From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review

Background Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised. Methods To investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed. Results Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants. Conclusions The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context

Primary Health Care: a strategic framework for the prevention and control of chronic non-communicable disease

In 2014, chronic, non-communicable diseases (NCDs) represent the leading causes of global mortality and disability. Government-level concern, and resulting policy changes, are manifesting. However, there continues to be a paucity of guiding frameworks for legislative measures. The surge of NCDs will require strong and effective governance responses, particularly in low and middle-income countries. Simultaneously following the 2008 World Health Report, there has recently been renewed interest in Primary Health Care (PHC) and its core principles. With this, has come strengthened support for revitalizing this approach, which aims for equitable and cost-effective population-health attainment. In this light and reflecting recent major global reports, declarations and events, we propose and critique a PHC approach to NCDs, highlighting PHC, with its core themes, as a valuable guiding framework for health promotion and policy addressing this group of diseases

Development of a core outcome set for diabetes after pregnancy prevention interventions (COS-DAP): a study protocol

BACKGROUND: Gestational diabetes mellitus (GDM) increases the risk of adverse short- and long-term outcomes, including development of type 2 diabetes. The US Diabetes Prevention Program demonstrates this risk can be halved with an intensive health behavior change intervention in women with pre-diabetes averaging 12&thinsp;years since a GDM pregnancy. In recent years, the number of studies looking at changing the behaviors of women with previous GDM closer to the time of delivery has steadily grown, but reported outcomes vary and most studies are not long enough or large enough to examine incident diabetes. This initiative aims to develop a core outcome set (COS) for interventions seeking to prevent diabetes after pregnancy (DAP) in both women with prior GDM and their families. METHODS: The COS-DAP project will use established COS methodology, in four stages: (1) a systematic literature review of DAP prevention intervention studies following GDM; (2) discussion and cataloguing of outcomes measured and implementation components at an investigator meeting; (3) a two-round online Delphi survey aimed at prioritizing the identified outcomes; and (4) a consensus meeting with key stakeholders to review, discuss, and refine suitable COS measures, using nominal group technique. DISCUSSION: COS-DAP aims to develop a COS for health behavior change interventions to prevent DAP. The COS is expected to enhance opportunities for comparison of future studies and allow for better synthesis of the effects. The inclusion of multiple stakeholder perspectives will increase the final COSs applicability and relevance. TRIAL REGISTRATION: Comet Initiative, COMET 1083; PROSPERO, CRD42018084853 . Registered in prospero on 03/01/2018

Cellulolytic and Xylanolytic Microbial Communities Associated With Lignocellulose-Rich Wheat Straw Degradation in Anaerobic Digestion

The enzymatic hydrolysis of lignocellulosic polymers is generally considered the rate-limiting step to methane production in anaerobic digestion of lignocellulosic biomass. The present study aimed to investigate how the hydrolytic microbial communities of three different types of anaerobic digesters adapted to lignocellulose-rich wheat straw in continuous stirred tank reactors operated for 134 days. Cellulase and xylanase activities were monitored weekly using fluorescently-labeled model substrates and the enzymatic profiles were correlated with changes in microbial community compositions based on 16S rRNA gene amplicon sequencing to identify key species involved in lignocellulose degradation. The enzymatic activity profiles and microbial community changes revealed reactor-specific adaption of phylogenetically different hydrolytic communities. The enzymatic activities correlated significantly with changes in specific taxonomic groups, including representatives of Ruminiclostridium, Caldicoprobacter, Ruminofilibacter, Ruminococcaceae, Treponema, and Clostridia order MBA03, all of which have been linked to cellulolytic and xylanolytic activity in the literature. By identifying microorganisms with similar development as the cellulase and xylanase activities, the proposed correlation method constitutes a promising approach for deciphering essential cellulolytic and xylanolytic microbial groups for anaerobic digestion of lignocellulosic biomass