Does First Nations ancestry modify the association between gestational diabetes and subsequent diabetes: a historical prospective cohort study among women in Manitoba, Canada.

BACKGROUND: Over the past 30 years, the prevalence of diabetes has steadily increased among Canadians, and is particularly evident among First Nations (FN) women. The interplay between FN ancestry, gestational diabetes and the development of subsequent diabetes among mothers remains unclear. METHODS: After excluding known pre-existing diabetes, we explored whether FN ancestry may modify the association between gestational diabetes and post-partum diabetes among women in Manitoba (1981-2011) via a historical prospective cohort database study. We analysed administrative data in the Population Health Research Data Repository using Kaplan-Meier survival analysis and Cox proportional hazards regression. RESULTS: Gestational diabetes was diagnosed in 11 906 of 404 736 deliveries (2.9%), 6.7% of FN and 2.2% of non-FN pregnant women (P < 0.0001). Post-partum diabetes during ≤ 30 years follow-up was more than three times higher among FN women than among non-FN women (P < 0.0001). Diabetes developed in 76.0% of FN and 56.2% of non-FN women with gestational diabetes within the follow-up period. The hazard ratio of gestational diabetes for post-partum diabetes was 10.6 among non-FN women and 5.4 among FN women. Other factors associated with a higher risk of diabetes included lower family income among FN and non-FN women and rural/remote residences among FN women. Among non-FN women, urban residence was associated with a higher risk of diabetes. CONCLUSION: Gestational diabetes increases post-partum diabetes in FN and non-FN women. FN women had substantially more gestational diabetes or post-partum diabetes than non-FN women, partially due to socio-economic and environmental barriers. Reductions in gestational diabetes and socio-economic inequalities are required to prevent diabetes in women, particularly in FN population.

Long-term benefits of full-day kindergarten: a longitudinal population-based study.

In the first longitudinal, population-based study of full-day kindergarten (FDK) outcomes beyond primary school in Canada, we used linked administrative data to follow 15 kindergarten cohorts (n ranging from 112 to 736) up to grade 9. Provincial assessments conducted in grades 3, 7, and 8 and course marks and credits earned in grade 9 were compared between FDK and half-day kindergarten (HDK) students in both targeted and universal FDK programmes. Propensity score matched cohort and stepped-wedge designs allowed for stronger causal inferences than previous research on FDK. We found limited long-term benefits of FDK, specific to the type of programme, outcomes examined, and subpopulations. FDK programmes targeted at low-income areas showed long-term improvements in numeracy for lower income girls. Our results suggest that expectations for wide-ranging long-term academic benefits of FDK are unwarranted.

Small bioactive molecules as dual functional co-dopants for conducting polymers.

Biological responses to neural interfacing electrodes can be modulated via biofunctionalisation of conducting polymer (CP) coatings. This study investigated the use of small bioactive molecules with anti-inflammatory properties. Specifically, anionic dexamethasone phosphate (DP) and valproic acid (VA) were used to dope the CP poly(ethylenedioxythiophene) (PEDOT). The impact of DP and VA on material properties was explored both individually and together as a codoped system, compared to the conventional dopant p-toluenesulfonate (pTS). Electrical properties of DP and VA doped PEDOT were reduced in comparison to PEDOT/pTS, however co-doping with both DP and VA was shown to significantly improve the electroactivity of PEDOT in comparison the individually doped coatings. Similarly, while the individually doped PEDOT coatings were mechanically friable, the inclusion of both dopants during electropolymerisation was shown to attenuate this response. In a whole-blood model of inflammation all DP and VA doped CPs retained their bioactivity, causing a significant reduction in levels of the pro-inflammatory cytokine TNF-α. These studies demonstrated that small charged bioactive molecules are able act as dopants for CPs and that co-doping with ions of varied size and doping affinity may provide a means of addressing the limitations of large bulky bimolecular dopants.

Degradable, click poly(vinyl alcohol) hydrogels: characterization of degradation and cellular compatibility.

The aim of this research was to understand the influence of functional group density on degradation and cell survival within injectable poly(vinyl alcohol) (PVA) hydrogels crosslinked through hydrazone bonds. For this purpose, PVA was modified with aldehyde and hydrazide functional groups. The click reaction between these two macromers, performed under physiologic conditions, led to hydrogel formation in less than 3 min. The influence of the crosslinking density on the gelation time, volumetric swelling ratio and mass loss of the hydrogels was investigated. These systems were slowly degradable as they maintained their gel-like state for more than 120 days. However, these networks also exhibited unusual degradation behaviour that could be the result of a breaking-forming bond phenomenon, attributable to the reversible nature of the hydrazone bond. This study also demonstrated that these networks maintained their mechanical strength while degrading, and cell encapsulation revealed the cytocompatibility of these systems.

Immunoisolating semi-permeable membranes for cell encapsulation: focus on hydrogels.

Cell-based medicine has recently emerged as a promising cure for patients suffering from various diseases and disorders that cannot be cured/treated using technologies currently available. Encapsulation within semi-permeable membranes offers transplanted cell protection from the surrounding host environment to achieve successful therapeutic function following in vivo implantation. Apart from the immunoisolation requirements, the encapsulating material must allow for cell survival and differentiation while maintaining its physico-mechanical properties throughout the required implantation period. Here we review the progress made in the development of cell encapsulation technologies from the mass transport side, highlighting the essential requirements of materials comprising immunoisolating membranes. The review will focus on hydrogels, the most common polymers used in cell encapsulation, and discuss the advantages of these materials and the challenges faced in the modification of their immunoisolating and permeability characteristics in order to optimize their function.

