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Purpose: Levothyroxine (L-T4) is the drug of choice for treating primary hypothyroidism. L-T4 tablets should be taken at least 30 min before breakfast. Several studies have suggested that serum thyroid profile is not affected by concomitant intake of liquid/softgel L-T4 with meals. Our aim is to review the evidence on therapeutic efficacy and patient compliance with the liquid and softgel formulation of L-T4 taken with meals, also compared with the standard tablet therapy regimen, in hypothyroid patients. Methods: We performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. PRISMA guidelines were applied, and the risk of bias of the included studies was assessed using the RoB 2 and ROBINS tools. The methodological quality was assessed following the GRADE criteria. Results: We included 13 studies, accounting for a total of 1697 patients. The timing of liquid L-T4 intake from breakfast did not affect the therapeutic efficacy of the treatment. No significant differences in the absorption of liquid L-T4 were found when administered together with different foods, beverages, drugs, or other supplements. TSH levels are not influenced by taking softgel L-T4 at breakfast; the efficacy of softgel and liquid formulation is similar when they are taken with a meal, but superior to that of tablet formulation. Shifting from L-T4 tablets taken 30 min before breakfast to liquid/softgel formulation taken with the meal improved medication adherence and perceived quality of life of patients. Conclusion: Liquid and softgel formulation of L-T4 can be taken at breakfast or close to meals, without losing therapeutic efficacy. These formulations could also improve patient compliance and quality of life compared to L-T4 tablet therapy taken 30 min before breakfast. [ABSTRACT FROM AUTHOR]

Objectives: In recent years, mindfulness has gone mainstream, reaching many adolescents through school programs and smartphone applications. Yet there is little empirical understanding of what mindfulness practice is like for adolescents. This mixed-methods study sought to capture adolescents' lived experiences as they embarked on a period of intensive mindfulness practice. Methods: Twenty-three self-selected youth (Mage = 16.68 years, SD = 1.55; 57% girls, 43% boys; 52% White, 13% African American, 4% Latino, 4% East Asian, and 26% Multiracial) participated in a 6-day residential mindfulness retreat. Participants completed self-report surveys, open-ended daily diaries, and discussed their experiences in focus groups. Qualitative data were analyzed using a two-cycle coding process to categorize common patterns of adolescents' experiences during mindfulness practice and quantitative data were examined for demographic subgroup differences. Results: Adolescents reported an array of experiences of distress from cognitive (83% of adolescents; e.g., self-loathing and rumination), to emotional (87% of adolescents; e.g., sadness), and to physical distress (44% of adolescents; e.g., physical pain) during mindfulness practice. They also described a range of well-being experiences from cognitive (87% of adolescents; e.g., self-inquiry and discovery), to emotional (65% of adolescents; e.g., acceptance), and to social well-being (39% of adolescents; e.g., loving-kindness and connection). The frequency of experiences of distress and well-being reported were relatively balanced overall, yet girls and experienced meditators reported greater distress. Conclusions: This study paints a descriptive picture of adolescents' experiences during mindfulness practice and suggested that their experiences might reflect core developmental concerns. Implications for adolescent development and contemplative science are discussed. [ABSTRACT FROM AUTHOR]

Aims: To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). Methods: Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. Results: From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81–87 mg/dl (4.5–4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. Conclusions: Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention. [ABSTRACT FROM AUTHOR]

Introduction: In persons with type 1 diabetes (T1D) insulin dosing can be adjusted based on trend arrows derived from continuous glucose monitoring (CGM). We propose a slide rule with narrower blood glucose intervals and more classes of insulin sensitivity than are available in current models. Methods: The slide rule was tested in silico, in which a meal was simulated in 100 virtual subjects and the insulin bolus was calculated either in the standard way based on the insulin-to-carbohydrate ratio and the correction factor or according to the slide rule, following which the percentage time spent in range (70–180 mg/dl; %TIR), hypoglycemia (< 70 mg/dl; %THYPO), and hyperglycemia (> 180 mg/dl; %THYPER) was compared between the methods during the 4 h after the meal. Slide rule performance was also tested in real life by analyzing the same variables at during the 4 h postprandial period in 27 individuals with T1D. Only meals starting while the rate of change was at least 1 mg/dl per minute (increasing or decreasing) were considered for analysis. Results: In silico, when the preprandial trend arrow was increasing, our slide rule reduced %THYPER and increased %TIR (p < 0.05), whereas when the preprandial trend arrow was decreasing, it reduced %THYPO and slightly increased %THYPER (p < 0.05). In real life, our slide rule kept subjects on target for 70.8 and 91.6% of postprandial time when preprandial trend arrows were increasing or decreasing, respectively. Conclusion: The proposed slide rule performed well both in silico and in real life, suggesting that it could be safely adopted by individuals with T1D to improve glucose control. [ABSTRACT FROM AUTHOR]

