Exercise is recommended as a principal treatment for individuals with knee osteoarthritis (KOA). However, the best choice for an optimal exercise program able to promote long-term compliance in KOA ...patients is not clear. This study aims to compare the effect of combined exercise (CE: quadriceps strengthening exercises (QSE) and Baduanjin qigong training (BDJ)) versus QSE alone and BDJ alone on older adults with KOA.
A three-arm, quasi-experimental trial with repeated measurements was used. As a cluster randomized trial, participants from three community centers were assigned respectively to QSE group, BDJ group and CE group. We assessed pain intensity, physical function, self-efficacy, and health-related quality-of-life (HRQoL) using standardized instruments at baseline, 3 months and 6 months follow-up.
One hundred and twenty-eight participants with KOA aged over 60 completed the study. Over the 6 months, there were significant group interaction effects on pain intensity (F = 28.888, P < 0.001), physical function (F = 26.646, P < 0.001), and self-efficacy (F = 22.359, P < 0.001), and, based on a short form-12 item health survey questionnaire (SF-12), physical component summary (F = 7.470, P < 0.001), and mental component summary (F = 10.207, P < 0.001). Overall, the CE group exhibited significantly greater improvement in all outcomes when compared to the QSE group and the BDJ group.
CE treatment is more effective than QSE and BDJ in pain relief, increasing physical function, improving self-efficacy, and raising quality-of-life in community-dwelling KOA older adults. Moreover, it promotes long-term compliance in KOA community patients.
Chinese Clinical Trails Registry number ChiCTR2000033387 (retrospectively registered). Registered 30 May 2020.
The cost-effectiveness of interventions has attracted increasing interest among researchers. Although web-based and home-based psychoeducational interventions have been developed to improve ...first-time mothers' postnatal health outcomes, very limited studies have reported their cost-effectiveness.
The aim of this study was to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period.
A randomized controlled 3-group pretest and posttest design was adopted, and cost-effectiveness analysis from the health care's perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017 who were randomly allocated to the web-based intervention (n=68), home-based intervention (n=68), or control (n=68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety, and health care resource utilization were measured using valid and reliable instruments at baseline and at 1 month, 3 months, and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over 5 years incurred by the 3 programs at various coverage levels (ie, 10%, 50%, and 100%) were also estimated.
The web-based intervention program dominated the other 2 programs (home-based program and routine care) with the least cost (adjusted costs of SGD 376.50, SGD 457.60, and SGD 417.90 for web-based, home-based, and control group, respectively; SGD 1=USD 0.75) and the best improvements in self-efficacy, social support, and psychological well-being. When considering the implementation of study programs over the next 5 years by multiplying the average cost per first-time mother by the estimated average number of first-time mothers in Singapore during the 5-year projection period, the web-based program was the least costly program at all 3 coverage levels. Based on the 100% coverage, the reduced total cost reached nearly SGD 7.1 million and SGD 11.3 million when compared to control and home-based programs at the end of the fifth year, respectively.
The web-based approach was promisingly cost-effective to deliver the postnatal psychoeducational intervention to first-time mothers and could be adopted by hospitals as postnatal care support.
ISRCTN registry ISRCTN45202278; https://www.isrctn.com/ISRCTN45202278.
Gout is a chronic disease that is on a rising trend and greatly affects one’s physical and psychosocial well-being. The aim of this study was to explore patients’ perceptions of living with gout. A ...descriptive qualitative study was conducted and 15 adults with gout were interviewed face-to-face between December 2014 and January 2015. Thematic analysis was used to analyze the transcribed data. The experiences of patients with gout were found to revolve around four themes: emotional experiences with gout, disruptions in daily lives, interactions with doctor, and coping with gout using internal and external resources. The in-depth understanding of the patients’ experiences indicates a need to provide holistic patient education and to involve family members to create nurse-led support groups and to raise public awareness regarding gout.
To describe changes in sleep patterns during the coronavirus disease 2019 (COVID-19) pandemic, develop profiles according to these patterns, and assess sociodemographic, economic, COVID-19 related, ...and sleep and mental health factors associated with these profiles.
A 25-minute online survey was distributed worldwide through social media from 5/21/2020 to 7/1/2020.
Participants reported sociodemographic/economic information, the impact of the pandemic on major life domains, insomnia and depressive symptoms, and changes in sleep midpoint, time-in-bed, total sleep time (TST), sleep efficiency (SE), and nightmare and nap frequency from prior to during the pandemic. Sleep pattern changes were subjected to latent profile analysis. The identified profiles were compared to one another on all aforementioned factors using probit regression analyses.
