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Background Exercise is recommended as a principal treatment for individuals with knee osteoarthritis (KOA). However, the best choice for an optimal exercise program able to promote long-term compliance in KOA patients is not clear. This study aims to compare the effect of combined exercise (CE: quadriceps strengthening exercises (QSE) and Baduanjin qigong training (BDJ)) versus QSE alone and BDJ alone on older adults with KOA. Methods A three-arm, quasi-experimental trial with repeated measurements was used. As a cluster randomized trial, participants from three community centers were assigned respectively to QSE group, BDJ group and CE group. We assessed pain intensity, physical function, self-efficacy, and health-related quality-of-life (HRQoL) using standardized instruments at baseline, 3 months and 6 months follow-up. Results One hundred and twenty-eight participants with KOA aged over 60 completed the study. Over the 6 months, there were significant group interaction effects on pain intensity (F = 28.888, P  < 0.001), physical function (F = 26.646, P  < 0.001), and self-efficacy (F = 22.359, P  < 0.001), and, based on a short form-12 item health survey questionnaire (SF-12), physical component summary (F = 7.470, P  < 0.001), and mental component summary (F = 10.207, P  < 0.001). Overall, the CE group exhibited significantly greater improvement in all outcomes when compared to the QSE group and the BDJ group. Conclusions CE treatment is more effective than QSE and BDJ in pain relief, increasing physical function, improving self-efficacy, and raising quality-of-life in community-dwelling KOA older adults. Moreover, it promotes long-term compliance in KOA community patients. Trial registration Chinese Clinical Trails Registry number ChiCTR2000033387 (retrospectively registered). Registered 30 May 2020.

The cost-effectiveness of interventions has attracted increasing interest among researchers. Although web-based and home-based psychoeducational interventions have been developed to improve first-time mothers' postnatal health outcomes, very limited studies have reported their cost-effectiveness. The aim of this study was to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. A randomized controlled 3-group pretest and posttest design was adopted, and cost-effectiveness analysis from the health care's perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017 who were randomly allocated to the web-based intervention (n=68), home-based intervention (n=68), or control (n=68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety, and health care resource utilization were measured using valid and reliable instruments at baseline and at 1 month, 3 months, and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over 5 years incurred by the 3 programs at various coverage levels (ie, 10%, 50%, and 100%) were also estimated. The web-based intervention program dominated the other 2 programs (home-based program and routine care) with the least cost (adjusted costs of SGD 376.50, SGD 457.60, and SGD 417.90 for web-based, home-based, and control group, respectively; SGD 1=USD 0.75) and the best improvements in self-efficacy, social support, and psychological well-being. When considering the implementation of study programs over the next 5 years by multiplying the average cost per first-time mother by the estimated average number of first-time mothers in Singapore during the 5-year projection period, the web-based program was the least costly program at all 3 coverage levels. Based on the 100% coverage, the reduced total cost reached nearly SGD 7.1 million and SGD 11.3 million when compared to control and home-based programs at the end of the fifth year, respectively. The web-based approach was promisingly cost-effective to deliver the postnatal psychoeducational intervention to first-time mothers and could be adopted by hospitals as postnatal care support. ISRCTN registry ISRCTN45202278; https://www.isrctn.com/ISRCTN45202278.

Background Overweight, obesity, and associated comorbidities are a pressing global issue among children of all ages, particularly among low-income populations. Rapid weight gain (RWG) in the first 6 months of infancy contributes to childhood obesity. Suboptimal sleep-wake patterns and gut microbiota (GM) have also been associated with childhood obesity, but little is known about their influences on early infant RWG. Sleep may alter the GM and infant metabolism, and ultimately impact obesity; however, data on the interaction between sleep-wake patterns and GM development on infant growth are scarce. In this study, we aim to investigate associations of infant sleep-wake patterns and GM development with RWG at 6 months and weight gain at 12 months. We also aim to evaluate whether temporal interactions exist between infant sleep-wake patterns and GM, and if these relations influence RWG. Methods The Snuggle Bug/ Acurrucadito study is an observational, longitudinal study investigating whether 24-h, actigraphy-assessed, sleep-wake patterns and GM development are associated with RWG among infants in their first year. Based on the Ecological Model of Growth, we propose a novel conceptual framework to incorporate sleep-wake patterns and the GM as metabolic contributors for RWG in the context of maternal-infant interactions, and familial and socio-physical environments. In total, 192 mother-infant pairs will be recruited, and sleep-wake patterns and GM development assessed at 3 and 8 weeks, and 3, 6, 9, and 12 months postpartum. Covariates including maternal and child characteristics, family and environmental factors, feeding practices and dietary intake of infants and mothers, and stool-derived metabolome and exfoliome data will be assessed. The study will apply machine learning techniques combined with logistic time-varying effect models to capture infant growth and aid in elucidating the dynamic associations between study variables and RWG. Discussion Repeated, valid, and objective assessment at clinically and developmentally meaningful intervals will provide robust measures of longitudinal sleep, GM, and growth. Project findings will provide evidence for future interventions to prevent RWG in infancy and subsequent obesity. The work also may spur the development of evidence-based guidelines to address modifiable factors that influence sleep-wake and GM development and prevent childhood obesity.