Research shows greater mindfulness is associated with less negative affect and more positive affect. Fewer studies have examined the mediating psychological processes linking mindfulness to these outcomes in adolescents. This three-wave, prospective longitudinal study examines rumination—the tendency to engage in repetitive and negative self-focused thinking—as one potential explanatory process. High school students (N = 599, Mage = 16.3 years; 49% girls) completed a short-form version of the Five Facet Mindfulness Questionnaire, in addition to self-report measures of rumination and negative and positive affect three times over the course of a school year. Autoregressive, cross-lagged panel models tested reciprocal, prospective associations between mindfulness, rumination, and negative and positive affect, while accounting for prior levels of each construct, within-wave covariances, and gender and grade level. The results showed that the nonjudgment mindfulness facet (and the total mindfulness score) predicted cross-wave reductions in rumination, that in turn predicted cross-wave reductions in negative affect. No evidence for mediation was found for positive affect, or for any of the other mindfulness facets (describe, acting with awareness, and nonreactivity). This study provides suggestive evidence that individual differences in mindfulness, and in particular nonjudgmental acceptance, prospectively predict less negative affect through lower rumination. [ABSTRACT FROM AUTHOR]

Aims: In 2010, Italian health professionals rapidly implemented the one-step screening for gestational diabetes mellitus (GDM) based on a 75 g OGTT, to comply with the diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). The change was promoted by the two main Italian scientific societies of diabetology, Associazione Medici Diabetologi (AMD) and Società Italiana di Diabetologia (SID), and it took just a few months for the Istituto Superiore di Sanità, together with several scientific societies, to revise the criteria and include them in the National Guidelines System. Over the last 9 years, the implementation of these guidelines has shown some benefits and some drawbacks. Methods: In order to evaluate the critical issues arisen from the implementation of the current Italian guidelines for the diagnosis of GDM, the studies published on this topic have been reviewed. The search was performed using the following keywords: "gestational diabetes" AND "diagnostic criteria" OR screening AND Ital*. The study is an expert opinion paper, based on the relevant scientific literature published between 2010 and 2019. The databases screened for the literature review included PubMed, MEDLINE, and Scopus. Results: The implementation of the Guidelines for Screening and Diagnosis of GDM in Italy present some strengths and some weaknesses. One of the positive aspects is that high-risk women are required to perform an OGTT early in pregnancy. By contrast, there are several aspects in need of improvement: (1) In spite of the current indications, only a minority of high-risk women perform OGTT early in pregnancy; (2) several low-risk women are screened for GDM; (3) in some low-risk women affected by GDM, the diagnosis might be missed with the application of the current guidelines; (4) there is a lack of homogeneity in the risk assessment data from different regions. Conclusions: In order to improve the current Italian GDM guidelines, some practical solutions have been suggested. [ABSTRACT FROM AUTHOR]

Aims: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk.Methods: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM.Results: Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59-3.87), large for gestational age (OR 3.99, 95% CI 2.40-6.63), fetal malformation (OR 2.66, 95% CI 1.00-7.18), and respiratory distress (OR 4.33, 95% CI 1.33-14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00-2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04-3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02-2.27) and obesity (OR 1.62, 95% CI 1.04-2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21-2.33 for obese; OR 1.38 95% CI 1.03-1.87 for overweight).Conclusions: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity. [ABSTRACT FROM AUTHOR]

Authors would like to correct the error in their publication. [ABSTRACT FROM AUTHOR]