?Vitamin?D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention“

The overall aim of the vitamin D and lifestyle intervention for gestational diabetes mellitus prevention (DALI) project funded by the European Commission is to identify the best available measures to prevent gestational diabetes mellitus (GDM). Additional aims are (1) to provide a cost-benefit calculation of GDM prevention for health care systems, (2) to establish the current status of GDM across Europe and facilitate the adoption of a single diagnostic approach and (3) to establish a pan-European cohort of mother-offspring pairs for future analyses with a central biobank and data base. The consortium comprises 11 partners from academia and 2 small to medium enterprises (SME) from 10 European countries. A randomized controlled trial will be conducted in ten European countries. In each country 100 women with a body mass index (BMI) ???29 will be recruited before the 12th week of pregnancy and followed up for approximately 7 months until delivery. The women will be randomized into two groups with lifestyle interventions and vitamin D supplementation or no intervention. Women receiving lifestyle interventions (e.g. physical activity, diet or a combination) will have personal contact with a lifestyle coach trained in motivational interviewing. The main outcome measures of the trial are fasting blood glucose, weight gain during pregnancy and insulin sensitivity.     

Lifestyle Factors Affecting the Gut Microbiota’s Relationship with Type 1 Diabetes

Purpose of Review

The incidence of type 1 diabetes (T1D) is rising drastically for the past decades at a rate that cannot be explained by genetic changes alone. Environmental changes are considered to be the main drivers of this change. Recently, the gut microbiota has been suggested as a missing link between known environmental disease modulators and T1D promotion. Lifestyle factors have changed over time and have altered the gut microbiota-host interaction affecting T1D development. The purpose of this review is to discuss recent data emphasizing the modulatory potential of early lifestyle factors on gut microbiota and to elucidate their implication for T1D.

Recent Findings

Recent findings show that lifestyle factors, especially those that affect the early establishment of gut homeostasis and the education of the immune system, are crucial disease modulators.

Summary

Changing lifestyle factors affecting the early establishment of gut homeostasis are suggested to be key drivers of the rising T1D incidence.

     

Evaluation of VA Women’s Health Fellowships: Developing Leaders in Academic Women’s Health

BACKGROUND

The Department of Veterans Affairs (VA) instituted the VA Women’s Health Fellowship (VAWHF) Program in 1994, to accommodate the health needs of increasing numbers of female veterans and to develop academic leaders in women’s health. Despite the longevity of the program, it has never been formally evaluated.

OBJECTIVE

To describe the training environments of VAWHFs and career outcomes of female graduates.

DESIGN AND PARTICIPANTS

Cross-sectional web-based surveys of current program directors (2010–2011) and VAWHF graduates (1995–2011).

RESULTS

Responses were received from six of seven program directors (86 %) and 42 of 74 graduates (57 %). The mean age of graduates was 41.2 years, and mean time since graduation was 8.5 years. Of the graduates, 97 % were female, 74 % trained in internal medicine, and 64 % obtained an advanced degree. Those with an advanced degree were more likely than those without an advanced degree to pursue an academic career (82 % vs. 60 %; P?<?0.01). Of the female graduates, 76 % practice clinical women’s health and spend up to 66 % of their time devoted to women’s health issues. Thirty percent have held a VA faculty position. Seventy–nine percent remain in academics, with 39 % in the tenure stream. Overall, 94 % had given national presentations, 88 % had received grant funding, 79 % had published in peer-reviewed journals, 64 % had developed or evaluated curricula, 51 % had received awards for teaching or research, and 49 % had held major leadership positions. At 11 or more years after graduation, 33 % of the female graduates in academics had been promoted to the rank of associate professor and 33 % to the rank of full professor.

CONCLUSIONS

The VAWHF Program has been successful in training academic leaders in women’s health. Finding ways to retain graduates in the VA system would ensure continued clinical, educational, and research success for the VA women veteran’s healthcare program.     

Women’s Health Training in Gastroenterology Fellowship: A National Survey of Fellows and Program Directors

Background and Aims  

The Gastroenterology Core Curriculum requires training in women’s digestive disorders; however, requirements do not necessarily produce knowledge and competence. Our study goals were: (1) to compare perceptions of education, fellow-reported levels of competence, and attitudes towards training in women’s gastrointestinal (GI) health issues during fellowship between gastroenterology fellows and program directors, and (2) to determine the barriers for meeting training requirements.     

Perspectives of Non-Hispanic Black and Latino Patients in Boston’s Urban Community Health Centers on their Experiences with Diabetes and Hypertension

Background  

Racial/ethnic disparities exist in the prevalence and outcomes of diabetes and hypertension in the U.S. A better understanding of the health beliefs and experiences of non-Hispanic Blacks and Latinos with these diseases could help to improve their care outcomes.     