Introduction Infant sleep is influenced by biopsychosocial interactions. However, the influence of an interactive home environment is underexplored. The aim was to examine whether early positive parent-child interactions and an enriched home environment were associated with better infant sleep later. Methods Pregnant, obese, and low-income Latina women were recruited for a RCT delivering a 12-month intervention for infants to prevent overweight (n=129). At 1, 6, and 12 months, mothers reported breastfeeding duration, completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), and underwent the Home Observation for Measurement of the Environment (HOME, range: 0-45) Inventory including subscales of Responsivity, Acceptance, Organization, Learning Materials, Involvement, and Variety. Pearson correlations between HOME and BISQ-R at each visit were conducted. Significant associations (α<0.05) were entered into stepwise multivariable linear regressions adjusting for infant sex, mother’s education, breastfeeding, and 1-month BISQ-R to determine which HOME subscales were associated with 6- and 12-month total BISQ-R if the total HOME was significant. Results The mean 1-, 6- and 12-month BISQ-R were 84(SD=6.1), 76.4(SD=8.3), and 78.5(SD=8.0), respectively. The 1-month HOME total score (M=21.8[SD=4.4]) significantly correlated with the 6- and 12-month BISQ-R. The regression of 1-month HOME with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.3, p=0.001), greater HOME total scores (β=0.2, p=0.037), and 1-month BISQ-R scores(β=0.2, p=0.038), which explained 13.1% of the variance (F[3,106]=6.5, p<0.001). The regression of 1-month HOME subscales with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.31, p=0.001), greater Responsivity scores (β=0.21, p=0.022), and 1-month BISQ-R scores (β=0.2, p=0.027), which explained 13.9% of the variance (F[3,106]=6.86, p<0.001). The regression of 1-month HOME with 12-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.24, p=0.013) and greater HOME total scores (β=0.24, p=0.016), which explained 7.9% of the variance (F[2,100]=5.4, p=0.006). The regression of 1-month HOME subscales with 12-month BISQ-R indicated greater BISQ-R scores were associated with greater Variety scores (β=0.29, p=0.003), shorter breastfeeding (β=-0.24, p=0.011), and 1-month BISQ-R scores(β=0.18, p=0.049), which explained 13.5% of the variance (F[3,99]=6.29, p=0.001). Conclusion Better infant sleep was associated with an early interactive home environment, especially parent’s responsiveness and people/events providing organized variety. Support (if any):

