A grounded theory approach to explore how women with Type 1 diabetes manage their diabetes during the menopausal transition

AimTo explore the experiences of women with Type 1 diabetes during the menopausal transition using a grounded theory approach and, from the data, develop a substantive theory that will have potential implications for service users and service providers.MethodsA qualitative exploratory research framework was employed using grounded theory as an approach. Data were collected from 10 participants using transcribed audio-taped semi-structured interviews and field notes. The transcripts, audio recordings and field notes were reviewed and a coding process facilitated data analysis.ResultsA wide range of conceptions was revealed. Data are presented in seven categories that reflect the experience of the menopausal transition for women with Type 1 diabetes: ‘Blank wall’ (relates to the lack of information regarding menopause and diabetes), ‘Juggling game’ (relates to glycaemic control), Anxiety and fear, Self-management, ‘Haywire’ (relates to the signs and symptoms of menopausal transition), Treating symptoms, Depression and mood, ‘I’m old’ (relates to aging and mortality).ConclusionWhat emerged from the study is a substantive theory in which absence of information regarding the menopause and its impact on Type 1 diabetes (blank wall) was identified as the main problem facing women with Type 1 diabetes during their menopausal transition. The findings may enable practitioners to identify the types of information, advice and support that should be made available to these women and contributes to the limited knowledge base currently available. The findings indicate also that further research into this under-studied but important area of diabetes care is required

Hormone replacement therapy for women with type 1 diabetes mellitus

Background: There is conflicting information about the impact of the menopause on glycaemic control amongst women with type 1 diabetes. Some menopausal women with type 1 diabetes are treated with hormone replacement therapy (HRT) but the effects of this treatment have, to date, not been established.Objectives: To assess the effects of HRT for women with type 1 diabetes mellitus.Search methods: We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycINFO from their inception to June 2012. The last search was run for all databases on 18 June 2012.Selection criteria: We selected randomised controlled trials or controlled clinical trials that involved peri‐ or postmenopausal women with type 1 diabetes undergoing HRT as an intervention.Data collection and analysis: Two researchers independently applied the inclusion criteria to the identified studies and assessed risk of bias. Disagreements were resolved by discussion or by intervention by a third party. Descriptive analysis was conducted for the review.Main results: Ninety‐two publications were screened. No studies met the inclusion criteria exclusively but one study that included both type 1 and type 2 diabetes participants was considered. This randomised clinical trial (RCT) compared HRT (N = 27) with placebo (N = 29) over 12 months. The outcome measures were cardiovascular risk factors, including lipid profile, glycaemic control, blood pressure and body weight. No significant differences between placebo and HTR were detected. Patient‐important outcomes like all‐cause mortality, cardiovascular disease, diabetic complications or health‐related quality of life were not investigated.Authors' conclusions: There is a lack of evidence around the use of HRT in women with type 1 diabetes. The one study that has been undertaken in this area is underpowered. More RCTs are required in the area to examine the impact of HRT on glycaemic control and cardiovascular outcomes.https://doi.org/10.1002/14651858.CD008613.pub2pubpub

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

Land use and soil factors affecting accumulation of phosphorus species in temperate soils

Data on the distribution of phosphorus (P) species in soils with differing land uses and properties are essential to understanding environmental P availability and how fertiliser inputs, cropping and grazing affect accumulation of soil inorganic P (Pi) and organic P (Po) forms. We examined thirty-two temperate soils (with soil organic C concentrations 12–449 g C kg− 1 and total P 295–3435 mg P kg− 1) for biogeochemical properties of soil C, reactive surfaces and P by common indices and 31P-NMR spectroscopy on NaOH–EDTA extracts for P species. Arable soil P was dominated by inorganic orthophosphate (276–2520 mg P kg− 1), > monoester P (105–446 mg P kg− 1). The limited diesters, polyphosphates and microbial P in arable soils suggest that cropping and fertiliser inputs limit ecosystem microbial functions and P diversity. Intensive grassland had inorganic orthophosphate concentrations (233–842 mg P kg− 1) similar to monoesters (200–658 mg P kg− 1) > diesters (0–50 mg P kg− 1) and polyphosphates (1–78 mg P kg− 1). As grazing became more extensive P in semi-natural systems was dominated by organic P, including monoesters (37–621 mg P kg− 1) and other diverse forms; principally diester (0–102 mg P kg− 1) and polyphosphates (0–108 mg P kg− 1). These were related to SOC, water extractable organic carbon (WEOC) and microbial P, suggesting strong microbially-mediated processes. A number of abiotic and biotic related processes appeared to control accumulation of different soil P species and gave considerable variability in forms and concentrations within land use groups. The implications are that to increase agricultural P efficiencies mechanisms to utilise both soil Pi and Po are needed and that specific management strategies may be required for site-specific circumstances of soil C and reactive properties such as Fe and Al complexes