Empirical Bayes Age–Period–Cohort Analysis of Retrospective Incidence Data

We analyse the (age, time)-specific incidence of diabetes based on retrospective data obtained from a prevalent cohort only including survivors to a particular date. From underlying point processes with intensities corresponding to the (age, time)-specific incidence rates the observed point pattern is assumed to be generated by an independent thinning process with parameters (assumed known) depending on population density and survival probability to the sampling date. A Bayesian procedure is carried out for the optimal adjustment and comparison of isotropic and anisotropic smoothing priors for the intensity functions, as well as for the decomposition of the intensity on the (time, age) Lexis diagram into the three factors of age, period and cohort.     

Breastfeeding practices in women with type 1 diabetes: A discussion of the psychosocial factors and policies in Sweden and Australia

BackgroundWomen with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth and in the postnatal period, including breastfeeding initiation and continuation while maintaining stable glycaemic control. In both Sweden and Australia the rates of breastfeeding initiation are high. However, overall there is limited information about the breastfeeding practices of women with T1DM and the factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion.AimThe aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM.FindingsSwedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socio-economic factors, particular perceived support from social networks and health professionals.ConclusionThere is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.     

Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review

BackgroundObesity and gestational weight gain impact maternal and fetal risks. Gestational weight gain guidelines are not stratified by severity of obesity.AimConduct a systematic review of original research with sufficient information about gestational weight gain in obese women stratified by obesity class that could be compared to current Institute of Medicine guidelines. Evaluate variance in risk for selected outcomes of pregnancy with differing gestational weight gain in obese women by class of obesity.MethodsA keyword advanced search was conducted of English-language, peer-reviewed journal articles using 3 electronic databases, article reference lists and table of content notifications through January 2015. Data were synthesized to show changes in risk by prevalence.FindingsTen articles met inclusion criteria. Outcomes assessed were large for gestational age, small for gestational age, and cesarean delivery. Results represent nearly 740,000 obese women from four different countries. Findings consistently demonstrated gestational weight gain varies by obesity class and most obese women gain more than recommended by Institute of Medicine guidelines. Obese women are at low risk for small for gestational age and high risk for large for gestational age and risk varies with class of obesity and gestational weight gain. Research suggests the lowest combined risk of selected outcomes with weight gain of 5–9 kg in women with class I obesity, 1 to less than 5 kg for class II obesity and no gestational weight gain for women with class III obesity.ConclusionsGestational weight gain guidelines may need modification for severity of obesity.     

糖尿病患者健康行为对其生命质量的影响评价——基于江苏省第五次卫生服务调查的实证研究

目的:评价糖尿病患者健康行为对其健康相关生命质量的影响?方法:利用第五次国家卫生服务调查中的江苏省家庭健康询问调查资料,对其中全部糖尿病患者的社会经济学特征?生命质量?健康行为和体重指数进行分析?逐步回归法构建OLS回归模型研究健康行为和体重指数对生命质量的影响?结果:2013年江苏省糖尿病患病率为4.19%?在控制了社会经济学因素后,体重过低对糖尿病患者生命质量的负效应最强?每周锻炼3~5次和锻炼6次及以上对生命质量的正效应基本一致?每周饮酒至少3次则与生命质量具有正相关性?结论:增加锻炼频次对改善糖尿病患者生命质量具有正效应;体重过低会增加糖尿病患者生命质量降低的风险;糖尿病患者饮酒频次对其生命质量的影响需进一步研究确认?     

本溪市中心城区2型糖尿病合并冠心病的患病率及相关因素调查分析

目的了解2008年至2009年本溪市中心城区2型糖尿病合并冠心病（CHD）的患病率,并对其相关因素进行调查分析。方法对常住本溪市中心城区的2276例2型糖尿病患者问卷调查,采集临床资料,应用SPSS13.0软件进行统计分析。结果2型糖尿病合并CHD患病率为28.34%。女性高于男性,男女患病率均随着年龄增长、病程延长而上升（P〈0.05）。吸烟、BMI≥24kg/m2、高血压、血脂异常、高尿酸血症,伴有视网膜病变（DR）、周围神经病变（DPN）的2型糖尿病患者合并CHD的患病率高于非上述情况者（P〈0.05）。结论增龄、病程增长、吸烟、BMI≥24kg/m2、高血压、血脂异常、高尿酸血症,合并DR、DPN是糖尿病合并CHD的危险因素。因此,严格控制血糖、血脂、血压,同时戒烟、减轻体重、低嘌呤饮食,积极治疗DR、DPN对预防CHD的发生有重要的意义。     

