Early Dysglycemia Is Detectable Using Continuous Glucose Monitoring in Very Young Children at Risk of Type 1 Diabetes.

OBJECTIVE: Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with presymptomatic type 1 diabetes (T1D) and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measured in children being longitudinally observed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to age 10 years. RESEARCH DESIGN AND METHODS: Between January 2021 and June 2023, 31 ENDIA children with persistent multiple islet autoimmunity (PM Ab+) and 24 age-matched controls underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose SD (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL), and percentage of time >7.8 mmol/L (140 mg/dL) were determined and examined for between-group differences. RESULTS: The mean (SD) ages of PM Ab+ and Ab- children were 4.4 (1.8) and 4.7 (1.9) years, respectively. Eighty-six percent of eligible PM Ab+ children consented to CGM wear, achieving a median (quartile 1 [Q1], Q3) sensor wear period of 12.5 (9.0, 15.0) days. PM Ab+ children had higher median (Q1, Q3) SDSGL (1.1 [0.9, 1.3] vs. 0.9 [0.8, 1.0] mmol/L; P < 0.001) and CEV (17.3% [16.0, 20.9] vs. 14.7% [12.9, 16.6]; P < 0.001). Percentage of time >7.8 mmol/L was greater in PM Ab+ children (median [Q1, Q3] 8.0% [4.4, 13.0] compared with 3.3% [1.4, 5.3] in Ab- children; P = 0.005). Mean SGL did not differ significantly between groups (P = 0.10). CONCLUSIONS: CGM is feasible and well tolerated in very young children at risk of T1D. Very young PM Ab+ children have increased SDSGL, CEV, and percentage of time >7.8 mmol/L, consistent with prior studies involving older participants.

Key Factors to Consider When Implementing an Advanced Practice Registered Nurse-Led Heart Failure Clinic.

Advanced practice registered nurses (APRNs) such as clinical nurse specialists and nurse practitioners excel at chronic disease management. Development of an APRN-led heart failure (HF) clinic is an ideal way to manage complex HF patients. However, there are important factors to consider when implementing an APRN-led HF clinic. The purpose of this paper is to provide a consolidation of recommendations to consider when developing and implementing an APRN-led HF clinic. A review of applicable literature within the last 10 years was conducted to determine the key factors to be considered when developing organizational structures and processes for an APRN-led HF clinic. The increasing need for primary care and internal medicine providers supports using APRNs to fill the gap and provide disease management for HF patients. Also, APRNs can impact the overall costs of HF treatment by optimizing postdischarge care and preventing hospitalizations and readmissions. Multiple studies supported implementation of APRN-led HF clinics for disease management to provide complex treatment strategies and comprehensive care to these patients.

Mental Health During Late Pregnancy and Postpartum in Mothers With and Without Type 1 Diabetes: The ENDIA Study.

OBJECTIVE: Pregnancy and type 1 diabetes are each associated with increased anxiety and depression, but the combined impact on well-being is unresolved. We compared the mental health of women with and without type 1 diabetes during pregnancy and postpartum and examined the relationship between mental health and glycemic control. RESEARCH DESIGN AND METHODS: Participants were women enrolled from 2016 to 2020 in the Environmental Determinants of Islet Autoimmunity (ENDIA) study, a pregnancy to birth prospective cohort following children with a first-degree relative with type 1 diabetes. Edinburgh Postnatal Depression Scale (EPDS) and Perceived Stress Scale (PSS) were completed during the third trimester (T3) (median [interquartile range] 34 [32, 36] weeks) and postpartum (14 [13, 16] weeks) by 737 women (800 pregnancies) with (n = 518) and without (n = 282) type 1 diabetes. RESULTS: EPDS and PSS scores did not differ between women with and without type 1 diabetes during T3 and postpartum. EPDS scores were marginally higher in T3: predicted mean (95% CI) 5.7 (5.4, 6.1) than postpartum: 5.3 (5.0, 5.6), independent of type 1 diabetes status (P = 0.01). HbA1c levels in type 1 diabetes were 6.3% [5.8, 6.9%] in T3 and did not correlate with EPDS or PSS scores. Reported use of psychotropic medications was similar in women with (n = 44 of 518 [8%]) and without type 1 diabetes (n = 17 of 282 [6%]), as was their amount of physical activity. CONCLUSIONS: Overall, mental health in late pregnancy and postpartum did not differ between women with and without type 1 diabetes, and mental health scores were not correlated with glycemic control.

Beyond the Baby Bump: Subtle Discrimination Against Working Mothers In the Hiring Process.

