Umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis.

BACKGROUND: Placental management strategies such as umbilical cord milking and delayed cord clamping may provide a range of benefits for the newborn. The aim of this review was to assess the effectiveness of umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia. METHODS: Three databases and five clinical trial registries were systematically reviewed to identify randomised controlled trials comparing umbilical cord milking or delayed cord clamping with control in term and preterm infants. The primary outcome was neonatal hypoglycaemia (study defined). Two independent reviewers conducted screening, data extraction and quality assessment. Quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB-2). Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis using a random effect model was done using Review Manager 5.4. The review was registered prospectively on PROSPERO (CRD42022356553). RESULTS: Data from 71 studies and 14 268 infants were included in this review; 22 (2 537 infants) compared umbilical cord milking with control, and 50 studies (11 731 infants) compared delayed with early cord clamping. For umbilical cord milking there were no data on neonatal hypoglycaemia, and no differences between groups for any of the secondary outcomes. We found no evidence that delayed cord clamping reduced the incidence of hypoglycaemia (6 studies, 444 infants, RR = 0.87, CI: 0.58 to 1.30, p = 0.49, I2 = 0%). Delayed cord clamping was associated with a 27% reduction in neonatal mortality (15 studies, 3 041 infants, RR = 0.73, CI: 0.55 to 0.98, p = 0.03, I2 = 0%). We found no evidence for the effect of delayed cord clamping for any of the other outcomes. The certainty of evidence was low for all outcomes. CONCLUSION: We found no data for the effectiveness of umbilical cord milking on neonatal hypoglycaemia, and no evidence that delayed cord clamping reduced the incidence of hypoglycaemia, but the certainty of the evidence was low.

Get active now or later? The association between physical activity and risk and time preferences.

Despite the well-established link between physical activity and positive health outcomes, much of the world's population remains inactive. Many people don't invest in health behaviours, such as physical activity, in the present, despite the long-term benefits of this. The aim of this study was to assess the relationship between physical activity levels and risk and time preferences in university students. A maximum likelihood model was used to jointly estimate risk and time preferences (elicited in an incentivised choice experiment), and to examine the relationship between these preferences and self-reported physical activity. Physically inactive people discounted the future significantly more than physically active people did. Physically active people made slightly more risky choices in our risk attitude task, although this directional relationship was not statistically significant. The link between time preferences and physical activity suggests that further research on behavioural strategies such as commitment devices, nudging or temptation bundling may be helpful in increasing physical activity for individuals who discount the future in favour of more immediate benefits.

Early Feeding for the Prevention of Neonatal Hypoglycaemia: A Systematic Review and Meta-Analysis.

BACKGROUND: Poor feeding, among other factors, predisposes neonates to hypoglycaemia. Early feeding is widely recommended to prevent hypoglycaemia in those at risk, but the effectiveness of this is uncertain. This review aimed to summarise and analyse the evidence on the effectiveness of early feeding for prevention of neonatal hypoglycaemia. METHODS: Four databases and three clinical trial registries were searched from inception to May 24, 2023. Published and unpublished randomised controlled trials (RCTs), quasi-RCTs, cluster randomised trials, non-randomised studies of interventions, and observational studies with comparison groups were considered for inclusion with no language or publication date restrictions. We included studies of neonates who were fed early (within 60 min of birth or study defined) versus delayed. Study quality was assessed using the Cochrane Risk of Bias 1 tool or Effective Public Health Practice Project Quality Assessment tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RevMan 5.4.1 or R was used to synthesise results in random-effects meta-analyses. This review was registered prospectively with PROSPERO (CRD42022378904). RESULTS: A total of 175,392 participants were included across 19 studies, of which two were RCTs, 14 cohort studies, two cross-sectional studies, and one a case-control study. Most studies (13/19) were conducted in low- or lower-middle-income countries. Early feeding may be associated with reduced neonatal hypoglycaemia (four cohort studies, 744 infants, odds ratio [OR] 0.19 (95% CI: 0.10-0.35), p < 0.00001, I2 = 44%) and slightly reduced duration of initial hospital stay (one cohort study, 1,673 infants, mean difference: -0.20 days [95% CI: -0.31 to -0.09], p = 0.0003), but the evidence is very uncertain. One RCT found early feeding had little or no effect on the risk of neonatal mortality, but three cohort studies found early feeding may be associated with reduced risk (136,468 infants, OR 0.51 [95% CI: 0.37-0.72]; low certainty evidence; p <0.0001; I2 = 54%). CONCLUSION: We found that early feeding may reduce the incidence of neonatal hypoglycaemia, but the evidence is very uncertain. Given its many other benefits, early feeding should continue to be recommended. This review was primarily funded by the Aotearoa Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.

Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation?

Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.

Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention.

While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called "Baby steps", in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country's needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention's effect on women's activity levels during and after pregnancy needs to be studied.

Tapentadol for the Treatment of Moderate-to-Severe Acute Pain in Children Under the Age of Two Years.

BACKGROUND: Pharmacokinetics (PK), efficacy, and safety of the opioid analgesic tapentadol in the treatment of moderate-to-severe acute pain have so far not been investigated in pediatric patients <2 years of age. PATIENTS AND METHODS: Two multicenter, open-label trials assessed the pharmacokinetic profile, safety, tolerability, and efficacy of single doses of tapentadol oral solution (OS; NCT02221674; n=19) or intravenous infusion (IV, EudraCT 2014-002259-24; n=38) in children from birth to <2 years of age. Of these, 8 preterm neonates were included in the IV trial. A third randomized, double-blind, placebo-controlled trial (NCT02081391) investigated the efficacy and safety of multiple tapentadol OS doses in patients from birth to <2 years (placebo n=4, tapentadol n=11) using an immediate rescue trial design. Patients in all three trials underwent surgery that, in the investigator's opinion, reliably produced moderate-to-severe pain requiring opioid treatment. RESULTS: Administration of single tapentadol doses resulted in tapentadol serum concentrations within the targeted range known to be safe and efficacious in adults and compared well to the range observed for children aged 2 to <18 years. Pain intensity already improved 15 min after administration. In the multiple dose trial, amounts of supplemental opioid analgesic medication within the first 24 h after start of trial medication were low (placebo 0.02 mg/kg, tapentadol 0.05 mg/kg). All patients stopped treatment with the trial medication because opioid analgesics were no longer required. Treatment-emergent adverse events occurred in 42.1% (tapentadol OS single dose), 28.9% (tapentadol IV), and 75% of placebo and 54.5% of tapentadol patients (tapentadol OS multiple doses), none of them serious. CONCLUSION: Tapentadol showed a favorable PK and safety profile in children <2 years of age. Multiple tapentadol OS dosing is efficacious and generally well tolerated in children ≥2 years and might also be a useful treatment option for children <2 years in need of strong analgesics.

Population Pharmacokinetics of Tapentadol in Children from Birth to <18 Years Old.

OBJECTIVE: The main aim of this analysis was to characterize the pharmacokinetics (PK) of tapentadol in pediatric patients from birth to <18 years old who experience acute pain, requiring treatment with an opioid analgesic. PATIENTS AND METHODS: Data from four clinical trials and 148 pediatric patients who received a single dose of tapentadol oral or intravenous solution were included. Population PK analysis was performed to determine the contribution of size-related (bodyweight) and function-related (maturation) factors to the changes in oral bioavailability (F), volume of distribution (V), and clearance (CL) with age. Simulations were carried out to compare pediatric exposures to reference adult values. RESULTS: A one-compartment model with allometric scaling on disposition parameters (using theoretical or estimated exponents) and maturation functions on CL and F best described tapentadol PK. The estimated allometric exponents for CL (0.603) and V (0.820) differed slightly from the theoretical values of 0.75 for CL and 1 for V. A maximum in CL/F was observed at about 2-3 years when expressed on a bodyweight basis. Results for younger children as well as the F estimate were sensitive to the scaling approach, but CL/F and V/F as a function of age for the two scaling approaches led to similar curves within the bioequivalence range except below 5 weeks of age. Model-based simulations indicated that the doses used in the included clinical trials lead to exposures within the lower half of the targeted adult exposure. CONCLUSION: The development of tapentadol is one of the first examples following a systematic approach for analgesic drug development for children. Our analysis enabled a full characterization and robust understanding of tapentadol PK in children from birth to <18 years, including preterm infants, and showed the importance of evaluating the sensitivity of the inferences of the PK parameters to the selected scaling approach.

