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This study was undertaken to assess the effects of a web-based program, MyLupusGuide, developed to facilitate self-management in systemic lupus erythematosus (SLE).In this randomized controlled online study, participants received either immediate access to the MyLupusGuide site or delayed access starting on month 3. The primary outcome was the patient activation measure (PAM) score. Secondary outcomes included measurements of health status, self-efficacy, coping, perceived patient-physician relationship, and medication adherence. Outcomes were measured at the baseline visit and at the 3-month and 6-month follow-up visits. We used linear mixed modeling to compare PAM scores between the 2 groups at months 3 and 6.There were 541 participants included in this study. The mean ± SE age was 50 ± 14 years; 93% were female and 74% were White. The mean ± SE disease duration was 17 ± 12 years, and 56% visited MyLupusGuide at least once. The baseline mean ± SE PAM score was 61.2 ± 13, with 36% scoring low for perceived self-management skills. After 3 months of exposure to MyLupusGuide, there were no differences in terms of PAM scores between groups. In exploratory analyses, we found significant improvement in PAM scores in those who had low PAM scores at baseline and in male individuals. We observed significant improvements in self-efficacy before and after access to MyLupusGuide and delayed improvements at month 6 compared to month 3 in terms of mental health and emotional coping.MyLupusGuide increases self-efficacy but not patient activation. A total of 56% of participants visited the MyLupusGuide site during the study period. Individuals with lupus need support to become activated toward self-management behaviors.

Objective: This prospective longitudinal cohort aims to identify biological, psychological, and social factors that contribute to maternal perinatal mental health, family well-being, and child development. Method: Pregnant individuals (N=1130) were recruited between 8-20 gestation weeks. Questionnaire data were collected through a web-based platform together with biosamples for genetic analysis. Baseline characteristics of the cohort are described. A Bayesian model explored potential pandemic-associated changes in baseline maternal mental health symptoms throughout recruitment. Results: At baseline, 28.3% and 11.6% of pregnant participants reported clinically significant symptoms of anxiety (Spielberger Trait Anxiety Inventory ≥ 40) or depression (Edinburgh Postnatal Depression Scale ≥ 13). The onset of the COVID-19 pandemic was associated with increased likelihood of elevated scores on brief screening instruments for anxiety and depression. There was insufficient evidence for such effects using other screening tools. Conclusion(s): We further highlight anxiety and depression as common complications of pregnancy but find a modest impact of the pandemic on mental health within this cohort. Leveraging the unique data collected through this study we seek to inform screening practices and health policy to improve the well-being of mothers and families.

A bidirectional association between depression and diabetes exists, but has not been evaluated in the context of immigrant status. Given that social determinants of health differ between immigrants and nonimmigrants, we evaluated the association between diabetes and depression incidence, depression and diabetes incidence, and whether immigrant status modified this association, among immigrants and nonimmigrants in Canada.We employed a retrospective cohort design using data from the Canadian Longitudinal Study on Aging Comprehensive cohort (baseline [2012-2015] and 3-year follow-up [2015-2018]). We defined participants as having diabetes if they self-reported it or if their glycated hemoglobin ACohort 1 (We found an overall bidirectional association between diabetes and depression that was not significantly modified by immigrant status. Screening for diabetes for people with depression and screening for depression for those with diabetes should be considered.

Prior investigations have examined risk factors associated to postpartum depression in immigrant women, but depression during pregnancy has received less attention. This study describes the prevalence and early determinants of antenatal depression among recent (≤ 5 years) and long-term immigrants (> 5 years), compared to Canadian-born women. 503 women completed standardized self-report questionnaires measuring sociodemographics and psychosocial factors. Multivariate logistic regressions identified first trimester risk factors for depression in each immigrant group. The prevalence of depressive symptoms was highest for recent immigrant (25.3-30.8%) compared to long-term immigrant (16.9-19.2%) and Canadian-born women (11.7-13.8%). Among recent immigrants, multiparity, higher stress and pregnancy-specific anxiety in early pregnancy increased the risk of antenatal depression. Among long-term immigrants, stress in the first trimester was significantly associated with antenatal depressive symptoms. Knowledge of modifiable risk factors (pregnancy-specific anxiety and stress) may help improve antenatal screening and inform the development of tailored interventions to meet the mental health needs of immigrant women during the perinatal period.

BACKGROUND Youth (aged 14-24 years) living with type 1 diabetes (T1D) encounter increased challenges in their diabetes self-management (DSM), especially during the transition to adult care. Although DSM education and support are imperative, there is insufficient information on how web-based digital tools tailored to their demands can be developed. OBJECTIVE On the basis of the Behavior Change Wheel, this study aims to identify, among youth living with T1D, the needs and factors influencing their DSM in the context of health care transition and to inform the adaptation (content and features) of an adult self-guided web application (Support). METHODS Internet-based semistructured individual interviews based on a phenomenological study design were conducted with 21 youths, and transcripts were analyzed using an inductive approach with concept mapping. RESULTS Factors influencing T1D self-management were categorized into barriers and facilitators and then as external or internal. Features influencing the accessibility to information, increasing the sense of support, and use of the tool were positively accepted. Features unrelated to their expectations of digital tool use or difficulty navigating were viewed negatively. Participants expressed an interest in reliable, practical, and novel educational content. Although youth considered the information provided by medical professionals to be important, peer exchange was deemed necessary to obtain a practical perspective and real-life examples. CONCLUSIONS Compared with the adult population, in addition to tailored content and a simplified information search process, when building a DSM education and support digital tool for youth, features should be selected to encourage supervised peer exchange. CLINICALTRIAL

