Publications by authors named "Riitta Luoto"

96 Publications

Effects of dietary counselling on micronutrient intakes in pregnant women in Finland.

Matern Child Nutr 2021 Jun 19:e13203. Epub 2021 Jun 19.

The Social Insurance Institution of Finland (Kela), Helsinki, Finland.

The intake of some micronutrients is still a public health challenge for pregnant women in Finland. This study examined the effects of dietary counselling on micronutrient intakes among pregnant women at increased risk of gestational diabetes mellitus in Finland. This study utilised data from was a cluster-randomised controlled trial (n = 399), which aimed to prevent gestational diabetes. In the intervention group, the dietary counselling was carried out at four routine visits to maternity care and focused on dietary fat, fibre and saccharose intake. A validated 181-item food frequency questionnaire was used for evaluating the participants' food consumption and nutrient intakes. The differences in changes in micronutrient intakes from baseline (pre-pregnancy) to 36-37 weeks' gestation were compared between the intervention and the usual care groups using multilevel mixed-effects linear regression models, adjusted for confounders. Based on the multiple-adjusted model, the counselling increased the intake of niacin equivalent (coefficient 0.50, 95% confidence interval [CI] 0.03-0.97), vitamin D (0.24, CI 0.05-0.43), vitamin E (0.46, CI 0.26-0.66) and magnesium (5.05, CI 0.39-9.70) and maintained the intake of folate (6.50, CI 1.44-11.56), from early pregnancy to 36 to 37 weeks' gestation. Except for folate and vitamin D, the mean intake of the micronutrients from food was adequate in both groups at baseline and the follow-up. In conclusion, the dietary counselling improved the intake of several vitamins and minerals from food during pregnancy. Supplementation on folate and vitamin D is still needed during pregnancy.
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http://dx.doi.org/10.1111/mcn.13203DOI Listing
June 2021

Higher number of steps and breaks during sedentary behaviour are associated with better lipid profiles.

BMC Public Health 2021 03 31;21(1):629. Epub 2021 Mar 31.

The UKK Institute for Health Promotion Research, Tampere, Finland.

Background: Physical activity (PA) is known to be associated with lipid profiles and the risk of both cardiovascular diseases and cancer. The aim of this study was to evaluate the association of objectively measured PA, sedentary behaviour (SB), amount of breaks during SB and number of daily steps with serum lipids in a healthy, Finnish, middle-aged, female population.

Methods: The participants (571) were recruited at mammography screening, target group was women aged 50-60 years. A measurement of PA was done with accelerometer, blood lipid profile was assessed, and questionnaires of participants characteristics were sent to participants.

Results: The participants with the highest number of daily breaks during SB (≥ 41) had the highest mean concentration of HDL-cholesterol (high density lipoprotein cholesterol, HDL-c) (1.9 mmol/l, standard deviation (SD) 0.4) and the lowest mean concentration of triglycerides (1.0 mmol/l, SD 0.5). HDL-c level was 0.16 mmol/l higher (p < 0.001) in the group with 28-40.9 breaks/day and 0.25 mmol/l higher (p < 0.001) among participants with ≥41 breaks/day than in the group with the fewest breaks during SB (< 28). Those with the most daily steps (≥ 9100) had the highest mean HDL-c level (1.9 mmol/l). HDL-c level was 0.16 mmol/l higher (p < 0.001) among the participants with 5600-9099 steps/day and 0.26 mmol/l higher (p < 0.001) among participants with ≥9100 steps/day than those with the fewest steps (< 5600). The number of daily steps was inversely associated with the triglyceride concentration. From wake-time, participants spent 60% in SB, 18% standing, 14% in light PA, and 9% in moderate-to-vigorous PA (MVPA). PA was associated with serum total cholesterol (TC), HDL-c and triglyceride levels. The mean HDL-c level was the highest in the lowest quartile of SB and in the highest quartile of MVPA.

Conclusions: To our knowledge, this is the first study showing a high number of objectively measured breaks during SB is associated with a favourable effect on the level of serum lipids, which may later translate into cardiovascular health among middle-aged women.

Trial Registration: This study was registered and approved by the Regional Ethics Committee of Tampere University Hospital in Finland (approval code R15137 ).
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http://dx.doi.org/10.1186/s12889-021-10656-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010961PMC
March 2021

Relationship between mothers' enjoyment and sedentary behavior and physical activity of mother-child dyads using a movement-to-music video program: a secondary analysis of a randomized controlled trial.

BMC Public Health 2020 Nov 4;20(1):1659. Epub 2020 Nov 4.

University of Jyväskylä, Faculty of Sport and Health Sciences, PO Box 35, FI-40014, Jyväskylä, Finland.

Background: Parental support and participation in physical activity (PA) with children and parents' acting as a role model for less sedentary behaviors (SB) are critical factors for children's healthier lifestyle. The purpose of the study was to assess the relationship between mothers' enjoyment and participants' sedentary behavior (SB) and physical activity (PA) as a secondary analysis of a randomized controlled trial (RCT) using data from Moving Sound RCT in the Pirkanmaa area of Finland.