系统健康教育对妊娠期糖尿病孕妇知、信、行的影响

目的:观察系统健康教育对妊娠期糖尿病孕妇的干预效果,进一步探索对妊娠期糖尿病患者科学、便捷、经济、有效的饮食治疗和健康促进方法.方法:120名妊娠期糖尿病孕妇按1∶1随机分为实验组和对照组,实验组接受系统健康教育,对照组接受传统健康教育.观察两组相关知识的认知情况、态度及饮食习惯等方面的改变.结果:系统教育组和传统教育组均可使知识调查总分上升,但系统教育组要优于传统教育组;而态度总分仅在系统教育组干预后上升,且饮食习惯系统教育组优于传统教育组.结论:妊娠期糖尿病孕妇系统健康教育在相关知识的认知情况、态度及饮食习惯等方面的改变有一定意义.     

“Not my child to give away”: A qualitative analysis of gestational surrogates’ experiences

Problem/backgroundLimited empirical data are available on the experiences of women who have been a gestational surrogate.QuestionWhat are the experiences of gestational surrogates along the surrogacy pathway?MethodsAn anonymous study-specific cross-sectional survey was used to evaluate participants’ experience of being a surrogate. A total of 184 Canadian women who were recruited from Canadian surrogacy agencies and the Internet completed the online survey; 9446 words were collected from 110 participants who entered comments to one or more questions. The qualitative data were analyzed through thematic analysis.FindingsSeven main themes, and eighteen interrelated sub-themes grouped under the pre-, during, and post-surrogacy stages were identified. Many surrogates viewed surrogacy as a positive experience and as something meaningful and impactful to other people’s lives. Most surrogates had harmonious relationships with their intended parents and maintained on-going contact with the surrogacy family post birth.DiscussionSurrogacy involves deliberate efforts to establish a trustful surrogate-parent partnership through relationship building, boundary negotiation, and management of expectations. The compatibility between surrogate and intended parents, regarding aspects such as communication and pregnancy management styles, was an important contributing factor to a positive experience.ConclusionOur findings provide a deeper understanding of participants’ reasons for and motivation to be a surrogate, the relationship dynamics with their intended parents and the gestated fetus during surrogacy, and their satisfaction on personal and relationship levels post surrogacy. The findings would be useful to mental health professionals in preparing new surrogates for the potential challenges along the surrogacy pathway.     

Factors associated with breastfeeding to 3 months postpartum among women with type 1 and type 2 diabetes mellitus: An exploratory study

ProblemBreastfeeding has significant health benefits for maternal and infant health, yet women with pre-pregnancy diabetes (type 1 or type 2 diabetes mellitus) are often less likely to breastfeed compared with other childbearing women.BackgroundIntention to breastfeed and making the decision to breastfeed during pregnancy are significant predictors of breastfeeding in the general population, but intention to breastfeed has not been assessed during pregnancy among women with pre-pregnancy diabetes.AimTo investigate factors associated with breastfeeding to three months postpartum, including demographic, health and reproductive characteristics, perceived support and pre-birth intention to breastfeed, among women with pre-pregnancy diabetes.MethodsA prospective cohort of women with pre-pregnancy diabetes was recruited at three metropolitan hospitals in Melbourne, Australia. Women completed surveys during the third trimester of pregnancy (including intention to breastfeed) and at approximately 3 months postpartum (including current breastfeeding). Factors associated with any breastfeeding at 3 months postpartum were investigated using logistic regression.FindingsPregnancy surveys were completed by 79 women; three-month postpartum data were available for 47 women. Of these, more than two-thirds (n = 32, 68%) indicated that they were breastfeeding. Controlling for other relevant variables, only pre-birth intention to breastfeed was significantly associated with any breastfeeding at three months (Adjusted Odds Ratio (95% confidence intervals, p) = 20.49 (20.18–20.80, 0.017)).DiscussionPre-birth intention to breastfeed was the only significant predictor of continued breastfeeding to 3 months postpartum.ConclusionPregnancy provides an important opportunity for health professionals to educate and support women with pre-pregnancy diabetes about their breastfeeding intentions.     

Postnatal gestational diabetes mellitus follow-up: Perspectives of Australian hospital clinicians and general practitioners

Problem

The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up.