The Research Question posed was 'What coping strategies do fertility patients and trained peer supporters discuss in an online infertility peer support forum?' A thematic analysis was used to examine 244 online posts from a sample of 39 users (37 women and two men) for themes in coping with fertility-related stressors. Data were collected from Connect, a monitored online discussion forum with trained peer supporters. Connect users ranged from 27 to 44 years of age (mean = 34.38) and 33 (84.6%) were nulliparous at the time of the study. A variety of cognitive-reappraisal and practical management coping strategies was discussed across four themes: (i) balancing interpersonal relationships; (ii) partner support; (iii) uncertainty and lack of control; and (iv) positivity and negativity. Experiences of uncertainty and lack of control related to time and schedule, outcomes and waiting for physical symptoms, and the clinic. Connect users commonly discussed the helpfulness of coping strategies. Connect users actively requested experiential information about ways of coping from other patients and peer supporters, highlighting the importance of lived experience to those currently in treatment. Findings support conceptualizations of infertility coping as a process that is unique to the infertility treatment context and that may change throughout a patient's treatment. Trained peer supporters may benefit fertility patients by normalizing, reappraising, and providing practical strategies to ameliorate difficult infertility-related challenges.

BACKGROUND: Perinatal loss affects many parents in the workforce. Yet, current knowledge about their workplace experience while facing this difficult event is sparse. OBJECTIVES: The goal of this study was to review and synthesize the extent of scientific literature on the specific experiences of workers coping with perinatal loss and the resulting bereavement. METHODS: A scoping review was carried out using eight different databases. A total of 15 references, all using a qualitative methodology, were identified. RESULTS: Most of the references focused on the experience of mothers and on late perinatal loss (from the 20th week of pregnancy). All references highlighted the taboo and the non-recognition of perinatal grief and bereavement in both organizational practices and interpersonal relationships with colleagues and immediate supervisors. They also emphasized the difficulties associated with returning to work after the loss and the significant changes in the meaning attributed to work. CONCLUSIONS: While the studies included in this review clearly indicate that perinatal loss can affect working life, larger, quantitative studies are needed to quantify this phenomenon and its impact on employees and their organizations.

Nos dias 8 e 9 de dezembro de 2020 foi realizado de forma remota o “Encontro Mauricio de Almeida Abreu: memória, trajetória e perspectivas”, cujas apresentações se encontram disponíveis na íntegra. O evento foi organizado por antigos orientandos e orientandas que integravam o Núcleo de Pesquisa de Geografia Histórica (NPGH/UFRJ), coordenado, por décadas, pelo Prof. Mauricio de Almeida Abreu.

Background Feelings of loss, shame and stigmatization, reduced quality of life, isolation and loneliness are common among men and women with infertility. Fertility patients may seek peer mentoring and support, specifically through the use of online forums, to fulfil their needs for shared experience and guidance through the fertility treatment process. Objective To assess the use and benefits of an online fertility-related peer support forum through two research questions: (1) do socio-demographics, stress, and anxiety differ between posters on the forum, lurkers who read messages but did not post, and people who chose not to use it?; and (2) how did forum users describe their experiences? Design A sample of 220 male and female fertility patients aged 23–54 years old (M = 35.51, SD = 4.94) were recruited at fertility clinics in Montreal and Toronto, Canada, to test a mobile application called ‘Infotility’. They answered questionnaires before and after being given access to Infotility for eight weeks. The peer support forum was accessible through the Infotility dashboard. Main Outcome Measures Psychological distress was measured through the 4-item Perceived Stress Scale and the Generalized Anxiety Disorder 7-item Scale. Experiences using the forum were assessed through open-ended questions and in-depth interviews. Results Participants with heightened psychological distress were more likely to become posters rather than lurkers or non-users and reported less distress after using the forum. Forum users appreciated the opportunity to share their experiences with others in similar situations. Conclusion The forum reduced loneliness and allowed participants to learn new ways to manage stress. It was particularly beneficial for those with heightened psychological distress.

Hypertensive disorders of pregnancy occur in approximately 7%-10% of pregnancies and are associated with adverse maternal cardiovascular health outcomes across the lifespan. In contrast, breastfeeding has been associated with a reduction in cardiovascular risk factors in a dose-dependent manner. Despite the potential protective effects of lactation on cardiovascular risk, how hypertensive disorders of pregnancy relate to breastfeeding practices and experiences is not well understood. The aim of this study was to investigate the association between hypertensive disorders of pregnancy and breastfeeding outcomes in the first year postpartum.We conducted a secondary analysis of prospective data from the All Our Families Cohort, a population-based study conducted in Calgary, Alberta, Canada. Women with a singleton pregnancy (n = 1418) who completed self-report questionnaires at25 weeks and 34-36 weeks of gestation, and 4 months and 12 months postpartum, and provided consent to link to electronic medical records that identified diagnoses of hypertensive disorders of pregnancy (n = 122). Logistic and multiple linear regression analyses were used to model associations between hypertensive disorders of pregnancy and breastfeeding outcomes. Outcomes included breastfeeding intention, intended duration, exclusive breastfeeding at 4 months, breastfeeding duration at 12 months and breastfeeding difficulties.Hypertensive disorders of pregnancy were not associated with breastfeeding intention (odds ration [OR] 1.30, 95% confidence interval [CI] 0.47-3.03, P = 0.57), intended breastfeeding duration (b = -3.28, 95% CI -7.04 to 0.48, P = 0.09), or initiation (OR = 0.64, 95% CI 0.29- 1.65, P = 0.32), but were associated with an increase in the odds of non-exclusive breastfeeding at 4 months postpartum (OR = 2.11, 95% CI 1.39-3.22, P 0.001). Women with hypertensive disorders breastfed for 6.26 (95% CI -10.00 to -2.51, P 0.001) weeks less over 12 months postpartum, had significantly higher odds of reporting insufficient milk supply (OR = 1.75, 95% CI 1.19-2.46, P 0.05) and had lower odds of breast and/or nipple pain (OR = 0.66, 95% CI 0.44-0.92, P 0.05) compared with those without hypertensive disorders of pregnancy.Hypertensive disorders of pregnancy are associated with altered breastfeeding practices and experiences during the first year postpartum. Further research is needed to examine biopsychosocial mechanisms through which hypertensive disorders associate with shorter breastfeeding duration, and to examine whether greater breastfeeding duration, intensity or exclusivity reduces short- or long-term maternal cardiovascular risk.

