A review of public health guidelines for postpartum physical activity and sedentary behavior from around the world.

BACKGROUND: The period following pregnancy is a critical time window when future habits with respect to physical activity (PA) and sedentary behavior (SB) are established; therefore, it warrants guidance. The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide. METHODS: To identify guidelines published since 2010, we performed a (a) systematic search of 4 databases (CINAHL, Global Health, PubMed, and SPORTDiscus), (b) structured repeatable web-based search separately for 194 countries, and (c) separate web-based search. Only the most recent guideline was included for each country. RESULTS: We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines. The continents with guidelines included Europe (n = 12), Asia (n = 5), Oceania (n = 2), Africa (n = 1), North America (n = 1), and South America (n = 1). The most common benefits recorded for PA included weight control/management (n = 10), reducing the risk of postpartum depression or depressive symptoms (n = 9), and improving mood/well-being (n = 8). Postpartum guidelines specified exercises to engage in, including pelvic floor exercises (n = 17); muscle strengthening, weight training, or resistance exercises (n = 13); aerobics/general aerobic activity (n = 13); walking (n = 11); cycling (n = 9); and swimming (n = 9). Eleven guidelines remarked on the interaction between PA and breastfeeding; several guidelines stated that PA did not impact breast milk quantity (n = 7), breast milk quality (n = 6), or infant growth (n = 3). For SB, suggestions included limiting long-term sitting and interrupting sitting with PA. CONCLUSION: Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.

A prospective observational cohort pilot study of the association between midazolam use and delirium in elderly endoscopy patients.

BACKGROUND: Midazolam is a benzodiazepine commonly used in procedural sedation and general anaesthesia. Current anaesthetic guidelines advise the avoidance of benzodiazepines in elderly patients due to concerns of an increased risk of delirium. Delirium is associated with significant patient morbidity and mortality, while also increasing health costs. Despite this, midazolam is often used in elderly patients undergoing low risk procedures due to the benefits of rapid onset, anxiolysis and haemodynamic stability compared to other sedatives. To date, studies describing the relationship between midazolam use and delirium in elderly patients undergoing low risk procedures, such as endoscopy, are limited. METHOD: This was a prospective observational cohort pilot study identifying the prevalence of delirium pre-procedure and incidence of delirium post-procedure in elderly endoscopy patients receiving midazolam. The study population was elderly patients greater than 65 years of age, without underlying cognitive dysfunction, undergoing elective endoscopy. Electronic databases were used for collection of demographic and clinical information. Delirium was identified through the administration of the Family Confusion Assessment Method survey; this was administered to carers of the study population 24-48 h pre and post procedure to categorically identify the presence or absence of delirium. RESULTS: Fifty-eight participants were recruited for this study and eighteen were subsequently excluded based upon additional exclusion criteria. Forty patients were included in the final results. American Society of Anaesthesiology Classification (ASA) of patients were as follows: 1 (9 patients), 2 (12 Patients), 3 (16 Patients) and 4 (3 patients). Patients underwent gastroscopy, colonoscopy or combined gastroscopy and colonoscopy. This study identified no cases of delirium in elderly patients after administration of midazolam for elective endoscopy procedures 24-48 h post-procedure. Additionally, a high proportion of elderly patients were found to have received midazolam. CONCLUSION: No episodes of delirium were identified in this study. This finding runs counter to current guideline recommendations regarding midazolam use in the elderly patient and that elderly patients undergoing elective endoscopy represent a significantly different patient population compared to those previously studied. This study suggests that in the study population that the risk of delirium in patients exposed to midazolam in elective endoscopy was not demonstrated and that it may be safe to perform experimental studies to elucidate the safety of midazolam in larger studies.

A review of pregnancy information on nutrition, physical activity and sleep websites.

PROBLEM: Most pregnant women report using the internet to source health information during pregnancy. However, little is known about the information presented on the internet and whether it is consistent with current evidence-based guidelines. BACKGROUND: Pregnancy is considered a risk period for women as it is associated with poorer health behaviours including an inadequate diet, decreased physical activity and reduced sleep. As a result, pregnant women and their unborn child are at a greater risk of adverse health outcomes. AIM: The purpose of this study was to review pregnancy related information about nutrition, physical activity and sleep provided on Australian government and leading industry body websites, and to compare this information to current evidence-based guidelines. METHODS: A systematic online search was conducted to identify Australian Government, and leading industry websites that provided information on nutrition, physical activity, or sleep during pregnancy. The content of each website was reviewed and compared against current nutrition, physical activity and sleep guidelines. FINDINGS: 27 government and leading industry websites were included in this study. 18 websites included nutritional information, none of which aligned 100% with guidelines. Nine websites included physical activity information, only one of which was 100% in accordance with guidelines. Two websites included information on sleep during pregnancy, however neither were in accordance with guidelines. CONCLUSION: Women are accessing information via the internet that is not in accordance with current evidence-based guidelines. These results call to attention the need for government and leading industry websites to review and update their website information in accordance with current evidence-based guidelines.

