41 research outputs found
Prenatal influences on childhood overweight
Background: Childhood overweight has become a growing public health challenge. It has been suggested that inadequate or excessive gestational weight gain (GWG) may result in permanent metabolic and neuronal changes in the developing fetus. Although effects of GWG on birth weight are established, less is known about its effects on the long-term weight status of the child. In 2009, the Institute of Medicine (IOM) and the National Research Council (NRC) published recommendations for trimester-specific and total GWG depending on maternal pre-pregnancy body mass index (BMI). It is unknown, however, how well the trimester-specific IOM/NRC recommendations for GWG identify women at risk of total GWG outside those recommendations. It is also unknown, whether a reverse from excessive GWG in early or mid-pregnancy reduces the risk of childhood overweight.
Aims: Contribute to the existing knowledge on the association between GWG and childhood overweight (study 1). Examine whether and to what extent inadequate or excessive total GWG can be predicted in the first, second and third trimester, based on trimester-specific GWG cut-off values (study 2). Investigate whether a reverse from excessive GWG before the third trimester is associated with a risk reduction of childhood overweight (study 3).
Methods: A retrospective cohort study was conducted. The sample was recruited prior to the school entry health examinations in 2009 and 2010. Data on maternal weight was derived from medical records and childâs anthropometric data were measured. From 11,730 mother-child pairs available, 6,837 were included in study 1, 7,962 in study 2 and 6,767 in study 3. To investigate the effect of total GWG, overall and stratified by maternal pre-pregnancy BMI, and reverse from excessive GWG in early or mid-pregnancy, multivariate logistic regression analyses were conducted including a large number of potential confounders. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. The prognostic values of lower and upper trimester-specific GWG cut-off values were examined by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive diagnostic likelihood ratio (DLR+).
Results: 1) Overall, the risk of childhood overweight increased by 4% per additional kg GWG (OR: 1.04, 95% CI: 1.02, 1.05). Excessive total GWG was associated with a 57 % higher risk of childhood overweight (OR: 1.57, 95% CI: 1.30, 1.91). Stratified by maternal pre-pregnancy BMI, significant associations between excessive GWG and childhood overweight found among normal weight mothers (OR: 1.29, 95% CI: 1.01, 1.66) and overweight mothers (OR: 1.64, 95% CI: 1.06, 2.63). 2) Prediction of total GWG within the IOM/NRC recommendations increased with gestational age and was related to the maternal BMI category and outcome. In trimester two, inadequate total GWG could be predicted with a sensitivity of 49% and 60.2% and a PPV of 72.1% and 68.3% in underweight and normal-weight mothers, respectively. Excessive GWG could be predicted with a sensitivity of 72.7% and 70.4% and a PPV of 94.3% and 93.3% in overweight and obese mothers, respectively. 3) Compared to mothers who always gained below the excessive GWG cut-off values (reference category), children of mothers with excessive GWG in the third and any previous trimester had a 42% higher risk of overweight at school entry (OR: 1.42, 95% CI: 1.17, 1.72). There was a 39% higher risk if mothers gained excessively in the third trimester only (OR: 1.39, 95% CI: 1.06, 1.82). No higher risk was observed for mothers who reversed from excessive GWG before the third trimester compared to reference category.
Conclusions: Excessive total GWG appears to be a risk factor for childhood overweight. It can be well predicted from the second trimester on, in particular in overweight and obese women. Reverse from excessive GWG before the third trimester may reduce the risk of childhood overweight. More research is required to further establish the strength of association between GWG and childhood overweight. It appears possible to identify women at risk of gaining outside the recommendations as early as the second trimester. Those women should be allocated to appropriate weight modifying measures. The long-term benefit of GWG modifying measures on childhood overweight, especially a reverse from excessive GWG in the first or second trimester, should be investigated in randomised controlled studies.Hintergrund: Kindliches Ăbergewicht stellt eine wachsende Herausforderung an das Gesundheitssystem dar. Es wird angenommen, dass eine inadĂ€quate oder exzessive mĂŒtterliche gestationale Gewichtszunahme (GGZ) zu dauerhaften metabolischen und neuronalen VerĂ€nderungen im heranwachsenden Fötus fĂŒhren kann. ZusammenhĂ€nge zwischen der GGZ und dem Geburtsgewicht des Kindes wurden umfassend belegt. Weniger erforscht ist der Einfluss der GGZ auf die langfristige Gewichtsentwicklung des Kindes. Im Jahre 2009 veröffentlichten das Institute of Medicine (IOM) und das National Research Council (NRC) Grenzwerte fĂŒr die trimester-spezifische und totale GGZ in AbhĂ€ngigkeit des mĂŒtterlichen Body Mass Index (BMI). Bisher unbekannt ist, in wie weit sich diese trimester-spezifischen Grenzwerte dazu eigenen, um eine Abweichung von den Grenzwerten am Ende der Schwangerschaft vorherzusagen und somit gefĂ€hrdete MĂŒtter frĂŒhzeitig zu identifizieren. Zudem ist ungeklĂ€rt, ob eine Umkehr von der exzessiven GGZ vor dem dritten Trimester mit einer Risikoreduktion fĂŒr kindliches Ăbergewicht einhergeht.