The sample of 991 participants (ages: 18-80 years; 72.5% women; 60.3% residing outside of the United States) reported significantly delayed sleep midpoint, reductions in TST and SE, and increases in nightmares and naps. Over half reported significant insomnia symptoms, and almost two-thirds reported significant depressive symptoms. Latent profile analysis revealed 4 sleep pattern change profiles that were significantly differentiated by pre-pandemic sleep patterns, gender, and various COVID-19-related impacts on daily living such as severity of change in routines, and family stress and discord.
In an international online sample, poor sleep and depressive symptoms were widespread, and negative shifts in sleep patterns from pre-pandemic patterns were common. Differences in sleep pattern response to the COVID-19 crisis suggest potential and early targets for behavioral sleep health interventions.
Background Overweight, obesity, and associated comorbidities are a pressing global issue among children of all ages, particularly among low-income populations. Rapid weight gain (RWG) in the first 6 ...months of infancy contributes to childhood obesity. Suboptimal sleep-wake patterns and gut microbiota (GM) have also been associated with childhood obesity, but little is known about their influences on early infant RWG. Sleep may alter the GM and infant metabolism, and ultimately impact obesity; however, data on the interaction between sleep-wake patterns and GM development on infant growth are scarce. In this study, we aim to investigate associations of infant sleep-wake patterns and GM development with RWG at 6 months and weight gain at 12 months. We also aim to evaluate whether temporal interactions exist between infant sleep-wake patterns and GM, and if these relations influence RWG. Methods The Snuggle Bug/ Acurrucadito study is an observational, longitudinal study investigating whether 24-h, actigraphy-assessed, sleep-wake patterns and GM development are associated with RWG among infants in their first year. Based on the Ecological Model of Growth, we propose a novel conceptual framework to incorporate sleep-wake patterns and the GM as metabolic contributors for RWG in the context of maternal-infant interactions, and familial and socio-physical environments. In total, 192 mother-infant pairs will be recruited, and sleep-wake patterns and GM development assessed at 3 and 8 weeks, and 3, 6, 9, and 12 months postpartum. Covariates including maternal and child characteristics, family and environmental factors, feeding practices and dietary intake of infants and mothers, and stool-derived metabolome and exfoliome data will be assessed. The study will apply machine learning techniques combined with logistic time-varying effect models to capture infant growth and aid in elucidating the dynamic associations between study variables and RWG. Discussion Repeated, valid, and objective assessment at clinically and developmentally meaningful intervals will provide robust measures of longitudinal sleep, GM, and growth. Project findings will provide evidence for future interventions to prevent RWG in infancy and subsequent obesity. The work also may spur the development of evidence-based guidelines to address modifiable factors that influence sleep-wake and GM development and prevent childhood obesity. Keywords: infant sleep, Actigraphy, circadian rhythm, sleep-wake pattern, Gastrointestinal microbiota, Rapid weight gain, child overweight; time varying effect models
Abstract
Introduction
Exclusively breastfed (EBF) newborns wake more often at night than partially breastfed, or exclusively formula fed (EFF) newborns. Contextual factors during the first weeks of ...life related to these associations are understudied. We examined relationships among post-birth experiences, objectively-estimated sleep-wake patterns, and feeding practices through three weeks post-delivery.
Methods
English or Spanish speaking mothers (n=20) and their full-term (≥37wk), singleton infants were recruited from Phoenix, Arizona. Mothers were 32.7±5.1y, 30.0% identified as Hispanic, 20.0% with < high school degree, and 15.0% were enrolled in the federal Women, Infants, and Children program. Infants were born normal weight (2500-4000g) and without major complications. At three weeks post-delivery, infants wore a Micro Motionlogger (Ambulatory Monitoring Inc.) on their left ankle for five 24hr periods at three weeks of age. Mothers completed an accompanying sleep diary and an adapted Infant Feeding Practices Study-II questionnaire. Pearson correlations and t-tests examined relationships between nocturnal sleep-wake patterns and feeding practices at birth and 3-weeks post-delivery.