Methods: The participants were 108 mother-child dyads (child age 5-7 years) who completed the eight-week exercise intervention using a movement-to-music video program in their homes. Mothers' enjoyment was examined using a modified version of the enjoyment in sport questionnaire. The proportion of SB, standing, light PA, moderate-to-vigorous PA, and Total PA were derived from accelerometers at baseline and during the final week of the intervention. Analyses were performed using linear mixed-effect models for (1) intervention and control groups, (2) groups based on mothers' enjoyment.

Results: The results highlighted that mothers' enjoyment of exercise with their children was overall high. Although there was no difference between the intervention and control groups, mothers in the intervention group increased their enjoyment during the intervention (p = 0.007). With mothers' higher enjoyment at baseline, children's light PA increased (p < 0.001), and with mothers' lower enjoyment, children's SB increased (p = 0.010). Further, if mothers' enjoyment decreased during the study, their own LPA increased (p = 0.049), and their children's SB increased (p = 0.013). If mothers' enjoyment remained stable, children's light PA (p = 0.002) and Total PA (p = 0.034) increased.

Conclusions: In this RCT, no differences were found between the intervention and control groups or groups based on mothers' enjoyment, possibly due to the low power of the study. However, mothers' enjoyment of exercise with their children increased within the intervention group, and mothers' enjoyment influenced children's SB and PA. For future studies, it would be essential to focus on children's enjoyment and factors behind the behavior change.

Trial Registration: The study is registered at ClinicalTrials.gov, registration number NTC02270138 , on October 2, 2014.
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http://dx.doi.org/10.1186/s12889-020-09773-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640412PMC
November 2020

Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland.

Womens Health (Lond) 2020 Jan-Dec;16:1745506520910911

Faculty of Social Sciences/ Health Sciences, Tampere University, Tampere, Finland.

Objective: We compared the prevalence of gestational diabetes and hypertensive disorders in the most recent pregnancy among women of Russian, Somali, and Kurdish origin and women in the general population in Finland.

Methods: The study groups were selected from population-based samples of 18- to 64-year-old women. The women were of Russian (n = 318), Somali (n = 583), and Kurdish (n = 373) origin or from the general population (n = 243), and had given birth in Finland between 2004 and 2014. The data were obtained from the National Medical Birth Register and the Hospital Discharge Register. Data on gestational diabetes and hypertensive disorders were extracted based on relevant codes. The main statistical methods were logistic regression analyses adjusted for age, parity, body mass index, socioeconomic status, and smoking.

Results: The prevalence of gestational diabetes was 19.1% in Kurdish, 14.4% in Somali, 9.3% in Russian, and 11.8% in the general population. The prevalence of hypertensive disorders was 5.4% in the general population, 3.8% in Somali, 3.1% in Kurdish, and 1.7% in Russian. When adjusted for confounders, Kurdish women had two-fold odds for gestational diabetes (odds ratio = 1.98; 95% confidence interval = 1.20-3.32) compared with the general population, but the odds for hypertensive disorders did not differ between groups.

Conclusion: Women of Kurdish origin were more likely to develop gestational diabetes. Studies with larger samples are required to confirm these findings to develop prevention strategies for later development of type 2 diabetes. Future research including other migrant groups is recommended to identify differences in pregnancy complications among the women in migrant and general population.
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http://dx.doi.org/10.1177/1745506520910911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160768PMC
August 2020

Physical Activity and Body Composition in Children and Their Mothers According to Mother's Gestational Diabetes Risk: A Seven-Year Follow-Up Study.

Medicina (Kaunas) 2019 Sep 25;55(10). Epub 2019 Sep 25.

Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere Finland.

There is lack of knowledge on whether mothers' gestational diabetes (GDM) risk is related to their physical activity (PA) or their children's PA and body composition. We aimed to examine the difference in (1) change in self-reported PA from pre-pregnancy to seven-year follow-up and (2) accelerometer-based PA at seven years after delivery between the mothers having GDM risk (GDMRyes-mothers) and not having GDM risk (GDMRno-mothers). Furthermore, we examined the difference in children's PA and/or body composition at six years of age according to their mothers' GDM risk. The study included 199 Finnish women. GDM risk factors were screened at the beginning of pregnancy, and the women were classified as GDMRyes-mothers if they had at least one GDM risk factor (body mass index ≥25 kg/m; age ≥40 years; family history of diabetes; GDM, signs of glucose intolerance, or newborn's macrosomia (≥4500 g) in earlier pregnancy) or as GDMRno-mothers if they had no risk factors. Mothers' PA was assessed by self-reporting at 8-12 gestational weeks concerning pre-pregnancy PA and at a follow-up seven years after the delivery. Moreover, mothers' and their children's PA was measured using a triaxial Hookie AM20-accelerometer at seven years after delivery. Children's body composition was assessed using a TANITA bioelectrical impedance device. Adjusted linear regression analyses were applied. GDMRno-mothers increased their self-reported PA more than GDMRyes-mothers from pre-pregnancy to the seven-year follow-up. Concerning women's measured PA as well as children's PA and body composition at seven years after delivery, the differences were non-significant between GDMRyes-mothers and GDMRno-mothers. However, of the GDM risk factors, mothers' pre-pregnancy body mass index was positively related to unhealthier body composition in boys at six years of age. Health promotion should be targeted at women with GDM risk factors, in particular overweight women, in enhancing women's PA in the long term and their children's healthy body composition.
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http://dx.doi.org/10.3390/medicina55100635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843146PMC
September 2019

Using Household Socioeconomic Indicators to Predict the Utilization of Maternal and Child Health Services Among Reproductive-Aged Women in Rural Yemen.

