From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions

Assaying reproductive capacity in female rodents

It is an important part of many rodent studies to assess reproductive capacity in the female. Animal models that involve exposure to organic compounds, teratogenicity studies, or exposure to suboptimal environments during early development often result in deficits in female fertility. In addition to longitudinal physiology assays of fecundity, there are several molecular biology approaches to assessing female reproductive potential that can be performed to provide a ‘snap-shot’ of fertility potential at a single time-point. Here we describe some of the most useful ways to assess female reproductive capacity in rodents

Improving outcomes in gestational diabetes: does gestational weight gain matter?

AIM: Excessive gestational weight gain increases risk of gestational diabetes mellitus (GDM) but it remains unclear whether weight control after GDM diagnosis improves outcomes. We assessed whether: (1) total gestational weight gain during pregnancy (0-36 weeks); (2) early gestational weight gain (0-28 weeks, before GDM diagnosis); or (3) late gestational weight gain (28-36 weeks, after diagnosis) are associated with maternal-fetal outcomes. METHODS: Some 546 women with GDM who delivered viable singleton infants at a single UK obstetric centre (October 2014 to March 2017) were included in this retrospective observational study. RESULTS: Higher total gestational weight gain was associated with Caesarean section [n = 376; odds ratio (OR) 1.05; confidence intervals (CI) 1.02-1.08, P < 0.001] and large for gestational age (OR 1.08; CI 1.03-1.12, P < 0.001). Higher late gestational weight gain (28-36 weeks; n = 144) was associated with large for gestational age (OR 1.17; CI 1.01-1.37, P < 0.05), instrumental deliveries (OR 1.26; CI 1.03-1.55, P < 0.01), higher total daily insulin doses (36 weeks; beta coefficient 4.37; CI 1.92-6.82, P < 0.001), and higher post-partum 2-h oral glucose tolerance test concentrations (beta coefficient 0.12; CI 0.01-0.22, P < 0.05). Women who avoided substantial weight gain after GDM diagnosis had 0.7 mmol/l lower postnatal 2-h glucose and needed half the amount of insulin/day at 36 weeks compared with women with substantial weight gain after diagnosis. There were no significant associations between early gestational weight gain (0-28 weeks) and pregnancy outcomes. CONCLUSIONS: These findings suggest that controlling gestational weight gain should be a priority following GDM diagnosis to optimize pregnancy outcomes and improve maternal postnatal glucose homeostasis. The period after diagnosis of GDM (often 28 weeks gestation) is not too late to offer lifestyle advice or intervention to improve weight management and pregnancy outcomes

The early life environment influences trajectory of post-partum weight loss

Research question: The physiological processes of pregnancy and lactation require profound changes in maternal metabolism and energy balance. The timescale of metabolic reversion after pregnancy, in particular postpartum weight loss, is highly variable between individuals. Currently, mechanisms influencing postpartum metabolic recovery are not well understood. We hypothesize that, in common with other metabolic and obesity-related outcomes, capacity for postpartum weight-loss is influenced by developmental programming. Design: Adult female Wistar rats exposed to a maternal low-protein diet in utero then weaned onto a control diet postnatally (recuperated) were compared to controls. Adult females from both groups underwent pregnancy at 3 months of age. Weight changes and metabolic parameters during pregnancy and lactation were compared between control and recuperated groups, and also to non-pregnant littermates. Results: Pregnancy weight gain was not different between the control and recuperated groups, but postpartum recuperated animals remained significantly heavier than both postpartum control animals (p<0.05) and their non-pregnant recuperated littermates (p<0.05) at the end of lactation. Postpartum recuperated animals had increased intra-abdominal fat mass (p<0.05) and increased serum triglycerides (p<0.01) compared to controls. Postpartum recuperated animals also had increased expression of IL6, NRF2, and ALOX12 (key regulators of inflammation and lipoxygenase activity) in the intra-abdominal adipose tissue compared to control groups. Conclusions: Mothers who themselves have been exposed to adverse early-life environments are likely to have slower metabolic recovery from pregnancy than controls. Failure to return to pre-pregnancy weight after delivery predisposes to persisting sequential inter-pregnancy weight gain, which can represent a significant metabolic burden across a life-course involving several pregnancies.The study was funded by a grant from the Addenbrooke’s Charitable Trust (ACT) and by an Issac Newton Trust/Wellcome Trust ISSF/ University of Cambridge Joint Research Grant to CEA. SEO is supported by the MRC (MC_UU_12012/4). This work was supported by the MRC MDU Mouse Biochemistry Laboratory (MRC_MC_UU_12012/5