Introduction Infant sleep is influenced by biopsychosocial factors. However, the influences of early parental sleep quality and parent-infant bonding on infant sleep development are underexplored. This study aimed to examine the relationships between early maternal sleep quality and mother-infant bonding at 8 weeks postpartum, and infant bedtime difficulty at 3 months postpartum. Methods This study is a secondary analysis from the Snuggle Bug/Acurrucadito Study, an observational, longitudinal cohort study investigating the associations between 24-hr sleep-wake patterns, gut microbiome, and weight development among infants. Mothers (n=60, 31.5±5.4y, 66.3% married, 40.8% Hispanic, 41.5% < bachelor’s degree) and their full-term (≥37wk), singleton infants without major complications were recruited from Phoenix, Arizona metropolitan area. At 3 and 8 weeks, and 3 months of infant age, mothers completed the Pittsburgh Sleep Quality Index (PSQI, range:0-21, higher scores indicate worse sleep quality), and reported on infant bedtime difficulty, using a 5-point Likert scale (range:1-5) with higher scores indicating greater bedtime difficulty. Mother-infant bonding was measured by the Postpartum Bonding Questionnaire (PBQ, range:0-125) at 8-week age, with higher scores indicating greater bonding problems. Based on the Transactional Model of Infant Sleep, path analyses were conducted to identify the direct effect of 8-week PSQI scores, and indirect effects of 8-week PBQ total scores and 8-week bedtime difficulty on 3-month bedtime difficulty, using z scores for all variables and the 3-week bedtime difficulty as a covariate. Results At 8 weeks postpartum, the means of PSQI, PBQ, and bedtime difficulty were 5.8±2.6, 5.3±4.7, and 2.4±1.0, respectively. Bedtime difficulty at 3 months was 2.0±1.0. After adjusting for the 3-week bedtime difficulty, the 8-week maternal sleep quality was not directly associated with 8-week (β=.005, 95%CI [-0.31, 0.32]) or 3-month infant bedtime difficulty (β=-0.14, 95%CI [-0.43, 0.14]), whereas 8-week mother-infant bonding significantly mediated the relationship between 8-week maternal sleep quality and 3-month infant bedtime difficulty (β=0.1, 95%CI [0.02, 0.22]). Conclusion This study highlighted that early maternal sleep may disrupt early mother-infant bonding, which, in turn, may increase infant bedtime difficulty later in development. Future research should investigate how best to support healthy family sleep and bonding relationships. Support (if any) NIH/NHLBI R01HL147931

Infant sleep disturbances are prevalent and can adversely affect child development and family well-being. Current behavioral and educational intervention programs have demonstrated efficacy in improving sleep disturbances, however, these interventions are best applied to infants older than six months. Responsive parenting intervention indicated mixed findings on improving infant sleep consolidation, including frequency and duration of night awakenings, bedtime routines, self-soothe to sleep, sleep durations, and the parent-child relationship. Based on the infant sleep transactional model, this dissertation study aimed to address the gaps in the literature through a systematic review, a secondary longitudinal path analysis, and a pilot study testing an adapted responsive parenting intervention to improve infant sleep.The systematic review searched PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsycINFO. This study included 10 articles and identified the impact of responsive interventions among infants, which showed improvement in infant sleep outcomes, including infant sleep consolidation, sleep durations, and sleep practice during bedtime and nighttime. Further, the path analysis showed that the 3-month greater maternal Stress was not related to 6-month WASO (Wake After Sleep Onset) and WAKES (night awakenings) directly, but indirectly related to 6-month WASO through PBQ (Postpartum Bonding Questionnaire) impaired bonding subscale (β=0.28, 95%CI:0.009-0.54]) and PBQ total score (β=0.30, 95%CI:0.04-0.57]), and also indirectly related to 6-month WAKES through PBQ total score (β=0.24, 95%CI:0.03-0.45]). Further, the 3-month greater maternal Depression was not directly, but indirectly related to 6-month WASO (β=0.26, 95%CI:0.06-0.59]) and WAKES (β=0.19, 95%CI:0.03-0.47]) through PBQ Rejection subscale. Additionally, the pilot study showed that 37% (34/92) of participants participated in this study, and 88.2% (30/34) retained. The 7-day actigraphy wear was feasible with 75% valid data at both the pre-and post-intervention assessments. The main barrier to completing the study was the busy family schedule. Parents reported 96.7% moderate acceptability.Future research directions could integrate parent-child interactive interventions, maternal psychological and parent-infant bonding support, and technology tools into research on improving infant sleep. Researchers can develop innovative and holistic approaches to address the complex interplay between parental well-being, parent-child interactions, and sleep health.