Glob Pediatr Health 2019 6;6:2333794X19868926. Epub 2019 Aug 6.

Columbia University, New York, NY, USA.

Using principal component analysis (PCA) and integrating both individual and household factors, we had previously derived and proposed 3 socioeconomic indices (namely, wealth index, educational index, and housing quality index) that can be used to classify rural Yemeni women into different socioeconomic statuses (SES). In the current article, we examined whether the PCA-derived indices can be used to predict the use of maternal and child health care services in rural Yemen. We used data from subnational representative multistage sampling cross-sectional household survey conducted in rural Yemen in 2008-2009 among women (N = 6907) who had given birth. The resulting component scores for each SES index were divided into tertiles. Logistic regression was used to study the associations between the SES indices and 4 indicators of maternal health care use. Higher tertiles of each socioeconomic index increased the likelihood of adequate antenatal care use, delivery assistance, and contraceptive use, but decreased the likelihood of unmet need for contraception. Key maternal health indicators can be determined by socioeconomic indicators. Therefore, in planning maternal and child health interventions, considering disparities of care by socioeconomic factors should be taken into account.
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http://dx.doi.org/10.1177/2333794X19868926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686312PMC
August 2019

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis.

BMJ Open 2019 08 1;9(8):e025620. Epub 2019 Aug 1.

Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy.

Objectives: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment.

Design: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed.

Data Sources: Major electronic databases, from inception to February 2017.

Eligibility Criteria: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary).

Risk Of Bias: Cochrane risk of bias tool was used.

Data Synthesis: Principle measures of effect were OR and regression coefficient.

Results: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B -0.055; 95% CI -0.098 to -0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B -0.053; 95% CI -0.069 to -0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education.

Conclusions: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.
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http://dx.doi.org/10.1136/bmjopen-2018-025620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688690PMC
August 2019

Factors associated with female genital cutting in Yemen and its policy implications.

Midwifery 2019 Jul 18;74:99-106. Epub 2019 Mar 18.

Averting Maternal Death and Disability Program, Department of Population and Family Health, the Mailman School of Public Health, Columbia University, New York, United States.

Background: A tremendous number of girls in Yemen are still subjected to female genital cutting (FGC), which carries an increased risk of health complications and violates children's rights. This study describes the prevalence of FGC in four Yemeni provinces and investigates the determinants of FGC.

Methods: We analyzed data from women aged 15 to 49 years who responded to a sub-national household survey conducted in six rural districts of four Yemeni provinces in 2008-2009. Logistic regression was used to estimate the association between individual and household socioeconomic factors and FGC practices and attitudes.

Results: The prevalence of women's FGC was 48% while daughters' FGC was 34%. Almost 45.8% of the women surveyed believe the FGC practice should discontinue. Higher odds of FGC practice and positive attitude towards it were associated with older age, family marriage, and lower tertiles of wealth and education indices. Early marriage was also associated with increased odds of FGC practice (p < 0.01).

Conclusions: Socioeconomic indices and other individual factors associated with FGC are differing and complex. Younger generations of women are more likely to not have FGC and to express negative attitudes towards the tradition. Appropriate strategies to invest in girls' education and women's empowerment with effective engagement of religious and community leaders might support the change of attitudes and practice of FGC in the younger generation.
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http://dx.doi.org/10.1016/j.midw.2019.03.010DOI Listing
July 2019

Delivery and its complications among women of Somali, Kurdish, and Russian origin, and women in the general population in Finland.

Birth 2019 03 20;46(1):35-41. Epub 2018 May 20.

Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland.

Introduction: Limited information is available on delivery and its complications among migrant women in Finland. We compared mode of delivery, delivery complications, and use of pain medication during delivery between migrant women of Somali, Kurdish, and Russian origin and women in the general population in Finland.

Methods: The women were of Russian (n = 318), Somali (n = 583), and Kurdish (n = 373) origin and 243 women from the general population (reference group) who had given birth in Finland between 2004 and 2014. The data were obtained from the National Medical Birth Register and the Hospital Discharge Register. The most recent birth of each woman was included in the analyses. The main statistical methods were logistic regression analyses adjusting for age, parity, body mass index, gestational age, and smoking during pregnancy.

Results: Vaginal delivery was the most common mode of delivery among all study groups (79%-89%). The prevalence of any delivery complications varied between 15% and 19% among all study groups. When adjusted for confounders, Russian women had lower odds (OR 0.49; CI 0.29-0.82) of having a cesarean delivery, whereas Somali and Kurdish women did not differ from the reference group. Somali women had an increased risk of any delivery complications (OR 1.62; CI 1.03-2.55) compared with the reference group. No differences were observed in the use of pain medication between the groups.

