Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up

<p>Abstract</p> <p>Background</p> <p>Annual prevalence of gestational diabetes mellitus (GDM) is 12.5% among Finnish pregnant women. The prevalence is expected to rise with the increasing overweight among women before pregnancy. Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM. We aimed to investigate, whether GDM can be prevented by counseling on diet, physical activity and gestational weight gain during pregnancy.</p> <p>Methods/Design</p> <p>A cluster-randomized controlled trial was conducted in 14 municipalities in the southern part of Finland. Pairwise randomization was performed in order to take into account socioeconomic differences. Recruited women were at 8-12 weeks' gestation and fulfilled at least one of the following criteria: body mass index ≥ 25 kg/m², history of earlier gestational glucose intolerance or macrosomic newborn (> 4500 g), age ≥ 40 years, first or second degree relative with history of type 1 or 2 diabetes. Main exclusion criterion was pathological oral glucose tolerance test (OGTT) at 8-12 weeks' gestation. The trial included one counseling session on physical activity at 8-12 weeks' gestation and one for diet at 16-18 weeks' gestation, and three to four booster sessions during other routine visits. In the control clinics women received usual care. Information on height, weight gain and other gestational factors was obtained from maternity cards. Physical activity, dietary intake and quality of life were followed by questionnaires during pregnancy and at 1-year postpartum. Blood samples for lipid status, hormones, insulin and OGTT were taken at 8-12 and 26-28 weeks' gestation and 1 year postpartum. Workability and return to work were elicited by a questionnaire at 1- year postpartum. Linkage to the national birth register of years 2007-2009 will provide information on perinatal complications and GDM incidence among the non-participants of the study. Cost-effectiveness evaluation will be based on quality-adjusted life years. This study has received ethical approval from the Ethical board of Pirkanmaa Hospital District.</p> <p>Discussion</p> <p>The study will provide information on the effectiveness and cost-effectiveness of gestational physical activity and dietary counseling on prevention of GDM in a risk group of women. Also information on the prevalence of GDM and postpartum metabolic syndrome will be gained. Results on maintaining the possible health behaviour changes are important in order to prevent chronic diseases such as cardiovascular disease and diabetes.</p> <p>Trial registration</p> <p>The trial is registered ISRCTN 33885819</p

Sosiaali- ja terveydenhuollon paloturvallisuuteen liittyvät käytännöt aitoshoidossa, tuetussa asumisessa ja kotiin annettavissa palveluissa 2015

Tutkimusraportti on osa Sosiaali- ja terveydenhuollon paloturvallisuuteen liittyvät käytännöt ja pelastuslaki (STEP) -hanketta. Hanke on Terveyden ja hyvinvoinnin laitoksen vuosina 2012–2016 toteuttama tutkimus- ja kehittämishanke. Hanke käynnistettiin pelastuslain vaatimusten toteutumisen seuraamiseksi. Taustalla on huoli sosiaali- ja terveydenhuollon asiakkaiden paloturvallisuudesta. Huoli kytkeytyy yhteiskunnalliseen muutokseen, jossa erityistä tukea tarvitsevien ryhmien asumisessa suositaan ja tuetaan kotona asumista.Raportissa julkaistaan 2015 tehdyn kyselyn tulokset ja pohditaan tilanteen muuttumista 2013 tehdyn edellisen vastaavan kyselyn perusteella. Raportissa arvioidaan vuoden 2011 pelastuslain vaatimusten toteutumista ja tilanteen muutosta asteittain vuoteen 2015.Hankkeen aikana on tehty yhteensä neljä erillistä kyselyä ja yksi haastattelututkimus. Lisäksi on tehty kirjallisuushakua ja tuotettu maksuton koulutusaineisto. Tämä raportti, 2013 tehdyn kyselyn raportti, samoin kuin koulutusaineisto ovat maksutta saatavissa hankkeen verkkosivuilta http://www.thl.fi/stepSTEP-hankkeen osana tehty haastattelututkimus antaa laadullista tietoa paloturvallisuusriskeistä ja niiden parannusehdotuksista. Haastattelututkimuksen tulokset julkaistaan erillisinä artikkeleina.STEP-hanke on toteutettu Palosuojelurahaston, Sisäministeriön sekä Terveyden ja hyvinvoinnin laitoksen rahoituksella. Kiitämme Palosuojelurahastoa ja Sisäministeriötä, Pelastusopistoa ja pelastuslaitoksia hankkeen aikana tehdystä yhteistyöstä ja kaikkia kyselyihin ja haastatteluihin osallistuneita henkilöitä arvokkaasta panoksestanne. Samoin kiitämme STEP-hankkeen ensimmäisen vaiheen toteuttaneita henkilöitä: Mirka Råback, Markus Grönfors, Antti Impinen, Nina Martikainen ja Pirjo Lillsunde.</p

