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Purpose: To determine the associations between glycated hemoglobin (A1C) values at three, 12 and 24 months postpartum taken during the Families Defeating Diabetes trial. Methods: The Families Defeating Diabetes trial was a randomized 12 month lifestyle intervention delivered in the first year postpartum. Women were reviewed at three, 6 12 and 24 months for body habitus, diet and lifestyle choices. Glycated hemoglobin levels were measured at three, 12 and 24 months. Results: There were 170 randomization participants: 89 interventional (INT); and 81 control (CON). Of these 170 participants, 50 INT and 47 CON completed 12-month follow-up and 26 INT and 24 CON completed 24-month follow-up. Study outcomes did not differ between the cohorts. Combined intraclass correlation coefficients for reliability of repeated results showed substantial reliability: 0.74 (95% CI 0.63, 0.83) between three and 12 month A1C; and 0.72 (95% CI 0.51, 0.85) for three and 24 month A1C. Pearson correlations for three month vs 12 month A1C were r=0.745 (p

At the start of the twentieth century, Dublin city's slums bore comparison to those of Calcutta. The last inner city slums were finally cleared in the 1980s. This paper takes a long-term perspectiv...

With levels of student debt unprecedented and rising in many democracies, growing attention has been given by academics and practitioners to its possible effects for student wellbeing. This...

The dynamics of cerebral blood flow (CBF) at the onset of hypoglycemia may play a key role in hypoglycemia unawareness; however, there is currently a paucity of techniques that can monitor adult CBF with high temporal resolution. Herein, we investigated the use of diffuse correlation spectroscopy (DCS) to monitor the dynamics of CBF during insulin-induced hypoglycemia in adults. Plasma glucose concentrations, cortisol levels, and changes in CBF were measured before and during hypoglycemia in 8 healthy subjects. Cerebral blood flow increased by 42% following insulin injection with a delay of 17 ± 10 min, while the onset of hypoglycemia symptoms was delayed by 24 ± 11 min. The findings suggest that the onset of CBF increments precedes the appearance of hypoglycemia symptoms in nondiabetic subjects with normal awareness to hypoglycemia, and DCS could be a valuable tool for investigating the role of CBF in hypoglycemia unawareness.

Summary Background Although metformin is increasingly being used in women with type 2 diabetes during pregnancy, little data exist on the benefits and harms of metformin use on pregnancy outcomes in these women. We aimed to investigate the effects of the addition of metformin to a standard regimen of insulin on neonatal morbidity and mortality in pregnant women with type 2 diabetes. Methods In this prospective, multicentre, international, randomised, parallel, double-masked, placebo-controlled trial, women with type 2 diabetes during pregnancy were randomly assigned from 25 centres in Canada and four in Australia to receive either metformin 1000 mg twice daily or placebo, added to insulin. Randomisation was done via a web-based computerised randomisation service and stratified by centre and pre-pregnancy BMI ( ClinicalTrials.gov , NCT01353391 . Findings Between May 25, 2011, and Oct 11, 2018, we randomly assigned 502 women, 253 (50%) to metformin and 249 (50%) to placebo. Complete data were available for 233 (92%) participants in the metformin group and 240 (96%) in the placebo group for the primary outcome. We found no significant difference in the primary composite neonatal outcome between the two groups (40% vs 40%; p=0·86; relative risk [RR] 1·02 [0·83 to 1·26]). Compared with women in the placebo group, metformin-treated women achieved better glycaemic control (HbA1c at 34 weeks' gestation 41·0 mmol/mol [SD 8·5] vs 43·2 mmol/mol [–10]; 5·90% vs 6·10%; p=0·015; mean glucose 6·05 [0·93] vs 6·27 [0·90]; difference −0·2 [–0·4 to 0·0]), required less insulin (1·1 units per kg per day vs 1·5 units per kg per day; difference −0·4 [95% CI −0·5 to −0·2]; p Interpretation We found several maternal glycaemic and neonatal adiposity benefits in the metformin group. Along with reduced maternal weight gain and insulin dosage and improved glycaemic control, the lower adiposity and infant size measurements resulted in fewer large infants but a higher proportion of small-for-gestational-age infants. Understanding the implications of these effects on infants will be important to properly advise patients who are contemplating the use of metformin during pregnancy. Funding Canadian Institutes of Health Research, Lunenfeld-Tanenbaum Research Institute, University of Toronto.