Results
At birth, all mothers attempted breastfeeding, 40.0% of infants received formula, and mean time for milk to come in was 2.7 days (range: 1-4). At three weeks, one mother was EFF, 55.5% (n=11) were EBF, and 40.0% (n=8) were mixed feeding. Infant sleep-wake patterns included midpoint of 2:40±1:01, long wake episode (≥5min) frequency of 5.8±2.3, longest sleep bout duration of 127.2±34.9min, WASO of 124.1±54.3min, and TST of 434.7±79.7min. Breastmilk feeding frequency was positively related to long wake episode frequency (r=.49, p=0.03) and WASO (r=.47, p=0.04), and negatively related to longest sleep bout (r=-.59, p=0.006). Formula feeding frequency was positively related to longest sleep bout (r=.58, p=0.007). Greater time for milk to come in was positively related to long wake episode frequency (r=.53, p=0.02) and WASO (r=.56, p=0.01), and negatively related to longest sleep bout (r=-.47, p=0.04). Receiving formula in the hospital was associated with later sleep midpoint (t18=3.2, p=0.005), regardless of current formula feeding.
Conclusion
Feeding experiences and ability to breastfeed during the first few days of life may play a role in the quality and patterning of actigraphy-estimated sleep among newborns. Future research should investigate whether these associations persist into later infancy.
Support (If Any)
National Institutes of Health / National Heart, Lung, and Blood Institute R01 HL147931
Abstract
Introduction
Increased sleep problems in adults have been repeatedly reported during the COVID-19 pandemic. However, infant sleep was understudied. We aimed to examine the relationships ...between the impact of the COVID-19 pandemic, parent insomnia, infant temperament, and infant sleep during the COVID-19 pandemic.
Methods
Parents from the Phoenix metropolitan area with a full-term healthy infant (<1 year) were recruited through social media from 2/27/2021 to 8/7/2021. A sample of 70 parents (baby age 5.5±3.5mo; parental age: 31.7±5.0y) completed the COVID-19 Exposure and Family Impact Survey Part 2 (CEFIS-Part 2, range: 12-60), a measure of the impact of the COVID-19 pandemic on families with higher scores indicating greater negative impact/distress; the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), with higher scores indicating better sleep quality, more positive sleep perception, and parent behaviors promoting healthy sleep; and the Insomnia Severity Index (ISI, range: 0-28, cutoff: 10). Infant temperament was assessed with the Infant Behavioral Questionnaire-Revised (IBQ-R), including the subscale Negative Affect. Path analyses were conducted based on the Transactional Model of Infant Sleep to identify the direct effect of CEFIS scores, and indirect effects of parent ISI scores and infant IBQ-R Negative Affect scores on BISQ-R scores, with z scores of all variables and infant age as a covariate.
Results
The parent sample was predominantly female (94.3%), identified as White (72.9%), had obtained a bachelor’s degree or above (71.5%), was married or in a domestic partnership (98.6%), and had household incomes > US$70,000 (57.1%). More than one third (35.7%) experienced insomnia symptoms. The means of CEFIS, ISI, IBQ-R subscale Negative Affect, and BISQ-R scores were 29.3±9.5, 8.7±5.2, 4.1±1.1, and 68.8±12.7, respectively. After adjusting for infant age, the COVID-19 related family impact was not directly associated with BISQ-R scores, whereas parent ISI scores (β=-0.11, 95%CI -.25, -.01) and infant IBQ-R Negative Affect scores (β=-0.10, 95%CI -.25, -.002) significantly mediated the relationship.
Conclusion
The study highlighted the indirect effects of parent insomnia symptom severity and infant negative affect on infant sleep from the family impact of the COVID-19 pandemic. Future research should investigate how best to support healthy sleep for families during global crises.
Support (If Any)
Abstract Introduction Maternal stress levels, sleep, and mother-infant interactions are associated with infant sleep. However, the potential impact of these factors experienced during the early ...postpartum period on future infant sleep development is understudied. This study examined whether maternal stress and sleep at 3 weeks postpartum predicted infant wakefulness at 6 months of age through mother-infant bonding and the home environment quality at 8 weeks postpartum. Methods This secondary analysis of the longitudinal Snuggle Bug/Acurrucadito cohort included a subsample of mothers (n=171, 31.4±5.4y, 74.9% married, 38% Hispanic/Latina, 64.3% ≥ bachelor’s degree) and their full-term infants who were visited in their homes at 3 and 8 weeks, and 6 months postpartum. Infant wakefulness after sleep onset (WASO) was assessed using ankle-actigraphy and sleep diaries over 5 days at the 3-week and 6-month visits. At the 3-week visit, mothers completed the Pittsburgh Sleep Quality Index (PSQI, range:0-21) and the Stress subscale of the Depression Anxiety Stress Scales-21 (range:0-42). At 8 weeks, mothers completed the Postpartum Bonding Questionnaire infant-focused anxiety subscale (PBQ-anxiety, range:0-20, higher scores indicate greater anxiety-related bonding difficulties), and staff assessed the home environment quality with the Home Observation