Systemic cross-talk between brain, gut, and peripheral tissues in glucose homeostasis : effects of exercise training (CROSSYS). Exercise training intervention in monozygotic twins discordant for body weight

Background: Obesity and physical inactivity are major global public health concerns, both of which increase the risk of insulin resistance and type 2 diabetes. Regulation of glucose homeostasis involves cross-talk between the central nervous system, peripheral tissues, and gut microbiota, and is affected by genetics. Systemic cross-talk between brain, gut, and peripheral tissues in glucose homeostasis: effects of exercise training (CROSSYS) aims to gain new systems-level understanding of the central metabolism in human body, and how exercise training affects this cross-talk. Methods: CROSSYS is an exercise training intervention, in which participants are monozygotic twins from pairs discordant for body mass index (BMI) and within a pair at least the other is overweight. Twins are recruited from three population-based longitudinal Finnish twin studies, including twins born in 1983-1987, 1975-1979, and 1945-1958. The participants undergo 6-month-long exercise intervention period, exercising four times a week (including endurance, strength, and high-intensity training). Before and after the exercise intervention, comprehensive measurements are performed in Turku PET Centre, Turku, Finland. The measurements include: two positron emission tomography studies (insulin-stimulated whole-body and tissue-specific glucose uptake and neuroinflammation), magnetic resonance imaging (brain morphology and function, quantification of body fat masses and organ volumes), magnetic resonance spectroscopy (quantification of fat within heart, pancreas, liver and tibialis anterior muscle), echocardiography, skeletal muscle and adipose tissue biopsies, a neuropsychological test battery as well as biosamples from blood, urine and stool. The participants also perform a maximal exercise capacity test and tests of muscular strength. Discussion: This study addresses the major public health problems related to modern lifestyle, obesity, and physical inactivity. An eminent strength of this project is the possibility to study monozygotic twin pairs that share the genome at the sequence level but are discordant for BMI that is a risk factor for metabolic impairments such as insulin resistance. Thus, this exercise training intervention elucidates the effects of obesity on metabolism and whether regular exercise training is able to reverse obesity-related impairments in metabolism in the absence of the confounding effects of genetic factors.Peer reviewe

Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care

<p>Abstract</p> <p>Background</p> <p>Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems. Intervention studies aiming at preventing excessive pregnancy-related weight gain are needed. The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study.</p> <p>Methods</p> <p>A non-randomized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finland. Altogether, 132 pregnant and 92 postpartum women and 23 public health nurses (PHN) participated in the study. The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks' gestation or ten months postpartum. The control clinics continued their usual care. The components of the feasibility evaluation were 1) recruitment and participation, 2) completion of data collection, 3) realization of the intervention and 4) the public health nurses' experiences.</p> <p>Results</p> <p>1) The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months. The average participation rate of eligible women at study enrolment was 77% and the drop-out rate 15%. 2) In total, 99% of the data on weight, physical activity and diet and 96% of the blood samples were obtained. 3) In the intervention clinics, 98% of the counselling sessions were realized, their contents and average durations were as intended, 87% of participants regularly completed the weekly records for physical activity and diet, and the average participation percentage in the group exercise sessions was 45%. 4) The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study.</p> <p>Conclusion</p> <p>The study protocol was mostly feasible to implement, which encourages conducting large trials in comparable settings.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN21512277</p

Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial

In a cluster-randomized trial, Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing gestational diabetes mellitus (GDM), but fail to find an effect on GDM

Systemic cross-talk between brain, gut, and peripheral tissues in glucose homeostasis: effects of exercise training (CROSSYS). Exercise training intervention in monozygotic twins discordant for body weight

