The expectations and acceptability of a smart nursing home model among Chinese older adults: a mixed methods study.

BACKGROUND: Smart nursing homes (SNHs) integrate advanced technologies, including IoT, digital health, big data, AI, and cloud computing to optimise remote clinical services, monitor abnormal events, enhance decision-making, and support daily activities for older residents, ensuring overall well-being in a safe and cost-effective environment. This study developed and validated a 24-item Expectation and Acceptability of Smart Nursing Homes Questionnaire (EASNH-Q), and examined the levels of expectations and acceptability of SNHs and associated factors among older adults in China. METHODS: This was an exploratory sequential mixed methods study, where the qualitative case study was conducted in Hainan and Dalian, while the survey was conducted in Xi'an, Nanjing, Shenyang, and Xiamen. The validation of EASNH-Q also included exploratory and confirmatory factor analyses. Multinomial logistic regression analysis was used to estimate the determinants of expectations and acceptability of SNHs. RESULTS: The newly developed EASNH-Q uses a Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree), and underwent validation and refinement from 49 items to the final 24 items. The content validity indices for relevance, comprehensibility, and comprehensiveness were all above 0.95. The expectations and acceptability of SNHs exhibited a strong correlation (r = 0.85, p < 0.01), and good test-retest reliability for expectation (0.90) and acceptability (0.81). The highest tertile of expectations (X2=28.89, p < 0.001) and acceptability (X2=25.64, p < 0.001) towards SNHs were significantly associated with the willingness to relocate to such facilities. Older adults with self-efficacy in applying smart technologies (OR: 28.0) and those expressing a willingness to move to a nursing home (OR: 3.0) were more likely to have the highest tertile of expectations compared to those in the lowest tertile. Similarly, older adults with self-efficacy in applying smart technologies were more likely to be in the highest tertile of acceptability of SNHs (OR: 13.8). CONCLUSIONS: EASNH-Q demonstrated commendable validity, reliability, and stability. The majority of Chinese older adults have high expectations for and accept SNHs. Self-efficacy in applying smart technologies and willingness to relocate to a nursing home associated with high expectations and acceptability of SNHs.

Defining the concepts of a smart nursing home and its potential technology utilities that integrate medical services and are acceptable to stakeholders: a scoping review.

BACKGROUND AND OBJECTIVES: Smart technology in nursing home settings has the potential to elevate an operation that manages more significant number of older residents. However, the concepts, definitions, and types of smart technology, integrated medical services, and stakeholders' acceptability of smart nursing homes are less clear. This scoping review aims to define a smart nursing home and examine the qualitative evidence on technological feasibility, integration of medical services, and acceptability of the stakeholders. METHODS: Comprehensive searches were conducted on stakeholders' websites (Phase 1) and 11 electronic databases (Phase 2), for existing concepts of smart nursing home, on what and how technologies and medical services were implemented in nursing home settings, and acceptability assessment by the stakeholders. The publication year was inclusive from January 1999 to September 2021. The language was limited to English and Chinese. Included articles must report nursing home settings related to older adults ≥ 60 years old with or without medical demands but not bed-bound. Technology Readiness Levels were used to measure the readiness of new technologies and system designs. The analysis was guided by the Framework Method and the smart technology adoption behaviours of elder consumers theoretical model. The results were reported according to the PRISMA-ScR. RESULTS: A total of 177 literature (13 website documents and 164 journal articles) were selected. Smart nursing homes are technology-assisted nursing homes that allow the life enjoyment of their residents. They used IoT, computing technologies, cloud computing, big data and AI, information management systems, and digital health to integrate medical services in monitoring abnormal events, assisting daily living, conducting teleconsultation, managing health information, and improving the interaction between providers and residents. Fifty-five percent of the new technologies were ready for use in nursing homes (levels 6-7), and the remaining were proven the technical feasibility (levels 1-5). Healthcare professionals with higher education, better tech-savviness, fewer years at work, and older adults with more severe illnesses were more acceptable to smart technologies. CONCLUSIONS: Smart nursing homes with integrated medical services have great potential to improve the quality of care and ensure older residents' quality of life.

Predictors and incidence of post-partum depression: a longitudinal cohort study.

