Good professional practices for promoting positive parenting and child participation in reunification processes

Professional support of families that are under temporary protection, with the goal of reunification, is necessary for helping families re‐establish their family dynamics. Without this support, the conditions that contributed to child abuse and neglect will likely persist. In this context, the attitude of professionals towards positive parenting and child participation is a decisive factor. The quantitative study presented here contributes knowledge regarding these 2 variables. The study was conducted with 106 professionals who work in the child protection system. The results show a high degree of consensus among professionals regarding the following practices: (a) incorporating positive parenting into family reunification processes; (b) training the biological parents in parenting skills; and (c) promoting the active participation of children in foster care and reunification. Regarding the latter point, the study found that older and more experienced professionals are more open and inclined to promote participation in family reunification processes. The practical implications of the results invite us to review attitudinal competencies training for professionals working in child protection services, focusing on encouraging a positive attitude towards the parental competencies of the biological family and the active participation of children in foster care and reunification. These professionals' attitudes are a key factor in mediating the process of family reunificatio

Valoración de los cambios de hábitos dietéticos según tratamientos clínicos para la obesidad: el Balón Intragástrico vs la técnica POSE.

Este trabajo se ha querido realizar a raíz del problema de obesidad que actualmente hay en España, no es una enfermedad nueva pero cada vez hay más población que la sufre. Una parte de dicha población que sufre de obesidad recurre a los hospitales para realizarse un tratamiento clínico, es por ello que el estudio se centra en dos técnicas clínicas y evaluar el cambio de hábitos dietéticos en los pacientes de ambos tratamientos dirigidos por la nutricionista. Los dos tratamientos clínicos de este estudio donde la nutricionista realizará consulta para hacer una educación nutricional a los pacientes serán, el Balón Intragástrico y el POSE, ya que ambos tratan a población con obesidad que tengan una media de 35-40 de IMC

Implementation and Evaluation of the "Learning Together, Growing In Family Programme": The Impact on the Families

The article looks at the characteristics of the programme and its application and evaluation. We have chosen a mixed methodological focus that is characterised by a research process that collects analyses and links quantitative and qualitative data, as well as its integration and joint discussion, to achieve a greater understanding of the phenomenon under study. The application has been under- taken with 1,834 people of whom 1,270 have undertaken the programme (609 parents and 661 children), and 564 (296 parents and 268 children) formed part of the control group. The results show that after the programme the strict (authoritarian) style, permissive style, criticism and rejection have decreased and paren- tal affection and communication have increased. There has been an increase in leisure activities undertaken in the family, both in everyday and special activities, satisfaction with family life has improved and there has been greater community integration along with learning processes of an emotional, behavioural and cog- nitive nature. We describe proposals for change to improve the efficiency of the programme by means of going deeper into the subject matter of the programme and the creation of reference bodies to establish networking with the small entities, attending to the largest number of families possible within the characteristics of the programme

Glibenclamide, metformin, and insulin for the treatment of gestational diabetes : a systematic review and meta-analysis

Objective To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational diabetes requiring drug treatment. Design Systematic review and meta-analysis. Eligibility criteria for selecting studies Randomized controlled trials that fulfilled all the following: (1) published as full text; (2) addressed women with gestational diabetes requiring drug treatment; (3) compared glibenclamide v insulin, metformin v insulin, or metformin v glibenclamide; and (4) provided information on maternal or fetal outcomes. Data sources Medline, CENTRAL, and Embase were searched up to 20 May 2014. Outcomes measures We considered 14 primary outcomes (6 maternal, 8 fetal) and 16 secondary (5 maternal, 11 fetal) outcomes. Results We analyzed 15 articles, including 2509 subjects. Significant differences for primary outcomes in glibenclamide v insulin were obtained in birth weight (mean difference 109 g (95% confidence interval 35.9 to 181)), macrosomia (risk ratio 2.62 (1.35 to 5.08)), and neonatal hypoglycaemia (risk ratio 2.04 (1.30 to 3.20)). In metformin v insulin, significance was reached for maternal weight gain (mean difference −1.14 kg (−2.22 to −0.06)), gestational age at delivery (mean difference −0.16 weeks (−0.30 to −0.02)), and preterm birth (risk ratio 1.50 (1.04 to 2.16)), with a trend for neonatal hypoglycaemia (risk ratio 0.78 (0.60 to 1.01)). In metformin v glibenclamide, significance was reached for maternal weight gain (mean difference −2.06 kg (−3.98 to −0.14)), birth weight (mean difference −209 g (−314 to −104)), macrosomia (risk ratio 0.33 (0.13 to 0.81)), and large for gestational age newborn (risk ratio 0.44 (0.21 to 0.92)). Four secondary outcomes were better for metformin in metformin v insulin, and one was worse for metformin in metformin v glibenclamide. Treatment failure was higher with metformin than with glibenclamide. Conclusions At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available. Systematic review registration NCT0199811

Usual dietary treatment of gestational diabetes mellitus assessed after control diet in randomized controlled trials : subanalysis of a systematic review and meta-analysis

Peer reviewe

Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight

OBJECTIVE: Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions. RESEARCH DESIGN AND METHODS: Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms. RESULTS: From 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (−4.07 mg/dL [95% CI −7.58, −0.57]; P = 0.02 and −7.78 mg/dL [95% CI −12.27, −3.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (−170.62 g [95% CI −333.64, −7.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison. CONCLUSIONS: Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM

A multilayered post-GWAS assessment on genetic susceptibility to pancreatic cancer

Funder: Fundación Científica Asociación Española Contra el Cáncer (ES)Funder: Cancer Focus Northern Ireland and Department for Employment and LearningFunder: Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, USAAbstract: Background: Pancreatic cancer (PC) is a complex disease in which both non-genetic and genetic factors interplay. To date, 40 GWAS hits have been associated with PC risk in individuals of European descent, explaining 4.1% of the phenotypic variance. Methods: We complemented a new conventional PC GWAS (1D) with genome spatial autocorrelation analysis (2D) permitting to prioritize low frequency variants not detected by GWAS. These were further expanded via Hi-C map (3D) interactions to gain additional insight into the inherited basis of PC. In silico functional analysis of public genomic information allowed prioritization of potentially relevant candidate variants. Results: We identified several new variants located in genes for which there is experimental evidence of their implication in the biology and function of pancreatic acinar cells. Among them is a novel independent variant in NR5A2 (rs3790840) with a meta-analysis p value = 5.91E−06 in 1D approach and a Local Moran’s Index (LMI) = 7.76 in 2D approach. We also identified a multi-hit region in CASC8—a lncRNA associated with pancreatic carcinogenesis—with a lowest p value = 6.91E−05. Importantly, two new PC loci were identified both by 2D and 3D approaches: SIAH3 (LMI = 18.24), CTRB2/BCAR1 (LMI = 6.03), in addition to a chromatin interacting region in XBP1—a major regulator of the ER stress and unfolded protein responses in acinar cells—identified by 3D; all of them with a strong in silico functional support. Conclusions: This multi-step strategy, combined with an in-depth in silico functional analysis, offers a comprehensive approach to advance the study of PC genetic susceptibility and could be applied to other diseases