Lodging and boarding were well-established housing options which played an important economic and social role in early twentieth-century cities, yet there has been little academic study of the phenomenon in an Irish context. For many people arriving to Dublin in search of work, as well as for adults who were not in a position to establish a separate household, lodging was an important accommodation choice. Offering lodgings was also economically beneficial to householders. Drawing on a range of sources, including census returns, city electoral rolls, newspaper and other archival sources, this article will examine the demographic and socio-economic profile of lodgers and the households in which they resided in Dublin in the early twentieth century. A wide variety of arrangements and durations of lodging is revealed for the period centred on the 1911 census, suggesting that this form of accommodation appealed to a diverse range of individuals due to their economic or family circumstances, or need for mobility.

At its inception, the Irish Free State faced an apparently intractable housing problem that required immediate action. This article examines the legislation enacted in the 1920s and 1930s, focusing on its impact on local authority housing in Ireland's provincial towns. Whereas the 1932 Housing Act has generally been heralded as the start of a concerted attack on the slums, this assertion is re-evaluated in the context of the debates of the 1920s. Following an overview of the national situation, a case-study of Ballina, Co. Mayo, explores the impacts of the housing drive. State-aided housing schemes made a significant contribution to the housing stock between 1923 and 1940. Although characterized by contemporary media as a triumph, however, the housing drive raised many issues including build quality, costs, opposition and social segregation. The article considers some of these challenges and raises a number of questions for future consideration.

Purpose:The Families Defeating Diabetes intervention evaluated a postpartum healthy living program for women with recent gestational diabetes mellitus (GDM).Design:Randomized controlled trial.Setting:Tertiary centers in London, Calgary, and Victoria, Canada.Participants:Women with GDM and partners; 46% of eligible maternal participants agreed to participate.Intervention:Interventional (INT) participants received a healthy living seminar at 3 months; access to a walking group/Website; biweekly e-mails. Control (CON) participants received a contemporary postpartum diabetes prevention handout.Measures:Maternal, partner, and offspring demographics at baseline, 3, and 12 months.Analysis:Percentages of women losing ≥7% of postpartum weight were compared by χ2testing; body habitus comparisons by analysis of covariance (ANCOVA); maternal A1C comparisons by unpaired t tests; participant outcome associations by Pearson correlation coefficients.Results:Maternal participants were 170 (89 INT and 81 CON) with 63 partners (30 INT and 33 CON); 103 (73 maternal; 30 partners) were lost to follow-up; 57% of maternal participants completed 12 months; 33% INT women (n = 50) lost ≥7% weight versus 25% CON women (n = 47), P = .43. Interventional participant results did not correlate with accession of study elements. Maternal completion was significantly associated with partner involvement, breastfeeding, higher income, and education. Paternal weights correlated significantly with maternal and offspring weights.Conclusion:Families Defeating Diabetes outcomes were not significantly different for INT maternal or paternal participants versus CON participants. Secondary outcomes of future value included statistically significant positive associations between paternal participation, socioeconomic indicators, and maternal study completion, significant correlations between maternal, paternal, and offspring weights as well as insights into study component engagement.

This chapter draws on material from throughout the entire book including geography, place, memory, WWI commemorations, case studies and especially education with an emphasis on Teaching and Learning (T&L) including autonomous individual work. It promotes studies in geography including inter-disciplinary and inter-cultural approaches drawing on the wealth of geographical, educational and cultural capital displayed by the various authors from a wide range of countries and traditions. The chapter provides resources to encourage both self-directed readers and educators to reflect on the themes of the volume. A broad range of sources and methodologies is presented, combined with both chapter-specific and broader questions, project exemplars and suggestions for enhancing & extending learning.

