Late pregnancy thyroid-binding globulin predicts perinatal depression

Previously we found that late pregnancy total and free thyroxine (TT4, FT4) concentrations were negatively related to greater pre and/or postpartum depressive symptoms. In a much larger cohort, the current study examined whether these thyroid indices measured earlier in the third trimester (31-33 weeks) predict subsequent perinatal depression and anxiety ratings as well as syndromal depression. Thyroid-binding globulin (TBG) concentrations increase markedly during pregnancy and may be an index of sensitivity to elevated estrogen levels. TBG was examined in this study because prior findings suggest that postpartum depression is related to sensitivity to mood destabilization by elevated sex hormone concentrations during pregnancy. Our cohort was 199 euthyroid women recruited from a public health obstetrics clinic (63.8% Hispanic, 21.6% Black). After screening and blood draws for hormone measures at pregnancy weeks 31-33, subjects were evaluated during home visits at pregnancy weeks 35-36 as well as postpartum weeks 6 and 12. Evaluations included psychiatric interviews for current and life-time DSM-IV psychiatric history (M.I.N.I.-Plus), subject self-ratings and interviewer ratings for depression and anxiety (Edinburgh Postnatal Depression Scale, Montgomery-Ǻsberg Depression Rating Scale; Spielberger State-Trait Anxiety Inventory, Hamilton Anxiety Inventory), as well as a standardized interview to obtain life-time trauma history. Numerous covariates were included in all regression analyses. Trauma and major depression history were robustly significant predictors of depression and anxiety ratings over the study period when these variables were analyzed individually or in a combined model including FT4 or TBG (p<.001). When analyzed alone, FT4 levels were a less strong but still significant predictor of all depression and anxiety ratings (p<.05) while TBG levels was a significant or nearly significant predictor of most ratings. FT4, TBG and trauma history, but not major depression history, were significant individual predictors of syndromal depression during the study period (p<.05) in single predictor models. In models combining each with trauma and major depression history, FT4 and TBG generally were not significantly predictive of depression or anxiety ratings, and FT4 was also not a significant predictor of syndromal depression: however, in the combined model TBG was a particularly strong predictor of perinatal syndromal depression (p=.005) and trauma history was also significant (p=.016). Further study of the interactions among TBG, FT4, sex hormones, trauma history and perinatal depression may provide insights into the pathophysiological basis of individual variance in vulnerability to mood destabilization by the hormone conditions of pregnancy

Quantile Differences in the Age-Related Decline in Cardiorespiratory Fitness Between Sexes in Adults Without Type 2 Diabetes Mellitus in the United States

Objective: To comprehensively assess the extent to which the decline in cardiorespiratory fitness (CRF) with age differs between sexes. Participants and Methods: This study used data from the Aerobics Center Longitudinal Study, conducted between September 1974 and August 2006, consisting primarily of White adults from middle-to-upper socioeconomic strata restricted to adults without type 2 diabetes mellitus (33,742 men and 9,415 women). Quantile regression models were used to estimate the differences in age-associated changes in CRF between the sexes, estimated using a maximal treadmill test. Results: For adults aged up to 45 years, significant differences in slopes relating to age and CRF between men and women were observed for all adjusted percentiles of CRF other than the 90th percentile; women reported significantly greater declines in CRF per year. For those aged 45-60 years and those older than 60 years, no significant differences in age-related declines in CRF were observed between the sexes. Conclusion: This study found that compared with men, the onset of decline in CRF was found to occur earlier and at lower CRF percentiles in women. This is of particular concern, given that compared with men, women already tend to have lower CRF levels. These findings suggest that maintaining the levels of physical activity sufficient to maintain moderate-to-high levels of fitness is particularly important for women earlier during adulthood

Evaluating a Technology-Mediated HPV Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes ( = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by liking a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population

Characterizing Patterns of Adherence to Physical Activity Goals in Behavioral Weight Control