Ziele: Beitrag zur existierenden Literatur ĂŒber den Zusammenhang zwischen GGZ und kindlichem Ăbergewicht (Studie 1). Analyse, ob und in welchem AusmaĂ inadĂ€quate oder exzessive GGZ am Ende der Schwangerschaft durch trimester-spezifische IOM/NRC GGZ Grenzwerte vorhergesagt werden kann (Studie 2). Analyse, ob eine Umkehr von exzessiver GGZ in der frĂŒhen oder mittleren Schwangerschaft das Risiko von spĂ€teren kindlichen Ăbergewichts reduziert (Studie 3).
Methoden: In einer retrospektiven Kohortenstudie wurden Daten von 11.730 Mutter-Kind Paaren erhoben. Die Stichprobenrekrutierung erfolgte im Rahmen der Schuleingangsuntersuchungen in den Jahren 2009 und 2010. Angaben zum mĂŒtterlichen Gewicht wurden dem Mutterpass entnommen und die anthropometrischen Daten des Kindes gemessen. Von 11.730 verfĂŒgbaren Mutter-Kind Paaren, wurden 6.837 in Studie 1, 7.962 in Studie 2 und 6.767 in Studie 3 eingeschlossen. Multivariate logistische Regressionsanalysen wurden herangezogen, um den Effekt von totaler GGZ wĂ€hrend der Schwangerschaft, ĂŒber alle MĂŒtter hinweg und stratifiziert nach prĂ€konzeptionellen BMI, und der Umkehr von exzessiver GGZ vor dem dritten Trimester zu analysieren. Odds Ratios (OR) und 95% Konfidenzintervalle (CI) wurden berechnet und eine groĂe Anzahl an potenziellen Störvariablen eingeschlossen. Die Vorhersagekraft der trimester-spezifischen Grenzwerte wurde mittels der Berechnung von SensitivitĂ€t, SpezifitĂ€t, positiver prĂ€diktiver Wert (PPV), negativer prĂ€diktiver Wert (NPV) und der positive diagnostische Likelihood Ratio (DLR+) analysiert.
Ergebnisse: 1) Insgesamt war jedes zusĂ€tzliche kg GGZ mit einer 4%igen Risikoerhöhung fĂŒr kindliches Ăbergewicht assoziiert (OR: 1.04, 95% CI: 1.02, 1.05). Eine exzessive totale GGZ war mit einer 57%igen Risikosteigerung verbunden (OR: 1.57, 95% CI: 1.30, 1.91). Die stratifizierte Analyse ergab signifikante Effekte fĂŒr exzessive totale GGZ innerhalb der normalgewichtigen (OR: 1.29, 95% CI: 1.01, 1.66) und ĂŒbergewichtigen MĂŒtter (OR: 1.64, 95% CI: 1.06, 2.63). 2) Die Vorhersage der totalen GGZ innerhalb der IOM/NRC Empfehlungen verbesserte sich mit fortschreitendem Gestationsalter und war abhĂ€ngig von der mĂŒtterlichen BMI Kategorie und der ZielgröĂe. Bei den untergewichtigen bzw. normalgewichtigen MĂŒttern konnte mit den trimester-spezifischen GGZ Grenzwerten des zweiten Trimesters eine inadĂ€quate totale GGZ mit einer SensitivitĂ€t von 49% bzw. 60.2% und einem PPV von 72.1% bzw. 68.3% vorhergesagt werden. Bei den ĂŒbergewichtigen und adipösen MĂŒttern konnte mit den trimester-spezifschen GGZ Grenzwerten des zweiten Trimesters eine totale exzessive GGZ mit einer SensitivitĂ€t von 72.7% bzw. 70.4% und einem PPV von 94.3% bzw. 93.3% vorhergesagt werden. 3) Im Vergleich zu MĂŒttern die wĂ€hrend der gesamten Schwangerschaft unterhalb des Grenzwertes fĂŒr exzessives GGZ lagen (Referenzkategorie), war eine exzessive Gewichtszunahme im dritten und mindestens einem vorhergehenden Trimester mit einer 42%igen Risikoerhöhung assoziiert (OR: 1.42, 95% CI: 1.17, 1.72). Nahmen die MĂŒtter nur im letzten Trimester exzessiv zu, lag die Risikoerhöhung bei 39% (OR: 1.39, 95% CI: 1.06, 1.82). Kein erhöhtes Risiko fĂŒr kindliches Ăbergewicht zeigte sich bei den MĂŒttern die ausschlieĂlich in den ersten zwei Trimestern exzessiv zugenommen hatten.
