Postnatal Lifestyle Intervention for Overweight Women With Previous Gestational Diabetes: A Randomized Controlled Trial.

Background: Gestational diabetes mellitus (GDM) is associated with a sevenfold increased lifetime risk of type 2 diabetes. Excessive gestational weight gain and postpartum weight retention are established predictors of long-term obesity. Objective: To determine the impact of a postnatal lifestyle intervention program for overweight women with previous gestational diabetes mellitus (PAIGE). Design: Postnatal overweight women with previous GDM participated in a multicenter randomized controlled trial between June 2013 and December 2014. The intervention comprised a 1-hour educational program, a free 3-month referral to a commercial weight management organization (Slimming World), a pedometer, and structured telephone and text support, in addition to usual care. The control group received usual care only. The primary outcome was weight loss at 6 months. Results: Sixty women were randomized (29 intervention; 31 control) in two centers based on their week of attendance. The intervention group demonstrated significant weight loss at 6 months after randomization compared with the control group: mean ±SD, 3.9 ± 7.0 kg vs 0.7 ±3.8 kg (P = 0.02). Blood glucose levels did not significantly differ. With respect to well-being measures, a bodily pain was significantly reduced in the intervention group (P = 0.007). Conclusions: PAIGE resulted in significantly greater weight loss at 6 months compared with usual care. Such weight loss could prove beneficial in terms of better long-term health and subsequent prevention of type 2 diabetes in overweight women with previous GDM. Future interventions must consider recruitment strategies, timing of the intervention, and inclusion of partners and/or other family members.

Stereodynamics and edge-to-face CH-pi aromatic interactions in o-phenethyl-substituted biaryls.

As part of a search for systems that exhibit intramolecular aromatic edge-to-face interactions, a series of four biaryl compounds containing a phenethyl side chain were prepared. These compounds exist as a slowly interconverting mixture of two atropisomers due to steric hindrance to rotation about the biaryl bond. The more thermodynamically stable isomer exhibits an abnormal shielding of an ortho-proton in solution indicative of an edge-to-face CH-pi interaction with the terminal phenyl ring on the side chain. This tilted-T type of geometry was observed in the X-ray crystal structure of one of the compounds. The edge-to-face conformation in solution is estimated by variable temperature NMR studies to be energetically favored by ca. 1.6 kcal mol(-1) but entropically disfavored by ca. 5.0 cal K(-1) mol(-1).

An evaluation of a GP out-of-hours service: meeting patient expectations of care.

BACKGROUND: The reorganized out-of-hours general practitioner (GP) service, resulting in the creation of out-of-hours cooperatives has been widely welcomed by the medical profession. However, GP satisfaction remains only one aspect of this reorganized service and patients' views and levels of satisfaction must have a contribution to make to the organization and delivery of the service. AIM: To assess patient satisfaction at two out-of-hours cooperatives in Northern Ireland. METHOD: A sample of 4466 patients contacting the out-of-hours service was surveyed by postal questionnaires using a previously validated patient satisfaction instrument. RESULTS: Patients who initially requested to be seen at the out-of-hours centre were more likely to receive the contact they requested than those who requested telephone advice or a home visit. Only 41.8% of patients requesting a home visit actually received one. Patients were generally satisfied with the service provided and most satisfied with the 'doctor's manner' and the 'explanation and advice' received. Patients who received the contact they initially requested were more satisfied with all aspects of the service than other patients. The type of contact actually received had little effect on the satisfaction levels reported by patients who received the contact they initially requested. CONCLUSION: The population should be made fully aware of the services provided by out-of-hours cooperatives to enable them to have realistic expectations. With realistic expectations, patients are more likely to receive the medical contact they request and consequently will be more satisfied with the service provided. High satisfaction level is an important outcome measure of any out-of-hours service as it increases patient confidence and compliance and ultimately clinical outcome.