Absolute Accelerometer-Based Intensity Prescription Compared to Physiological Variables in Pregnant and Nonpregnant Women.

Estimation of the intensity of physical activity (PA) based on absolute accelerometer cut points (Cp) likely over- or underestimates intensity for a specific individual. The purpose of this study was to investigate the relationship between absolute moderate intensity Cp and the first ventilatory threshold (VT1). A group of 24 pregnant and 15 nonpregnant women who performed a submaximal incremental walking test with measures of ventilatory parameters and accelerations from three different accelerometers on the wrist (ActiGraph wGT3X-BT, GENEActiv, Axivity AX3) and one on the hip (Actigraph wGT3X-BT) were analyzed. Cp were determined corresponding to 3 metabolic equivalents of task (MET), using the conventional MET definition (Cp3.5) (3.5 mL/kg×min) and individual resting metabolic rate (Cpind). The ventilatory equivalent (VE/VO2) was used to determine VT1. Accelerations at VT1 were significantly higher (p < 0.01) compared to Cp3.5 and Cpind in both groups. Cp3.5 and Cpind were significantly different in nonpregnant (p < 0.01) but not in pregnant women. Walking speed at VT1 (5.7 ± 0.5/6.2 ± 0.8 km/h) was significantly lower (p < 0.01) in pregnant compared to nonpregnant women and correspondent to 3.8 ± 0.7/4.9 ± 1.4 conventional METs. Intensity at absolute Cp was lower compared to the intensity at VT1 independent of the device or placement in pregnant and nonpregnant women. Therefore, we recommend individually tailored cut points such as the VT1 to better assess the effect of the intensity of PA.

Screen Time and Sleep of Rural and Urban South African Preschool Children.

This study aimed to investigate the extent to which preschool children meet guidelines for screen time (<1 h/day) and sleep (10-13 h/24-h) and explored home factors that affect these behaviors. Parents of preschoolers across income settings in South Africa (urban high-income n = 27, urban low-income n = 96 and rural low-income n = 142) completed a questionnaire. Urban high-income children had higher rates of exceeding screen time guidelines (67.0%) than children from urban low-income (26.0%) and rural low-income (3.5%) settings. Most children (81.0%) met sleep guidelines on weekdays and on weekends (75.0%). More urban high-income children met the sleep guideline, in comparison to both low-income settings. Fewer urban high-income parents (50.0%) thought that screen time would not affect their preschooler's health, compared to urban low-income (90.4%) and rural low-income (81.7%) parents. Weeknight bedtime was positively correlated with both weekday screen time (p = 0.001) and weekday TV time (p = 0.005), indicating that more time on screens correlated with later bedtimes. Meeting screen time and sleep guidelines differs across income settings, but it is evident that parents of preschoolers across all income settings would benefit from greater awareness about guidelines.

Current Evidence of Measurement Properties of Physical Activity Questionnaires for Older Adults: An Updated Systematic Review.