Research on mindfulness has extended to the prevention of psychopathology and physical conditions during pregnancy. The purpose of this study was to investigate the relationship between trait mindfulness assessed in the first or early second trimester to health outcomes throughout pregnancy.A total of 510 women were recruited at McGill University-affiliated obstetrics clinics (average gestational age: 13.43 weeks, sd = 1.2). The Mindful Awareness and Attention Scale (MAAS) was administered at baseline. At three timepoints during pregnancy, participants completed the Perceived Stress Scale (PSS-10), the Edinburgh Postnatal Depression Scale (EPDS), the Prenatal Distress Questionnaire-revised (PDQR) and a measure of pregnancy symptom intensity and indicated whether they had been diagnosed with gestational diabetes or high blood pressure.Higher MAAS scores predicted lower PSS, EPDS and PDQR scores and less severe physical discomforts throughout pregnancy. MAAS scores were a stronger predictor of PSS scores earlier in pregnancy. Logistic regressions found that trait mindfulness did not predict the presence of physical discomforts, diabetes or high blood pressure.These results indicate that trait mindfulness is an important predictor of subjective stress, depression, anxiety and the severity of physical discomforts during pregnancy. These findings suggest that interventions earlier in pregnancy may increase the impact of mindfulness on maternal health.

Background Diabetes self-management education and support (DSME/S) are central in type 1 diabetes (T1D) where individuals are responsible for 95% of care. In-person DSME/S programs have been proven clinically effective (e.g. optimizing glycemic management, improving diabetes-related behaviors) but are limited by a lack of accessibility and long-term follow-up. Self-guided digital tools such as web applications (web apps) can be an alternative for delivering DSME/S. Objective This article describes the development of Support, a behavioral theory-based, self-guided, web application for adults living with T1D in the province of Quebec, Canada. Methods A multi-disciplinary team developed Support. Patient partners first proposed its focus, learning topics, and expressed barriers to using digital tools for DSME/S. These barriers were analyzed based on the Behaviour Change Wheel. A group of healthcare professionals (HCPs) drafted the evidence-based learning content which was reviewed by external HCPs and by patient partners. Results Support is a bilingual (English and French) web app accessible at any time via the Internet. It has four learning paths focusing on hypoglycemia and based on the user's method of diabetes treatment. Learning modules are divided into six categories with a maximum of three learning levels. It contains features such as a discussion forum, videos, and quizzes to ensure interactivity, provide social support, and maintain the motivation and long-term engagement of users. Conclusions To the best of the authors’ knowledge, Support is the first self-guided evidence-based web app for adults living with T1D. It is currently under study to evaluate its feasibility and clinical impacts.

A sociedade não pode ser desvinculada do espaço em que vive e este, por consequência, só faz sentido se associado à sociedade que o criou. Como geógrafa me foi ensinado a ver o mundo desta maneira e agora, como professora, esforço-me para que meus alunos façam o mesmo. Entretanto, esta não é uma tarefa fácil. A sociedade atual, fruto do meio técnico-científico-informacional, se torna cada vez mais individualizada, e a escola, inserida neste contexto, segue a mesma lógica. No processo educacional, alunos e professores estão tão preocupados com provas e notas que o refletir, muitas vezes, fica em segundo plano. Neste sentido, o presente trabalho pretende apresentar e discutir uma experiência de atividade intitulada Árvore da Vida cujo objetivo é despertar o olhar geográfico dos alunos a partir de aspectos observados em suas próprias vidas. Através da construção da sua árvore genealógica e da descrição das trajetórias familiares, os estudantes são convidados a realizar um trabalho de investigação sobre suas próprias histórias, tendo as ferramentas da análise geográfica como suporte.

IntroductionType 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating meal replacement products can induce diabetes remission, but do not lead to improved diastolic function, unlike supervised exercise interventions. We are examining the impact of a combined low energy diet and supervised exercise intervention on T2DM remission, with peak early diastolic strain rate, a sensitive MRI-based measure, as a key secondary outcome.Methods and analysisThis prospective, randomised, two-arm, open-label, blinded-endpoint efficacy trial is being conducted in Montreal, Edmonton and Leicester. We are enrolling 100 persons 18–45 years of age within 6 years’ T2DM diagnosis, not on insulin therapy, and with obesity. During the intensive phase (12 weeks), active intervention participants adopt an 800–900 kcal/day low energy diet combining meal replacement products with some food, and receive supervised exercise training (aerobic and resistance), three times weekly. The maintenance phase (12 weeks) focuses on sustaining any weight loss and exercise practices achieved during the intensive phase; products and exercise supervision are tapered but reinstituted, as applicable, with weight regain and/or exercise reduction. The control arm receives standard care. The primary outcome is T2DM remission, (haemoglobin A1c of less than 6.5% at 24 weeks, without use of glucose-lowering medications during maintenance). Analysis of remission will be by intention to treat with stratified Fisher’s exact test statistics.Ethics and disseminationThe trial is approved in Leicester (East Midlands – Nottingham Research Ethics Committee (21/EM/0026)), Montreal (McGill University Health Centre Research Ethics Board (RESET for remission/2021-7148)) and Edmonton (University of Alberta Health Research Ethics Board (Pro00101088). Findings will be shared widely (publications, presentations, press releases, social media platforms) and will inform an effectiveness trial.Trial registration numberISRCTN15487120.