Introduction In early childhood, irregular sleep schedules that may promote circadian rhythm misalignment predict greater weight gain. However, circadian rest-activity (CRA) rhythmicity in infancy in relation to growth is understudied. The aim of the present study was to investigate the association between newborn circadian rest-activity rhythmicity and change in weight-for-age from birth to three months. Methods Data were captured as a secondary data analysis from the Snuggle Bug / Acurrucadito Study (see Support). English or Spanish speaking mothers (n=41, age M±SD=33.1±4.6y, 31.7% Hispanic/Latina) and their full-term (≥37wk) infants of normal weight (2.5-4kg; 58.5% female; 25.6% WIC enrolled) were recruited from Phoenix, Arizona. CRA rhythmicity was measured at eight weeks with ankle-worn Micro Motionloggers (Ambulatory Monitoring Inc.) for five 24hr periods at one-minute epochs. CRA metrics assessed included 24hr autocorrelation, mesor, magnitude, acrophase, goodness-of-fit R2, interdaily stability, intradaily variability, and relative amplitude. Birthweight was mother-reported and 3mon infant weight was measured with a Seca scale. Weight-for-age Z-scores (WAZ) by infant sex were computed based upon World Health Organization growth charts and the change difference between timepoints was the primary outcome. Regression models adjusting for birth WAZ examined the relationships between CRA metrics at eight weeks with change in WAZ from birth to 3mo. Results At eight weeks, mean±SD CRA metrics were as follows: 24hr autocorrelation of 0.25±0.03, mesor of 115.6±14.7, amplitude of 68.1±18.3, goodness-of-fit R2 of 0.42±0.10, acrophase of 14:12±1:42, interdaily stability of 0.57±0.12, intradaily variability of 0.93±0.19, and relative amplitude of 0.61±0.11. Mean birth WAZ and change in WAZ from birth to 3mon were 0.39±0.73 and -0.57±0.77, respectively. After adjusting for birth WAZ, in separate models, greater mesor (R2 Change=0.10, β=-0.32, p=0.03), amplitude (R2 Change=0.11, β=-0.34, p=0.03), and goodness-of-fit R2 (R2 Change=0.10, β=-0.32, p=0.04) were significantly associated with less change in WAZ from birth to 3mon. Conclusion Among relatively healthy, full-term infants born of normal weight, greater 24hr circadian rest-activity rhythmicity achieved by 8 weeks was associated with slower rate of weight gain across the newborn stage. Promoting behaviors and environmental cues from parents that strengthen early circadian rhythmicity in their infants may promote healthy weight trajectories. Support (if any) NIH/NHLBI R01HL147931

Introduction Evening chronotype (i.e., night owl preference) is associated with worse insomnia and depressive symptoms, and poorer health behaviors. The aim of this study was to examine the association between chronotype and these symptoms and health behaviors during COVID-19 pandemic quarantine. Methods An online survey, distributed internationally via social media from 5/21/2020–7/1/2020, asked adults to report sociodemographic/economic information, changes in sleep (midpoint, total sleep time, sleep efficiency, time-in-bed), and health behaviors (i.e., physical activity, sedentary screen time, and outdoor light exposure patterns) from prior to during the pandemic, chronotype preference (definitely morning [DM], rather more morning [RM], rather more evening [RE], or definitely evening [DE]), and complete the Insomnia Severity Index (ISI) and the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10). Multinomial logistic regression and ANCOVA models, adjusting for age and sex, examined associations of chronotype with COVID-19 pandemic related impacts on sleep, depressive symptoms, and health behaviors. Results A subsample of 579 participants (M age: 39y, range: 18–80; 73.6% female), currently under quarantine and neither pregnant nor performing shift work, represented each chronotype evenly (~25%). Participants delayed their sleep midpoint by 72.0min (SD=111.5) during the pandemic. DE chronotypes had a greater delay than morning types (M±SD DE: 91.0±9.0 vs. RM: 55.9±9.2 & DM: 66.1±9.3; p=0.046) with no significant change in other sleep patterns relative to other chronotypes. However, DE and RE chronotypes had greater odds of reporting that their new sleep/wake schedule was still not consistent with their “body clock” preference relative to morning types (Χ2[15]=54.8, p<0.001), reported greater ISI (F[3,503]=5.3, p=.001) and CES-D-10 scores (F[3,492]=7.9, p<.001), and had greater odds for increased or consistently moderate-to-high sedentary screen time (Χ2[12]=22.7, p=0.03) and decreased physical activity (Χ2[12]=22.5, p=0.03) than DM chronotype. There was no significant difference in change in outdoor light exposure by chronotype (Χ2[12]=12.1, p=0.43). Conclusion In an international online sample of adults under COVID-19 pandemic quarantine, evening chronotypes, despite taking the opportunity to delay sleep to match biological clock preference, reported their sleep/wake schedules were still inconsistent with personal preference, and reported greater insomnia and depressive symptoms, and odds of engaging in poorer health behaviors than morning chronotypes. Support (if any):