for Measurement of the Environment Inventory (HOME, range:0-45, higher scores indicate a more enriched and interactive environment). Based on the Transactional Model of Infant Sleep, path analyses were conducted to identify the direct effect of 3-week PSQI and Stress scores, and indirect effects via 8-week PBQ-anxiety and HOME scores, on 6-month WASO, adjusting for 3-week WASO, maternal age, education, and marital status. Results Average 3-week PSQI and Stress, and 8-week PBQ-anxiety and HOME scores were 6.8±3.1, 7.4±6.5, 2.1±1.9, and 36±4.5, respectively. WASO at 3 weeks and 6 months were 146.9±64.9 and 63.4±33.2min. The 3-week Stress score was not directly related to 6-month WASO (β=-0.28, 95%CI: -0.79-0.17), but positively related to 6-month WASO indirectly through 8-week PBQ-anxiety (β=0.14, 95%CI:0.02-0.31). The 3-week PSQI was not directly or indirectly associated with 6-month WASO, and the HOME score was not a significant mediator. Conclusion Early, heightened maternal stress, independent of maternal sleep quality may indirectly lead to greater infant nighttime wakefulness later in infancy by disrupting early mother-infant bonding. Support (if any) NIH/NHLBIR01HL147931
Abstract
Introduction
Infant sleep is influenced by biopsychosocial interactions. However, the influence of an interactive home environment is underexplored. The aim was to examine whether early ...positive parent-child interactions and an enriched home environment were associated with better infant sleep later.
Methods
Pregnant, obese, and low-income Latina women were recruited for a RCT delivering a 12-month intervention for infants to prevent overweight (n=129). At 1, 6, and 12 months, mothers reported breastfeeding duration, completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), and underwent the Home Observation for Measurement of the Environment (HOME, range: 0-45) Inventory including subscales of Responsivity, Acceptance, Organization, Learning Materials, Involvement, and Variety. Pearson correlations between HOME and BISQ-R at each visit were conducted. Significant associations (α<0.05) were entered into stepwise multivariable linear regressions adjusting for infant sex, mother’s education, breastfeeding, and 1-month BISQ-R to determine which HOME subscales were associated with 6- and 12-month total BISQ-R if the total HOME was significant.
Results
The mean 1-, 6- and 12-month BISQ-R were 84(SD=6.1), 76.4(SD=8.3), and 78.5(SD=8.0), respectively. The 1-month HOME total score (M=21.8SD=4.4) significantly correlated with the 6- and 12-month BISQ-R. The regression of 1-month HOME with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.3, p=0.001), greater HOME total scores (β=0.2, p=0.037), and 1-month BISQ-R scores(β=0.2, p=0.038), which explained 13.1% of the variance (F3,106=6.5, p<0.001). The regression of 1-month HOME subscales with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.31, p=0.001), greater Responsivity scores (β=0.21, p=0.022), and 1-month BISQ-R scores (β=0.2, p=0.027), which explained 13.9% of the variance (F3,106=6.86, p<0.001). The regression of 1-month HOME with 12-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.24, p=0.013) and greater HOME total scores (β=0.24, p=0.016), which explained 7.9% of the variance (F2,100=5.4, p=0.006). The regression of 1-month HOME subscales with 12-month BISQ-R indicated greater BISQ-R scores were associated with greater Variety scores (β=0.29, p=0.003), shorter breastfeeding (β=-0.24, p=0.011), and 1-month BISQ-R scores(β=0.18, p=0.049), which explained 13.5% of the variance (F3,99=6.29, p=0.001).
Conclusion
Better infant sleep was associated with an early interactive home environment, especially parent’s responsiveness and people/events providing organized variety.
Support (if any):
To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life, glycated hemoglobin, ...body mass index (BMI), and blood pressure (BP) levels of adults with type 2 diabetes mellitus .
A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Studies published in English from January 2007 to January 2018 were considered. Only randomized controlled trials (RCTs) of smartphone-based self-management interventions for patients with type 2 diabetes mellitus that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes.
A total of 26 articles, consisting of 22 studies with 2645 participants, were included in the review. The results from meta-analysis on the studies revealed that as compared to control group, participants received smartphone-based self-management intervention had better self-efficacy with large effect size of 0.98 (P < 0.001), self-care activities with effect size of 0.90 (P < 0.001), health related quality of life with effect size of 0.26 (p=0.01), and lower glycated hemoglobin (pooled MD=-0.55; p<0.001). Subgroup analyses were also conducted for self-efficacy as significant heterogeneity was present among the studies. The effects on BMI and BP were not statistically significant.
Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with type 2 diabetes mellitus. However, more research with good study design is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM.
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