Objective To assess the feasibility and acceptability of using a Sequential Multiple Assignment Randomized Trial (SMART) to optimize the delivery of a web-based, stress management intervention for patients with a cardiovascular disease (CVD). Methods 59 patients with a CVD and moderate stress were randomized to a self-directed web-based stress management program (n = 30) or the same intervention plus lay telephone coaching (n = 29). After 6 weeks, non-responders were re-randomized to continue with their initial intervention or switched to motivational interviewing (MI). Feasibility, acceptability, and clinical significance were assessed. Results SMART procedures were feasible. Attrition rates were almost twice as high in the web-only group than the lay coach group. This might be because of the low satisfaction (47%) in the web-only group. On average, 1.7/5 modules were completed. Effect sizes for stress and quality of life generally exceeded 0.2 (clinical benchmark), except for the group that initially received lay coaching and then switched to MI. Conclusions Results suggest that a larger trial would be feasible. Issues pertaining to attrition and satisfaction for non-responders need to be addressed. Practice implications Findings contribute to the evidence on how best to develop and deliver e-Health interventions to maximize their efficacy while remaining cost-effective.

Background: Exclusive breastfeeding is recommended for the first 6 months of life and has significant benefits for both mother and child. Pregnancy-specific anxiety is a distinct and definable syndrome that has been identified as a robust predictor of pregnancy outcomes, but whether it is associated with exclusive breastfeeding status has not been determined. Research aims: To examine the association between pregnancy-specific anxiety in each trimester of pregnancy and exclusive breastfeeding status early in the postpartum period. Methods: Data were available from 412 women who participated in a longitudinal pregnancy cohort study. Pregnancy-specific anxiety and exclusive breastfeeding status were assessed using an online self-report questionnaire. Results: Logistic regression analyses showed that a one-unit increase in pregnancy-specific anxiety in the first ( OR = 0.94, 95% CI [0.90, 0.98]) and third ( OR = 0.95, 95% CI [0.91, 0.99]) trimester of pregnancy was associated with a 5–6% decrease in the odds of exclusive breastfeeding at 6–8 weeks postpartum. Conclusions: Pregnancy-specific anxiety was associated with lower odds of exclusive breastfeeding at 6–8 weeks postpartum. Prenatal interventions designed to increase exclusive breastfeeding duration may benefit from the incorporation of strategies that help reduce worries and concerns unique to the pregnancy experience.

Purpose: To evaluate the results of a workplace wellness program that incorporates gamification principles. Design: In this prospective cohort study, the participation rate and observed health outcomes were evaluated after approximately 2 years. Setting and participants: All permanent employees (n = 775) of a national company located in Canada were eligible to participate. Intervention: The wellness program included web-based challenges (team or individual) incorporating gamification strategies to improve exercise, nutrition, weight reduction, and mental health management behaviors. Measures and analysis: The primary outcomes were employee participation rates. The secondary pre-specified outcomes were the sustained benefits of the program on physical and mental health measures. Results: Participation rates in the health screenings were 78% (baseline), 54% (year 1), and 56% (year 2). Participation in the 4 team web-based challenges ranged from 33% to 68% with 76% to 86% of participants tracking their activity on at least half of the days. After 2 years, there were significant clinical improvements in systolic blood pressure (−1.3mm Hg), total cholesterol/high-density lipoprotein (HDL) ratio (−0.14), glycated haemoglobin (HbA1c; −0.1%), weekly physical activity (+264 Metabolic Equivalents [METs]), perceived stress score (−17%), insomnia severity index (−16%), general fatigue (−10%), and reductions in the cardiovascular age gap (−0.3 years). Greater benefits occurred among employees at higher risk. Conclusions: Workplace wellness programs that evolve over time and focus primarily on fun and competitive challenges may support long-term participation, behavior change, and sustained improvements in clinical outcomes.

Romina Pace,1 Elham Rahme,1,2 Deborah Da Costa,1,2 Kaberi Dasgupta1,2 1Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; 2Department of Medicine, McGill University Health Center, Montreal, QC, Canada Purpose: The aim of this study was to examine the association between gestational diabetes mellitus (GDM) and depression incidence in mothers and fathers during prenatal and postnatal periods.Patients and methods: Matched pairs (GDM vs no GDM) of randomly selected mothers with singleton live births (matched by age group, delivery year, and health region) and their partners (Quebec, Canada; cohort inception 1990–2007) were assessed for a composite outcome of depression/self-harm/suicide using a health administrative database. We examined the association of GDM and the composite outcome in the following three nonoverlapping periods: 1) 24weeks gestation up to delivery; 2) delivery up to 1year postpartum; and 3) 1year postpartum to study end (March 31, 2012). We used stratified Cox proportional regression hazards models, with three models in mothers and three models in fathers, corresponding to each of the time periods of interest.Results: In the 58,400 mothers, women with GDM had a nearly twofold greater risk (adjusted HR: 1.82, 95% CI 1.28, 2.59) of being diagnosed with depression compared to those without GDM during the prenatal period. In the first year postpartum, there was no conclusive difference observed between the two groups of mothers (adjusted HR: 1.05, 95% CI 0.84, 1.30). Beyond the first year postpartum, there was an 8% increased risk (adjusted HR: 1.08, 95% CI 1.03, 1.14) of depression in women with a history GDM compared to those without. A total of 63,384 fathers were included in our analyses, and no association between GDM in one’s partner and depression was found during any of the three time periods evaluated.Conclusion: GDM is associated with an increased risk of depression in women particularly during pregnancy highlighting the need to screen for depression and provide supportive interventions during this period. Keywords: depression, self-harm, suicide, administrative health data, pregnancy, postpartum

IntroductionThe ‘Developmental Origins of Health and Disease’ hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase ‘preconception to early childhood’ lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years.Method and analysisA randomised controlled multicentre trial will be conducted in two of Canada’s highly populous provinces—Alberta and Ontario—with 786 nulliparous (15%) and 4444 primiparous (85%) women, their partners and, when possible, the first ‘sibling child.’ The intervention is telephone-based collaborative care delivered by experienced public health nurses trained in healthy conversation skills that includes detailed risk assessments, individualised structured management plans, scheduled follow-up calls, and access to a web-based app with individualised, evidence-based resources. An ‘index child’ conceived after randomisation will be followed until age 5 years and assessed for the primary and secondary outcomes. Pregnancy, infancy (age 2 years) and parental outcomes across time will also be assessed.Ethics and disseminationThe study has received approval from Clinical Trials Ontario (CTO 1776). The findings will be published in peer-reviewed journals and disseminated to policymakers at local, national and international agencies. Findings will also be shared with study participants and their communities.Trial registration numberISRCTN13308752; Pre-results.