BACKGROUND: Questionnaires provide valuable information about physical activity (PA) behaviors in older adults. Until now, no firm recommendations for the most qualified questionnaires for older adults have been provided. OBJECTIVES: This review is an update of a previous systematic review, published in 2010, and aims to summarize, appraise and compare the measurement properties of all available self-administered questionnaires assessing PA in older adults. METHODS: We included the articles evaluated in the previous review and conducted a new search in PubMed, Embase, and SPORTDiscus from September 2008 to December 2019, using the following inclusion criteria (1) the purpose of the study was to evaluate at least one measurement property (reliability, measurement error, hypothesis testing for construct validity, responsiveness) of a self-administered questionnaire; (2) the questionnaire intended to measure PA; (3) the questionnaire covered at least one domain of PA; (4) the study was performed in the general, healthy population of older adults; (5) the mean age of the study population was > 55 years; and (6) the article was published in English. Based on the Quality Assessment of Physical Activity Questionnaires (QAPAQ) checklist, we evaluated the quality and results of the studies. The content validity of all included questionnaires was also evaluated using the reviewers' rating. The quality of the body of evidence was evaluated for the overall construct of each questionnaire (e.g., total PA), moderate-to-vigorous physical activity (MVPA) and walking using a modified Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: In total, 56 articles on 40 different questionnaires (14 from the previous review and 26 from the update) were included. Reliability was assessed for 22, measurement error for four and hypotheses testing for construct validity for 38 different questionnaires. Evidence for responsiveness was available for one questionnaire. For many questionnaires, only one measurement property was assessed in only a single study. Sufficient content validity was considered for 22 questionnaires. All questionnaires displayed large measurement errors. Only versions of two questionnaires showed both sufficient reliability and hypotheses testing for construct validity, namely the Physical Activity Scale for the Elderly (PASE; English version, Turkish version) for the assessment of total PA, and the Physical Activity and Sedentary Behavior Questionnaire (PASB-Q; English version) for the assessment of MVPA. The quality of evidence for these results ranged from very low to high. CONCLUSIONS: Until more high-quality evidence is available, we recommend the PASE for measuring total PA and the PASB-Q for measuring MVPA in older adults. However, they are not equally qualified among different languages. Future studies on the most promising questionnaires should cover all relevant measurement properties. We recommend using and improving existing PA questionnaires-instead of developing new ones-and considering the strengths and weaknesses of each PA measurement instrument for a particular purpose.

Population pharmacokinetic modeling to facilitate dose selection of tapentadol in the pediatric population.

OBJECTIVE: The main aim of this analysis was to characterize the pharmacokinetics (PK) of the strong analgesic tapentadol in 2-year-old to <18-year-old patients with acute pain and to inform the optimal dosing strategy for a confirmatory efficacy trial in this patient population. METHODS: The analysis dataset included tapentadol concentrations obtained from 92 pediatric patients receiving a single tapentadol oral solution (OS) dose of 1.0 mg/kg bodyweight in two single-dose PK clinical trials. Population PK analysis was performed using nonlinear mixed effects modeling. Simulations were performed to identify tapentadol OS doses in pediatric subjects (2 to <18 years) that would produce exposures similar to those in adults receiving safe and efficacious doses of tapentadol IR (50-100 mg every 4 hrs). RESULTS: Tapentadol PK in children aged from 2 to <18 years was best described by a one-compartment model. Mean population apparent clearance and apparent volume of distribution for a typical subject weighing 45 kg were 170 L/h and 685 L, respectively. Clearance, expressed in bodyweight units as L/h/kg, decreased with increasing age whereas total clearance (L/h) increased with increasing age. Model-based simulations suggested that a tapentadol OS dose of 1.25 mg/kg to children and adolescents aged 2 to <18 years would result in efficacious tapentadol exposures similar to those in adults receiving tapentadol immediate release 50-100 mg every 4 hrs. The proposed tapentadol OS dose was subsequently applied in a confirmatory efficacy trial in 2 to <18-year-old patients suffering from acute postsurgical pain. CONCLUSION: This analysis provides an example of a model-based approach for a dose recommendation to be used in an efficacy trial in the pediatric population. Uniform dosing based on bodyweight was proposed for the treatment of acute pain in children aged from 2 to <18 years.

Body Mass Index, Physical Activity, Sedentary Behavior, Sleep, and Gross Motor Skill Proficiency in Preschool Children From a Low- to Middle-Income Urban Setting.

BACKGROUND: Limited research reports on the relationship between body mass index (BMI) and physical activity (PA), sedentary behavior (SB), sleep, and gross motor skills (GMS) in low- and middle-income countries. The aim of this study was to (1) describe BMI, PA, SB, sleep duration, and GMS proficiency in South African preschool children and (2) identify relationships between variables. METHODS: BMI, including z scores for height, weight, and BMI were determined. Seven-day PA, SB, and sleep were measured using accelerometry. GMS were assessed using the Test of Gross Motor Development (second edition). Associations were explored by comparing sleep, PA, SB, and GMS between BMI tertiles using the Kruskal-Wallis test. RESULTS: Most (86%) children (n = 78, 50% boys) had a healthy BMI (15.7 [1.3] kg/m2). Children spent 560.5 (52.9) minutes per day in light- to vigorous-intensity PA and 90.9 (30.0) minutes per day in moderate- to vigorous-intensity PA; most (83%) met the current PA guideline. Nocturnal sleep duration was low (9.28 [0.80] h/d). Although daytime naps increased 24-hour sleep duration (10.17 [0.71] h/d), 38% were classified as short sleepers. Around half (54.9%) of participants complied with both PA and sleep guidelines. No associations between variables were found. CONCLUSION: Despite being lean, sufficiently active, and having adequate GMS, many children were short sleepers, highlighting a possible area for intervention.