AIM: This study was designed to identify the incidence and the related factors contributing to post-partum depression (PPD) in women in Iran for the first time. MATERIAL AND METHODS: A total of 2279 eligible pregnant women from 32-42 weeks of pregnancy to 12 weeks post-partum (2009) who attended primary health centers in Mazandaran province were screened for depression using the Iranian version of the Edinburgh Postnatal Depression Scale. Pregnant women free from depression were assessed using validated questionnaires, including the Premenstrual Syndrome Questionnaire, Social Support Appraisal Scale, Network Orientation Scale, General Health Questionnaire, Marital Inventory, Life Events Rating Scale and Parental Expectation Survey. Logistic regression analysis was used to determine the risk factors of PPD. RESULTS: Of 1801 women who screened negative for depression at 32-42 weeks' gestation, cumulative incidence proportions were 6.7%, 4.3% and 4.5% during 0-2, >2-8 and >8-12 weeks post-partum, respectively. The factors predictive of PPD were: history of depression during the first two trimesters of pregnancy (odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.59-4.1); psychiatric disorder during pregnancy (OR = 1.08, 95%CI = 1.06-1.11); gestational diabetes (OR = 2.93, 95%CI = 1.46-5.88); recurrent urinary infection (OR = 2.25, 95%CI = 1.44-3.52); unwanted pregnancy (OR = 2.5, 95%CI = 1.69-3.7) and low household income (OR = 3.57, 95%CI = 1.49-8.5). The risk was decreased with increasing age (OR = 0.88, 95%CI = 0.84-0.92) and those with high self-efficacy for mothering (OR = 0.7, 95%CI = 0.62-0.78). CONCLUSION: A high rate of new cases of PPD was identified in Iranian women. A combination of psychological, sociological, obstetric and sociodemographic factors can render mothers vulnerable to post-partum depression.

Poor glycemic control in younger women attending Malaysian public primary care clinics: findings from adults diabetes control and management registry.

BACKGROUND: Women of reproductive age are a group of particular concern as diabetes may affect their pregnancy outcome as well as long-term morbidity and mortality. This study aimed to compare the clinical profiles and glycemic control of reproductive and non-reproductive age women with type 2 diabetes (T2D) in primary care settings, and to determine the associated factors of poor glycemic control in the reproductive age group women. METHODS: This was a cross-sectional study using cases reported by public primary care clinics to the Adult Diabetes Control and Management registry from 1st January to 31st December 2009. All Malaysian women aged 18 years old and above and diagnosed with T2D for at least 1 year were included in the analysis. The target for glycemic control (HbA1c < 6.5%) is in accordance to the recommended national guidelines. Both univariate and multivariate approaches of logistic regression were applied to determine whether reproductive age women have an association with poor glycemic control. RESULTS: Data from a total of 30,427 women were analyzed and 21.8% (6,622) were of reproductive age. There were 12.5% of reproductive age women and 18.0% of non-reproductive age women that achieved glycemic control. Reproductive age group women were associated with poorer glycemic control (OR = 1.5, 95% CI = 1.2-1.8). The risk factors associated with poor glycemic control in the reproductive age women were being of Malay and Indian race, longer duration of diabetes, patients on anti-diabetic agents, and those who had not achieved the target total cholesterol and triglycerides. CONCLUSION: Women with T2D have poor glycemic control, but being of reproductive age was associated with even poorer control. Health care providers need to pay more attention to this group of patients especially for those with risk factors. More aggressive therapeutic strategies to improve their cardiometabolic control and pregnancy outcome are warranted.

The Expectations and Acceptability of a Smart Nursing Home Model Among Chinese Older Adults and Family Members: A Qualitative Study.

