The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus-A living systematic review and meta-analysis.

BACKGROUND: While previously considered a transient condition, with no lasting adverse impact, gestational diabetes mellitus (GDM) is now a well-established risk factor for developing type 2 diabetes mellitus (T2DM). The risk of developing T2DM appears to be particularly high in the first few years after childbirth, providing a compelling case for early intervention. This review provides an up-to-date systematic review and meta-analysis to assess the effectiveness of interventions to reduce incidence of T2DM in women with a recent history of GDM. METHODS: The search was conducted on October 20, 2023 with an annual surveillance planned for the next 5 years to maintain a living systematic review. The inclusion criteria were randomized controlled trials of any type in women within 5 years of GDM-complicated pregnancy that reported outcomes of T2DM diagnosis or measures of dysglycemia with a follow-up of at least 12 months. RESULTS: Seventeen studies met our inclusion criteria and have been included in this review. There were 3 pharmacological and 14 lifestyle interventions. Intervention was not associated with significant reduction in the primary outcome of T2DM (risk ratio, 0.78; 95% confidence interval [CI]: 0.43-1.41; p = 0.41; I2 = 79%) compared with the control group (placebo or usual care). However, meta-analysis of the four studies reporting hazard ratios suggested a reduction in diabetes incidence (hazard ratio, 0.68; 95% CI: 0.48-0.97; p = 0.03; I2 = 31%). CONCLUSION: This review provides equivocal evidence about the efficacy of interventions to reduce the risk of T2DM in women within 5 years of GDM-complicated pregnancy and highlights the need for further studies, including pharmacotherapy.

Sequential oxonium-olefin-alkyne cyclization for the stereoselective synthesis of (octahydro-1H-pyrano[3,4-c]pyridin-5-yl)methanone derivatives.

A broad range of aldehydes undergo a smooth cascade cyclization with (E)-5-(3-phenylprop-2-ynylamino)pent-3-en-1-ol in the presence of BF3·OEt2 at room temperature to furnish a novel series of (octahydro-1H-pyrano[3,4-c]pyridin-5-yl)methanone derivatives in good yields and diastereoselectivities. This cascade process provides a simple and proficient alternative for the stereoselective construction of fused pyranopiperidine derivatives.

Perceptions of barriers and facilitators in physical activity participation among women in Thiruvananthapuram City, India.

BACKGROUND: Despite the known benefits of physical activity, very few people, especially women, are found to engage in regular physical activity. This study explored the perceptions, barriers and facilitators related to physical activity among women in Thiruvananthapuram City, India. METHODS: Four focus group discussions were conducted among individuals between 25 and 60 years of age, in a few areas of Thiruvananthapuram City Corporation limits in Kerala, preparatory to the design of a physical activity intervention trial. An open-ended approach was used and emergent findings were analyzed and interpreted. RESULTS: Women associated physical activity mostly with household activities. The majority of the women considered their activity level adequate, although they engaged in what the researchers concluded were quite low levels of activity. Commonly reported barriers were lack of time, motivation, and interest; stray dogs; narrow roads; and not being used to the culture of walking. Facilitators of activity were seeing others walking, walking in pairs, and pleasant walking routes. Walking was reported as the most feasible physical activity by women. CONCLUSION: Physical activity promotion strategies among women should address the prevailing cultural norms in the community, and involve social norming and overcoming cultural barriers. They should also target the modifiable determinants of physical activity, such as improving self-efficacy, improving knowledge on the adequacy of physical activity and its recommendations, facilitating goal-setting, and enhancing social support through peer support and group-based activities.

An appraisal of the tuberculosis programme in India using an ethics framework.

This is a review of the manner in which the Revised National Tuberculosis Control Programme (RNTCP) is being implemented, with a focus on the attention being paid to ethical principles and the incorporation of these into the programme. The article elucidates how ethical principles can be applied to protect the rights of the potential beneficiaries of the RNTCP. The authors consider the RNTCP in the light of a framework that is usually applied in research to evaluate ethical principles in public health practice. The three key principles of the framework are: respect for persons, beneficence and justice. The authors propose that this framework be used to make an ethical evaluation of other pu health programmes at several levels, since this could bring far-reaching benefits to society.

Qualitative study to explore stakeholder perceptions related to road safety in Hyderabad, India.

The Bloomberg Philanthropies Global Road Safety Programme in India focuses on reduction of drink driving and increase in helmet usage in the city of Hyderabad. During the early stages of implementation, perceptions of stakeholders on road safety were explored as part of the monitoring and evaluation process for a better understanding of areas for improving road safety in Hyderabad. Fifteen in-depth interviews with government officials, subject experts, and road traffic injury victims, and four focus group discussions with trauma surgeons, medical interns, nurses, and taxi drivers were conducted, analysed manually, and presented as themes. Respondents found Hyderabad unsafe for road-users. Factors such as inadequate traffic laws, gaps in enforcement, lack of awareness, lack of political will, poor road engineering, and high-risk road users were identified as threats to road safety. The responsibility for road safety was assigned to both individual road-users and the government, with the former bearing the responsibility for safe traffic behaviour, and the latter for infrastructure provision and enforcement of regulations. The establishment of a lead agency to co-ordinate awareness generation, better road engineering, and stricter enforcement of traffic laws with economic and non-economic penalties for suboptimal traffic behaviour, could facilitate improved road safety in Hyderabad.

Less equal than others? Experiences of AYUSH medical officers in primary health centres in Andhra Pradesh.

The National Rural Health Mission (NRHM) includes, inter alia, the establishment of an AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) component (practitioner, trained assistants, drugs and equipment) in every primary health centre (PHC). However, five years following the launch of the NRHM, the AYUSH mainstreaming scenario is below expectations, riddled with ethical and governance issues. Accounts from AYUSH practitioners at PHCs in various regions of the state of Andhra Pradesh reveal enormous lacunae in implementation: unfilled positions, inequitable emoluments, inadequate or absent infrastructure, assistance and supplies, unethical interpersonal arrangements, and limited support from non-AYUSH personnel. The widespread negative impact of these conditions undermines the value of AYUSH, demotivating both practitioners and patients, and failing to provide the intended support to the public health system.