Conclusion: Delivery complications were more common among migrant Somali women than among women in the general Finnish population. Somali women represent a high-risk group calling for special attention and care.
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http://dx.doi.org/10.1111/birt.12357DOI Listing
March 2019

The effects of mothers' musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-to-music video program.

PLoS One 2018 18;13(4):e0195837. Epub 2018 Apr 18.

The UKK Institute for Health Promotion Research, Tampere, Finland.

Objectives: The purpose of this study was to examine whether mothers' musical background has an effect on their own and their children's sedentary behavior (SB) and physical activity (PA). The aim was also to assess children's and their mothers' exercise adherence when using movement-to-music video program.

Design: Sub-group analysis of an intervention group in a randomized controlled trial (ISRCTN33885819).

Method: Seventy-one mother-child-pairs were divided into two categories based on mothers' musical background. Each pair performed 8 weeks exercise intervention using movement-to-music video program. SB and PA were assessed objectively by accelerometer, and exercise activity, fidelity, and enjoyment were assessed via exercise diaries and questionnaires. Logistic regression model was used to analyze associations in the main outcomes between the groups.

Results: Those children whose mothers had musical background (MB) had greater probability to increase their light PA during the intervention, but not moderate-to-vigorous PA compared to those children whose mothers did not have musical background (NMB). SB increased in both groups. Mothers in the NMB group had greater probability to increase their light and moderate-to-vigorous PA and decrease their SB than mothers in the MB group. However, exercise adherence decreased considerably in all groups. Completeness, fidelity, and enjoyment were higher among the NMB group compared to the MB group.

Conclusions: The present results showed that mothers without musical background were more interested in movement-to-music exercises, as well as their children. For further studies it would be important to evaluate an effect of children's own music-based activities on their SB and PA.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195837PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905892PMC
July 2018

A pragmatic controlled trial to prevent childhood obesity within a risk group at maternity and child health-care clinics: results up to six years of age (the VACOPP study).

BMC Pediatr 2018 02 27;18(1):89. Epub 2018 Feb 27.

Faculty of Social Sciences, University of Tampere, Tampere, Finland.

Background: Obesity in childhood appears often during the toddler years. The prenatal environment influences obesity risk. Maternal gestational diabetes, the child's diet, and physical activity in the first few years have an important role in subsequent weight gain. A study was conducted to evaluate effectiveness of a primary health-care lifestyle counselling intervention in prevention of childhood obesity up to 6 years of age.

Methods: The study was a controlled pragmatic trial to prevent childhood obesity and was implemented at maternity and child health-care clinics. The participants (n = 185) were mothers at risk of gestational diabetes mellitus with their offspring born between 2008 and 2010. The prenatal intervention, started at the end of the first trimester of pregnancy, consisted of counselling on diet and physical activity by municipal health-care staff. The intervention continued at yearly appointments with a public health-nurse at child health-care clinics. The paper reports the offspring weight gain results for 2-6 years of age. Weight gain up to 6 years of age was assessed as BMI standard deviation scores (SDS) via a mixed-effect linear regression model. The proportion of children at 6 years with overweight/obesity was assessed as weight-for-height percentage and ISO-BMI. Priority was not given to power calculations, because of the study's pragmatic nature.

Results: One hundred forty seven children's (control n = 76/85% and intervention n = 71/56%) weight and height scores were available for analysis at 6 years of age. There was no significant difference in weight gain or overweight/obesity proportions between the groups at 6 years of age, but the proportion of children with obesity in both groups was high (assessed as ISO-BMI 9.9% and 11.8%) relative to prevalence in this age group in Finland.

Conclusion: As the authors previously reported, the intervention-group mothers had lower prevalence of gestational diabetes mellitus, but a decrease in obesity incidence before school age among their offspring was not found. The authors believe that an effective intervention should start before conception, continuing during pregnancy and the postpartum period through the developmentally unique child's first years.

Trial Registration: ClinicalTrials.gov NCT00970710 . Registered 1 September 2009. Retrospectively registered.
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http://dx.doi.org/10.1186/s12887-018-1065-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828437PMC
February 2018

The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial.

PLoS One 2017 31;12(8):e0183317. Epub 2017 Aug 31.

The UKK Institute for Health Promotion Research, Tampere, Finland.

Regular physical activity (PA) and the avoidance of prolonged sitting are essential for children's healthy growth, and for the physical and mental wellbeing of both children and adults. In the context of exercise, music may promote behavioral change through increased exercise adherence and participation. The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior (SB) and increase PA in mother-child pairs in the home environment. A randomized controlled trial was conducted in the Pirkanmaa region, Finland, in 2014-2016. The participants consisted of 228 mother-child pairs (child age 5-7 years). The primary outcomes of interest were tri-axial accelerometer-derived SB and PA, which were measured in weeks one (baseline), two, and eight in both the intervention and control groups. Further, the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight. Secondary outcomes included self-reported screen time. The statistical methods employed comprised an intention-to-treat and linear mixed effects model design. No statistically significant differences between groups were found in primary or secondary outcomes. Among the children in the control group, light PA decreased significantly over time and screen time increased from 89 (standard deviation, SD 37) to 99 (SD 41) min/d. Among mothers and children in the intervention group, no statistical differences were found. In supplementary analysis, the children who stayed at home instead of attending daycare/preschool had on average 25 (95% confidence interval, CI 19-30) min/d more sedentary time and 11 (95% CI 8-14) min/d less moderate-to-vigorous PA than those who were at daycare/preschool. The higher body mass index of mothers was related with 5 (95% CI 2-7) min/d more sedentary time and 1 (95% CI 0-2) min/d less moderate-to-vigorous PA. The movement-to-music video program did not change the objectively measured SB or PA of the mother-child pairs. However, mothers and children seemed to be more sedentary at home, and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183317PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578653PMC
October 2017