PURPOSE: This study aims to explore the expectations and acceptability of a smart nursing home model among Chinese older adults and their family members based on a scoping review that defines the concept of smart nursing homes. METHODS: A qualitative case study was employed for this research. Semi-structured, in-depth interviews and focus group discussions were conducted on WeChat. Participants were purposively sampled through snowball sampling in Hainan and Dalian, China. A total of 28 older adults aged 60-75 and six adult children were interviewed until data saturation was achieved, followed by a thematic analysis. RESULTS: The expectations of smart nursing homes include: 1) quality of care supported by governments and societies; 2) smart technology applications; 3) the presence of a skilled healthcare professional team; 4) access to and scope of basic medical services; and 5) integration of medical services. The acceptability of smart nursing homes included factors such as stakeholders' perceived efficaciousness, usability, and collateral damages of using smart technologies, and the coping process of adoption was influenced by factors such as age, economic status, health status, education, and openness to smart technologies among older adults. CONCLUSIONS: Chinese older adults and their family members have a positive perception of the smart nursing home model. The qualitative evidence regarding their expectations and acceptability of smart nursing homes contributes valuable insights for a wide range of stakeholders involved in the planning and implementation of smart nursing homes.

Healthcare resources, organisational support and practice in asthma in six public health clinics in Malaysia.

Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors' practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow metre measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.

Feasibility of supported self-management with a pictorial action plan to improve asthma control.

Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre-post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference -19.7; 95% CI -34.7 to -3.1; 6 months: % difference -20.3; 95% CI -5.8 to -3.2), one or more emergency visit (1 month: % difference -28.6; 95% CI -41.2 to -15.5; 3 months: % difference -18.0; 95% CI -32.2 to -3.0; 6 months: % difference -20.3; 95% CI -34.9 to -4.6), and one or more asthma admission (1 month: % difference -14.3; 95% CI -25.2 to -5.3; 6 months: % difference -11.9; 95% CI -23.2 to -1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530 .

Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis.

Shoulder rotator cuff tendinopathy is a common debilitating condition that affects a person daily function and the quality of life. Despite its frequent occurrence, the best treatment is still inconclusive. This review assessed the clinical effect of platelet-rich plasma injection for rotator cuff tendinopathy. A systematic literature search was conducted using CINAHL, Medline, SCOPUS, SPORTSDiscus and Web of Science databases to retrieve articles published in peer-reviewed journals until December 2020. Randomised controlled trials (RCTs), which compared clinical effects of PRP injection to the usual care among adults diagnosed with rotator cuff conditions were reviewed. The main outcomes of interest were changes in shoulder pain symptoms and shoulder functions. All variables were analysed using random effects meta-analyses. Eight RCTs were reviewed in this study. The risk of bias for randomization was low for 6 RCTs, one study had unclear risk and the other was a high risk. Studies vary on the PRP techniques including preparation and injections. Moreover, the control intervention also differs. Four studies compared PRP with normal saline injection while in the remaining 4 RCTs the control intervention were rehabilitation program and dry needling. Meta-analysis of selected studies showed that PRP injection was safe and effective intervention for long-term pain control and shoulder function in patients with RC disorders.

The expectations and acceptability of a smart nursing home model among Chinese elderly people: A mixed methods study protocol.

Nursing homes integrated with smart information such as the Internet of Things, cloud computing, artificial intelligence, and digital health could improve not only the quality of care but also benefit the residents and health professionals by providing effective care and efficient medical services. However, a clear concept of a smart nursing home, the expectations and acceptability from the perspectives of the elderly people and their family members are still unclear. In addition, instruments to measure the expectations and acceptability of a smart nursing home are also lacking. The study aims to explore and determine the levels of these expectations, acceptability and the associated sociodemographic factors. This exploratory sequential mixed methods study comprises a qualitative study which will be conducted through a semi-structured interview to explore the expectations and acceptability of a smart nursing home among Chinese elderly people and their family members (Phase I). Next, a questionnaire will be developed and validated based on the results of a qualitative study in Phase I and a preceding scoping review on smart nursing homes by the same authors (Phase II). Lastly, a nationwide survey will be carried out to examine the levels of expectations and acceptability, and the associated sociodemographic factors with the different categories of expectations and acceptability (Phase III). With a better understanding of the Chinese elderly people's expectations and acceptability of smart technologies in nursing homes, a feasible smart nursing home model that incorporates appropriate technologies, integrates needed medical services and business concepts could be formulated and tested as a solution for the rapidly ageing societies in many developed and developing countries.

The prevalence and factors associated with sarcopenia among community living elderly with type 2 diabetes mellitus in primary care clinics in Malaysia.