Diskussion: Exzessive GGZ scheint ein Risikofaktor fĂŒr kindliches Ăbergewicht zu sein. Insbesondere bei ĂŒbergewichtigen und adipösen MĂŒttern kann eine exzessive GGZ auĂerhalb der IOM/NRC Empfehlungen ab dem zweiten Trimester vorhergesagt werden. Die Umkehr einer exzessiven GGZ vor dem dritten Trimester scheint das Risiko fĂŒr kindliches Ăbergewicht zu reduzieren. Weitere Forschung ĂŒber StĂ€rke des Zusammenhangs zwischen GGZ und kindlichem Ăbergewicht ist notwendig. Es scheint möglich, Frauen deren totale GGZ potenziell auĂerhalb der Empfehlungen liegt ab dem zweiten Trimester zu identifizieren. Diese Frauen sollten wirkungsvollen gewichtsmodifizierenden MaĂnahmen zugefĂŒhrt werden. Die langfristige positive Auswirkung dieser MaĂnahmen, insbesondere eine Umkehr von exzessiver GGZ vor dem dritten Trimester, auf die PrĂ€vention von kindlichem Ăbergewicht, sollte in randomisiert-kontrollierten Studien untersucht werden
Gibt es einen Zusammenhang zwischen BewegungsaktivitÀt und psychischem Befinden im Alltag?
Mit diesem Beitrag wollen wir illustrieren, wie mit Hilfe der Technik des ambulanten Monitoring gesundheitspsychologische Fragestellungen im Alltag untersucht werden können. Dazu wurde der Zusammenhang von körperlicher AktivitĂ€t und Wohlbefinden im Alltag analysiert. Mit Hilfe von Beschleunigungssensoren wurden Bewegungsdaten ĂŒber einen Zeitraum von 12 Stunden an 124 Probanden zwischen 18 und 73 Jahren aufgezeichnet. Energetische Aktiviertheit/positiver Affekt (EA/PA) und Anspannung/negativer Affekt (WA/NA) wurden etwa stĂŒndlich mittels Pocketcomputer erfasst. Die Daten wurden mit Mehrebenenmodellen ausgewertet. Bewegungsepisoden, die vor der Befindensabfrage auftraten, waren positiv mit EA/PA assoziiert. ZusammenhĂ€nge mit WA/NA konnten hingegen nicht beobachtet werden. Weiterhin waren BMI und EA/PA negativ miteinander assoziiert, wobei dieser Zusammenhang vor allem auf die MĂ€nner zurĂŒckzufĂŒhren war. Weiterhin zeigte sich, dass mit zunehmendem BMI der Zusammenhang zwischen Bewegung und EA/PA anstieg. Die Ergebnisse zeigen, dass die Untersuchung gesundheitspsychologischer Fragestellungen im Feld viel versprechend ist und die Befunde bisheriger Untersuchungen erweitern.This study aimed to examine if a correlation exists between physical activity and mood in daily life using ambulatory monitoring technology. 124 individuals (64 females, age range 18-73 years) participated. Physical activity was recorded throughout one day (12 hours) via accelerometers and mood (energetic arousal/positive affect and tension arousal/negative affect) was assessed about every hour using handheld (palm) computers. Mixed model analyses revealed that energetic arousal/positive affect was significantly positively associated with preceding physical activity episodes. Moreover, BMI was negatively associated with energetic arousal/positive affect and this effect was especially pronounced in males. Further analyses showed that with increasing BMI the relation between physical activity and energetic arousal/positive affect grew stronger. Contrary to energetic arousal/positive affect tension arousal/negative affect was unrelated to physical activity. The results suggest that daily physical activity episodes seem to modulate mood aspects and that ambulatory monitoring technology is a useful tool for examining these associations
Effectiveness of a multi-level intervention to improve tobacco policy in alcohol addiction treatment centers
Psychische Belastung, AlkoholabhÀngigkeit und Rauchen
Die PrĂ€valenz des Tabakkonsums ist bei Personen mit einer Neigung zur Depression höher als in der Allgemeinbevölkerung. Gleiches gilt fĂŒr Personen mit einer Erkrankung aus dem schizophrenen Formenkreis. AlkoholabhĂ€ngige Patienten weisen eine höhere psychische Belastung auf als nichtabhĂ€ngige Personen. Bislang ungeklĂ€rt ist, inwiefern sich die rauchenden von den nichtrauchenden alkoholabhĂ€ngigen Personen hinsichtlich ihrer psychischen Belastung unterscheiden.