Background: The numbers of women attending Diabetes and Pregnancy Clinics (DPC) are increasing. Some of the increase may reflect obesity effects on GDM prevalence, but changes in numbers and characteristics of women with type 1 diabetes (T1DM) are unknown. The DPC in London Ontario sees all pregnant women with diabetes within the catchment area with stable clinic structures and procedures. Longitudinal characteristics of women with T1DM were documented for demographic insights. Methods: DPC pregnancy charts were assessed for 2000-2002, 2010-2012 and 2014-2016. Data were abstracted for: age; weight, A1C and medication use. Continuous results were analyzed by one-way analysis of variance (ANOVA); non-parametric results by Chi-square testing; p≤ 0.05 signifying significance. Conclusions: Clinic numbers of pregnant women with T1DM increased non-significantly over the study timeline while pump usage rose concurrent with access to government funding. A1C values fell 0.5% from first to last visit in all time periods. A1C values at first visit rose over the time periods suggesting women with less optimal glucose control were conceiving pregnancies. Disclosure P. Khanna: None. K. Anukam: None. L. Chow: None. E. Brydges: None. S.L. Liu: Consultant; Self; Novo Nordisk Inc., Sanofi. Research Support; Self; Physicians' Services Inc. Foundation. J. Mahon: None. T.R. Joy: Speaker's Bureau; Self; Amgen Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Amgen Inc., AstraZeneca, Novo Nordisk Inc. R.M. McManus: None.

Pregnancies complicated by diabetes are increasingly frequent. The Endocrine and Pregnancy Clinic [EPC] at St Joseph’s Health Care London is the stable, local provider of all outpatient pregnancy diabetes care, thereby providing an opportunity to document patient characteristics with time. Methods EPC charts were reviewed for: 2000-2002; 2010-2012; 2014-2016 documenting DM type (T1DM, T2DM, GDM); age; weight; year/week of DM diagnosis; medication/pump use; A1C. Continuous results were analyzed by one-way analysis of variance (ANOVA); non-parametric results were analyzed by Chi-square testing; p Results Total EPC DM women were: 2000-2002: 408; 2010-2012: 571; 2014-2016: 813. GDM women represented 72.8% of EPC patients in 2001-2002 and 88.4% in 2014-2016. Weights and oral medication use increased with time for women with GDM, while insulin use decreased. Pump use in women with T1DM increased by 2010-2012 and 2014-2016 while A1C decreased significantly comparing first to last visits within each time interval. Numbers of women with T2DM increased significantly but weight at first clinic visit was lower over time, while A1C decreased significantly when comparing first to last visits within each time interval. Discussion/Conclusions EPC volumes doubled from 2000 to 2016 with no increase in background deliveries, predominantly due to increased numbers of women GDM, along with a small increase in women with T2DM. These findings may help inform decisions around health care planning and resource allocation.

Objectives: FDD was a 12 month, multi-centre, Canadian, randomized study translating diabetes-protective messages after GDM. Male partner participation was encouraged. We compared paternal vs. maternal food choices for interventional (INT) and control (CON) participants before and after FDD. Methods: INT maternal and paternal participants received information promoting high fibre/low fat foods; portion control; healthy restaurant choices via postpartum seminar, access to branded FDD website and twice-monthly email contact. CON maternal subjects received a postpartum healthy living handout. One-day food records at 3 and 12 months were analyzed for fast food intake (FF) and Canada’s Food Guide (CFG) servings. Results: 15 INT and 16 CON maternal/paternal pairs provided food records at 3 and 12 months. Considering INT and CON cohorts together: paternal and maternal grain products, milk/alternatives and meat/alternatives consumption met CFG guidelines at 3 and 12 months. Paternal and maternal vegetables and fruit (V and F) intakes were similar but lower than recommended (paternal: goal 8-10 servings/day; baseline 3.8±2.2; 12 months 4.6±2.9; maternal: goal 7-8 servings/day; baseline 4.1±2.8; 12 months 5.4±3.2). Paternal FF intake was higher than maternal at baseline: (0.41±0.61 vs. 0.12±0.34; p=0.03) but not at 12 months (0.44±0.62 vs. 0.34±0.40, p=0.6). Paternal and maternal V and F intakes were modestly correlated by 12 months (r=0.35, p=0.05). Conclusions: Notable paternal and maternal postpartum diet choices were: servings of V and F did not meet CFG recommendations at 3 and 12 months for men or women; paternal FF intake was higher than maternal soon after delivery, but not at 12 months as maternal servings increased; paternal and maternal V and F intakes were correlated at 12 months postpartum. Therefore, it may be helpful to target both paternal and maternal food choices when promoting healthy living after GDM. Disclosure A. Vezina: None. R.M. McManus: None. L.E. Donovan: None. D.B. Miller: None. I.T. Giroux: None.