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation.

Health Technol Assess 2017 08;21(41):1-158

UKK Institute for Health Promotion Research, Tampere, Finland.

Background: Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.

Objectives: To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.

Data Sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).

Review Methods: Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.

Results: Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI -0.92 to -0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate -0.10 kg, 95% CI -0.14 to -0.06 kg) and multiparity (summary estimate -0.73 kg, 95% CI -1.24 to -0.23 kg).

Limitations: The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.

Conclusion: Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.

Future Work: The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.

Study Registration: This study is registered as PROSPERO CRD42013003804.

Funding: The National Institute for Health Research Health Technology Assessment programme.
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http://dx.doi.org/10.3310/hta21410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572115PMC
August 2017

Pregnancy to postpartum transition of serum metabolites in women with gestational diabetes.

Metabolism 2017 07 4;72:27-36. Epub 2017 Jan 4.

Institute of Neuroscience and Physiology, University of Gothenburg.

Context: Gestational diabetes is commonly linked to development of type 2 diabetes mellitus (T2DM). There is a need to characterize metabolic changes associated with gestational diabetes in order to find novel biomarkers for T2DM.

Objective: To find potential pathophysiological mechanisms and markers for progression from gestational diabetes mellitus to T2DM by studying the metabolic transition from pregnancy to postpartum.

Design: The metabolic transition profile from pregnancy to postpartum was characterized in 56 women by mass spectrometry-based metabolomics; 11 women had gestational diabetes mellitus, 24 had normal glucose tolerance, and 21 were normoglycaemic but at increased risk for gestational diabetes mellitus. Fasting serum samples collected during trimester 3 (gestational week 32±0.6) and postpartum (10.5±0.4months) were compared in diagnosis-specific multivariate models (orthogonal partial least squares analysis). Clinical measurements (e.g., insulin, glucose, lipid levels) were compared and models of insulin sensitivity and resistance were calculated for the same time period.

Results: Women with gestational diabetes had significantly increased postpartum levels of the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine, and their circulating lipids did not return to normal levels after pregnancy. The increase in BCAAs occurred postpartum since the BCAAs did not differ during pregnancy, as compared to normoglycemic women.

Conclusions: Postpartum levels of specific BCAAs, notably valine, are related to gestational diabetes during pregnancy.
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http://dx.doi.org/10.1016/j.metabol.2016.12.018DOI Listing
July 2017

Metabolic syndrome in Finnish women 7 years after a gestational diabetes prevention trial.

BMJ Open 2017 03 15;7(3):e014565. Epub 2017 Mar 15.

UKK Institute for Health Promotion Research, Tampere, Finland.

Background: Risk for developing metabolic syndrome (MeS) after delivery is high among women with gestational diabetes mellitus (GDM), but little is known about development of MeS among women with risk factors for GDM during pregnancy. In the present study, we studied the prevalence of MeS 7 years postpartum among women with GDM risk factors during pregnancy, women with early GDM diagnosis and women without GDM risk factors. We also analysed the early pregnancy risk factors associated with MeS.

Methods: A Finnish cluster randomised controlled GDM prevention trial was conducted in 2007-2009. The prevalence of MeS according to International Diabetes Federation criteria was determined in the follow-up study 7 years after original trial. Eligible participants (n=289) in 4 study groups (intervention (n=83) and usual care (n=87) with GDM risk factors; early GDM (n=51), and healthy control without GDM risk factors (n=68)) were evaluated for MeS. Binary logistic regression models were used to analyse risk factors associated with MeS.

Results: 7 years postpartum, the MeS prevalence was 14% (95% CI 8% to 25%) in the intervention group; 15% (CI 8% to 25%) in the usual care group; 50% (CI 35% to 65%) in the early GDM group and 7% (CI 2% to 18%) in the healthy control group. OR for MeS in women with GDM risk factors did not differ from the healthy control group. Body mass index (BMI)-adjusted OR for MeS was 9.18 (CI 1.82 to 46.20) in the early GDM group compared with the healthy control group. Increased prepregnancy BMI was associated with MeS (OR, 1.17, CI 1.08 to 1.28, adjusted for group).