Despite a large proportion of working mothers in the American workforce, research suggests that negative stereotypes and discrimination against working mothers continue to exist. In a set of two experimental studies, the current paper examined subtle discrimination against non-pregnant, working mothers in different hiring settings. In Study 1, using a between-subject field experiment and applying for geographically dispersed jobs with manipulated resumes, we found evidence for subtle discrimination, such that mothers received more negativity in callback messages than women without children, men without children, and fathers. They were also rejected more quickly than women without children and fathers. In Study 2, using a more controlled experimental paradigm, we tested our hypothesis in a hypothetical interview evaluation setting. We found that mothers faced more interpersonal hostility across different job types as compared to women without children. Together, these studies highlight the presence of subtle discrimination against working mothers at different stages of the hiring process.

Serpentovirus (Nidovirus) and Orthoreovirus Coinfection in Captive Veiled Chameleons (Chamaeleo calyptratus) with Respiratory Disease.

Serpentoviruses are an emerging group of nidoviruses known to cause respiratory disease in snakes and have been associated with disease in other non-avian reptile species (lizards and turtles). This study describes multiple episodes of respiratory disease-associated mortalities in a collection of juvenile veiled chameleons (Chamaeleo calyptratus). Histopathologic lesions included rhinitis and interstitial pneumonia with epithelial proliferation and abundant mucus. Metagenomic sequencing detected coinfection with two novel serpentoviruses and a novel orthoreovirus. Veiled chameleon serpentoviruses are most closely related to serpentoviruses identified in snakes, lizards, and turtles (approximately 40-50% nucleotide and amino acid identity of ORF1b). Veiled chameleon orthoreovirus is most closely related to reptilian orthoreoviruses identified in snakes (approximately 80-90% nucleotide and amino acid identity of the RNA-dependent RNA polymerase). A high prevalence of serpentovirus infection (>80%) was found in clinically healthy subadult and adult veiled chameleons, suggesting the potential for chronic subclinical carriers. Juvenile veiled chameleons typically exhibited a more rapid progression compared to subadults and adults, indicating a possible age association with morbidity and mortality. This is the first description of a serpentovirus infection in any chameleon species. A causal relationship between serpentovirus infection and respiratory disease in chameleons is suspected. The significance of orthoreovirus coinfection remains unknown.

The Influence of DHA on Language Development: A Review of Randomized Controlled Trials of DHA Supplementation in Pregnancy, the Neonatal Period, and Infancy.

This review summarizes randomized controlled trials (RCTs) assessing the effect of docosahexaenoic acid (DHA) supplementation in the first 1000 days on child language. Six databases were searched and RCTs were included if they involved supplementation with DHA during pregnancy, to preterm infants, or during the postpartum period, included a placebo group with less or no DHA, and reported a language outcome. We included 29 RCTs involving n = 10,405 participants from 49 publications. There was a total of 84 language measures at ages ranging from 3 months to 12 years. Of the 84 assessments, there were 4 instances where the DHA group had improved scores, and 2 instances where the DHA group had worse scores (with the majority of these significant effects found within one RCT). The remaining comparisons were null. A few RCTs that included subgroup analyses reported (inconsistent) effects. There was limited evidence that DHA supplementation had any effect on language development, although there were some rare instances of both possible positive and adverse effects, particularly within population subgroups. It is important that any subgroup effects are verified in future trials that are adequately powered to confirm such effects.

Development of a Measure of Informal Workplace Social Interactions.

A measure of informal, non-task-related workplace social interactions that captures both the frequency of interactions and the positive affect that can accompany such interactions was developed and validated. In two samples of employees (N = 188 and N = 315, respectively), the factor structure, reliability, and incremental predictive validity of the newly developed measure were evaluated. Results support the anticipated two-factor structure, demonstrate strong psychometric properties, and reveal that the new measure explains additional variance in employee outcomes (job satisfaction and job-related positive affect). This newly developed, 16-item scale provides a psychometrically sound measure for researchers and organizations to use in assessing, and potentially improving, two dimensions of workplace social interactions.

Hinge action versus grip in translocation by RNA polymerase.

Based on molecular dynamics simulations and functional studies, a conformational mechanism is posited for forward translocation by RNA polymerase (RNAP). In a simulation of a ternary elongation complex, the clamp and downstream cleft were observed to close. Hinges within the bridge helix and trigger loop supported generation of translocation force against the RNA-DNA hybrid resulting in opening of the furthest upstream i-8 RNA-DNA bp, establishing conditions for RNAP sliding. The ß flap tip helix and the most N-terminal ß' Zn finger engage the RNA, indicating a path of RNA threading out of the exit channel. Because the ß flap tip connects to the RNAP active site through the ß subunit double-Ψ-ß-barrel and the associated sandwich barrel hybrid motif (also called the flap domain), the RNAP active site is coupled to the RNA exit channel and to the translocation of RNA-DNA. Using an exonuclease III assay to monitor translocation of RNAP elongation complexes, we show that K+ and Mg2+ and also an RNA 3'-OH or a 3'-H2 affect RNAP sliding. Because RNAP grip to template suggests a sticky translocation mechanism, and because grip is enhanced by increasing K+ and Mg2+concentration, biochemical assays are consistent with a conformational change that drives forward translocation as observed in simulations. Mutational analysis of the bridge helix indicates that 778-GARKGL-783 (Escherichia coli numbering) is a homeostatic hinge that undergoes multiple bends to compensate for complex conformational dynamics during phosphodiester bond formation and translocation.