This study examined sleep disturbances in first-time fathers from the third trimester of their partner's pregnancy to 2 months postpartum to determine prevalence, incidence, and persistence of sleep disturbances and identify associated determinants.Men expecting their first child were recruited from local prenatal classes and university-affiliated obstetric clinics. During their partner's third trimester of pregnancy and 2 months postpartum, 459 men completed standardized online self-report questionnaires measuring sociodemographics, lifestyle, and psychosocial variables and sleep quality.Disturbed sleep (Pittsburgh Sleep Quality Index [PSQI] global score 5) increased from 29.6% during the third trimester to 44.7% at 2 months postpartum. The incidence of poor sleep at 2 months postpartum was 33.7%. Among men with disturbed sleep at the antenatal assessment, 70.6% continued to have sleep disturbances at 2 months postpartum. An increase in depressive symptoms and higher parenting stress was independently associated with onset and persistence of disturbed sleep at 2 months postpartum.Sleep is compromised in expectant and new fathers. Strategies aimed at improving sleep, depressed mood, and managing the challenges of parenting may be important components to include in prenatal interventions aimed at enhancing the transition to parenthood and infant development.Introducción. Este estudio examinó los trastornos para dormir en papás primerizos a partir del tercer trimestre del embarazo de su pareja hasta 2 meses después del parto para determinar la prevalencia, incidencia y persistencia de los trastornos para dormir e identificar determinantes asociados. Métodos. Se reclutaron hombres en espera de su primer niño en las clases prenatales locales y en las clínicas de obstetricia afiliadas con la universidad. Durante el tercer trimestre del embarazo de su pareja y 2 meses después del parto, 459 hombres completaron cuestionarios autorreportados electrónicamente para medir aspectos sociodemográficos, las variables de estilo de vida y sicosociales, y la calidad del sueño. Resultados. El sueño trastornado (PSQI puntaje global5) aumentó de 29.6% durante el tercer semestre al 44.7% a los 2 meses después del parto. La incidencia del sueño débil a los 2 meses después del parto fue de 33.7% Entre los hombres con trastorno para dormir al momento de la evaluación antenatal, 70.6% continuó teniendo trastornos para dormir a los 2 meses después del parto. Un aumento en síntomas de depresión y un más alto estrés de crianza se asociaron independientemente con el comienzo y la persistencia del trastorno para dormir a los 2 meses después del parto. Conclusiones. El sueño de los papás que esperan su primer niño está en peligro. Las estrategias dirigidas a mejorar el sueño, el estado de ánimo depresivo, así como el arreglárselas con los retos de la crianza pudieran ser componentes importantes que incluir en las intervenciones prenatales que tienen como objetivo mejorar la transición a la paternidad y el desarrollo del infante.Cette étude a examiné les troubles du sommeil chez les pères étant pères pour la première fois du troisième trimestre de la grossesse de leur partenaire à deux mois après la naissance afin de déterminer la prévalence, l'incidence et la persistance de perturbation du sommeil et d'identifier les déterminants qui y sont liés. Méthodes: Des hommes attendant leur premier enfant ont été recrutés dans des classes locales de préparation à la naissance et des cliniques obstétriques affiliées à un CHU. Durant le troisième trimestre de la grossesse de leur partenaire et deux mois après la naissance 459 hommes ont rempli des questionnaires standardisés en ligne et auto-rapportés, mesurant l'information sociodémographique, le style de vie, les variables psychosociales et la qualité du sommeil. Résultats: Le sommeil perturbé (score global PSQI5) a augmenté de 29,6% durant le troisième trimestre à 44,7% à deux mois après la naissance. L'incidence de mauvais sommeil à deux mois après la naissance était de 33,7%. Chez les hommes avec un sommeil perturbé dans l’évaluation avant la naissance, 70,6% ont continué à avoir des troubles du sommeil à deux mois après la naissance. Une augmentation des symptômes dépressifs et un stress de parentage plus élevé étaient indépendamment liés à l'apparition et à la persistance de sommeil perturbés à