Sarcopenia is a recognised geriatric syndrome but few studies address its associated factors among elderly with type 2 diabetes mellitus (T2DM) in South East Asia. This study aimed to determine the prevalence of sarcopenia and its associated factors among the elderly with T2DM in public primary care clinics in Malaysia. This study utilised data from a longitudinal study of 506 adults with T2DM aged ≥60 years. Data on socio-demography, clinical and functional status, diet and levels of physical activity (PA) were collected. Sarcopenia was defined using Asian Working Group for Sarcopenia criteria and its associated factors were analysed using multiple logistic regression. The proportion of elderly with T2DM with sarcopenia was 28.5%. Those aged ≥70 years (ß = 0.73;OR = 2.07; 95%CI = 1.24, 3.48; p = 0.006), men (ß = 0.61; OR = 1.84; 95%CI = 1.12, 3.02; p = 0.017), with ≥10 years duration of diabetes (ß = 0.62; OR = 1.85; 95%CI = 1.11, 3.09; p = 0.018), not using insulin sensitizers (ß = -1.44; OR = 0.24; 95%CI = 0.08, 0.71; p = 0.010), using less than 5 medications (ß = 0.68; OR = 1.98; 95%CI = 1.17, 3.36; p = 0.011), low body mass index (BMI) (ß = -2.43; OR = 0.09; 95%CI = 0.05, 0.17; p<0.001), and engaging in low (ß = 0.77; OR = 2.15; 95%CI = 1.07, 4.35; p = 0.032) and moderate physical activities (ß = 0.80; OR = 2.23; 95%CI = 1.07, 4.66; p = 0.033) were associated with sarcopenia. Factors that predicts sarcopenia such as level of physical activity and body mass index were among the modifiable factors that could be used in developing future strategies to prevent or delay the progression of sarcopenia among elderly with T2DM to improve their health status.

Cardiovascular disease risk factors among older people: Data from the National Health and Morbidity Survey 2015.

Study on cardiovascular disease (CVD) risk factors and their prevalence among the older people in Malaysia is limited. We aimed to determine the prevalence and factors associated with CVD risk factors using the non-laboratory Framingham Generalized 10-Year CVD risk score among older people in Malaysia. This was a population-based cross-sectional study using data of 3,375 participants aged ≥60 years from the National Health and Morbidity Survey 2015. Sociodemographic, health factors and clinical assessments (anthropometry and blood pressure) were included. Complex survey analysis was used to obtain prevalence with 95% confidence intervals (CI). We applied ordinal regression to determine the factors associated with CVD risk. The prevalence for the high 10-year CVD risk was 72.1%. Body mass index was higher among those aged 60-69 years in men (25.4kg/m2, 95%CI 25.1-25.8) and women (26.7kg/m2, 95%CI 26.3-27.1) than the other age groups. The factors associated with moderate and high 10-year CVD risk were Malay ethnicity (Odds Ratio(OR) 0.76, 95%CI 0.63-0.92, p = 0.004), unmarried status (OR 1.55, 95%CI 1.22-1.97, p<0.001) and physically inactive (OR 0.72, 95%CI 0.55-0.95, p = 0.020). There is a need for future study to evaluate preventive strategies to improve the health of older people in order to promote healthy ageing.

Interventions for obesity among schoolchildren: A systematic review and meta-analyses.

BACKGROUND: Childhood overweight and obesity has emerged as a major public health threat worldwide with challenges in its management. This review assessed the effectiveness of interventions for childhood overweight and obesity. METHODS: A systematic literature search was conducted using CINAHL, EMBASE, Ovid MEDLINE, PsycINFO and SPORTDiscus databases to retrieve articles published from 1st January 2000 to 31st December 2017. Randomised controlled trials (RCTs) and quasi-experimental studies comparing different strategies in managing overweight and obesity among schoolchildren (6 to 12 years of age) were included. The main outcomes of interest were reductions in weight related variables included anthropometry and body composition measurements. All variables were analysed using random effects meta-analyses. RESULTS: Fourteen studies were reviewed, 13 were RCTs and one was a quasi-experimental study. The risk of bias for randomisation was low risk for all of RCTs except for one, which was unclear. The risk of bias for randomisation was high for the quasi-experimental study. Most interventions incorporated lifestyle changes and behavioural strategies such as coping and problem solving skills with family involvement. The meta-analyses did not show significant effects of the intervention in reducing weight related outcomes when compared with controls. CONCLUSION: Meta-analyses of the selected studies did not show significant effects of the interventions on weight related outcomes among overweight and obese schoolchildren when compared with controls. The role of interdisciplinary team approaches with family involvement using behaviour and lifestyle strategies to curb obesity among schoolchildren is important.