Iodine status of pregnant women in South Australia after mandatory iodine fortification of bread and the recommendation for iodine supplementation.

Mandatory iodine fortification of bread was introduced in 2009 in Australia in response to the reemergence of iodine deficiency. The aim of this study was to assess iodine intake, urinary iodine concentration (UIC) and their correlation in pregnant women (n = 783) recruited from South Australia 2 years following mandatory iodine fortification. Total iodine intake (food and supplements) and UIC were assessed at study entry (<20 weeks') and at 28 weeks' gestation. Mean (±SD) total iodine intake at study entry and 28 weeks' gestation was 307 ± 128 µg/day and 300 ± 127 µg/day, respectively. Overall, 85.9% of women met the estimated average intake (≥160 µg/day) for iodine in pregnancy, but only 44.5% met the estimated average intake from food alone. The main food sources of iodine were dairy foods and iodine-fortified bread. Median (interquartile range) UIC at study entry and 28 weeks' gestation was 189 µg/L and 172 µg/L, respectively. At study entry, median UIC was higher in women taking supplements containing iodine ≥150 µg/day compared with those containing iodine <150 µg/day (221 µg/L vs. 163 µg/L, p = .003) and those not taking supplements containing iodine (221 µg/L vs. 159 µg/L, p < .001). At 28 weeks' gestation, the median UIC for the groups was 187, 152 and 141 µg/L, respectively (each of the two comparisons yielded p < .001). Total iodine intake (food and supplements) from all women was positively, though weakly, correlated with UIC (r = .23, p < .001). In conclusion, pregnant women in South Australia are iodine sufficient postmandatory iodine fortification of bread. However, without iodine supplementation, it may be difficult to achieve a UIC >150 µg/L.

Association of cord blood vitamin D with early childhood growth and neurodevelopment.

AIM: The association between fetal vitamin D [25-hydroxyvitamin D (25(OH)D)] exposure and early child growth and neurodevelopment is controversial. The aim of this study was to investigate the association between cord blood 25(OH)D and birth size, childhood growth and neurodevelopment. METHODS: Cord blood samples from 1040 Australian women enrolled in a randomised trial of docosahexaenoic acid (DHA) supplementation during pregnancy were analysed for 25(OH)D using mass spectroscopy. Infant length, weight and head circumference were measured at delivery. A sub-sample of 337 infants with cord blood samples were selected for growth and neurodevelopment assessment at 18 months and 4 years of age. Associations between standardised 25(OH)D and outcomes were assessed, taking into account DHA treatment, social and demographic variables. RESULTS: Standardised 25(OH)D in cord blood was not associated with length, weight or head circumference at birth, 18 months or 4 years of age. 25(OH)D was not associated with cognitive, motor, social-emotional or adaptive behaviour scores at 18 months, or cognitive score at 4 years of age. A 10 nmol/L increase in cord blood 25(OH)D was associated with a modest increase in average Language scores of 0.60 points at 18 months (adjusted 95% CI 0.04-1.17, P = .04) and 0.68 points at 4 years (adjusted 95% CI 0.07-1.29, P = .03) of age. CONCLUSIONS: Cord blood vitamin D was modestly, positively associated with language development in early childhood in our sample, although the magnitude of the association was small. Randomised controlled trials are needed to confirm a causal association and establish the potential clinical significance of the relationship between vitamin D status and language development.

Association of cord blood vitamin D at delivery with postpartum depression in Australian women.

