Reducing Maternal Obesity and Diabetes Risks Prior to Conception with the National Diabetes Prevention Program.

INTRODUCTION: Intrauterine exposure to maternal obesity and hyperglycemia greatly increases offspring health risks. Scalable lifestyle interventions to lower weight and glycemia prior to conception are needed, but have been understudied, especially in diverse and low-income women with disproportionately high risks of negative maternal-child outcomes. The objective of this report is to provide initial evidence of the National Diabetes Prevention Program's (NDPP) effects on maternal-child outcomes in diverse, low-income women and their offspring. METHODS: The yearlong NDPP was delivered in a safety net healthcare system to 1,569 participants from 2013 to 2019. Using medical records, we evaluated outcomes for women < 40 years who became pregnant and delivered after attending the NDPP for ≥ 1 month (n = 32), as compared to a usual care group of women < 40 years (n = 26) who were initially eligible for the NDPP but were excluded due to pregnancy at enrollment. RESULTS: Most women in either group were Latinx, had Medicaid or were uninsured, and had obesity at baseline. The mean difference in BMI change from baseline to conception was - 1.8 ± 0.6 kg/m2 (p = 0.002) for NDPP versus usual care. Fewer NDPP participants had obesity at conception (56.7% vs. 88.0%, p = 0.011) and hyperglycemia in early pregnancy (4.0% vs. 25.0%; p = 0.020) than usual care. No other differences were statistically significant, yet nearly all outcomes favored the NDPP. Covariate-adjusted results were consistent, except the difference in frequency of obesity at conception was no longer significant (p = 0.132). DISCUSSION: Results provide preliminary evidence that the NDPP may support a reduction in peri-conceptional obesity/diabetes risks among diverse and low-income women.

SIGNIFICANCE: Scalable lifestyle interventions to lower weight and glycemia prior to conception are needed, especially to support diverse and low-income women with disproportionately high risks of negative maternal-child outcomes. This report presents initial evidence of the National Diabetes Prevention Program?s effects on maternal-child outcomes in diverse, low-income women and their offspring. Results encouragingly suggest that the program can reduce peri-conceptional obesity and glycemia, and may be a resource to help break the cycle of disease across generations.

Virtual Care for Behavioral Health Conditions.

The COVID-19 pandemic has highlighted the urgent need for behavioral health care services. A substantial portion of mental health care transitioned to virtual care during the COVID-19 pandemic, remains virtual today, and will continue that way in the future. Mental health needs continue to grow, and there has been growing evidence showing the efficacy of virtual health for behavioral health conditions at the system, provider, and patient level. There is also a growing understanding of the barriers and challenges to virtual behavioral health care.

Unpacking the layers: a meta-ethnography of cancer survivors' loneliness.

PURPOSE: To review the empirical qualitative literature on cancer survivor's experiences with loneliness to inform assessments and interventions for improving cancer survivors' social well-being. METHODS: A rigorous systematic review of qualitative studies published in five databases between 1993 and 2016 was conducted. Three coders reviewed 285 titles and abstracts and, after applying a critical review process, 20 manuscripts were synthesized using meta-ethnography. RESULTS: The synthesis of the 20 studies provided a framework for understanding survivors' layers of loneliness at the level of the individual, their social support system, the healthcare system, and society. Internally, survivors described loneliness resulting from feelings of inauthenticity, of being alone in their cancer experience, and of lack of control. In their social networks, survivors attributed loneliness to others' avoidance, misperceptions of cancer, and others' failure to recognize the effects of cancer after active treatment. Unmet needs after treatment contributed to feelings of loneliness within the healthcare system. Further, societal stigma around cancer and pressures to experience growth after cancer created another layer of loneliness. The results suggest the need to move beyond an individual level perspective in assessing and treating loneliness in cancer survivors. CONCLUSIONS: This meta-ethnography presents an integrated framework of loneliness in cancer survivors as a multi-layered experience. Implications for Cancer Survivors Conceptualizing loneliness from a systemic perspective adds missing pieces to the loneliness puzzle by encouraging assessment and intervention at interacting levels of functioning; considering how individuals respond to and are affected by their social systems can deepen our understanding of cancer survivorship.

Correlates of engaging in drug distribution in a national sample.

In this study, we examined self-reported behaviors and characteristics of individuals involved in drug distribution to identify correlates of engaging in drug-distribution behaviors. Correlates of interest included demographic characteristics, substance-use patterns, psychological impairment, and criminal involvement. Data from the 2012 National Survey on Drug Use and Health (U.S. Department of Health and Human Services, Substance Abuse & Mental Health Services Administration, 2013) were used for analyses (N = 55,108). A logistic regression analysis distinguished those who have sold drugs from those who have not sold drugs to identify correlates of engaging in drug distribution. Results showed that recency of substance use, severity of substance use, criminal activity, mental health diagnoses, substance-use treatment, and arrest history were all significantly associated with distribution behaviors. Findings indicate the importance of accounting for the heterogeneous characteristics of individuals involved in distribution behaviors when considering treatment options or criminal proceedings.