identify effective strategies and programmes to decrease the risk of T2DM in women who experience GDM, the barriers to participation, and the opportunities for midwives to assist women in prevention.MethodsEnglish language, peer reviewed and professional literature published between 1998 and 2013 were searched. A systematic review of the literature was undertaken, included studies were then appraised for quality and finally findings of the studies were thematically analysed.FindingsThis review identified that there are interventions that are effective, however most lifestyle changes are difficult to translate into everyday life. As the incidence of GDM is expected to rise, midwives’ role in promoting long-term health behaviours requires further review.ConclusionsWomen need to overcome barriers and be supported in making the behavioural changes necessary to prevent T2DM following GDM. Midwives as the primary carers for women in pregnancy and childbirth are ideally positioned to educate women and engage them in lifestyle and behaviour programmes that prevent the onset of Type 2 Diabetes.     

Capitals, assets, and resources: some critical issues

This paper explores the potential of Bourdieu's approach to capital as a way of understanding class dynamics in contemporary capitalism. Recent rethinking of class analysis has sought to move beyond what Rosemary Crompton (1998) calls the 'employment aggregate approach', one which involves categorizing people into class groups according to whether they have certain attributes (e.g. occupations). Instead, recent contributions by Pierre Bourdieu, Erik Wright, Aage Sorensen, and Charles Tilly have concentrated on understanding the mechanisms that produce class inequalities. Concepts such as assets, capitals and resources (CARs) are often used to explain how class inequalities are produced, but there remain ambiguities and differences in how such terms are understood. This paper identifies problems faced both by game theoretical Marxism and by the rational choice approach of Goldthorpe in developing an adequate approach to CARs. It then turns to critically consider how elements of Bourdieu's approach, where his concept of capital is related to those of habitus and field, might overcome these weaknesses. Our rendering of his arguments leads us to conclude that our understanding of CARs might be enriched by considering how capital is distinctive not in terms of distinct relations of exploitation, but through its potential to accumulate and to be converted to other resources. This focus, we suggest, sidesteps otherwise intractable problems in CAR based approaches.     

Risk of Norovirus Gastroenteritis from Consumption of Vegetables Irrigated with Highly Treated Municipal Wastewater—Evaluation of Methods to Estimate Sewage Quality

Quantitative microbial risk assessment was used to assess the risk of norovirus gastroenteritis associated with consumption of raw vegetables irrigated with highly treated municipal wastewater, using Melbourne, Australia as an example. In the absence of local norovirus concentrations, three methods were developed: (1) published concentrations of norovirus in raw sewage, (2) an epidemiological method using Melbourne prevalence of norovirus, and (3) an adjustment of method 1 to account for prevalence of norovirus. The methods produced highly variable results with estimates of norovirus concentrations in raw sewage ranging from 10⁴ per milliliter to 10⁷ per milliliter and treated effluent from 1 × 10^?3 per milliliter to 3 per milliliter (95th percentiles). Annual disease burden was very low using method 1, from 4 to 5 log₁₀ disability adjusted life years (DALYs) below the 10^?6 threshold (0.005–0.1 illnesses per year). Results of method 2 were higher, with some scenarios exceeding the threshold by up to 2 log₁₀ DALYs (up to 95,000 illnesses per year). Method 3, thought to be most representative of Melbourne conditions, predicted annual disease burdens >2 log₁₀ DALYs lower than the threshold (～4 additional cases per year). Sensitivity analyses demonstrated that input parameters used to estimate norovirus concentration accounted for much of the model output variability. This model, while constrained by a lack of knowledge of sewage concentrations, used the best available information and sound logic. Results suggest that current wastewater reuse behaviors in Melbourne are unlikely to cause norovirus risks in excess of the annual DALY health target.     

Family group conferences: evidence,outcomes and future research

This is the second article of a two‐part review of the literature relating to family group conferences (FGCs); it explores outcomes and challenges in implementing FGCs. The complex data relating to outcomes, drawing on a range of national contexts, is presented. The challenges of researching outcomes and the role of longitudinal and randomized, controlled trials are considered. The article concludes with a discussion of the implementation of FGC policy and practice in the contemporary context.     

Advice to Risk Assessors Modeling Viral Health Risk Associated with Household Graywater

Quantitative microbial risk assessment (QMRA) is a valuable tool that can be used to predict the risk associated with human exposure to specific microbial contaminants in water sources. The transparency inherent in the QMRA process benefits discussions between multidisciplinary teams because members of such teams have different expertise and their confidence in the risk assessment output will depend upon whether they regard the selected input data and assumptions as being suitable and/or plausible. Selection of input data requires knowledge of the availability of appropriate data sets, the limitations of using a particular data set, and the logic of using alternative approaches. In performing QMRA modeling and in the absence of directly relevant data, compromises must be made. One such compromise made is to use available Escherichia coli data and apply a ratio of enteric viruses to indicator E. coli in wastewater obtained from prior studies to estimate the concentration of enteric viruses in other wastewater types/sources. In this article, we have provided an argument for why we do not recommend the use of a pathogen to E. coli ratio to estimate virus concentrations in single household graywater and additionally suggested circumstances in which use of such a ratio may be justified.     

Interrelationships Between Childbearing and Housing Transitions in the Family Life Course

Research has examined the effect of family changes on housing transitions and childbearing patterns within various housing types. Although most research has investigated how an event in one domain of family life depends on the current state in another domain, the interplay between them has been little studied. This study examines the interrelationships between childbearing decisions and housing transitions. We use rich longitudinal register data from Finland and apply multilevel event history analysis to allow for multiple births and housing changes over the life course. We investigate the timing of fertility decisions and housing choices with respect to each other. We model childbearing and housing transitions jointly to control for time-invariant unobserved characteristics of women, which may simultaneously influence their fertility behavior and housing choices, and we show how joint modeling leads to a deeper understanding of the interplay between the two domains of family life.     

The role of family centres in reducing social isolation in deprived communities

Social exclusion and isolation are worldwide social and health concerns with negative effects becoming exacerbated in deprived communities. There is limited understanding related to the role of community‐based centres in reducing social exclusion and isolation, so the aim of this research was to explore the role one family centre had in improving social inclusion in a deprived community in Glasgow, Scotland. Interpretative Phenomenological Analysis was utilized to analyse interviews from 10 parents to explore their lived experiences of creating and developing social networks through family centre attendance. Findings indicate that attending the family centre positively impacted on social inclusion and social support for all parents interviewed. Relationships created in the centre were proposed as being meaningful, non‐judgemental and produced social capital—rooted in reciprocity and trust. Findings can inform services that aim to reduce social isolation in deprived communities.