BACKGROUND: Observational studies have implicated low serum vitamin D (25-hydroxyvitamin D (25(OH)D)) levels in the development of mood disorders. Postpartum depression (PPD) is an important public health issue, although little is known about its association with serum 25(OH)D. AIMS: To determine the association between 25(OH)D at delivery and the subsequent risk of PPD at six weeks and six months postpartum in a large cohort of Australian women. MATERIALS AND METHODS: Cord blood samples from 1040 women participating in the docosahexaenoic acid (DHA) to Optimise Maternal Infant Outcome randomised controlled trial were analysed for 25(OH)D by mass spectroscopy. Maternal PPD was assessed using the Edinburgh Postnatal Depression Scale at six weeks and six months postpartum. The association between standardised 25(OH)D and PPD was assessed, taking into account DHA treatment, social and demographic variables. RESULTS: There was no association between cord blood 25(OH)D concentration at delivery and PPD at either six weeks or six months postpartum. Cord blood 25(OH)D 25-50 and >50 nmol/L at delivery was associated with decreased risk of PPD at six weeks postpartum compared with 25(OH)D <25 nmol/L in the control group, but not the DHA group. There was no association between cord blood 25(OH)D <25 nmol/L at delivery and PPD at six months postpartum. CONCLUSIONS: This largest study to date of 25(OH)D levels at delivery and PPD did not reveal a consistent link with PPD.

Effect of iodine supplementation in pregnancy on child development and other clinical outcomes: a systematic review of randomized controlled trials.

BACKGROUND: Routine iodine supplementation during pregnancy is recommended by leading health authorities worldwide, even in countries where the iodine status of the population is sufficient. OBJECTIVES: We evaluated the efficacy and safety of iodine supplementation during pregnancy or the periconceptional period on the development and growth of children. Secondary outcomes included pregnancy outcome and thyroid function. DESIGN: A systematic review of randomized controlled trials (RCTs) was conducted. PUBMED, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched to identify relevant RCTs. RESULTS: Fourteen publications that involved 8 trials met the inclusion criteria. Only 2 included trials reported the growth and development of children and clinical outcomes. Iodine supplementation during pregnancy or the periconceptional period in regions of severe iodine deficiency reduced risk of cretinism, but there were no improvements in childhood intelligence, gross development, growth, or pregnancy outcomes, although there was an improvement in some motor functions. None of the remaining 6 RCTs conducted in regions of mild to moderate iodine deficiency reported childhood development or growth or pregnancy outcomes. Effects of iodine supplementation on the thyroid function of mothers and their children were inconsistent. CONCLUSIONS: In this review, we highlight a lack of quality evidence of the effect of prenatal or periconceptional iodine supplementation on growth and cognitive function of children. Although contemporary RCTs of iodine supplementation with outcomes addressing childhood development are indicated, conduct of such RCTs may not be feasible in populations where iodine supplementation in pregnancy is widely practiced.

Flavored and nonflavored smokeless tobacco products: rate, pattern of use, and effects.

INTRODUCTION: The initiation and maintenance of tobacco use are influenced by several factors, but of equal and often overlooked importance, until recently, is the palatability of the product. Because of the role that flavor may play in the initiation and maintenance of tobacco use, the Food and Drug Administration has decided to ban the use of flavorings, other than menthol, from cigarettes. To date, little attention has been paid to the impact of flavoring in smokeless tobacco (ST) products. METHODS: This study combined the data from 5 previously completed treatment or switching studies to examine the choice of brand flavor in the course of ST use, from initiation to regular use. RESULTS: The analyses revealed that a majority of subjects' first and current choice of product was flavored, specifically mint or wintergreen, and that a significant number of ST users switched to a flavored brand after already initiating ST use with a regular nonflavored product. In this population, however, flavored products did not appear to lead to greater dependence or increased exposure to nicotine or carcinogens. CONCLUSIONS: More treatment seeking ST users began by using mint-flavored product and switched to and were current users of mint-flavored products. It is possible that mint products play a role in the initiation and maintenance of ST use.

Comparing an immediate cessation versus reduction approach to smokeless tobacco cessation.

INTRODUCTION: Relatively few studies have investigated pharmacological or behavioral treatment of smokeless tobacco (ST) users who do not have immediate quit plans. In this study, we compared a reduction treatment approach with an immediate cessation approach in a population of ST users who reported no immediate plans to quit. METHODS: Subjects randomly assigned to the immediate cessation condition set a quit date soon after enrollment and were offered 2 weeks of nicotine patch therapy to help in their cessation efforts. Subjects assigned to the ST reduction group were provided with their choice of either 4 mg nicotine lozenge or ST brand switching to help them reduce their ST use or levels of nicotine exposure, respectively. Quit date was 6 weeks after the onset of treatment. Follow-up was at 12 weeks and 26 weeks postenrollment and 26 weeks postquit. RESULTS: Both 7-day point prevalence abstinence and prolonged abstinence rates following the quit date were significantly higher in the immediate cessation group versus the reduction group at 12 and 26 weeks (all p values ≤ .04) and for prolonged abstinence at 6 months postquit (p = .002). Significant reductions in ST use among nonquitters were observed for both groups (p < .0001) with no differences between groups. CONCLUSION: Our study demonstrated that immediate cessation with an established quit date resulted in greater cessation success than a gradual reduction approach among ST users who do not have an immediate quit plan but are motivated to quit.