Es wurden Daten von 1403 Patienten mit der Hauptdiagnose âAlkoholabhĂ€ngigkeitâ aus 40 Suchtrehabilitationskliniken zu Beginn der stationĂ€ren Behandlung erhoben. 84% der Stichprobe sind Raucher. Die Messung der subjektiv empfundenen psychischen Symptombelastung erfolgte mittels der neun Skalen des Brief Symptom Inventory (BSI).
Innerhalb der untersuchten Population der alkoholabhÀngigen Patienten weisen die zusÀtzlich rauchenden Patienten in den Bereichen Zwanghaftigkeit (T-Werte: 58 vs. 55), DepressivitÀt (T-Werte: 64 vs. 61), AggressivitÀt (T-Werte: 59 vs. 55) und Psychotizismus (T-Werte: 63 vs. 59) signifikant höhere Werte auf als die Vergleichsgruppe.
Diese Ergebnisse implizieren eine im Durchschnitt höhere Symptombelastung von rauchenden Alkoholpatienten im Vergleich zu nichtrauchenden Patienten.
Dies impliziert eine klarere Diagnostik dieser Patientengruppe sowie das Bereitstellen von intensiveren TabakentwöhnungsmaĂnahmen fĂŒr spezifische Subgruppen von Rauchern.
Die Ergebnisse können als mögliche ErklÀrung herangezogen werden, weshalb diesen Patienten eine Aufgabe des Tabakkonsums besonders schwer fÀllt. Zu diskutieren bleibt die Richtung der KausalitÀt
Population-based validation of a German version of the Brief Resilience Scale
Smith and colleagues developed the Brief Resilience Scale (BRS) to assess the individual ability to recover from stress despite significant adversity. This study aimed to validate the German version of the BRS. We used data from a population-based (sample 1: n = 1.481) and a representative (sample 2: n = 1.128) sample of participants from the German general population (age â„ 18) to assess reliability and validity. Confirmatory factor analyses (CFA) were conducted to compare one- and two-factorial models from previous studies with a method-factor model which especially accounts for the wording of the items. Reliability was analyzed. Convergent validity was measured by correlating BRS scores with mental health measures, coping, social support, and optimism. Reliability was good (α = .85, Ï = .85 for both samples). The method-factor model showed excellent model fit (sample 1: Ï2/df = 7.544; RMSEA = .07; CFI = .99; SRMR = .02; sample 2: Ï2/df = 1.166; RMSEA = .01; CFI = 1.00; SRMR = .01) which was significantly better than the one-factor model (ÎÏ2(4) = 172.71, p < .001) or the two-factor model (ÎÏ2(3) = 31.16, p < .001). The BRS was positively correlated with well-being, social support, optimism, and the coping strategies active coping, positive reframing, acceptance, and humor. It was negatively correlated with somatic symptoms, anxiety and insomnia, social dysfunction, depression, and the coping strategies religion, denial, venting, substance use, and self-blame. To conclude, our results provide evidence for the reliability and validity of the German adaptation of the BRS as well as the unidimensional structure of the scale once method effects are accounted for
Resilience and depressive symptoms in inpatients with depression: a cross-lagged panel model
Resilienceâthe ability to bounce back or quickly recover from stressâhas been found to predict treatment outcome in patients with mental disorders such as depression. Yet, there are mixed findings whether resilience itself changes during treatment and whether resilience exclusively predicts changes in depressive symptoms or whether depressive symptoms also predict changes in resilience. Inpatients with depression (N = 2165; average length of stay M = 60 days, SD = 32) completed the Brief Resilience Scale and the Patient Health Questionnaire Depression Scale at admission and discharge. Resilience increased and depressive symptoms decreased from admission to discharge. Cross-sectionally, higher resilience related to lower depressive symptoms at admission and discharge. Prospectively, a cross-lagged panel model revealed that higher resilience at admission predicted stronger decreases in depressive symptoms and that higher depressive symptoms at admission predicted smaller increases in resilience. The current study further supports that resilience is not only related to fewer mental health problems cross-sectionally but is also sensitive to change and a predictor of treatment outcome in patients with mental disorders. Given this pivotal role in mental health, the current findings highlight the importance of prevention and intervention approaches for promoting resilience in the general population and in persons with mental disorders in particular
Resilience and depressive symptoms in inpatients with depression: A crossâlagged panel model
BACKGROUND:
Resilienceâthe ability to bounce back or quickly recover from stressâhas been found to predict treatment outcome in patients with mental disorders such as depression. The current study aimed to test whether resilience itself changes during treatment and whether resilience exclusively predicts changes in depressive symptoms or whether depressive symptoms also predict changes in resilience.