deux mois après la naissance.Le sommeil est compromis chez les pères qui attendent un enfant et les nouveaux pères. Des stratégies destinées à améliorer le sommeil, l'humeur déprimée et à contrôler les défis du parentage peuvent s'avérer être des composants importants à inclure dans les interventions prénatales destinées à améliorer la transition au parentage et au développement du nourrisson.Eine prospektive Studie zum Verlauf von Schlafstörungen bei erstmaligen Vätern während des Übergangs in die Elternschaft Einleitung. In dieser Studie wurden Schlafstörungen bei Erstvätern untersucht, um deren Prävalenz, Inzidenz und Persistenz zu bestimmen und damit verbundene Determinanten zu identifizieren. Der Untersuchungszeitraum reichte vom dritten Trimenon der Schwangerschaft ihrer Partnerin bis 2 Monate nach der Geburt. Methoden. Aus örtlichen Schwangerschaftsvorbereitungskursen und Geburtskliniken wurden Männer rekrutiert, die ihr erstes Kind erwarteten. 459 Teilnehmer füllten während des dritten Schwangerschaftstrimenons ihrer Partnerin und 2 Monate nach der Geburt standardisierte Online-Fragebögen aus, in denen Soziodemographie, Lebensstil und psychosoziale Variablen sowie die Schlafqualität erhoben wurden. Ergebnisse. Schlafstörungen (PSQI Global Score5) stiegen von 29,6% im dritten Trimenon auf 44,7% 2 Monate nach der Geburt. Die Inzidenz von Schlafstörungen betrug 2 Monate nach der Geburt 33,7%. Von den Männern, die bei der vorgeburtlichen Untersuchung Schlafstörungen aufwiesen, hatten 70,6% 2 Monate nach der Geburt weiterhin Schlafstörungen. Eine Zunahme depressiver Symptomatik und höherer elterlicher Stress waren jeweils mit dem Einsetzen und dem Fortbestehen von Schlafstörungen 2 Monate nach der Geburt assoziiert. Fazit. Bei werdenden und neuen Vätern ist der Schlaf beeinträchtigt. Strategien zur Verbesserung von Schlaf und depressiver Symptomatik sowie zur Bewältigung der Herausforderungen einer Elternschaft könnten wichtige Komponenten für vorgeburtliche Interventionen sein, die auf eine Verbesserung des Übergangs in die Elternschaft und der Entwicklung des Kindes abzielen.初めての父親における、親への移行期間の睡眠障害の経過に関する縦断的コホート研究 背景 本研究は、初めての父親になる際の睡眠障害について、パートナーの妊娠 後期から産後2か月までの期間について検討し、睡眠障害の有病率、発症、持続 について調査し、関連性のある要因を同定した。 方法 第一子の出産をひかえている男性を、地元の母親学級と大学付属の産科ク リニックで募集した。パートナーの妊娠後期から産後2か月までの期間に、459人 の男性が、社会人口統計学、ライフスタイル、心理社会的変数および睡眠の質に ついての標準化された自己申告質問票にオンラインで記入した。 結果:睡眠障害 (PSQIグローバルススコア５) は、妊娠後期に29.6％であった が、産後2か月に44.7％と増加していた。産後2か月に睡眠不足を33.7％に認めた。 出産前の調査で睡眠障害を認めた男性の70.６％に、引き続き産後2か月時にも睡 眠障害を認めた。うつ症状や子育てのストレスの高まりは、それぞれが、産後2 か月の睡眠障害の発症と持続とに関連していた。 結論 初めての父親になる際、睡眠障害が起きていた。睡眠改善、うつ状態の改 善と親になるという課題の管理を目的とした方策を、親への移行と乳幼児の発達 を促進するための出生前の介入に加えることが重要であろう。.摘 要: 研究简介:这项研究调查了初生父亲从伴侣的妊娠晚期到产后两个月的睡眠障碍, 以确定其患病率、发病率和持续性, 并确定相关的决定因素。 研究方法:从当地的产前班和大学附属的产科诊所招募即将迎来第一个孩子的男性。在伴侣的妊娠晚期和产后两个月中, 459名男性完成了标准化的在线自我报告调查问卷, 这些问卷调查了社会人口指数、生活方式和心理社会变量以及睡眠质量。 研究结果:睡眠障碍 (PSQI总分5) 从妊娠晚期的29.6%增加到产后2个月的44.7%。产后2个月睡眠不良发生率为33.7%。在产前评估时有睡眠障碍的男性中, 70.6%的人在产后2个月仍有睡眠障碍。产后2个月, 抑郁症状的增加和较高的育儿压力与睡眠障碍的发生和持续存在独立相关。 研究结论:准爸爸和新爸爸的睡眠受到影响。旨在改善睡眠、抑郁情绪和应对育儿挑战的策略可能是促进向父母身份和婴儿发育过渡的产前干预措施中的重要组成部分。.دراسة استطلاعية حول مسار اضطرابات النوم عند الآباء للمرة الأولى خلال فترة الانتقال إلى الأبوة مقدمة: تناولت هذه الدراسة اضطرابات النوم لدى الآباء لأول مرة من بداية الثلث الأخير من حمل الشريكة إلى شهرين بعد الولادة لتحديد مدى حدوث واستمرار اضطرابات النوم وتحديد العوامل المرتبطة بها. منهج البحث: تم تعيين الرجال الذين يتوقعون مولودهم الأول من صفوف الرعاية الصحية المحلية قبل الولادة وعيادات الولادة التابعة للجامعة. وخلال الثلث الثالث من الحمل الذي مارسه شريكهم وشهرين بعد الولادة، أكمل 459 رجلاً استبيانات موحدة للتقرير الذاتي على الإنترنت تقيس الجوانب الاجتماعية والديموغرافية ونمط الحياة والمتغيرات النفسية والاجتماعية وجودة النوم. النتائج: زادت درجة النوم المضطرب (PSQI5) من29.6 % خلال الثلث الثالث من الحمل إلى 44.7٪ بعد شهرين من الولادة. وكان معدل النوم الضعيف 33.7% في عينة البحث . ومن بين الرجال الذين يعانون من اضطراب النوم في تقييم ما قبل الولادة، استمر 70.6٪ يعانون من اضطرابات النوم بعد شهرين من الولادة. وارتبطت الزيادة في أعراض الاكتئاب وارتفاع الإجهاد الوالدي بشكل مستقل مع بداية واستمرار النوم المضطرب عند شهرين بعد الولادة.الاستنتاجات: يواجه الآباء المتوقعون والجدد اضطرابات في النوم. وقد تكون الاستراتيجيات الرامية إلى تحسين النوم، والمزاج المُكتئب، ومواجهة تحديات الأبوة والأمومة، عناصر هامة يجب استخدامها في تدخلات ما قبل الولادة التي تهدف إلى تعزيز الانتقال إلى الأبوة والأمومة ونمو الرضع.

