Medicine

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The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus-A living systematic review and meta-analysis
(Blackwell Publishing Asia, 2024) Lee, V.Y.; Monjur, M.R.; Santos, J.A.; Patel, A.; Liu, R.; Tanna, G.L.D.; Gupta, Y.; Goyal, A.; Ajanthan, S.; Praveen, D.; Lakshmi, J.K.; De Silva, H.A.; Tandon, N.
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.
Prevention of suicides associated with global warming: perspectives from early career psychiatrists
(Frontiers Research Foundation, 2023) Shoib, S.; Hussaini, S.S.; Armiya'u, A.Y.; Saeed, F.; Őri, D.; Roza, T.H.; Gürcan, A.; Agrawal, A.; Solerdelcoll, M.; Lucero-Prisno Iii, D.E.; Nahidi, M.; Swed, S.; Ahmed, S.; Chandradasa, M.
Climate change poses significant challenges to global mental health, with potential consequences including increased rates of suicide and mental health disorders. Early Career Psychiatrists (ECPs) play a crucial role in addressing these challenges. The Climate Psychiatry Alliance, a group of psychiatrists dedicated to improving mental health amidst climate change, recognizes the importance of cultivating climate-aware ECPs. Training ECPs to become confident climate-aware clinicians enables them to effectively treat patients experiencing anxiety, depression, and PTSD in the context of climate-related distress. Together with other mental health professionals, ECPs can contribute to efforts by implementing strategies for monitoring and treating mental health problems arising from climate events. Additionally, they can raise awareness about the psychological consequences and risks of suicide associated with climate change. Collaboration among ECPs from various regions is essential in developing community-based approaches and reducing vulnerabilities. ECPs must prioritize supporting vulnerable populations by advocating for increased funding for mental health support and research in affected areas. Long-term solutions to address the mental health impacts of climate change and global warming should be pursued to mitigate future suicidality. Integrating climate considerations into local mental health programs and expanding psychological support services is crucial. By promoting emotional resilience and self-awareness, ECPs can contribute to building a more climate-resilient and mentally healthy society.
Redesigning new policy options for thalassemia prevention in Sri Lanka
(Multidisciplinary Digital Publishing Institute, 2022) Amarasinghe, N.; Amarasena, A.; Thabrew, A.; Werawatte, P.; Premawardhena, A.; Malik, F.; Abusayeed, M.; Wickramasinghe, C.
Sri Lanka, a country with 22 million people, has nearly 2000 thalassemia patients with severe thalassemia, two-thirds of whom have beta thalassemia major (TM). The current prevention program based on promoting “safe marriages”, which has been in existence for over 15 years, has failed to reduce thalassemia major births. We set about to examine the cost-effectiveness of novel policy options for thalassemia prevention in Sri Lanka. METHODS: The current cost for treatment of a thalassemia major patient (USD 2602/yr) was compared against the cost per reduction of single birth with three novel strategies, namely intensifying the screening in the current five districts combined with an education program (policy option 1), a nationwide screening program (policy option 2), and antenatal screening combined with the termination of pregnancy (policy option 3). The incremental cost-effectiveness ratio (ICER) of the different strategies was calculated. RESULTS: The status quo was considered to reduce one TM birth whilst the new policy options were able to reduce births by 14, 35, and 48, respectively. The costs incurred for the program for a year for status quo and the three novel programs were USD 104,788, 173,884, 781,372, and 904,186 respectively. Cost per prevention of a thalassemia major birth was USD 87,324, 12,420, 22,324, and 20,084, respectively. The lifetime cost per treatment of a thalassemia major patient was USD 34,653. CONCLUSIONS: Given the current legal restriction on termination of pregnancy for fetal indications, policy option 2, an island-wide screening with mass education, is the most cost-effective and will be expected to deliver a substantial reduction in new births.

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