Anthropometric profiles of 8-11 year old children from a low-income setting in South Africa.

BACKGROUND: Communities in low-to-middle income countries undergoing rapid urbanisation as well as nutrition transition are particularly at risk for associated health issues such as overweight and obesity. South Africa has a double-burden of both under- and over-nutrition, creating some uncertainty as to where to direct healthcare interventions. Therefore, providing anthropometric data in vulnerable populations, such as in early childhood, is much needed. METHODS: This observational study assessed height, weight, head circumference and age-adjusted BMI in 1785 Grade 4 (9.5 ± 0.7 years old) learners from 12 schools in two different areas in South Africa. RESULTS: Overall, the results of this study found a higher prevalence of overnutrition (>95th percentile for age-adjusted BMI) than undernutrition (<15th percentile for age-adjusted BMI), 27.3% versus 12.4% respectively. Although the boys were significantly older and taller than the girls in this sample, there were no significant sex differences between boys and girls for BMI (19.9 kg/m2 ± 6.0 vs 20 kg/m2 ± 5.8, p = 0.59). Significant differences were found between peri-urban and urban areas for undernutrition (16.1% versus 9.5%, p < 0.001) and overnutrition (9.7% versus 41.2%, p < 0.001). CONCLUSION: South African children living in urban areas are particularly vulnerable to high rates of overweight and obesity. Therefore, interventions that are area and context specific are needed to address the issues of malnutrition in South Africa.

Physical Activity Questionnaires for Pregnancy: A Systematic Review of Measurement Properties.

BACKGROUND: In order to assess physical activity (PA) during pregnancy, it is important to choose the instrument with the best measurement properties. OBJECTIVES: To systematically summarize, appraise, and compare the measurement properties of all self-administered questionnaires assessing PA in pregnancy. METHODS: We searched PubMed, Embase, and SPORTDiscus with the following inclusion criteria: (i) the study reported at least one measurement property (reliability, criterion validity, construct validity, responsiveness) of a self-administered questionnaire; (ii) the questionnaire intended to measure PA; (iii) the questionnaire was evaluated in healthy pregnant women; and (iv) the study was published in English. We evaluated results, quality of individual studies, and quality of evidence using a standardized checklist (Quality Assessment of Physical Activity Questionnaires [QAPAQ]) and the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. RESULTS: Seventeen articles, reporting 18 studies of 11 different PA questionnaires (17 versions), were included. Most questionnaire versions showed insufficient measurement properties. Only the French and Turkish versions of the Pregnancy Physical Activity Questionnaire (PPAQ) showed both sufficient reliability and construct validity. However, all versions of the PPAQ pooled together showed insufficient construct validity. The quality of individual studies was usually high for reliability but varied considerably for construct validity. Overall, the quality of evidence was very low to moderate. CONCLUSIONS: We recommend the PPAQ to assess PA in pregnancy, although the pooled results revealed insufficient construct validity. The lack of appropriate standards in data collection and processing criteria for objective devices in measuring PA during pregnancy attenuates the quality of evidence. Therefore, research on the validity of comparison instruments in pregnancy followed by consensus on validation reference criteria and standards of PA measurement is needed.

The Influence of Objectively Measured Physical Activity During Pregnancy on Maternal and Birth Outcomes in Urban Black South African Women.