ObjectiveTo evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.DesignA cross-sectional analysis using data from Canadian Community Health Survey—Mental Health (2012).SettingThe survey was administered across Canada’s 10 provinces using multistage cluster sampling.ParticipantsThe study sample consisted of individuals reporting depression, anxiety or bipolar disorder.Study variables and analysisThe explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region.ResultsAmong 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support.ConclusionComorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care.

We aim to clarify whether type and timing of mental health symptoms in early pregnancy distinctly contribute to maternal-fetal vascular function, independent from the psychotropic medications given to treat these conditions.Data from a prospective cohort study (n = 1678) were used to test whether self-reported fears about giving birth and depressive symptoms prior to 16 weeks of gestation were associated with vascular outcomes predictive of hypertensive disorders of pregnancy (HDP) i.e., systolic and diastolic blood pressure (BP); uterine artery pulsatility index (UAPI); umbilical artery resistance index (UmbARI); and urine protein creatinine ratio. Multiple linear regressions models and mediation models were used to test for associations between predictors and outcomes, controlling for previously identified risk factors for vascular dysfunction such as maternal age and history of infertility.Fears about giving birth in early pregnancy were inversely associated with UmbARI (β = -0.33, p = 0.03, df = 51) mid- to late-pregnancy (≥20 weeks). Depressive symptoms in early pregnancy were also inversely associated with maternal systolic BP (β = -0.13, p = 0.01, df = 387) and diastolic BP (β = -0.10, p = 0.04, df = 387) during the first trimester.While fears about giving birth in early pregnancy were associated with lower vascular resistance in the fetal-placental unit, early depressive symptoms were associated with lower maternal vascular tone. At the very least, our results support the notion that early maternal psychological distress is unlikely to account for the development of HDP later during pregnancy and provide preliminary evidence to support distinct roles of pregnancy-related anxiety and depressive symptoms in maternal-fetal vascular function.

Objective Systemic lupus erythematosus is a chronic autoimmune disease with varied and unpredictable levels of disease activity. The ability to self-manage lupus is important in controlling disease activity. Our objective was to determine levels of patient activation toward self-management in lupus. Methods We used baseline results from the MyLupusGuideTM study that had recruited 541 lupus patients from ten centers. We used the Patient Activation Measure (PAM), a validated self-reported tool designed to measure activation towards self-management ability, as our primary variable and examined its association with demographic, disease-related, patient-provider communication and psychosocial variables captured in our study protocol. Univariable and multivariable linear regressions were performed using linear mixed models, with a random effect for centers. Results The average age was 50±14 years, 93% were female, 74% were Caucasian and the average disease duration was 17±12 years. The mean PAM score was 61.2±13.5 with 36% of participants scoring in the two lower levels, indicating low activation. Variables associated with low activation included being single, lower physical health status, lower self-reported disease activity, lower self-efficacy, use of more emotional coping and less distraction and instrumental coping strategies, and perceived lack of clarity in patient-doctor communication. Conclusion Low patient activation was observed in more than one third of lupus patients indicating a large proportion of patients perceived that they are lacking in lupus self-management skills. These results highlight a modifiable gap in perceived self-management ability among patients with lupus.

BACKGROUND Type 1 Diabetes Mellitus Virtual Patient Network (T1DM-VPN) is a private Facebook group for youths with type 1 diabetes mellitus (T1DM) in Canada intended to facilitate peer-to-peer support. It was built on the finding that stigma is prevalent among youth with T1DM and impedes self-management. OBJECTIVE We aim to determine if T1DM-VPN provides support as intended and to ascertain what type of members provide support. Specifically, we will (1) identify text consistent with any one of 5 social support categories, (2) describe the network by visualizing its structure and reporting basic engagement statistics, and (3) determine whether being a designated peer leader is related to a member’s centrality (ie, importance in the network) and how frequently they offer social support. METHODS We will manually extract interaction data from the Facebook group (posts, comments, likes/reactions, seen) generated from June 21, 2017 (addition of first member), to March 1, 2020. Two researchers will independently code posts and comments according to an existing framework of 5 social support categories—informational, emotional, esteem, network, and tangible—with an additional framework for nonsocial support categories. We will calculate how frequently each code is used. We will also report basic engagement statistics (eg, number of posts made per person-month) and generate a visualization of the network. We will identify stable time intervals in the history of T1DM-VPN by modeling monthly membership growth as a Poisson process. Within each interval, each member’s centrality will be calculated and standardized to that of the most central member. We will use a centrality formula that considers both breadth and depth of connections (centrality = 0.8 × total No. of connections + 0.2 × total No. of interactions). Finally, we will construct multivariate linear regression models to assess whether peer leader status predicts member centrality and the frequency of offering social support. Other variables considered for inclusion in the models are gender and age at diagnosis. RESULTS T1DM-VPN was launched in June 2017. As of March 1, 2020, it has 196 patient-members. This research protocol received ethics approval from the McGill University Health Centre Research Ethics Board on May 20, 2020. Baseline information about each group member was collected upon addition into the group, and collection of interaction data is ongoing as of May 2020. CONCLUSIONS This content analysis and social network analysis study of a virtual patient network applies epidemiological methods to account for dynamic growth and activity. The results will allow for an understanding of the topics of importance to youth with T1DM and how a virtual patient network evolves over time. This work is intended to serve as a foundation for future action to help youth improve their experience of living with diabetes. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/18714