The article asks whether disasters that destroy life but leave the material infrastructure relatively intact tend to prompt communal coping focusing on loss, while disasters that destroy significant material infrastructure tend to prompt coping through restoration/rebuilding. After comparing memorials to New Zealand’s Christchurch earthquake and Pike River mine disasters, we outline circumstances in which collective restorative endeavor may be grassroots, organized from above, or manipulated, along with limits to effective restoration. We conclude that bereavement literature may need to take restoration more seriously, while disaster literature may need to take loss more seriously.

Individuals who register as body donors do so for various reasons, with aiding medical science a common motivation. Despite awareness of several key reasons for donation, there are few in-depth explorations of these motivations to contextualize persons' reasons for donating. This study undertakes a mixed-method exploration of motivations for body donation to facilitate deeper understanding of the reasons underpinning donor registration. A survey of all newly registered body donors at a New Zealand university was performed over a single year. The survey included basic demographic information, a categorical question on reason for donation, a free-text question on donation motivation, and a free-text question allowing "other" comments on body donation. Basic statistical analysis was performed on demographic and categorical data, and thematic analysis used on free-text responses. From 169 registrants, 126 people (average age 70.5 years; 72 female) returned completed surveys (response rate 75%). Categorical data indicate a primary motivation of aiding medical science (86%). Fifty-one respondents (40%) provided free-text data on motivation, with other comments related to motivation provided by forty-one (33%). Common themes included reference to usefulness, uniqueness (pathophysiology and anatomy), gift-giving, kinship, and impermanence of the physical body. Consistent with previous studies, the primary reason for body donation was aiding medical science, however underpinning this was a complex layer of themes and sub-themes shaping motivations for choices. Findings provide important information that can guide development of robust informed consent processes, aid appropriate thanksgiving service delivery, and further contextualize the importance of medical professionals in body donation culture.

This chapter presents a concise overview of the evolution and development of Irish suburbia from the nineteenth century to the present. As well as charting the changing nature, form, function and meaning of the Irish suburb, the chapter also recognises key phases in its development that reflect social, political and economic change. It reveals that while the growth and development of Irish suburbia largely mirrors the American and British experience, Irish suburbia has its own particular character and unique cultures.

Background: Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. Methods: In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. Findings: Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). Interpretation: Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. Funding: Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.

Prevailing discourses condemn funerals as a costly distress purchase where funeral directors have greedily preyed upon funeral arrangers’ grief laden vulnerability. They explain funerals as distres...

Objective Gestational diabetes mellitus (GDM) has been associated with inflammation as well as Vitamin D insufficiency. While Vitamin D has anti-inflammatory properties, relationships between Vitamin D and inflammatory markers remain unexplored in GDM. Therefore, this case - control study investigated adipocytokine and Vitamin D [25(OH)D] concentrations and correlations in GDM and control women, as well as their neonates. Design/Participants/Measurements seventy-three women participated: 36 GDM and 37 controls. Maternal samples were drawn at 31 weeks. Umbilical arterial and venous samples were collected at birth. 25(OH)D and adipocytokine concentrations were compared for GDM vs control maternal, umbilical arterial and venous samples. Correlations were explored between biochemical results, maternal and neonatal demographics. Results Compared with age- and weight-matched control participants, GDM women had significantly lower concentrations of 25(OH)D (77·3 ± 24·3 vs 93·2 ± 19·2 nm/l; P = 0·009); adiponectin (17·5 ± 11·8 vs 34·1 ± 20·3 μg/ml, P < 0·001); resistin (25·4 ± 9·1 vs 31·9 ± 12·1 ng/ml, P = 0·045); and plasminogen activator inhibitor-1 (PAI-1) 13·9 ± 10·0 vs 21·0 ± 12·6 ng/ml, P = 0·038), while delivering 1 week earlier (38·2 ± 1·2 vs 39·5 ± 0·9 weeks, P < 0·001). GDM maternal 25(OH)D concentrations positively correlated with PAI-1, IL-8 and TNF-α concentrations. Umbilical 25(OH)D concentrations were not significantly different in GDM vs control offspring, whereas adiponectin, resistin and PAI-1 concentrations were significantly lower in GDM offspring. Conclusions GDM women had lower 25(OH)D concentrations than controls, while neonatal umbilical concentrations of 25(OH)D did not differ. GDM maternal and GDM offspring had lower adiponectin, resistin and PAI-1 concentrations compared with controls. Results suggest that both GDM women and their offspring demonstrate abnormal adipocytokine patterns. © 2013 John Wiley & Sons Ltd.

