Reproductive dysfunction is a common but little studied complication of diabetes. The spectrum of reproductive health problems in diabetes is broad, and encompasses delayed puberty and menarche, menstrual cycle abnormalities, subfertility, adverse pregnancy outcomes, and potentially early menopause. Depending on the age at diagnosis of diabetes, reproductive problems can manifest early on in puberty, emerge later when fertility is desired, or occur during the climacteric period. Historically, women with type 1 diabetes have frequently had amenorrhoea and infertility, due to central hypogonadism. With the intensification of insulin therapy and improved metabolic control, these problems have declined, but do persist. Additional reproductive implications of contemporary diabetes management are now emerging, induding polycystic ovary syndrome and hyperandrogenism, which are underpinned by insulin action on the ovary. The sharp rise in type 2 diabetes incidence in youth suggests that more women of reproductive age will encounter diabetes-related reproductive problems in their lifetimes. With an ever increasing number of young women living with diabetes, clinicians need to be aware of and equipped for the challenges of navigating reproductive health concerns across the lifespan. ; Fondo Nacional de Ciencia y Tecnologia (FONDECYT), from the Government of Chile 1170895
INTRODUCTION: Evidence-based approaches for achieving gender equity for women in leadership are lacking. Current efforts are of limited effectiveness, especially in healthcare. This work occurs in the context of an Australian National Health and Medical Research Council funded partnership to advance women in healthcare leadership. Partners include government, professional colleges and healthcare organisations with national reach and international links. Here we present a protocol for a systematic review, aiming to capture evidence on effective organisational strategies across multiple sectors with comparable challenges in advancing women in leadership. The aim of the review is to learn from other sectors and analyse the evidence to inform implementation in the health sector. METHODS AND ANALYSIS: A systematic search will be performed on Ovid MEDLINE, PsycINFO and SCOPUS databases to identify studies since 2000, reflecting a major shift in the global gender equality agenda with the development of the 2000 Millennium Development Goals. Titles and abstracts will be screened to assess eligibility; data extraction, quality assessment (using the Critical Appraisal Skill Programme checklist) and synthesis of outcomes will be performed. Outcomes will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. Studies in English using quantitative or qualitative design, which investigate organisational practices in any sector, for advancing women in leadership, and report on one or more measurable outcomes (eg, capacity-building, incidence of promotion) will be included. Findings will be analysed, themes will be extracted and results will be described. ETHICS AND DISSEMINATION: Ethics approval is not required. To our knowledge, this review will be the first to provide a comprehensive synthesis of available evidence on organisational practices for advancing women in leadership from the last two decades. Findings will be published in peer-reviewed journals and disseminated at ...
Objective: To assess and share learnings on the motivators and behavioural adherence across sex and age to evolving strategies in public policy to prevent the spread of SARS-CoV-2 at the end of a first COVID-19 wave and the beginning of a second COVID-19 wave in Australia. Design and Setting: A national longitudinal survey using a framework based on evidence-based behaviour change models. The survey was administered to a national sample representative across sex, age and location was undertaken at two time points: May 1st to 5th, 2020, and July 1st to 7th, 2020. Results: Overall 2,056 surveys were completed across the first and second rounds, with 63% (1,296/2,056) completing both. Age range was 18–99 years (median 53, IQR: 34–64). Suboptimal physical distancing and self-quarantining if unwell/diagnosed was reported in one in four respondents and not getting a test at onset of symptoms reported in one in three. Those non-adherent to all three behaviours (19%, 60/323), were mainly male, younger, lived in major cities and reported fewer concerns or motivators to change behaviour. Overall, government lockdown measures were considered very important by 81% (835/1,032) and appropriate by 75% (772/1,029). Conclusions: Prior to the suppression of a second COVID-19 wave, a significant minority of Australians reported suboptimal behavioural adherence to vital policy strategies to limit SARS-CoV-2 spread, mostly young adults and men. Successful wave 2 suppression required consistent communication from political and health leaders and supportive public health and economic strategies. Additional lockdown and punitive strategies were needed in Victoria and were generally well-supported and adhered to. To limit subsequent lockdown, this work reinforces the need for a mix of communication around saving lives of the vulnerable, and other strategies targeting high risk groups, facilitation of easy testing and minimisation of financial impacts.
BACKGROUND: Women are underrepresented in healthcare leadership, yet evidence on impactful organisational strategies, practices and policies that advance women's careers are limited. We aimed to explore these across sectors to gain insight into measurably advancing women in leadership in healthcare. METHODS: A systematic review was performed across Medline via OVID; Medline in-process and other non-indexed citations via OVID; PsycINFO and SCOPUS from January 2000 to March 2021. Methods are outlined in a published protocol registered a priori on PROSPERO (CRD42020162115). Eligible studies reported on organisational interventions for advancing women in leadership with at least one measurable outcome. Studies were assessed independently by two reviewers. Identified interventions were organised into categories and meta-synthesis was completed following the 'ENhancing Transparency in REporting the synthesis of Qualitative research' (ENTREQ) statement. FINDINGS: There were 91 eligible studies from 6 continents with 40 quantitative, 38 qualitative and 13 mixed methods studies. These spanned academia, health, government, sports, hospitality, finance and information technology sectors, with around half of studies in health and academia. Sample size, career stage and outcomes ranged broadly. Potentially effective interventions consistently reported that organisational leadership, commitment and accountability were key drivers of organisational change. Organisational intervention categories included i) organisational processes; ii) awareness and engagement; iii) mentoring and networking; iv) leadership development; and v) support tools. A descriptive meta-synthesis of detailed strategies, policies and practices within these categories was completed. INTERPRETATION: This review provides an evidence base on organisational interventions for advancing women in leadership across diverse settings, with lessons for healthcare. It transcends the focus on the individual to target organisational change, capturing measurable change ...