Do singles or couples live healthier lifestyles? Trends in Queensland between 2005-2014.

OBJECTIVES: To compare the frequency of and trends in healthy lifestyle factors between singles and couples. METHODS: Cross-sectional data from annual surveys conducted from 2005-2014 were used. The pooled sample included 15,001 Australian adults (mean age: 52.9 years, 50% male, 74% couples) who participated in the annual Queensland Social Survey via computer-assisted telephone interviews. Relationship status was dichotomised into single and couple. Binary logistic regression was used to assess associations between relationship status, and the frequency of and trends in healthy lifestyle factors. RESULTS: Compared to singles, couples were significantly more likely to be a non-smoker (OR = 1.82), and meet recommendations for limited fast food (OR = 1.12), alcohol consumption (OR = 1.27) and fruit and vegetable intake (OR = 1.24). Fruit and vegetable intake was not significantly associated with relationship status after adjusting for the other healthy lifestyle factors. Conversely, couples were significantly less likely to be within a normal weight range (OR = 0.81). In both singles and couples, the trend data revealed significant declines in the rates of normal weight (singles: OR = 0.97, couples: OR = 0.97) and viewing TV for less than 14 hours per week (singles: OR = 0.85, couples: OR = 0.84), whilst non-smoking rates significantly increased (singles: OR = 1.12, couples: OR = 1.03). The BMI trend was no longer significant when adjusting for health behaviours. Further, in couples, rates of meeting recommendations for physical activity and fruit/vegetable consumption significantly decreased (OR = 0.97 and OR = 0.95, respectively), as did rates of eating no fast food (OR = 0.96). These trends were not significant when adjusting for the other healthy lifestyle factors. In singles, rates of meeting alcohol recommendations significantly increased (OR = 1.08). CONCLUSIONS: Health behaviour interventions are needed in both singles and couples, but relationship status needs to be considered in interventions targeting alcohol, fast food, smoking and BMI. Further research is needed to understand why health behaviours differ by relationship status in order to further improve interventions.

Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: a review of quality, features and behaviour change techniques.

BACKGROUND: The number of commercial apps to improve health behaviours in children is growing rapidly. While this provides opportunities for promoting health, the content and quality of apps targeting children and adolescents is largely unexplored. This review systematically evaluated the content and quality of apps to improve diet, physical activity and sedentary behaviour in children and adolescents, and examined relationships of app quality ratings with number of app features and behaviour change techniques (BCTs) used. METHODS: Systematic literature searches were conducted in iTunes and Google Play stores between May-November 2016. Apps were included if they targeted children or adolescents, focused on improving diet, physical activity and/or sedentary behaviour, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. App inclusion, downloading and user-testing for quality assessment and content analysis were conducted independently by two reviewers. Spearman correlations were used to examine relationships between app quality, and number of technical app features and BCTs included. RESULTS: Twenty-five apps were included targeting diet (n = 12), physical activity (n = 18) and sedentary behaviour (n = 7). On a 5-point Mobile App Rating Scale (MARS), overall app quality was moderate (total MARS score: 3.6). Functionality was the highest scoring domain (mean: 4.1, SD: 0.6), followed by aesthetics (mean: 3.8, SD: 0.8), and lower scoring for engagement (mean: 3.6, SD: 0.7) and information quality (mean: 2.8, SD: 0.8). On average, 6 BCTs were identified per app (range: 1-14); the most frequently used BCTs were providing 'instructions' (n = 19), 'general encouragement' (n = 18), 'contingent rewards' (n = 17), and 'feedback on performance' (n = 13). App quality ratings correlated positively with numbers of technical app features (rho = 0.42, p < 0.05) and BCTs included (rho = 0.54, p < 0.01). CONCLUSIONS: Popular commercial apps to improve diet, physical activity and sedentary behaviour in children and adolescents had moderate quality overall, scored higher in terms of functionality. Most apps incorporated some BCTs and higher quality apps included more app features and BCTs. Future app development should identify factors that promote users' app engagement, be tailored to specific population groups, and be informed by health behaviour theories.