Reducing risk of type 2 diabetes after gestational diabetes: a qualitative study to explore the potential of technology in primary care

BACKGROUND: Despite the seven-fold increased risk of type 2 diabetes mellitus (T2DM) among females previously diagnosed with gestational diabetes (GD), annual rates of follow-up in primary care are low. There is a need to consider how to reduce the incidence of progression to T2DM among this high-risk group. AIM: To examine the views of females diagnosed with GD to ascertain how to improve primary care support postnatally, and the potential role of technology in reducing the risk of progression to T2DM. DESIGN AND SETTING: A qualitative study of a purposive sample of 27 postnatal females leaving secondary care with a recent diagnosis of GD. METHOD: Semi-structured interviews were conducted with 27 females, who had been previously diagnosed with GD, at around 6-12 weeks postnatally. Interviews were audiotaped, transcribed, and analysed thematically. RESULTS: Facilitators and barriers to engaging in a healthy postnatal lifestyle were identified, the most dominant being competing demands on time. Although females were generally satisfied with the secondary care they received antenatally, they felt abandoned postnatally and were uncertain what to expect from their GP in terms of follow-up and support. Females felt postnatal care could be improved by greater clarity regarding this, and enhanced by peer support, multidisciplinary input, and subsidised facilities. Technology was seen as a potential adjunct by providing information, enabling flexible and personalised self-management, and facilitating social support. CONCLUSION: A more tailored approach for females previously diagnosed with GD may help reduce the risk of progression to T2DM. A need for future research to test the efficacy of using technology as an adjunct to current care was identified

Multi-ancestry genome-wide association study accounting for gene-psychosocial factor interactions identifies novel loci for blood pressure traits

Psychological and social factors are known to influence blood pressure (BP) and risk of hypertension and associated cardiovascular diseases. To identify novel BP loci, we carried out genome-wide association meta-analyses of systolic, diastolic, pulse, and mean arterial BP, taking into account the interaction effects of genetic variants with three psychosocial factors: depressive symptoms, anxiety symptoms, and social support. Analyses were performed using a two-stage design in a sample of up to 128,894 adults from five ancestry groups. In the combined meta-analyses of stages 1 and 2, we identified 59 loci (p value < 5e−8), including nine novel BP loci. The novel associations were observed mostly with pulse pressure, with fewer observed with mean arterial pressure. Five novel loci were identified in African ancestry, and all but one showed patterns of interaction with at least one psychosocial factor. Functional annotation of the novel loci supports a major role for genes implicated in the immune response (PLCL2), synaptic function and neurotransmission (LIN7A and PFIA2), as well as genes previously implicated in neuropsychiatric or stress-related disorders (FSTL5 and CHODL). These findings underscore the importance of considering psychological and social factors in gene discovery for BP, especially in non-European populations

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Reducing the risk of progression from Gestational Diabetes to Type 2 Diabetes Mellitus:Women’s perspectives on the content, research development and evaluation of a mobile health technology lifestyle intervention to support postnatal dietary and activity lifestyle change

The project aimed to consult with women who have had GD and their partners, in order to investigate how factors which support sustained lifestyle change could be enabled through the use of modern technology, such as:<br>·         online forums (for social support) <p>·         smartphones (for goal setting) </p> <p>·         fitness tracking wristbands (for behaviour tracking)</p> <p>·         use of  online tools to help women wishing to lose weight or be more physically active, such as the NHS 12 week diet and exercise plan. </p> <p> </p> <p> The study team also wished to explore:</p> <p>·         how and when women might be introduced to a mobile technology lifestyle intervention</p> <p>·         how they might be supported in continuing to use the new technology</p> <p>·         how family and friends view diet and exercise lifestyle change in the context of GD</p> <p> </p> <p>In order to embed patient perspectives from the outset within the <b>research design process</b>, we also sought their views and ideas about:</p> <p>·         Research questions including content of a topic guide for a qualitative study</p> <p>·         The antenatal behaviour change intervention that currently exists in secondary care</p> <p>·         Primary outcome measure for a clinical trial</p> <p>·         Recruitment strategy</p> <p>·         Study design </p> <p>·         Intervention content</p> <p>·         Data collection methods</p> <p>·         Ethical issues of online support and questionnaire and health practitioners lifestyle research data collection relating to weight, diet and exercise. </p> <p>·         Lifestyle and social media interaction data transfer on-line to a secure research database at the university.   </p> <p>·         PPI focused dissemination</p> <h2><a> </a>Patient and Public involvement Project Methods<br></h2><p> The lead researcher (BMc) first conducted a PPI group with a group of mums in Barnsley, at a ‘Sure Start’ Children’s centre, and then attended a Jessop Wing, Sheffield University Hospital Trust  established PPI group of women service users of maternity care at the hospital. BMc was introduced to a midwife at the antenatal clinic who invited him to attend one of the antenatal GD intervention sessions. This enabled us to map the current care at the Jessop Wing and helped inform our intervention plans in terms of how best this could be followed on in primary care.  <br></p><p> </p><p>ISBN-978-0-9571207-4-7</p

Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis

Abstract Background One million women per year seek medical advice for abnormal uterine bleeding (AUB) in the United Kingdom. Many low-risk patients who could be managed exclusively in primary care are referred to hospital based gynaecology services. Performing endometrial sampling (ES) in the community may improve care, reduce the rate of referrals and minimise costs. We aimed to search and synthesise the literature on the effectiveness of ES (Pipelle versus other devices) in managing AUB in low-risk patients. Methods We undertook an electronic literature search in MEDLINE via OvidSP, Scopus, and Web of Science for relevant English-language articles from 1984 to 2016 using a combination of MeSH and keywords. Two reviewers independently pre-selected 317 articles and agreed on 60 articles reporting data from over 7300 patients. Five themes were identified: sample adequacy, test performance, pain and discomfort, cost-effectiveness, and barriers and complications of office ES. Results Pipelle seems to perform as well as dilation and curettage and, as well or better than other ES devices in terms of sampling adequacy and sensitivity. It also seems to be better regarding pain/discomfort and costs. However, Pipelle can disrupt the sonographic appearance of the endometrium and may be limited by cervical stenosis, pelvic organ prolapse and endometrial atrophy. Conclusions The current evidence supports the use of Pipelle in the management of low-risk women presenting in the outpatient setting with symptomatic AUB when combined with clinical assessment and ultrasound scanning. However, the implications of its widespread use in primary care are uncertain and more research is required

Additional file 1: of Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis

Literature search strategy. Search strategies and key words employed in the literature review. (DOCX 11 kb)

Additional file 2: of Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis

Study quality assessment. Assessment of methodological quality of the studies included in the literature review. (DOCX 62 kb)