Mothers after gestational diabetes in Australia (MAGDA) : a randomised controlled trial of a postnatal diabetes prevention program

BACKGROUND: Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. METHODS AND FINDINGS: In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: -0.23 kg body weight in intervention group (95% CI -0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference -0.95 kg, 95% CI -1.87, -0.04; group by treatment interaction p = 0.04); -2.24 cm waist measurement in intervention group (95% CI -3.01, -1.42) compared with -1.74 cm in usual care group (95% CI -2.52, -0.96) (change difference -0.50 cm, 95% CI -1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference -0.05 mmol/l, 95% CI -0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. CONCLUSIONS: Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000338066.

Using digital devices in a first year classroom : a focus on the design and use of phonics software applications

When integrated within a holistic literacy program, phonics applications can be used in classrooms to facilitate students’ self-directed learning of letter-sound knowledge; but are they designed to allow for such a purpose? With most phonics software applications making heavy use of image cues, this project has more specifically investigated whether the design of the images used in such applications may impact on the effectiveness of their self-directed use in classrooms. Using a quasi-experimental study, we compared two types of pictorial mnemonics used in tablet applications, along with teacher-led activity in three first-year classrooms from the one school. The difference between teacher-led activity and integrated picture cues was significant, with teacher-led activity proving more effective. The difference between teacher-led activity and form-taking picture cues, however, was not statistically significant. Given that the outcomes of this small-scale study suggest that image design may be a significant design feature contributing to the educational value of using phonics applications in the classroom, we recommend that the design features of phonics software applications attract further research.

Teacher professional learning in early childhood education: insights from a mentoring program

In Australia, as is the case in other countries around the world, the Early Childhood workforce is in the process of ‘skilling up’ to meet government demands related to quality service provision. This paper sets out to identify what constitutes effective teacher professional learning through mentoring. Guided by critical realism and social practice as theoretical perspectives, the paper uses data drawn from the State-wide Professional Mentoring Program for Early Childhood Teachers (2011–2014), Victoria, Australia. The findings identify four C’s essential to effective professional learning – Context: the association between individual aspirations and systemic requirements; Collegiality: the positioning and importance of collegial relationships; Criticality: critical deliberation in ‘safe’ learning environments; and Change: recognition that teacher learning takes place in the domains of professional dispositions, pedagogical knowledge and social capital. These findings point to the need to consider teachers’ contexts of practice in the design of professional development programs such as mentoring, and to conceptualise learning as a socially situated practice rather than a detached pedagogic event.