Stressful life events and depression in late pregnancy: Comparison between rural and metropolitan women using data from an Australian cohort study.

OBJECTIVE: To identify whether a diagnosis of depression combined with rurality, compared with either depression or living in metropolitan areas alone, is associated with experiencing more stressful life events in pregnancy. DESIGN: This study uses data from 402 pregnant women (206 metropolitan and 196 rural), enrolled in the Western Australian arm of the Mercy Pregnancy and Emotional Wellbeing Study. Mercy Pregnancy and Emotional Wellbeing Study is a prospective, longitudinal cohort with women recruited during early pregnancy (<20 weeks) across 3 groups: those with diagnosed depression, those taking antidepressant medication and control. PARTICIPANTS: Women were recruited from 3 metropolitan and 3 rural hospitals in Western Australia from 2017 to 2018 and 2018 to 2020, respectively. This study uses antenatal data collected at recruitment and during third trimester (weeks 32-34). MAIN OUTCOME MEASURES: The Stressful Life Events Scale was used to measure the number of self-reported stressful events. The degree of perceived stress due to the stressful event was also reported. RESULTS: Compared to pregnant metropolitan women diagnosed with depression, pregnant rural women with depression were more likely to report experiencing at least 1 stressful life event. Despite this, pregnant women with depression in both regions reported similar numbers of stressful life events. CONCLUSIONS: This study highlights women in rural Western Australia diagnosed with depression might be more vulnerable to experiencing stressful life events than rural women without depression and their metropolitan counterparts. Due to known adverse effects of antenatal depression and stress on maternal well-being and child outcomes, there is a clear need for targeted, preventative interventions for Australian rural women during this period.

Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack.

BACKGROUND: Low cardiorespiratory fitness (CRF) is a predictor of stroke risk and poor outcome poststroke. Fitness levels are rarely assessed in the acute phase and it is unclear if it is safe for stroke survivors and people with transient ischemic attack (TIA) to perform a graded exercise test to assess fitness. OBJECTIVE: To determine if people within 14 days post stroke can safely perform a graded exercise test. DESIGN: Observational study. SETTING: Research institute. PARTICIPANTS: People with stroke or TIA admitted to an acute stroke unit. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Safety of performing a graded exercise test early post stroke. Safety outcomes were (1) occurrence of an adverse event or (2) <85% blood oxygen saturation (SpO2 ). Participants performed a graded exercise test on a recumbent stepper at a research institute <2 weeks postevent. CRF was determined by measuring peak volume of oxygen uptake (VO2peak ) using a metabolic cart. RESULTS: Twenty-nine participants were enrolled in the study (median age 69 years; interquartile range 58-75). Sixteen were diagnosed with TIA and 13 with a mild stroke. Twenty-eight participants completed the test; one participant was unable to perform the test due to back pain. The test was terminated due to standardized stopping criteria in 26 cases (5 = volitional fatigue, 6 = unable to keep required cadence, 15 = reaching 85% HRmax ), one due to safety (ie, SpO2 < 85%), and one was inadvertently terminated before stopping criteria were reached. Average CRF determined by the exercise test was low; mean VO2peak of 16.2 ± 4.5 mL/kg/min for men (n = 20) and 12.4 ± 3.6 mL/kg/min for women (n = 8). CONCLUSIONS: Determining exercise capacity early post stroke and TIA using a graded exercise test appears to be safe in patients with mild deficits. This information should be useful to plan tailored exercise programs. Further research should focus on determining safety of exercise testing in more severely affected stroke survivors.