Background: Obesity and physical inactivity are major global public health concerns, both of which increase the risk of insulin resistance and type 2 diabetes. Regulation of glucose homeostasis involves cross-talk between the central nervous system, peripheral tissues, and gut microbiota, and is affected by genetics. Systemic cross-talk between brain, gut, and peripheral tissues in glucose homeostasis: effects of exercise training (CROSSYS) aims to gain new systems-level understanding of the central metabolism in human body, and how exercise training affects this cross-talk.Methods: CROSSYS is an exercise training intervention, in which participants are monozygotic twins from pairs discordant for body mass index (BMI) and within a pair at least the other is overweight. Twins are recruited from three population-based longitudinal Finnish twin studies, including twins born in 1983-1987, 1975-1979, and 1945-1958. The participants undergo 6-month-long exercise intervention period, exercising four times a week (including endurance, strength, and high-intensity training). Before and after the exercise intervention, comprehensive measurements are performed in Turku PET Centre, Turku, Finland. The measurements include: two positron emission tomography studies (insulin-stimulated whole-body and tissue-specific glucose uptake and neuroinflammation), magnetic resonance imaging (brain morphology and function, quantification of body fat masses and organ volumes), magnetic resonance spectroscopy (quantification of fat within heart, pancreas, liver and tibialis anterior muscle), echocardiography, skeletal muscle and adipose tissue biopsies, a neuropsychological test battery as well as biosamples from blood, urine and stool. The participants also perform a maximal exercise capacity test and tests of muscular strength.Discussion: This study addresses the major public health problems related to modern lifestyle, obesity, and physical inactivity. An eminent strength of this project is the possibility to study monozygotic twin pairs that share the genome at the sequence level but are discordant for BMI that is a risk factor for metabolic impairments such as insulin resistance. Thus, this exercise training intervention elucidates the effects of obesity on metabolism and whether regular exercise training is able to reverse obesity-related impairments in metabolism in the absence of the confounding effects of genetic factors

Yrittäjyyden haasteet ja pelot

Yrittäjyys on lähes ainoa työllistymiskeino parturi-kampaamo alalla. Työpaikkoja ei ole ja yrittäjyyteen kannustetaan, mutta mikä siinä pelottaa? Opinnäytetyön tavoitteena oli selvittää yrittäjyyden esteitä, pelkoja sekä sitä mikä yrittäjyydessä mietityttää. Ongelmakohtien selvittämiseksi tehtiin alakohtainen kyselykartoitus. Kyselykartoituksen pohjalta selvisi, että suurimmat huolenaiheet kohdistuivat taloudelliseen toimeentuloon, asiakashankinnan vaikeuteen, yrittäjyystiedon hallinnan puutteisiin sekä siihen mistä apua yrittäjyyteen olisi saatavilla. Opinnäytetyö käsittelee kartoituksessa esille tulleita asioita helppotajuisesti ja pyrkii oppaan kaltaisesti tuomaan tietoa pelkoa ja huolta tuottavista asioista. Työssä pyritään tuomaan tietoa helposti lähestyttävästi asioista, joihin yrittäjyyttä suunnittelevalla ei vielä ole kokemusta. Samoin siinä tuodaan esille tiedonhallinnan tärkeyttä yrittäjyyden hallinnassa. Tavoitteena on myöhemmin tuottaa opinnäytetyön pohjalta helposti lähestyttävä opas sekä koulutusmateriaali, joka suunnataan opinto/koulutusmateriaaliksi alan opiskelijoille sekä yrittäjyyttä suunnittelevalle.Entrepreneurship is almost the only way of employment in the hairdressing branch. Jobs are not available and people are encouraged to entrepreneurship but what is so frightening about it? The aim in this thesis was to clarify the barriers and fears in entrepreneurship as well as what puzzles in it. Sectoral survey was made to make clear the problem areas. Based on the survey became clear that biggest concerns were focused at economical livelihood, difficulty purchasing customers and lack of entrepreneurships data management as well as where to receive help for entrepreneurship. The thesis handles facts that emerged in the survey in an easy-to-understand way and aims in a guiding way to give information about facts that cause fear and concern. The work pursues information in an approachable way about facts that a person who plans entrepreneurship does not have yet experience in. Likewise the work discloses the importance of data management in mastering entrepreneurship. Based on the thesis the goal is to later on produce an approachable guide as well as an education material, which is targeted as a study/education material for students in this branch as for those who plan entrepreneurship