Aims/hypothesis Women who develop gestational diabetes mellitus (GDM) have an elevated lifetime risk of type 2 diabetes mellitus. Recently, a series of studies has suggested that women with GDM also have an increased risk of cardiovascular disease (CVD). However, it is unclear if this risk is dependent upon the intercurrent development of type 2 diabetes. Thus, we conducted a systematic review and meta-analysis to evaluate the impact of GDM on future risk of incident CVD and to ascertain the role of type 2 diabetes in this regard. Methods We systematically searched the PubMed and EMBASE databases for observational studies that evaluated the association of GDM with subsequent CVD, with publication between 1 January 1950 and 30 August 2018. Two independent reviewers extracted data and the analysis was performed in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. RRs were calculated using a random-effects model to assess the predictive value of GDM for future cardiovascular events. To evaluate whether incident type 2 diabetes in the GDM population influenced the association with CVD, we used meta-regression models followed by sensitivity analyses restricted to women who did not develop type 2 diabetes during follow-up. Results A pooled analysis of nine studies yielded data from 5,390,591 women (101,424 cardiovascular events). Compared with those who did not have GDM, women with GDM had a twofold higher risk of future cardiovascular events (RR 1.98 [95% CI 1.57, 2.50]). Meta-regression analysis showed that the rates of incident type 2 diabetes across the studies did not affect this risk (p = 0.34). Moreover, when restricted to women who did not develop type 2 diabetes, GDM remained associated with a 56% higher risk of future cardiovascular events (RR 1.56 [95% CI 1.04, 2.32]). GDM conferred a 2.3-fold increased risk of cardiovascular events in the first decade postpartum (RR 2.31 [95% CI 1.57, 3.39]). Conclusions/interpretation The diagnosis of GDM identifies young women who have a twofold higher risk of cardiovascular events postpartum compared with their peers. This risk is not dependent upon intercurrent type 2 diabetes and is apparent within the first decade after pregnancy. Thus, even without progressing to type 2 diabetes, women with GDM comprise an at-risk population for CVD and hence a potential opportunity for early risk factor surveillance and risk modification.

Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. Design: Modified two-round postal Delphi questionnaire. Setting: Geographical spread across Great Britain. Participants: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). Main outcome measures: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. Results: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). Conclusions: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

Current evidence suggests that SGLT-2 inhibitors are more effective than either GLP-1 agonists or DPP-4 inhibitors for reducing the risk of hospitalization for HF in type 2 diabetes mellitus.

This study aimed to provide a quantitative synthesis on the effect of the Sport Education Model (SEM) on basic need satisfaction, intrinsic motivation, and prosocial attitudes in physical education (PE). We conducted a systematic review and meta-analysis on experimental studies conducted before August 2020. The initial search yielded 6061 articles, with 25 articles ( n = 2937) meeting the inclusion criteria. The articles were analyzed using five separate analyses using two- and three-level random-effects models and Hedges’ g effect size. The study showed the SEM to have a positive heterogeneous medium effect on autonomy ( g = 0.43; CI 95% [0.12, 0.74]), competence ( g = 0.42; CI 95% [0.17, 0.67]) and relatedness ( g = 0.57; CI 95% [0.28, 0.85]) need satisfaction, intrinsic motivation ( g = 0.63; CI 95% [0.37, 0.89]), and prosocial attitudes ( g = 0.46; CI 95% [0.09, 0.83]). All a priori categorical moderators were statistically insignificant. The analyses indicate that the SEM is more need-supportive and promotes intrinsic motivation and prosocial attitudes more compared to the skill-drill, direct, and traditional instructional styles used in PE. However, high-quality experimental and comparative trials testing the efficacy of the SEM on broad outcomes are needed. Specifically, the concept of novelty, potential negative outcomes, and essential behavioral outcomes, such as physical activity, should be included in the future. Further, the fidelity of the interventions should be measured and reported with more transparency and detail.

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