Diabetes risk reduction behaviours of rural postpartum women with a recent history of gestational diabetes

Introduction: For most women, gestational diabetes is temporary; however, an episode of gestational diabetes mellitus (GDM) confers an approximately seven-fold increased risk of developing type 2 diabetes mellitus. Objective: To examine readiness to adopt diabetes risk reduction behaviours and the prevalence of these behaviours among rural women with GDM during their last pregnancy.
Methods: The study design was a self-administered mailed questionnaire seeking information about demographics, stage of change, physical activity level and dietary fat intake. Setting: Regional outpatient context. Participants: Women with a single episode of GDM between 1 July 2001 and 31 December 2005 (n = 210). Main outcome measures: Stage of change for physical activity, weight loss and reducing dietary fat behaviour; meeting activity targets, body mass index (BMI) and dietary fat score.
Results: Eighty-four women returned completed questionnaires (40% response rate). Of the 77 women eligible (mean age 35 ± 3.8 years), 58% met recommended activity targets. Sixty-three percent of women were overweight or obese: mean BMI 29.6 kg/m2 (± 7.30). Women reported a high level of preparedness to engage in physical activity, weight loss and reduction of fat intake. Thirty-nine percent of women had not had any postpartum follow-up glucose screening. Women who remembered receiving diabetes prevention information were significantly more likely to meet physical activity targets (p<0.05).
Conclusions: Readiness to engage in behaviour change was high among this group of rural women for all three diabetes risk reduction behaviours measured. However, despite a high proportion of women meeting activity targets and reducing fat intake, the majority of women remained overweight or obese. Postpartum follow-up glucose testing needs to be improved and the impact of diabetes prevention information provided during pregnancy warrants further study.

The end of economic growth? A contracting threshold hypothesis

This paper argues that GDP growth in both developed and developing countries has associated costs that can outweigh the benefits and thus reduce sustainable well-being. This conclusion is based upon the findings of empirical applications of the Genuine Progress Indicator (GPI) to a range of countries in the Asia-Pacific region. The studies conducted on seven Asia-Pacific countries indicate that, in the case of five of the seven nations, more recent GDP growth has reduced the sustainable well-being experienced by the average citizen residing within them. Moreover, the threshold point at which the costs of GDP growth outweigh the benefits appears to be contracting (i.e., occurring at a much lower per capita level of GDP). This paper therefore introduces a new contracting threshold hypothesis: as the economies of the Asia-Pacific region and the world collectively expand in a globalised economic environment, there is a contraction over time in the threshold level of per capita GDP. As a consequence, the threshold point confronting growth late-comers (i.e., developing countries) occurs at a much lower level of sustainable welfare than what wealthy nations currently enjoy. The consequences of this for developing countries are clearly significant and require a new approach to economic development.

Cultural destruction and identity politics : targeting the history of Iraq

Since its inception in 1921, a number of successive regimes have sought to politicize Iraq‟s cultural history in order to develop national identity and foster social cohesion across this rich and complex nation. Foremost among these were the Baath party, particularly under the rule of Saddam Hussein, who used much of the nation‟s Oil wealth to undergo an extensive nation-building campaign. However, identity in Iraq is far from monolithic and various factions have long resisted the state sanctioned version of “Iraqi” identity and asserted alternative histories and narratives to underpin their own identity politics. With the invasion of Iraq by Coalition forces in 2003, however, came an unprecedented era of cultural destruction. Following the devastation of the battle phase of the war, there were further attacks on Iraq‟s cultural heritage including everything from the carefully choreographed removal of the giant bronze statue of Saddam in Firdos square, through to military bases set up at sensitive archaeological sites such as the ancient city of Babylon. In addition, Iraqi civilians targeted the cultural history of their nation with wanton looting and arson, as well as systematic attacks on sites of archaeological or ethno-religious significance. More recently, the Shia and Kurdish dominated Iraqi Government have organised the “Committee for Removing Symbols of the Saddam Era” and drew up plans to purge the state of its Sunni dominated past.

This paper argues that the unprecedented scale and magnitude of the destruction of Iraq‟s cultural history has played a part in eroding the various intersecting and overlapping versions of identity politics in Iraq. In turn, this has provided fertile ground for terrorists and sectarians to plant the seeds of their own narrow and deadly ideologies. This has brought about the rise of ethno-religious based violence and seen a series of bloody and protracted conflicts emerge between previously peaceful and compatible factions. In this way, Iraq serves as a powerful case study in furthering academic discussion on the complex inter-relationships between cultural and historical destruction and identity politics, sectarianism, violence and democracy.

Targeting the cultural history of Iraq : implications for national identity and democracy

Since its inception in 1921, a number of successive regimes have sought to politicize Iraq’s cultural history in order to build nationalistic sentiment and social cohesion across this rich and complex nation. Foremost among these were the Baath party, particularly under the rule of Saddam Hussein, who used much of the nation’s Oil wealth to undergo an extensive nation-building campaign. However, with the invasion of Iraq by the US in 2003 came the deliberate destruction and blatant negligence of the occupying forces. In addition, Iraqi civilians targeted the cultural landscape of their nation with wanton looting and arson, as well as systematic attacks on sites of archaeological or ethno-religious significance. More recently, the Shia and Kurdish dominated Iraqi Government have organised the “Committee for Removing Symbols of the Saddam Era” and plan to purge the state of its Sunni dominated past. This paper argues that the destruction of Iraq’s cultural history has played a part in eroding the national identity that many of these symbols and institutions were designed to promulgate. In turn, this has brought about the rise of ethno/religious sectarianism in Iraq which has had particular implications for the nation’s fledgling democratic order.

Antidepressants and suicidal thought

The association of antidepressants with suicidal thought in people aged up to 25 year is a thorny issue. Balancing risk with benefit must always be at the core of any decision to treat and when the risk is an increased risk of suicide then a balanced decision can be difficult to make. Some clinicians who have been successfully treating patients using antidepressants have felt skepticism with these studies, finding them to be not reflective of their personal clinical experience. It may be wondered by some whether highlighting the link between suicidal thoughts and antidepressants may paradoxically lead to an increase in suicide by reducing the number of cases treated, however there is no evidence that this has occurred.

The association between antidepressants and suicidal thought may be unpalatable, but as with all new research the only way it can be judged is by the evidence to support it. The weight of evidence to demonstrate the association between antidepressants and suicidal thought in young people is convincing although the risk is low, estimated at one case of emerging suicidal ideation or suicide attempt for every 143 pediatric patients treated [1]. This risk is too low to displace antidepressants as the first line of treatment for depression but is too high a risk to be ignored. The risk is also too low to be recognized based on clinical experience alone as it is low enough to be imperceptible amongst suicides which occur due to depressive illness independent of antidepressant treatment. Only large studies are sufficiently powered to detect suicidal thought associated with antidepressant treatment. Clearly further studies would be helpful, especially if they can help characterize those at greatest risk. This is why the study by Lucy Goldsmith and Joanna Moncrieff in this issue of Current Drug Safety is an important step towards improving our understanding of antidepressant safety. These researchers find a link between increased suicidal impulses and emotional blunting and emotional instability.

Treating clinicians are urged to monitor for risk of suicide after initiation of antidepressant treatment, typically more frequently for the first four weeks of treatment and as indicated thereafter. However, if there is no history of suicidal thought or attempt and the patient does not admit to suicidal thought, suicidality may be missed by the treating clinician, ending in tragedy. Studies that provide new insights into this serious problem may lead to improvements in the effectiveness of monitoring patients for suicide risk, ultimately leading to better outcomes for patients.