BackgroundGestational 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 FindingsIn 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.ConclusionsAlthough 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 RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12610000338066

Work-family conflict research has focused almost exclusively on professional, White adults. The goal of this article was to expand the understanding of culture and industry in shaping experiences and consequences of work-family conflict. Using in-depth interview data (n = 26) and structured survey data (n = 200) from immigrant Latinos employed in the poultry processing industry, the authors evaluated predictions drawn from emerging models emphasizing the influence of cultural characteristics such as collectivism and gender ideology on work-family conflict. Results indicated that immigrant Latinos in poultry processing experienced infrequent work-to-family conflict; both the level and the antecedents of work-to-family conflict differed by gender, with physical demands contributing to greater conflict for women but not men. In addition, there was little evidence that work-family conflict was associated with health in this population. These results demonstrate how traditional models of work-family conflict need to be modified to reflect the needs and circumstances of diverse workers in the new global economy.

ObjectivesTo determine the effectiveness of collaborative care in reducing depression in primary care patients with diabetes or heart disease using practice nurses as case managers.DesignA two-arm open randomised cluster trial with wait-list control for 6 months. The intervention was followed over 12 months.SettingEleven Australian general practices, five randomly allocated to the intervention and six to the control.Participants400 primary care patients (206 intervention, 194 control) with depression and type 2 diabetes, coronary heart disease or both.InterventionThe practice nurse acted as a case manager identifying depression, reviewing pathology results, lifestyle risk factors and patient goals and priorities. Usual care continued in the controls.Main outcome measureA five-point reduction in depression scores for patients with moderate-to-severe depression. Secondary outcome was improvements in physiological measures.ResultsMean depression scores after 6 months of intervention for patients with moderate-to-severe depression decreased by 5.7±1.3 compared with 4.3±1.2 in control, a significant (p=0.012) difference. (The plus–minus is the 95% confidence range.) Intervention practices demonstrated adherence to treatment guidelines and intensification of treatment for depression, where exercise increased by 19%, referrals to exercise programmes by 16%, referrals to mental health workers (MHWs) by 7% and visits to MHWs by 17%. Control-practice exercise did not change, whereas referrals to exercise programmes dropped by 5% and visits to MHWs by 3%. Only referrals to MHW increased by 12%. Intervention improvements were sustained over 12 months, with a significant (p=0.015) decrease in 10-year cardiovascular disease risk from 27.4±3.4% to 24.8±3.8%. A review of patients indicated that the study's safety protocols were followed.ConclusionsTrueBlue participants showed significantly improved depression and treatment intensification, sustained over 12 months of intervention and reduced 10-year cardiovascular disease risk. Collaborative care using practice nurses appears to be an effective primary care intervention.Trial registrationACTRN12609000333213 (Australia and New Zealand Clinical Trials Registry).

Symptoms reported exceeded rates reported by other community, clinical, and occupational samples. Findings suggest policy changes and research are needed to reduce the high rates of occupational illnesses and injuries in this vulnerable population.

The US poultry-processing industry employs a large number of immigrants and has among the highest occupational illness rates for manufacturing. Previous research has not studied the potential health effects of psychosocial indicators of how poultry-processing work is organized. The investigators collected survey data from 200 immigrant Latinos working in poultry processing. Management practices (eg, poor commitment to safety, abusive supervision) and indicators of job design (eg, authority, variety, psychological workload, frequent awkward posture, and repetitive movement) were associated with risk of recent musculoskeletal problems, respiratory problems, and self-reported injury/illness. The results provide preliminary evidence suggesting that the organization of work underlies injury and illness among immigrant workers in poultry processing.