Introduction: Many individuals fall short of the physical activity (PA) goals provided during lifestyle programs, and there is considerable variability in weight loss response and adherence to recommendations for behavior change. Weight loss response within the early weeks of program initiation predicts future weight loss success; however, little is known about what distinguishes those who respond well to treatment from those who fail to respond. Exposing the behavioral patterns which underlie weight loss response may point towards targets for treatment optimization. The purpose of this study was to (1) characterize individuals with distinct patterns of adherence to PA goals during the first 2 months of an online behavioral weight loss intervention and determine whether these patterns were associated with 6-month weight loss and (2) describe weekly transitions in adherence to steps-based and minutes-based PA goals and self-monitoring behavior across 6 months of intervention. Methods: Individuals participating in an online behavioral weight loss intervention were prescribed progressive goals for 7,000 to 10,000 daily steps and 50 to 200 minutes of weekly moderate-to-vigorous PA (MVPA). Goals increased incrementally during the initial two months (graded goal phase) and then stayed constant for the remainder of the program (fixed goal phase). Participants were instructed to self-monitor their total steps and minutes of MVPA daily on the study website. Individuals were classified each week as meeting the program goals for steps (yes/no) and minutes of MVPA (yes/no) based on self-monitoring records. A repeated-measures latent class analysis was conducted to identify distinct subgroups during the initial 2 months. Associations between latent classes and sociodemographic characteristics, weight loss outcomes, and treatment engagement parameters were then examined. Further, individuals were categorized as (1) “adherent”, (2) “suboptimally adherent”, or (3) “nonadherent” to the steps-based goals and separately to the minutes-based goals, based on whether they met the weekly goal (yes/no) and self-monitored their physical activity (yes/no). Weekly transition probabilities were examined across 6 months using multinomial logistic regression. Results: Participants (N=212) were predominantly female (91.5%), middle-aged (mean = 47.9 ± 11.1 years) with an average BMI of 35.8 ± 5.9 kg/m2, and 31.6% self-identified as a racial/ethnic minority. Three latent classes describing patterns of physical activity goal adherence were revealed: 27.3% had a high probability of consistently meeting both steps-based and minutes-based targets (“Both PA Goals”), 28.4% were estimated to meet the weekly MVPA goals but not the step goals (“MVPA Goals Only”), and the largest class (44.3%) had a low probability of attaining either weekly goal (“Neither PA Goal”). Weight losses at 6 months were significantly greater for members of the “Both PA Goals” class (estimated mean weight loss [95% CI]: -9.4% [7.4, 11.5]) compared to “MVPA Goals Only” (-4.8% [3.4, 6.1]) and “Neither PA Goal” (-2.5% [1.4, 3.6]). Factors differentiating these classes included age, gender, race/ethnicity, geographic region, and BMI at study entry, as well as engagement in other treatment components, such as group session attendance and self-monitoring of weight, dietary intake, and physical activity. The most consistent status among both types of goals was “nonadherent,” while “suboptimally adherent” was most vulnerable to movement, particularly during the graded goal phase. Few individuals were initially “adherent” to steps goals and had a high probability of either remaining “suboptimally adherent” from one week to the next or transitioning to a “nonadherent” status. Conversely, most individuals started out “adherent” to MVPA goals but were more likely to become less adherent for MVPA goals than steps goals during the graded goal phase (p=.0042). Across the fixed goal phase, the pattern of weekly adherence status did not differ significantly between steps-based versus minutes-based goals (p=.6530). Conclusion: Distinct patterns of adherence to weekly program PA goals underscore the early period of behavioral weight control as a critical window of opportunity to detect individuals at risk of poor treatment outcomes. This study provides novel insights about behavioral typologies in obesity treatment as they relate to physical activity adherence and contributes a preliminary framework for identifying individuals in need of additional or different support for successfully adopting physical activity during lifestyle modification

Evaluating a Technology-Mediated HPV Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by &ldquo;liking&rdquo; a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population

Late pregnancy thyroid-binding globulin predicts perinatal depression

Previously we found that late pregnancy total and free thyroxine (TT4, FT4) concentrations were negatively related to greater pre and/or postpartum depressive symptoms. In a much larger cohort, the current study examined whether these thyroid indices measured earlier in the third trimester (31-33 weeks) predict subsequent perinatal depression and anxiety ratings as well as syndromal depression. Thyroid-binding globulin (TBG) concentrations increase markedly during pregnancy and may be an index of sensitivity to elevated estrogen levels. TBG was examined in this study because prior findings suggest that postpartum depression is related to sensitivity to mood destabilization by elevated sex hormone concentrations during pregnancy. Our cohort was 199 euthyroid women recruited from a public health obstetrics clinic (63.8% Hispanic, 21.6% Black). After screening and blood draws for hormone measures at pregnancy weeks 31-33, subjects were evaluated during home visits at pregnancy weeks 35-36 as well as postpartum weeks 6 and 12. Evaluations included psychiatric interviews for current and life-time DSM-IV psychiatric history (M.I.N.I.-Plus), subject self-ratings and interviewer ratings for depression and anxiety (Edinburgh Postnatal Depression Scale, Montgomery-Ǻsberg Depression Rating Scale; Spielberger State-Trait Anxiety Inventory, Hamilton Anxiety Inventory), as well as a standardized interview to obtain life-time trauma history. Numerous covariates were included in all regression analyses. Trauma and major depression history were robustly significant predictors of depression and anxiety ratings over the study period when these variables were analyzed individually or in a combined model including FT4 or TBG (p<.001). When analyzed alone, FT4 levels were a less strong but still significant predictor of all depression and anxiety ratings (p<.05) while TBG levels was a significant or nearly significant predictor of most ratings. FT4, TBG and trauma history, but not major depression history, were significant individual predictors of syndromal depression during the study period (p<.05) in single predictor models. In models combining each with trauma and major depression history, FT4 and TBG generally were not significantly predictive of depression or anxiety ratings, and FT4 was also not a significant predictor of syndromal depression: however, in the combined model TBG was a particularly strong predictor of perinatal syndromal depression (p=.005) and trauma history was also significant (p=.016). Further study of the interactions among TBG, FT4, sex hormones, trauma history and perinatal depression may provide insights into the pathophysiological basis of individual variance in vulnerability to mood destabilization by the hormone conditions of pregnancy