Diet, physical activity and mental health status are associated with dysglycaemia in pregnancy: the Healthy Start Study.

AIMS: To examine the association between dysglycaemia and multiple modifiable factors measured during pregnancy. METHODS: The Healthy Start Study collected self-reported data on modifiable factors in early and mid-pregnancy (median 17 and 27 weeks gestation, respectively) from 832 women. Women received one point for each modifiable factor for which they had optimum scores: diet quality (Healthy Eating Index score ≥64), physical activity level (estimated energy expenditure ≥170 metabolic equivalent task-h/week), and mental health status (Perceived Stress Scale score <6 and Edinburgh Postnatal Depression Scale score <13). Dysglycaemia during pregnancy was defined as an abnormal glucose challenge result, ≥1 abnormal results on an oral glucose tolerance test, or a clinical diagnosis of gestational diabetes. Logistic regression models estimated odds ratios for dysglycaemia as a function of each factor and the total score, adjusted for age, race/ethnicity, pre-pregnancy BMI, history of gestational diabetes, and family history of Type 2 diabetes. RESULTS: In individual analyses, only physical activity was significantly associated with a reduced risk of dysglycaemia (adjusted odds ratio 0.67, 95% CI 0.44-1.00). We observed a significant, dose-response association between increasing numbers of optimal factors and odds of dysglycaemia (adjusted P=0.01). Compared with having no optimal modifiable factors, having all three was associated with a 73% reduced risk of dysglycaemia (adjusted odds ratio 0.27, 95% CI 0.08-0.95). CONCLUSIONS: An increasing number of positive modifiable factors in pregnancy was associated with a dose-response reduction in risk of dysglycaemia. Our results support the hypothesis that modifiable factors in pregnancy are associated with the risk of prenatal dysglycaemia.

Nature-Based Social Prescribing in Urban Settings to Improve Social Connectedness and Mental Well-being: a Review.

PURPOSE OF REVIEW: Recent reports of a "loneliness epidemic" in the USA are growing along with a robust evidence base that suggests that loneliness and social isolation can compromise physical and psychological health. Screening for social isolation among at-risk populations and referring them to nature-based community services, resources, and activities through a social prescribing (SP) program may provide a way to connect vulnerable populations with the broader community and increase their sense of connectedness and belonging. In this review, we explore opportunities for social prescribing to be used as a tool to address connectedness through nature-based interventions. RECENT FINDINGS: Social prescribing can include a variety of activities linked with voluntary and community sector organizations (e.g., walking and park prescriptions, community gardening, farmers' market vouchers). These activities can promote nature contact, strengthen social structures, and improve longer term mental and physical health by activating intrapersonal, interpersonal, and environmental processes. The prescriptions are appropriate for reaching a range of high-risk populations including moms who are minors who are minors, recent immigrants, older adults, economically and linguistically isolated populations, and unlikely users of nature and outdoor spaces. More research is needed to understand the impact of SPs on high-risk populations and the supports needed to allow them to feel at ease in the outdoors. Additionally, opportunities exist to develop technologically and socially innovative strategies to track patient participation in social prescriptions, monitor impact over time, and integrate prescribing into standard health care practice.

CAPS on the move: Crafting an approach to recruitment for a randomized controlled trial of community gardening.

OBJECTIVE: To describe and evaluate recruitment approaches for a randomized controlled trial (RCT) of community gardening in Denver, Colorado. (ClinicalTrials.gov: NCT03089177). METHODS: We used community and staff feedback to adapt our recruitment approach from year 1 to year 2 of a multi-year RCT to address health behaviors related to cancer prevention. In year 2, we added a full-time recruitment coordinator, designed and implemented a tracking spreadsheet, and engaged advisory committee members, local garden leaders, and health partners in planning and outreach. Screening and consent rates, staff time and costs for years 1 and 2 are compared. RESULTS: In year 1, recruitment methods yielded 136 initial contacts, 106 screenings and 64 consented participants. In year 2, enhanced staffing and outreach yielded 257 initial contacts, 193 screenings, and 123 consented participants. Personal referrals, health fairs, NextDoor, and fliers yielded the highest percentage of consented participants. School and community meetings yielded the lowest yield for potential participants. Spanish-speaking participants were mostly recruited by direct methods. Compared to year 1 recruitment, which required 707 h of staff time and cost $14,446, year 2 recruitment required 1224 h of staff time and cost $22,992. Average cost for retained participants was $226 (year 1) and $186 (year 2). DISCUSSION: Those planning pragmatic clinical trials with recruitment in multi-ethnic communities can use the results from this study to understand the efficacy of techniques, and to budget costs for recruitment. While our culturally-tailored recruitment methods cost more, they provided more effective and efficient ways to reach recruitment goals.

