Diabetes prevention program outcomes by in-person versus distance delivery mode among ethnically diverse, primarily lower-income adults.

Objective: Physical activity and weight loss outcomes of a diabetes prevention program were compared for ethnically diverse adults, with the majority participating in public assistance programs. Outcomes were compared for those who completed the program in person versus by distance delivery. Methods: A two-group, pre-post study design compared National Diabetes Prevention Program outcomes based on in-person delivery (2018-2020 pre-COVID-19 pandemic, n = 47) and distance delivery (after March 2020, n = 31). Outcomes were measured or self-reported depending on the delivery method. Linear mixed models with a random intercept for coach and covariates were used to assess delivery mode group differences in percent weight loss and weekly physical activity minutes. Results: Completion rates were similar by in-person versus distance delivery mode (57% vs. 65%). Among those who completed the program, the mean age was 58 years, the mean baseline body mass index was 33, and 39% were Hispanic. The majority were female (87%), participating in a public assistance program (63%), and living in a micropolitan area (61%). Percent weight loss was greater in the distance delivery group (7.7%) compared to the in-person group (4.7%) in the unadjusted analysis (p = 0.009) but not when adjusted for covariates. No differences were observed in adjusted weekly physical activity minutes between the in-person (219 min) versus the distance group (148 min). Conclusions: No differences were observed by delivery mode in percent weight loss or weekly physical activity minutes, indicating that distance delivery does not compromise program effectiveness.

Hepatitis E virus infection and acute non-traumatic neurological injury: A prospective multicentre study.

BACKGROUND & AIMS: Hepatitis E virus (HEV) has been associated with a number of neurological syndromes, but causality has not yet been established. The aim of this study was to explore the relationship between HEV and neurological illness by prospective HEV testing of patients presenting with acute non-traumatic neurological injury. METHODS: Four hundred and sixty-four consecutive patients presenting to hospital with acute non-traumatic neurological illnesses were tested for HEV by serology and PCR from four centres in the UK, France and the Netherlands. RESULTS: Eleven of 464 patients (2.4%) had evidence of current/recent HEV infection. Seven had HEV RNA identified in serum and four were diagnosed serologically. Neurological cases in which HEV infection was found included neuralgic amyotrophy (n=3, all PCR positive); cerebral ischemia or infarction (n=4); seizure (n=2); encephalitis (n=1); and an acute combined facial and vestibular neuropathy (n=1). None of these cases were clinically jaundiced and median ALT at presentation was 24IU/L (range 8-145). Cases of HEV-associated neuralgic amyotrophy were found in each of the participating countries: all were middle-aged males with bilateral involvement of the brachial plexus. CONCLUSIONS: In this cohort of patients with non-traumatic neurological injury, 2.4% had evidence of HEV infection. Symptoms of hepatitis were mild or absent and no patients were jaundiced. The cases of HEV-associated neuralgic amyotrophy had similarities with other HEV-associated cases described in a large retrospective study. This observation supports a causal relationship between HEV and neuralgic amyotrophy. To further understand the relevance of HEV infection in patients with acute neurological illnesses, case-control studies are warranted. Lay summary: Hepatitis E virus (HEV), as its name suggests, is a hepatotropic virus, i.e. it causes damage to the liver (hepatitis). Our findings show that HEV can also be associated with a range of injury to the nervous system.

Assisted conception, maternal personality and parenting: Associations with toddler sleep behaviour.

AIM: To explore the role of maternal personality (hardiness), sleep-related cognitions and bedtime involvement in child sleep behaviour during the second post-natal year in a sample of spontaneous and assisted conception first-time mothers. METHOD: Mothers (n = 134 (spontaneous (n = 81); assisted (n = 53) conception)) reported on a resilience measure (hardiness) during pregnancy and child sleep at 7 and 19 months post-partum. At 19 months post-partum, mothers also reported on their cognitions and involvement around their child's bedtime, and half the sample used Actigraph monitors (Acitiwatch-16, Mini Mitter Co. Inc, Bend, OR, USA) to validate maternal report of child sleep. RESULTS: No significant differences were found between spontaneous and assisted conception mothers on any of the study variables; therefore, assisted and spontaneous samples were combined. Structural equation modelling confirmed that lower pre-birth maternal hardiness was associated with more problematic sleep-related cognitions (ß = 0.23, P < 0.01) and involvement at bedtime (ß = 0.29, P < 0.01) and poorer child sleep outcomes (ß = -0.33, P < 0.001) during toddlerhood, even after considering concurrent maternal mood and child temperament. CONCLUSIONS: Pre-birth maternal hardiness rather than mode of conception contributes to parenting cognitions and behaviour around child sleep and, ultimately, toddlers' sleep outcomes. Findings suggest that targeting negative maternal perceptions of control and efficacy through clinical interventions could benefit toddlers' sleep.

Preschoolers' sleep behaviour: associations with parental hardiness, sleep-related cognitions and bedtime interactions.

BACKGROUND: Childhood sleep problems which are prevalent in Western societies are associated with a wide range of emotional, cognitive and behavioural disturbances. Growing evidence suggests that parents play a pivotal role in children's sleep behaviour and that a parenting style which promotes self-regulation is beneficial. This study tested a unique model that included parental hardiness, sleep-related cognitions, bedtime interactions and child sleep behaviour. METHODS: Parents (N = 110) with a child attending preschool (mean age = 3.81 years, SD = .84) responded to a survey assessing their level of hardiness, sleep-related cognitions, bedtime interactions and their child's sleep behaviour and temperament. Secondary caregivers completed a survey assessing child sleep and temperament, and teachers/childcare workers also reported on child temperament. RESULTS: In line with previous research, 37% of children in this community sample met criteria for a sleep problem. Regression analyses and structural equation modelling confirmed that low parental hardiness, problematic sleep-related cognitions and a greater number of parental interactions at bedtime significantly predicted child sleep problems, after considering child temperament. CONCLUSIONS: This study's theoretically driven model not only offers an explanation for what contributes to and maintains sleep problems in childhood but also suggests new areas for research. Importantly, the model can also be readily translated into clinical interventions to develop and enhance effective authoritative parenting.