BACKGROUND Chronic diseases contribute to 71% of deaths worldwide every year, and an estimated 15 million people between the ages of 30 and 69 years die mainly because of cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Web-based educational interventions may facilitate disease management. These are also considered to be a flexible and low-cost method to deliver tailored information to patients. Previous studies concluded that the implementation of different features and the degree of adherence to the intervention are key factors in determining the success of the intervention. However, limited research has been conducted to understand the acceptability of specific features and user adherence to self-guided web interventions. OBJECTIVE This systematic review aims to understand how web-based intervention features are evaluated, to investigate their acceptability, and to describe how adherence to web-based self-guided interventions is defined and measured. METHODS Studies published on self-guided web-based educational interventions for people (≥14 years old) with chronic health conditions published between January 2005 and June 2020 were reviewed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement protocol. The search was performed using the PubMed, Cochrane Library, and EMBASE (Excerpta Medica dataBASE) databases; the reference lists of the selected articles were also reviewed. The comparison of the interventions and analysis of the features were based on the published content from the selected articles. RESULTS A total of 20 studies were included. Seven principal features were identified, with goal setting, self-monitoring, and feedback being the most frequently used. The acceptability of the features was measured based on the comments collected from users, their association with clinical outcomes, or device adherence. The use of quizzes was positively reported by participants. Self-monitoring, goal setting, feedback, and discussion forums yielded mixed results. The negative acceptability was related to the choice of the discussion topic, lack of face-to-face contact, and technical issues. This review shows that the evaluation of adherence to educational interventions was inconsistent among the studies, limiting comparisons. A clear definition of adherence to an intervention is lacking. CONCLUSIONS Although limited information was available, it appears that features related to interaction and personalization are important for improving clinical outcomes and users’ experience. When designing web-based interventions, the selection of features should be based on the targeted population’s needs, the balance between positive and negative impacts of having human involvement in the intervention, and the reduction of technical barriers. There is a lack of consensus on the method of evaluating adherence to an intervention. Both investigations of the acceptability features and adherence should be considered when designing and evaluating web-based interventions. A proof-of-concept or pilot study would be useful for establishing the required level of engagement needed to define adherence.

This study sought to determine the level of interest in online peer support among infertility patients, factors associated with such interest, and preferences for features of an online peer support network. A sample of 236 men and 283 women (n = 519) seeking fertility treatment were recruited from four clinics in Ontario and Quebec, Canada. Participants completed an anonymous online questionnaire assessing demographics, perceived stress and fertility characteristics, in addition to interest in and preferences for online infertility peer support. Most men (80.1%) and women (89.8%) expressed interest in online peer support, with perceived stress being related to interest among both men and women. Non-White ethnicity and lower income were related to greater interest among men. Patients reported a preference for mobile accessibility, monitored peer-to-peer communication, and links to information. Men and women, particularly those with high levels of perceived stress, expressed interest in online peer support and shared similar preferences for features irrespective of fertility characteristics. Demographic characteristics and perceived stress were related to a desire for more personalized support options., Highlights • More than four of five fertility patients expressed interest in online peer support • Perceived stress was related to interest in online peer support for men and women • Income and ethnicity were associated with interest in online peer support among men • Fertility patients preferred peer support offered through mobile technology • Greater perceived stress related to a stronger preference for individual support

This study examined the patterns of consultation with health providers for emotional symptoms and barriers preventing mental health help-seeking among pregnant women. A total of 652 nulliparous women in their third trimester completed an online questionnaire assessing depressed mood, adjustment in their couple relationship, demographics, help-seeking behaviors for emotional problems and barriers to help-seeking in the past year. The prevalence of having consulted with at least one health provider over the past year for emotional symptoms was 20.1% for the entire sample and 32.7% for the subgroup of women reporting elevated depressive symptoms in the third trimester. Women in the 30-39 age range were more likely to discuss their emotional symptoms with a health provider in the past year compared to younger women (OR = 1.6, CI = 1.0, 2.6, p = 0.041). Among women depressed in the third trimester, being White was independently associated with a greater likelihood of having consulted with a health provider about their emotional symptoms (OR = 2.9, CI = 1.4, 6.1, p = 0.005). Barriers to mental help-seeking included not having gotten around to it (46.1%), being too busy (26.1%), deciding not to seek care (24.3%), cost (22.6%) and not knowing where to go (19.1%). Women with more depressive symptoms in the third trimester endorsed more barriers to mental health service use (β = 0.25, 95% CI = 0.02, 0.12, p = 0.015). Innovative, evidence-based approaches are needed to more effectively promote mental health during the perinatal period and help women overcome the practical barriers identified to help-seeking.

Background We recently demonstrated that a gestational diabetes history in mothers is associated with higher postpartum incident diabetes not only in mothers but also in fathers. In the present study, we examined changes in health behaviours and cardiometabolic profiles in both mothers and partners who participated in a diabetes prevention program within 5 years of a gestational diabetes pregnancy. Methods Couples were enrolled into a 13-week program that included 5 half-day group sessions and web/telephone-based support between sessions. It was designed in consultation with patients and previously studied in mothers. We computed mean changes from baseline (95% CI) for physical activity, eating, and sleep measures, and cardiometabolic parameters (fasting and 2-h post glucose load plasma glucose, BMI, blood pressure) in both partners and mothers. Results Among 59 couples enrolled, 45 partners (76%) and 47 mothers (80%) completed final evaluations. Baseline cardiometabolic measures averaged within normal limits. Similar to mothers, partners increased physical activity (+ 1645 steps/day, 95%CI 730, 2561; accelerometer assessed moderate-to-vigorous physical activity + 36.4 min/week, 95% CI 1.4, 71.4) and sleep duration (+ 0.5 h/night, 95% CI 0.1, 0.9) and reduced the sodium-to-potassium ratio of food intake (− 0.09 95% CI -0.19, − 0.001). No conclusive changes were observed in glucose measures or insulin resistance; in analyses combining mothers and partners, systolic blood pressure decreased (− 2.7 mmHg, 95% CI -4.4, − 1.0). Conclusions Partners and mothers demonstrated improved physical activity, sleep, and dietary quality. Baseline cardiometabolic profiles averaged at normal values and there were no changes in glucose or insulin resistance; some blood pressure impact was observed. While strategies need to be developed to attract participants at higher cardiometabolic risk, this study demonstrates that partners of women within 5 years of a gestational diabetes diagnosis can be recruited and do achieve health behaviour change. Trial registration ClinicalTrials.gov: NCT02343354 (date of registration: January 22, 2015). Electronic supplementary material The online version of this article (10.1186/s12889-018-5490-x) contains supplementary material, which is available to authorized users.