Temporal specificity in adaptations to high-intensity exercise training.

OBJECTIVE: The purpose was to test the hypothesis that time to exhaustion and oxygen deficit in high-intensity exercise at a particular time of day would be influenced by training regularly at that time of day. METHODS: Over a 5-wk period, 12 college-age women performed 20 high-intensity exercise training sessions. On Mondays, they performed four 2-min bouts of cycling at 2.5 W x kg(-1) with 4-min recoveries; on Tuesdays and Thursdays, eight 1-min bouts at 3.0 W x kg(-1) with 2-min recoveries; and on Wednesdays, three 3-min bouts at 2.2 W x kg(-1) with 2-min recoveries. Six participants (a.m.-trained group) were randomly assigned to train in the morning (a.m.) and six others (p.m.-trained group) trained in the afternoon (p.m.). Upon completion of training, all participants were tested in both the a.m. and p.m. (random order) at the same times as training sessions had been scheduled. Tests involved exhaustive efforts at 2.6 W x kg(-1). RESULTS: Results of a repeated measures ANOVA revealed a significant time of day of training x time of day of testing interaction effect on time to exhaustion (F1,10=8.29, P=0.02). This suggested that the time of day of training affected the a.m.-p.m. pattern in time to exhaustion. Time to exhaustion for the a.m.-trained group was 398+/-258 s in the a.m. test and 351+/-216 s in the p.m. test (P=0.07). The p.m.-trained group had significantly higher values in the p.m. test compared with the a.m. test (422+/-252 s vs 373+/-222 s; P=0.03). There was also a significant interaction effect on oxygen deficit (F1,10=8.03, P=0.02). This suggested that the time of day of training affected the a.m.-p.m. pattern in anaerobic capacity. Oxygen deficit for the a.m.-trained group was 64+/-24 mL x kg(-1) in the a.m. test and 50+/-11 mL x kg(-1) in the p.m. test (P=0.10). The p.m.-trained group had significantly higher values in the p.m. tests (64+/-24 mL x kg(-1) vs 50+/-11 mL x kg(-1); P=0.01) compared to the a.m. tests. CONCLUSIONS: These results demonstrate that there is temporal specificity in training to increase work capacity in high-intensity exercise. Greater improvements can be expected to occur at the time of day at which high-intensity training is regularly performed.

Mothers' mental distress and parenting practices with infants and toddlers.

The purpose of this study was to examine whether maternal mental distress affects parenting practices related to monitoring activities (i.e. daily routines, enrichment activities). The nationally representative sample consisted of 1638 mothers. Maternal mental distress was assessed by the 5-item Mental Health Index (MHI). Logistic regression models were conducted, controlling for covariates (e.g. marital status, education level, etc.). Approximately 14% of the women reported high levels of mental distress and 25% of the women failed to engage in enrichment activities or consistent daily routines with their children. There was a significant adverse relationship between mental distress and routines, with women who were mentally distressed being more likely to not engage in daily routines. There was no significant relationship between mental distress and enrichment activities. Race differentials were evident among these relationships. These findings highlight the prevalence of maternal mental distress and its deleterious effects on select parenting behaviors.

Differences in functional immune responses of high vs. low hardy healthy individuals.

An association between the personality trait of hardiness and immune responses was explored. Blood samples were collected from 21 healthy individuals under nonstressful conditions, who had either high or low levels of hardiness. Functional immune assays tested for natural killer (NK) cell activity and proliferation responses to Candida albicans (Candida), purified protein derivative from Mycobacterium tuberculosis (PPD), lipopolysaccharide (LPS), concanavalin A (Con A), and Staphylococcus enterotoxin A (Staph A). Differences between high and low hardy groups on these immune responses were examined using Bonferroni adjusted independent t-tests. Results revealed significant differences between the groups for Candida, PPD, Con A, and Staph A. In all instances, the high hardy group had larger mean proliferative responses than the low hardy group. Implications of the study as well as avenues for future research are discussed.