Objectives Research indicates the beneficial effects of physical activity during pregnancy on maternal health, although controversy still exists regarding its influence on birth outcomes. Little research has been done to objectively measure physical activity during pregnancy in black African women from low-to-middle income countries. The purpose of this study was to examine the association between physical activity and maternal and birth outcomes in this unique population. Methods This observational, longitudinal study assessed total physical activity using a hip-mounted triaxial accelerometer at 14-18 weeks (second trimester, n = 120) and 29-33 weeks (third trimester, n = 90) gestation. Physical activity is expressed as gravity-based acceleration units (mg). Maternal outcomes included both weight and weight gain at 29-33 weeks gestation. Birth outcomes included gestational age, birth weight, ponderal index and Apgar score, measured within 48 h of delivery. Results There was a significant decline in physical activity from the second to the third trimester (12.8 ± 4.1 mg vs. 9.7 ± 3.6 mg, p ≤ 0.01). Physical activity at 29-33 weeks as well as a change in PA was inversely associated with weight change at 29-33 weeks (ß = - 0.24; 95% CI - 0.49; - 0.00; p = 0.05 and ß = - 0.36; 95% CI - 0.62; - 0.10; p = 0.01, respectively). No significant associations were found between physical activity and birth outcomes. Conclusions for Practice Physical activity during pregnancy may be an effective method to control gestational weight gain, whilst presenting no adverse risk for fetal development, in women from a low-income urban setting.

The effect of lifestyle interventions on maternal body composition during pregnancy in developing countries: a systematic review.

Optimal maternal body composition during pregnancy is a public health priority due to its implications on maternal health and infant development. We therefore aimed to conduct a systematic review of randomised, controlled trials, and case-control and cohort studies using lifestyle interventions to improve body composition in developing countries. Of the 1 708 articles that were searched, seven studies, representing three countries (Brazil, Iran and Argentina), were included in the review. Two articles suggested that intervention with physical activity during pregnancy may significantly reduce maternal weight gain, and five studies were scored as being of poor quality. This systematic review highlights the lack of research within developing countries on lifestyle interventions for the management of excessive weight gain during pregnancy. Similar reviews from developed countries demonstrate the efficacy of such interventions, which should be confirmed using well-designed studies with appropriate intervention methods in resource-limited environments.

Validity and responsiveness of the Global Physical Activity Questionnaire (GPAQ) in assessing physical activity during pregnancy.

The physiological and biomechanical changes that occur during pregnancy make accurate measurement of physical activity (PA) a challenge during this unique period. The Global Physical Activity Questionnaire (GPAQ) has been used extensively in low-to-middle income countries, but has never been validated in a pregnant population. In this longitudinal study, 95 pregnant women (mean age: 29.5±5.7 years; BMI: 26.9±5.0 kg/m2) completed the GPAQ and were asked to wear an accelerometer for 7 days at two time points during pregnancy (14-18 and 29-33 weeks gestation). There was a significant difference between accelerometry and GPAQ when measuring moderate-to-vigorous physical activity (MVPA) at 29-33 weeks gestation (16.6 vs 21.4 min/day; p = 0.02) as well as sedentary behaviour (SB) at both 14-18 weeks (457.0 vs 300 min/day; p < 0.01) and 29-33 weeks gestation (431.5 vs 300 min/day; p < 0.01). There was poor agreement between the GPAQ and accelerometry for both PA and SB at both time points (ICC: -0.05-0.08). Bland Altman plots indicated that the GPAQ overestimates PA by 14.8 min/day at 14-18 weeks and by 15.8 min/day at 29-33 weeks gestation. It underestimates SB by 127.5 min/day at 14-18 weeks and by 89.2 min/day at 29-33 weeks gestation. When compared to accelerometry, the GPAQ shows poor agreement and appears to overestimate PA and underestimate SB during pregnancy.

Cardiovascular Disease Risk Profile and Readiness to Change in Blue- and White-Collar Workers.

This study provides a health and risk profile of blue- (BCWs) and white-collar workers (WCWs). Health screening data (n = 603; age 38.2 ± 9.7 years) included cholesterol and glucose finger-prick test, blood pressure, body mass index, and self-reported stress levels and readiness to change. Blue-collar workers were significantly older and had higher blood pressure readings and were more likely to develop hypertension (odds ratio [OR]: 1.72; 95% confidence interval [CI]: 1.05-2.81; P = .03), but less likely to present with hypercholesterolemia (OR: 0.50; 95% CI: 0.31-0.81; P = .01) and overweight/obesity (OR: 0.65; 95% CI: 0.42-0.99; P = .047). White-collar workers showed significantly higher cholesterol and stress levels. This study highlights the importance of occupation type in workplace health screening and intervention planning.