Conclusions: Increased prepregnancy BMI and early GDM diagnosis were the strongest risk factors for developing MeS 7 years postpartum. Overweight and obese women and especially those with early GDM should be monitored and counselled for cardiometabolic risk factors after delivery.
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http://dx.doi.org/10.1136/bmjopen-2016-014565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353289PMC
March 2017

The effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on longer-term maternal and early childhood outcomes: protocol for an individual participant data (IPD) meta-analysis.

Syst Rev 2017 03 9;6(1):51. Epub 2017 Mar 9.

The University of Adelaide, Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, Adelaide, South Australia, Australia.

Background: The aim of this individual participant data meta-analysis (IPDMA) is to evaluate the effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on later maternal and early childhood outcomes at ages 3-5 years.

Methods/design: We will build on the established International Weight Management in Pregnancy (i-WIP) IPD Collaborative Network, having identified researchers who have conducted randomised dietary and lifestyle interventions among pregnant women who are overweight or obese, and where ongoing childhood follow-up of participants has been or is being undertaken. The primary maternal outcome is a diagnosis of maternal metabolic syndrome. The primary childhood outcome is BMI above 90%. We have identified 7 relevant trials, involving 5425 women who were overweight or obese during pregnancy, with approximately 3544 women and children with follow-up assessments available for inclusion in the meta-analysis.

Discussion: The proposed IPDMA provides an opportunity to evaluate the effect of dietary and lifestyle interventions among pregnant women who are overweight or obese on later maternal and early childhood health outcomes, including risk of obesity. This knowledge is essential to effectively translate research findings into clinical practice and public health policy.

Systematic Review Registration: This IPD has been prospectively registered (PROSPERO), ID number CRD42016047165 .
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http://dx.doi.org/10.1186/s13643-017-0442-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343397PMC
March 2017

Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle Counseling Trial: A Seven-Year Follow-Up.

PLoS One 2016 9;11(12):e0167759. Epub 2016 Dec 9.

School of Health Sciences, University of Tampere, Tampere, Finland.

There is a link between the pregnancy and its long-term influence on health and susceptibility to future chronic disease both in mother and offspring. The objective was to determine whether individual counseling on physical activity and diet and weight gain at five antenatal visits can prevent type 2 diabetes mellitus (T2DM) and overweight or improve glycemic parameters, among all at-risk-mothers and their children. Another objective was to evaluate whether gestational lifestyle intervention was cost-effective as measured with mother's sickness absence and quality-adjusted life years (QALY). This study was a seven-year follow-up study for women, who were enrolled to the antenatal cluster-randomized controlled trial (RCT). Analysis of the outcome included all women whose outcome was available, in addition with subgroup analysis including women adherent to all lifestyle aims. A total of 173 women with their children participated to the study, representing 43% (173/399) of the women who finished the original RCT. Main outcome measures were: T2DM based on medication use or fasting blood glucose or oral glucose tolerance test (OGTT), body mass index (BMI), glycosylated hemoglobin (HbA1c). None of the women were diagnosed to have T2DM. HbA1c or fasting blood glucose differences were not found among mothers or children. Differences in BMI were non-significant among mothers (Intervention 27.3, Usual care 28.1 kg/m2, p = 0.33) and children (I 21.3 vs U 22.5 kg/m2, p = 0.07). Children's BMI was significantly lower among adherent group (I 20.5 vs U 22.5, p = 0.04). The mean total cost per person was 30.6% lower in the intervention group than in the usual care group (I €2,944 vs. U €4,243; p = 0.74). Intervention was cost-effective in terms of sickness absence but not in QALY gained i.e. if society is willing to pay additional €100 per one avoided sickness absence day; there is a 90% probability of the intervention arm to be cost-effective. Long-term effectiveness of antenatal lifestyle counseling was not shown, in spite of possible effect on children's BMI. Cost-effectiveness of the intervention in terms of sickness absence may have larger societal impact.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167759PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147978PMC
July 2017

Genome-wide analysis identifies 12 loci influencing human reproductive behavior.

Nat Genet 2016 12 31;48(12):1462-1472. Epub 2016 Oct 31.

Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.

The genetic architecture of human reproductive behavior-age at first birth (AFB) and number of children ever born (NEB)-has a strong relationship with fitness, human development, infertility and risk of neuropsychiatric disorders. However, very few genetic loci have been identified, and the underlying mechanisms of AFB and NEB are poorly understood. We report a large genome-wide association study of both sexes including 251,151 individuals for AFB and 343,072 individuals for NEB. We identified 12 independent loci that are significantly associated with AFB and/or NEB in a SNP-based genome-wide association study and 4 additional loci associated in a gene-based effort. These loci harbor genes that are likely to have a role, either directly or by affecting non-local gene expression, in human reproduction and infertility, thereby increasing understanding of these complex traits.
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http://dx.doi.org/10.1038/ng.3698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695684PMC
December 2016

6-mo aerobic exercise intervention enhances the lipid peroxide transport function of HDL.

Free Radic Res 2016 23;50(11):1279-1285. Epub 2016 Nov 23.

c The UKK Institute for Health Promotion Research , Tampere , Finland.