Background: women with type 1 diabetes strive for optimal glycemic control before and during pregnancy to avoid adverse obstetric and perinatal outcomes. For most women, optimal glycemic control is challenging to achieve and maintain. The aim of this study is to determine whether the use of real-time continuous glucose monitoring (RT-CGM) will improve glycemic control in women with type 1 diabetes who are pregnant or planning pregnancy.Methods/design: a multi-center, open label, randomized, controlled trial of women with type 1 diabetes who are either planning pregnancy with an HbA1c of 7.0 % to ?10.0 % (53 to ??86 mmol/mol) or are in early pregnancy (Discussion: this will be the first international multicenter randomized controlled trial to evaluate the impact of RT- CGM before and during pregnancy in women with type 1 diabetes.Trial registration: ClinicalTrials.gov Identifier: NCT01788527 Registration Date: December 19, 2012

Background Exercise may influence glucose metabolism during pregnancy. We examined the effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes mellitus (GDM) who followed a modified GDM meal plan. Methods Randomization occurred at study entry (16–20 weeks' gestation) into a low-intensity [30% heart rate reserve, low risk-30%I, n = 12; high risk-30%I, n = 11] or vigorous-intensity (70% heart rate reserve, low risk-70%I, n = 12; R-70%I, n = 11) exercise program with similar nutritional control. Exercise consisted of walking three to four times a week, gradually increasing time from 25 to 40 min/session. Free-living capillary glucose concentrations were measured once a week pre-exercise and post-exercise. Results Capillary glucose responses to exercise were strongly influenced by an interaction between GDM risk, exercise duration and exercise intensity (p = 0.006). Decreases in glucose concentrations were observed after 25 (4 ± 13%), 35 (21 ± 12%) and 40 min (15 ± 18%) of walking in high risk-30%I women, with the most noticeable decline after 35 and 40 min. In the high risk-70%I, glucose concentrations decreased significantly only after 25 (22 ± 14%) and 35 min (7 ± 23%) and increasing the exercise time attenuated glucose concentrations decline. In low risk women, regardless of exercise intensity and duration, decreases in glucose concentrations were significant and similar. Conclusion To achieve the best decline in glucose concentrations, pregnant women who follow a modified GDM meal plan should walk for 25 min/session at vigorous intensity or for 35–40 min/session at low intensity if they are at risk for GDM and for at least 25 min at either low or vigorous intensity if they are at low risk for GDM. Copyright © 2012 John Wiley & Sons, Ltd.

The new Canadian Diabetes Association (CDA)/Diabetes Quebec report entitled “Diabetes: Canada at the Tipping Point” (1) arrived at the end of 2011. This important document summarizes the challenges and opportunities bound up in the type 2 diabetes epidemic. Repeating for the sake of clarity, type 2 diabetes incidence and prevalence are increasing inexorably so that an estimated one-third of the Canadian population will be affected by one of diabetes, impaired glucose tolerance or impaired fasting glucose by the end of this decade (2). The epidemic of type 2 diabetes has importance that ranges from the personal to societal (3). At the clinical level, people with type 2 diabetes as well as their medical care providers find quality diabetes care to be hugely demanding. Further, increasing type 2 diabetes prevalence exerts immense pressure on our systems, including governmental abilities to adequately fund healthcare (3e5). Social and financial burdens will be further magnified when earlier onset of type 2 diabetes removes productive payers prematurely from the work force and tax base (6). That is the bad news. Here is the good news. Type 2 diabetes has been shown to be significantly preventable. Well-done studies of the past decade have confirmed that primary prevention (meaning: avoiding or significantly delaying the onset) of type 2 diabetes is possible, cost-effective and without worrying side effects, through lifestyle modification and medication (7e10). Further, even a small decrease in diabetes prevalence would result in a significant reduction in healthcare spending (3). Canadian medical systems are engaged in the type 2 diabetes secondary prevention journey with collective efforts to translate optimal care into reduced risk for complications for people with established diabetes (11). However, despite activity around chronic disease prevention (Manitoba’s “Reduce your Risk” campaign, BC and Alberta’s healthy living initiatives, the call for a national obesity strategy [1]) so far as a nationwe have not become usefully engaged in the urgent need for wide-spread and effective type 2 diabetes primary prevention. This present commentary is a Canadian call to action, asserting that right here and right now we have the