The effect of breastfeeding education on adolescent beliefs and attitudes: a randomized school intervention in the Canadian Ojibwa community of Sagkeeng.

Sagkeeng First Nation's adolescent breastfeeding educational session was evaluated using a randomized pretest-posttest control group design. The intervention group received the session first; the control group received the session following the posttest. A retention test to measure overall retained learning was given to all students 10 days later. Breastfeeding beliefs increased (mean +/- SD = 41.9 to 47.0, P = .0047) from pretest to posttest for intervention subjects but not for controls. There were no changes in bottle-feeding beliefs or breastfeeding attitudes. There was an increase in breastfeeding beliefs from pretest to retention test for all students (true treatment effect [TTE] = .85 standard deviation units [SDU], P = .004). Learning was gender specific, with females experiencing increases in breastfeeding beliefs (TTE = 1.12 SDU, P = .004), decreases in bottle-feeding beliefs (TTE = -.77 SDU, P = .04), and a trend to increased breastfeeding attitudes (TTE = .41 SDU, NS). Males showed small, inconsistent learning effects. Learning occurred in the areas of health, convenience, cost, and decreased embarrassment.

How Baby-Friendly are Manitoba hospitals? The Provincial Infant Feeding Study. Breastfeeding Promotion Steering Committee of Manitoba.

The Breastfeeding Promotion Steering Committee of Manitoba conducted the cross-sectional Provincial Infant Feeding Study in 1996 to examine: correlation between breastfeeding policies and actual practices in Manitoba hospitals; compliance with Baby-Friendly Hospital Initiative (BFHI) criteria; and associations between hospital practices and two-week breastfeeding duration. Three separate surveys obtained information from: administrators concerning hospital policy; nursing staff concerning hospital practices; and all women giving birth in a five-week period, concerning breastfeeding rates and maternal perceptions of hospital practices. The results highlighted the need for policy and practice changes to comply with BFHI criteria. 92% initiated breastfeeding, and 84% were breastfeeding at two weeks postpartum. Independent predictors of weaning included: in-hospital supplementation (adjusted RR = 2.1, 95% CI 1.02-4.36, p = 0.04); temporarily interrupting breastfeeding while in hospital (adjusted RR = 4.9, 95% CI 2.7-8.9, p = 0.0001); no previous breastfeeding experience (adjusted RR = 2.5, 95% CI 1.4-4.4, p = 0.002); and Grade 12 or less maternal education.

Does breastfeeding education affect nursing staff beliefs, exclusive breastfeeding rates, and Baby-Friendly Hospital Initiative compliance? The experience of a small, rural Canadian hospital.

The effectiveness of a breastfeeding education intervention consisting of a 1 1/2-hour mandated session for all nursing staff, with an optional self-paced tutorial, was evaluated in a small rural Canadian hospital. The intervention was designed to increase exclusive breastfeeding rates, create positive beliefs and attitudes among staff members, and increase compliance with the World Health Organization/UNICEF Baby-Friendly Hospital Initiative (BFHI). Staff surveys and chart audits were conducted at both the intervention and control site hospitals prior to the intervention and 7 months after the intervention. Over a 7-month period, the intervention hospital experienced an increase in BFHI compliance (24.4 vs. 31.9, P < .01), breastfeeding beliefs (55.0 vs. 58.8, P < .05), and exclusive breastfeeding rates (31% vs. 54% of breastfed babies, P < .05) but no change in breastfeeding attitudes (44.0 vs. 44.9, P = .80). The control site experienced no change in BFHI compliance, beliefs, or attitudes but a significant decrease in exclusive breastfeeding rates (43% vs. 0%, P < .05).

Prenatal infant feeding intent and perceived social support for breastfeeding in Manitoba first nations communities: a role for health care providers.

In a prospective study of pregnant women (n = 36) in four southern Manitoba First Nations communities to test a breastfeeding decision-making model, maternal perceptions of the impact of referents (individuals and groups which impact a woman's decisions) was measured. A quantitative "referent score" comprised of a measure of the referent's "breastfeeding-supportiveness" and a measure of maternal compliance with the referent. The woman's own mother, the community health nurse, and the physician were perceived as highly supportive of breastfeeding, and as people with whom the woman was most likely to comply. Women also identified the timing of their infant feeding decisions, as reported in the third trimester of pregnancy. Only 22% had decided prior to pregnancy. During the third trimester, 36% did not know their infant feeding choice. Women forced to verbalize a "choice" prior to being informed may make decisions based on the perceived cultural norm, which may be bottle feeding. A neutral attitude by health professionals may be harmful if it prevents informed choice by pregnant or postpartum clients. Prenatal education of the pregnant woman with her own mother, and adolescent school education of the peer group (sisters, close friends and male partner) may need to be incorporated into a community strategy to promote breastfeeding.

A mini-lesson in statistics: what causes treatment groups to be deemed 'not statistically different'?

The theory behind a "not-statistically significant difference" (NS) in group comparison research is crucial for proper study design. Proprietary company-sponsored research whose purpose is to demonstrate null intervention effects is widespread. Therefore, a discussion of null effects in research results was undertaken. Type I and Type II errors are explained, and reasons for "NS" results detailed. Clinical differences, power, statistical tests chosen, and values of alpha and beta are included in the discussion. Examples from studies of the effects of artificial baby milk gift packs are offered. If the aim of research is to demonstrate NS between treatments, or if the conclusion of published research is NS, then the research must demonstrate a design which ensures ethical and appropriate levels of both Type I and Type II errors.