During acute exercise, the concentration of oxidized high-density lipoprotein (HDL) lipids (ox-HDL) is reported to increase suggesting that HDL may function in decreasing the concentration of oxidized low-density lipoprotein (LDL) lipids. However, the effect of exercise intervention on the lipid peroxide transport function of HDL is unknown. A randomized controlled trial with sedentary women (N = 161), aged 43-63, with no current use of hormone therapy, were randomized into a 6-month (mo) exercise group and a control group. During the 6-mo intervention, the concentration of ox-HDL increased in the exercise group by 5% and decreased in the control group by 2% (p = .003). Also, the ratio of ox-HDL to HDL-cholesterol increased by 5% in the exercise group and decreased by 1.5% in the control group (p = .036). The concentrations of cholesteryl ester transfer protein (CETP) and adiponectin did not change during the intervention. The concentration of serum triglycerides trended to decrease by 6% in the intervention group (p = .051). We found that the concentration of ox-HDL increased during the 6-mo aerobic exercise intervention, but the increase was not related to changes in the levels of CETP or adiponectin. These results, together with earlier studies, suggest that HDL has an active role in the reverse transport of lipid peroxides.
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http://dx.doi.org/10.1080/10715762.2016.1252040DOI Listing
February 2017

Hot flushes among aging women: A 4-year follow-up study to a randomised controlled exercise trial.

Maturitas 2016 Jun 24;88:84-9. Epub 2016 Mar 24.

UKK Institute for Health Promotion Research, Tampere, Finland.

Objectives: The aim of this follow-up study was to explore the long-term effects of a 6-month trial of exercise training on hot flushes. The follow-up was 4 years after the exercise intervention ended.

Study Design: A cohort study after a randomised controlled trial. Ninety-five of the 159 randomised women (60%) participated in anthropometric measurements and performed a 2-km walk test. Participants completed a questionnaire and kept a one-week diary on physical activity, menopause symptoms and sleep quality. The frequency of 24-h hot flushes was multiplied by severity and the total sum for one week was defined as the Hot Flush Score (HFScore). Multilevel mixed regression models were analysed to compare the exercise and control groups.

Main Outcome Measure: Hot Flush Score (HFScore) as assessed with the one-week symptom diary.

Results: The women in the exercise group had a higher probability of improved HFScore, i.e. a decrease in HFScore points, adjusted for hormone therapy (OR 0.95; 95% CI 0.90-1.00) than women in the control group at the 4-year follow-up. After additional adjustment for sleep quality, the result approached statistical significance at HFScore≥13 with women in the exercise group. Women who had the least amount of hot flushes, HFScore<13, benefited most from exercise during the 4-year follow-up when compared with women in the control group.

Conclusions: Women in the exercise group had positive effects on their HFScore 4 years after a 6-month exercise intervention.
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http://dx.doi.org/10.1016/j.maturitas.2016.03.010DOI Listing
June 2016

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials.

Nutr Rev 2016 May;74(5):312-28

A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod

Context: Interventions targeting maternal obesity are a healthcare and public health priority.

Objective: The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy.

Data Sources: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration.

Study Selection: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified.

Data Synthesis: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain.

Conclusion: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.
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http://dx.doi.org/10.1093/nutrit/nuw005DOI Listing
May 2016

Differences in sedentary time and physical activity among mothers and children using a movement-to-music video program in the home environment: a pilot study.

Springerplus 2016 28;5:93. Epub 2016 Jan 28.

The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, PL 30, 33501 Tampere, Finland.

Measured objectively, less than a quarter of adults and under half of preschool children in Finland meet the physical activity recommendations. Moreover, higher sedentary time among parents (such as watching television) is associated with higher sedentary time of their children. The study introduces an intervention based on reducing sedentary behavior among mothers and their children. It utilizes a combination of music and exercise via a motivation-targeting movement-to-music video program in the home environment. Data were collected in summer 2014 from Finland's Pirkanmaa region. Each mother-child pair (n = 24, child age: 4-7 years) was assigned to the intervention and control group. Both groups used an accelerometer and completed physical activity diaries for two consecutive weeks (14 days) during waking hours. In addition, the intervention group was instructed to use the movement-to-music video program during the second week. Differences between groups were expected in analysis of sedentary time and physical activity between weeks 1 and 2. The parameters assessed were sedentary time (i.e., lying down or sitting), standing still, and time spent in physical activity. Less sedentary time was revealed in week 2 than in week 1 among both intervention group mothers (56.6 vs. 53.3 %) and for intervention group children (49.5 vs. 46.0 %). The opposite was true of control group mothers (52.1 vs. 52.4 %) and children (46.7 vs. 49.8 %). Within-group differences in mothers' sedentary time correlated moderately with the children's sedentary time (Spearman's r = 0.56). All groups exhibited slightly more standing in the second week than in week 1. Both sets of intervention participants also engaged in more light physical activity in week 2, with the opposite evident for the two control sets. In all groups, except the control children, the proportion of moderate to vigorous physical activity was higher in the second week than the first. The use of music and video content together may yield added benefits in efforts to reduce sedentary behavior and increase physical activity among mothers and their children in the home environment.
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http://dx.doi.org/10.1186/s40064-016-1701-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729752PMC
February 2016

Design and respondent selection of a population-based study on associations between breast cancer screening, lifestyle and quality of life.