Prevention of post-operative recurrence of Crohn’s disease

Endoscopic and clinical recurrence of Crohn’s disease(CD)is a common occurrence after surgical resection.Smokers,those with perforating disease,and those with myenteric plexitis are all at higher risk of recurrence.A number of medical therapies have been shown to reduce this risk in clinical trials.Metronidazole,thiopurines and anti-tumour necrosis factors(TNFs)are all effective in reducing the risk of endoscopic or clinical recurrence of CD.Since these are preventative agents,the benefits of prophylaxis need to be weighed-against the risk of adverse events from,and costs of,therapy.Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF.Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year.Clinical recurrence rates are variable,and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.     

Alcohol for the Prevention of Type 2 Diabetes Mellitus?

While diabetes mellitus is recognized clinically as a complication of alcohol dependence, in the last 15 years several large prospective studies have demonstrated a significant reduction in risk of incident type 2 diabetes in moderate drinkers. In this article, we review prospective studies on the association between alcohol consumption and incidence of diabetes. Few prospective studies have demonstrated an unequivocal positive association between alcohol use and incidence of diabetes. A number of large prospective studies have now demonstrated an inverse association: typically a 40% risk reduction after controlling for other major risk factors. Studies based on cohorts of health professionals have not demonstrated an increased risk of diabetes with heavier consumption, but these cohorts contain few heavy drinkers. Some cohorts drawn from the general population have shown a J- or U-shaped association between level of alcohol consumption and incidence of diabetes. Frequent moderate drinking has been reported to be associated with lower risk than infrequent drinking. There have been contradictory reports on the importance of the type of alcoholic beverage and whether the effect of alcohol differs according to the bodyweight of the drinker. We conclude that like many other chronic diseases, there is a delicate balance between the harmful and beneficial effects of alcohol on the incidence of diabetes. In moderate amounts, drinking is associated with a reduced risk of diabetes, whereas in higher amounts with an increased risk.     

Role of goblet cells in the progression of Barrett’s esophagus

正Objective To investigate the clinical pathological features of Barrett’s esophagus in China,and to study the relationship between the number of goblet cells and the severity of Barrett’s esophageal dysplasia.Methods From January 2008 to October 2018,in the Department of Gastroenterology and Hepatology,Tianjin Medical University     

The Health of the “Older Women” in Accra,Ghana: Results of the Women’s Health Study of Accra

The health of women residing in the developing countries is not limited to reproductive health conditions or infectious diseases. While these illnesses remain serious threats to a healthy life, as the population ages, the prevalence of illnesses considered to be of significance only in industrialized nations also increasingly afflicts the residents of the developing worlds. The health and well-being of the older women was evaluated in the 2003 Women’s Health Study of Accra. This community based survey and clinical and laboratory examination of 1,328 women identified a significantly high prevalence of malaria and chronic, non-communicable diseases in all age groups without regard to education level or income. Hypertension, diabetes and obesity are significantly prevalent in women age 50 years and older. The prevalence of conditions which adversely affect health and quality of life, including impaired visual acuity, poor dentition, pain and limitations with mobility is significant in the women age 50 years and older. While these data are specific to Ghana, they have the potential to be generalizable to women in other urban areas in transition. As the life expectancy is increasing in developing countries, an increased awareness and treatment of chronic health conditions in the older women is critical to ensure a healthy life as they enter their golden years.     

Optimising Women’s Cardiovascular Health After Hypertensive Disorders of Pregnancy: A Translational Approach to Cardiovascular Disease Prevention

Women who experience a hypertensive disorder of pregnancy (HDP) are among those at the highest risk of premature cardiovascular disease (CVD). In Canada, effective CVD prevention interventions tailored specifically for this high-risk population are urgently needed. The objective of this review is to summarise a broad range of mechanistic and clinical studies examining the association of HDPs with future CVD to inform postpartum clinical follow-up strategies focused on improving women’s cardiovascular health. The current state of the science (animal model, observational, and intervention studies) largely support 2 main hypotheses explaining the epidemiologic link between HDPs and long-term risk of CVD. First, that the complicated pregnancy “unmasks” women who were predisposed to CVD before pregnancy (eg, women with subclinical atherosclerosis or prepregnancy CVD risk factors). And second, that HDP causes vascular dysfunction and/or worsens preexisting subclinical CVD risk factors. Despite this strong evidence, several knowledge gaps remain in the understanding of specific mechanisms linking these theories and the impacts of other important contributors (eg, intersectional factors). From a clinical perspective, given the consistent data demonstrating a high prevalence of CVD risk factors after HDP, routine care after pregnancy at minimum should include: 1) standardised assessment of pregnancy-associated CV risks, 2) early and regular screening of traditional CVD risk factors, 3) education and support for health behaviours as first-line therapy (including breastfeeding), 4) individualised pharmacotherapy (eg, statins, antihypertensives, or antiglycemic agents as clinically indicated), and 5) consideration of a woman’s health goals, reproductive plans, and social context.