METHODS:
Inpatients with depression (Nâ=â2165; average length of stay Mâ=â60 days, SDâ=â32) completed the Brief Resilience Scale and the Patient Health Questionnaire Depression Scale at admission and discharge, scores of which were used to run a cross-lagged panel model.
RESULTS:
Resilience increased and depressive symptoms decreased from admission to discharge. Cross-sectionally, higher resilience was related to lower depressive symptoms at admission and at discharge. Prospectively, higher resilience at admission predicted stronger decreases in depressive symptoms, and higher depressive symptoms at admission predicted smaller increases in resilience.
LIMITATIONS:
Self-report questionnaires may potentially be biased (e.g., through recall bias, social desirability, or demand effects).
CONCLUSIONS:
The current study further supports that resilience is related not only to fewer mental health problems cross-sectionally but also is sensitive to change and a predictor of treatment outcome in patients with mental disorders. Given this pivotal role in mental health, the current findings highlight the importance of prevention and intervention approaches for promoting resilience in the general population and in persons with mental disorders in particular
How do spine surgeons cope with psychological distress: results of a cross-sectional study
Cross Sectional Study/Online Survey.Ă In this study, we sought to assess stress, psychological distress, resilience, and coping strategies among spine surgeons in German-speaking countries.Ă Recent studies have reported high rates of stress and burnout among surgeons.Ă A survey via Survey Monkeyù¹ was conducted among spine surgeons practicing in German-speaking countries using validated questionnaires for perceived stress, mental burden, resilience, and quality of life. Data on working situation and demographics were also collected.Ă 582 surgeons responded to the survey, representing 15% of those surveyed. 79% of respondents were satisfied with their professional success. Mental burden was higher than in the general population, as was perceived stress.Ă Chairpersons were exposed to the lowest levels of perceived stress and mental burden. Mental distress was high (GHQùù„ù12) in 59% of residents and 27% chairpersons. Self-reported psychological resilience was higher than levels found in the general population and highest among chairpersons. Quality of life was comparable to levels reported in the general population. There were statistically significant correlations between perceived stress and mental burden scores (rĂ
Pharmacological neuroenhancement and the ability to recover from stress â a representative cross-sectional survey among the German population
BACKGROUND: Pharmacological neuroenhancement (PNE) refers to the use of psychoactive substances without doctorâs prescription to enhance cognitive performance or to improve mood. Although some studies have reported that drugs for PNE are also being used to cope with stressful life situations, nothing is known about the relationship of PNE and resilience, i.e. the ability to recover from stress. This study aimed at investigating the relationship of PNE and resilience in the first representative population sample. METHODS: A cross-sectional survey in a representative sample of 1128 adults (ageââ„â18 yrs.) living in Germany was conducted. The use of PNE and related attitudes, perceptions and behaviours were assessed by structured interviews and self-report questionnaires. Stepwise logistic regression with backward elimination was conducted to identify potential risk factors for PNE use. RESULTS: Lifetime prevalence for the use of stimulating prescription drugs without medical indication was 4.3%, 10.2% for stimulating illicit drugs, 20.3% for mood modulating prescription drugs, and 23.4% for cannabis. Coping with stressful situations was more frequently reported as underlying motive for using stimulant or mood modulating prescription drugs than stimulating illicit drugs or cannabis. The individual perceived stress increased the risk of using stimulating prescription drugs (OR: 2.86; 95% Cl: 1.49â5.46) and the individual ability to recover from stress decreased the risk of using any substance for PNE and especially mood modulating prescription drugs (OR: .62; 95% Cl: .47â.81). CONCLUSIONS: The non-medical use of prescription drugs for PNE appears to be more prevalent in subjects who are less resilient to stress. Tailored resilience interventions that improve the ability to adapt to and recover from stressors may prevent the use of prescription medication for PNE. Further research should disentangle the association between psychological resilience and PNE as well as examine the efficacy of resilience interventions in the prevention of PNE
Psychological interventions for resilience enhancement in adults
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of resilienceâenhancing interventions in clinical and nonâclinical populations