Background: Women are underrepresented in healthcare leadership, yet evidence on impactful organisational strategies, practices and policies that advance women's careers are limited. We aimed to explore these across sectors to gain insight into measurably advancing women in leadership in healthcare. Methods: A systematic review was performed across Medline via OVID; Medline in-process and other non-indexed citations via OVID; PsycINFO and SCOPUS from January 2000 to March 2021. Methods are outlined in a published protocol registered a priori on PROSPERO (CRD42020162115). Eligible studies reported on organisational interventions for advancing women in leadership with at least one measurable outcome. Studies were assessed independently by two reviewers. Identified interventions were organised into categories and meta-synthesis was completed following the 'ENhancing Transparency in REporting the synthesis of Qualitative research' (ENTREQ) statement. Findings: There were 91 eligible studies from 6 continents with 40 quantitative, 38 qualitative and 13 mixed methods studies. These spanned academia, health, government, sports, hospitality, finance and information technology sectors, with around half of studies in health and academia. Sample size, career stage and outcomes ranged broadly. Potentially effective interventions consistently reported that organisational leadership, commitment and accountability were key drivers of organisational change. Organisational intervention categories included i) organisational processes; ii) awareness and engagement; iii) mentoring and networking; iv) leadership development; and v) support tools. A descriptive meta-synthesis of detailed strategies, policies and practices within these categories was completed. Interpretation: This review provides an evidence base on organisational interventions for advancing women in leadership across diverse settings, with lessons for healthcare. It transcends the focus on the individual to target organisational change, capturing measurable change across intervention categories. This work directly informs a national initiative with international links, to enable women to achieve their career goals in healthcare and moves beyond the focus on barriers to solutions.
Context: Interventions targeting maternal obesity are a healthcare and public health priority. Objective: The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. Data Sources: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. Study Selection: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. Data Synthesis: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. Conclusion: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice. ; National Institute for Health Research Health Technology Assessment UK program ; European Union ; EarlyNutrition ; Tommy's Charity ; Kings Coll London, Womens Hlth Acad Ctr, Sch Med, Diabet & Nutr Sci Div, London, England ; Kings Coll London, Womens Hlth Acad Ctr, Div Womens Hlth, London, England ; Early Life Nutr, Nutricia, Trowbridge, Wilts, England ; Univ London Imperial Coll Sci Technol & Med, Dept Cardiovasc Med, London, England ; Kings Coll London, Sch Med, Diabet & Nutr Sci Div, London, England ; Queen Mary Univ London, Barts & London Sch Med & Dent, Womens Hlth Res Unit & Multidisciplinary Evidence, London, England ; Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Publ & Occupat Hlth, Amsterdam, Netherlands ; Queen Mary Univ London, Barts & London Sch Med & Dent, Womens Hlth Res Unit, London, England ; Univ N Carolina, Sch Nursing, Chapel Hill, NC USA ; Univ Politecn Madrid, Fac Ciencias Actividad Fis & Deporte INEF, Madrid, Spain ; Univ Coll Leuven Limburg, Dept Obstet & Gynaecol, Div Mother & Child, Antwerp, Belgium ; Univ Antwerp, Fac Med & Hlth Sci, B-2020 Antwerp, Belgium ; Univ Estadual Campinas, Sch Med Sci, Dept Obstet & Gynecol, Campinas, Brazil ; Univ Adelaide, Sch Paediat & Reprod Hlth, Robinson Inst, Adelaide, SA 5005, Australia ; Katholieke Univ Leuven, Dept Dev & Regenerat, Leuven, Belgium ; Univ Hosp Leuven, Dept Obstet & Gynecol, Leuven, Belgium ; Monash Univ, Sch Publ Hlth, Monash Ctr Hlth Res & Implementat, Melbourne, Vic 3004, Australia ; Norwegian Sch Sport Sci, Dept Sports Med, Oslo, Norway ; Mazandaran Univ, Fac Phys Educ & Sport Sci, Dept Sport Physiol, Babol Sar, Iran ; Oslo Univ Hosp, Dept Obstet & Gynaecol, N-0450 Oslo, Norway ; UKK Inst Hlth Promot Res, Tampere, Finland ; Univ Western Australia, Sch Sport Sci Exercise & Hlth, Perth, WA 6009, Australia ; Univ Modena & Reggio Emilia, Mother Infant Dept, Modena, Italy ; Calif Polytech State Univ San Luis Obispo, Dept Kinesiol, San Luis Obispo, CA 93407 USA ; Sao Paulo Fed Univ Unifesp, Dept Hlth Sci, Phys Therapy Course, Santos, Brazil ; Tech Univ Munich, Klinikum Rechts Isar, Inst Nutr Med, D-80290 Munich, Germany ; Univ Copenhagen, Hvidovre Hosp, Dept Obstet, Copenhagen, Denmark ; Univ Copenhagen, Hvidovre Hosp, Dept Gynecol, Copenhagen, Denmark ; Univ Southern Denmark, Odense Univ Hosp, Dept Obstet & Gynecol, Odense, Denmark ; Sorlandet Hosp, Dept Obstet & Gynecol, Kristiansand, Norway ; Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway ; Univ Copenhagen, Fac Sci, Dept Nutr Exercise & Sports, Copenhagen, Denmark ; Copenhagen Univ Hosp, Nutr Res Unit, Herlev, Denmark ; Natl Matern Hosp, Univ Coll Dublin, Sch Med & Med Sci, UCD Obstet & Gynaecol, Dublin 2, Ireland ; Sao Paulo Fed Univ Unifesp, Dept Hlth Sci, Phys Therapy Course, Santos, Brazil ; EarlyNutrition: 289346 ; Tommy's Charity: 1060508 ; Web of Science