The self-care profiles and its determinants among adults with hypertension in primary health care clinics in Selangor, Malaysia.

INTRODUCTION: Self-care has been shown to improve clinical outcome of hypertension. Gauging the level of self-care among patients with hypertension enables the design of their personalized care plans. This study aimed to determine the self-care profiles and its determinants among patients with hypertension in the Malaysian primary care setting. METHODS: This was a cross sectional study conducted between 1 October 2016-30 April 2017 in three primary care clinics in the state of Selangor, Malaysia. All adults aged 18 years and above with hypertension for at least 6 months were recruited with a systematic random sampling of 1:2 ratio. The participants were assisted in the administration of the structured questionnaire, which included socio-demographic information, medical information and the Hypertension Self-Care Profile (HTN SCP) tool. Statistical analysis was done using SPSS version 20.0. Multiple linear regression was performed to determine the determinants for self-care. RESULTS: The mean age of the participants was 59.5 (SD10.2) years old. There were more women (52.5%) and most were Malays (44.0%) follow by Chinese (34%) and Indians (21%). Majority (84.2%) had secondary or primary school level of education. A third (30.7%) had a family history of hypertension. The mean total HTN-SCP score was 124.2 (SD 22.8) out of 180. The significant determinants that influenced the HTN-SCP scores included being men (B-4.5, P-value0.008), Chinese ethnicity (B-14.7, P-value<0.001), primary level education/no formal school education level (B-15.7, P-value<0.001), secondary level education (B-9.2, P-value<0.001) and family history of hypertension (B 4.4, P-value 0.014). CONCLUSIONS: The overall hypertension self-care profile among patients in this multi-ethnic country was moderate. Being men, Chinese, lower education level and without family history of hypertension were associated with lower hypertension self-care profile score. Healthcare intervention programmes to address self-care should target this group of patients.

The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty.

BACKGROUND: Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity. METHODS: In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. In Phase 2, feedback was sought from health professionals and the general public. In Phase 3, 366 participants completed preliminary testing on the revised draft, including 162 UK paramedics, and rated the scale on feasibility and usability. In Phase 4, following translation into Malay, the final prototype was tested in 95 participants in Peninsular Malaysia and Borneo. RESULTS: The final scale incorporated 14 domains, each conceptualized with 3-6 response levels. All domains were rated as "understood well" by most participants (range 64-94%). Percentage agreement with positive statements regarding appearance, feasibility, and usefulness ranged from 66% to 95%. Overall feedback from health-care professionals supported its content validity. CONCLUSIONS: The PFFS is comprehensive, feasible, and appears generalizable across countries, and has face and content validity. Investigation into the reliability and predictive validity of the scale is currently underway.

Behavioral interventions to improve self-management in Iranian adults with type 2 diabetes: a systematic review and meta-analysis.

PURPOSE: The aim of this study was to systematically-review published experimental studies to determine the effectiveness of behavioral interventions on self-management in Iranian adults with type 2 diabetes. METHOD: Pub Med, Web of Science, Science Direct, Ovid Medline, EBSCO, ProQuest, Google Scholar, and the Scientific Information Database (SID) were searched for English and Persian language studies published between 2009 and 2017. The primary outcome of this review was to assess the effects of behavioral interventions on glycosylated hemoglobin. Changes in the blood pressure, Lipid profiles, BMI, Self-efficacy, knowledge, attitude, practice, Self-care behaviors, social support, anxiety, and depression were the secondary outcomes. RESULTS: Comprehensive search procedures resulted in twenty-three experimental studies with 2208 participants. Eleven studies were included in the Meta-analysis. Compared with the control group, behavioral interventions significantly lower glycosylated hemoglobin -0.61% (95% CI -0.80, -0.41). To explore the effects of the study intervention (regarding what aspects of the intervention are most effective), we then conducted a stratified analysis for HbA1c. Larger effects were found in interventions with a longer duration and higher intensity, delivered in the group format, interventions offered to individuals with higher baseline HbA1c, and interventions delivered by a multidisciplinary team. Moreover, behavioral interventions were effective in improving blood glucose, lipid profiles, knowledge, attitude, practice, self-efficacy, quality of life, and self-care. CONCLUSION: In line with other behavioral studies, our study shows that behavioral interventions improve self-management in Iranian adults with type 2 diabetes.

Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes.

In recent years, great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes. Studies have reported that nurses, compared to other healthcare professionals, are more likely to promote preventive healthcare seeking behaviors. The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin. A two-arm parallel-group randomized controlled trial with the blinded outcome assessors was designed. One hundred forty-two adults with type 2 diabetes were randomized to receive either usual diabetes care (control group) or usual care plus a nurse-led diabetes self-management education (intervention group). Duration of the intervention was 12 weeks. The primary outcome was glycosylated hemoglobin (HbA1c values). Secondary outcomes were changes in blood pressure, body weight, lipid profiles, self-efficacy (efficacy expectation and outcome expectation), self-management behaviors, quality of life, social support, and depression. Outcome measures were assessed at baseline and at 12-week and 24-week postrandomizations. Patients in the intervention group showed significant improvement in HbA1c, blood pressure, body weight, efficacy expectation, outcome expectation, and diabetes self-management behaviors. The beneficial effect of a nurse-led intervention continued to accrue beyond the end of the trial resulting in sustained improvements in clinical, lifestyle, and psychosocial outcomes. This trial is registered with IRCT2016062528627N1.

Stability of depressive symptoms over 3 months post-partum.

AIM: Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum. METHODS: From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models. RESULTS: The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression. CONCLUSION: Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.

Prediction of incidence and bio-psycho-socio-cultural risk factors of post-partum depression immediately after birth in an Iranian population.

INTRODUCTION: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time. MATERIAL AND METHODS: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32-42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at 2 weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis. RESULTS: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32-42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04-1.09), p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69-0.88), p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9-0.99), p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89-0.99), p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88-0.99), p = 0.04). CONCLUSIONS: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.

Effectiveness of Personalized Feedback Alone or Combined with Peer Support to Improve Physical Activity in Sedentary Older Malays with Type 2 Diabetes: A Randomized Controlled Trial.

INTRODUCTION: Regular physical activity is an important aspect of self-management among older people with type 2 diabetes but many remain inactive. Interventions to improve physical activity levels have been studied but few studies have evaluated the effects of personalized feedback (PF) or peer support (PS); and there was no study on older people of Asian heritage. Hence, this trial evaluated whether PF only or combined with PS improves physical activity among older Malays with type 2 diabetes (T2DM) compared to usual care only. MATERIALS AND METHODS: A three-arm randomized controlled trial was conducted in a primary healthcare clinic in Malaysia. Sixty-nine sedentary Malays aged 60 years and older with T2DM who received usual diabetes care were randomized to PF or PS interventions or as controls for 12 weeks with follow-ups at weeks 24 and 36. Intervention groups performed unsupervised walking activity and received written feedback on physical activity. The PS group also received group and telephone contacts from trained peer mentors. The primary outcome was pedometer steps. Secondary outcomes were self-reported physical activity, cardiovascular risk factors, cardiorespiratory fitness, balance, quality of life, and psychosocial wellbeing. RESULTS: Fifty-two (75.4%) completed the 36-week study. The PS group showed greater daily pedometer readings than the PF and controls (p = 0.001). The PS group also had greater improvement in weekly duration (p < 0.001) and frequency (p < 0.001) of moderate intensity physical activity, scores on the Physical Activity Scale for Elderly (p = 0.003), 6-min walk test (p < 0.001), and social support from friends (p = 0.032) than PF and control groups. CONCLUSION: The findings suggest that PF combined with PS in older Malays with T2DM improved their physical activity levels, cardiorespiratory fitness, and support from friends. TRIAL REGISTRATION: Current Controlled Trials ISRCTN71447000.