BMC Public Health 2015 Dec 18;15:1256. Epub 2015 Dec 18.

Finnish Cancer Registry, Unioninkatu 20-22, 00130, Helsinki, Finland.

Background: Only few studies have integrated breast cancer screening, lifestyle, and quality of life. Potential bias due to selective non-response may disrupt associations being investigated. We describe the design of a Finnish population-based study on associations between breast cancer screening and various indicators for lifestyle and quality of life, and evaluate the level of bias among the respondents from the first study rounds over 2 years.

Methods: The study target population of 10,000, 49-year-old women was randomly drawn from the Finnish National Population Registry. The data included birth year, marital status, municipality, and primary language. Data on education were retrieved from Statistics Finland. Questionnaires focusing on lifestyle-related risk factors and quality of life were sent to the target population in 2012-13, 1 year before the first invitation to organized breast cancer screening. We evaluated associations between willingness to respond and demographic characteristics in the eligible study population. Additionally, we examined associations between the demographic characteristics and the Satisfaction With Life Scale (SWLS), and evaluated the impact of non-response using inverse probability weighting and multiple imputation.

Results: The questionnaire response proportion was 52.4%. Compared to non-respondents, respondents were more often married, academically educated, and native speakers of Finnish or Swedish. Nevertheless, the estimates of the SWLS among the respondents were in line with those corrected by non-response in the eligible study population.

Conclusions: Based on the SWLS, the respondents are representative of women in the entire eligible study population.
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http://dx.doi.org/10.1186/s12889-015-2603-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684601PMC
December 2015

Measures of Maternal Socioeconomic Status in Yemen and Association with Maternal and Child Health Outcomes.

Matern Child Health J 2016 Feb;20(2):386-97

Averting Maternal Death and Disability Program, Department of Population and Family Health, the Mailman School of Public Health, Columbia University, New York, NY, USA.

Background: Reliable measurement of socioeconomic status (SES) in health research requires extensive resources and can be challenging in low-income countries. We aimed to develop a set of maternal SES indices and investigate their associations with maternal and child health outcomes in rural Yemen.

Methods: We applied factor analysis based on principal component analysis extraction to construct the SES indices by capturing household attributes for 7295 women of reproductive age. Data were collected from a sub-national household survey conducted in six rural districts in four Yemeni provinces in 2008-2009. Logistic regression models were fitted to estimate the associations between the SES indices and maternal mortality, spontaneous abortion, stillbirth, neonatal and infant mortality.

Results: Three SES indices (wealth, educational and housing quality) were extracted, which together explained 54 % of the total variation in SES. Factor scores were derived and categorized into tertiles. After adjusting for potential confounding factors, higher tertiles of all the indices were inversely associated with spontaneous abortion. Higher tertiles of wealth and educational indices were inversely associated with stillbirth, neonatal and infant mortality. None of the SES indices was strongly associated with maternal mortality.

Conclusion: By subjecting a number of household attributes to factor analysis, we derived three SES indices (wealth, educational, and housing quality) that are useful for maternal and child health research in rural Yemen. The indices were worthwhile in predicting a number of maternal and child health outcomes. In low-income settings, failure to account for the multidimensionality of SES may underestimate the influence of SES on maternal and child health.
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http://dx.doi.org/10.1007/s10995-015-1837-4DOI Listing
February 2016

Rationale and methods for a randomized controlled trial of a movement-to-music video program for decreasing sedentary time among mother-child pairs.

BMC Public Health 2015 Oct 5;15:1016. Epub 2015 Oct 5.

UKK Institute for Health Promotion Research, Tampere, Finland.

Background: Measured objectively, under a quarter of adults and fewer than half of preschool children meet the criteria set in the aerobic physical activity recommendations of the Centers for Disease Control and Prevention. Moreover, adults reportedly are sedentary (seated or lying down) for most of their waking hours. Importantly, greater amounts of sedentary time on parents' part are associated with an increased risk of more sedentary time among their children. A randomized controlled trial targeting mother-child pairs has been designed, to examine whether a movement-to-music video program may be effective in reducing sedentary time and increasing physical activity in the home environment.

Methods: Mother-child pairs (child age of 4-7 years) will be recruited from among NELLI lifestyle-modification study five-year follow-up cohort participants, encompassing 14 municipalities in Pirkanmaa region, Finland. Accelerometer and exercise diary data are to be collected for intervention and control groups at the first, second and eighth week after the baseline measurements. Background factors, physical activity, screen time, motivation to exercise, and self-reported height and weight, along with quality of life, will be assessed via questionnaires. After the baseline and first week measurements, the participants of the intervention group will receive a movement-to-music video program designed to reduce sedentary time and increase physical activity. Intervention group mother-child pairs will be instructed to exercise every other day while watching the video program over the next seven weeks. Information on experiences of the use of the movement-to-music video program will be collected 8 weeks after baseline. Effects of the intervention will be analyzed in line with the intention-to-treat principle through comparison of the changes in the main outcomes between intervention and control group participants. The study has received ethics approval from the Pirkanmaa Ethics Committee in Human Sciences.

Discussion: The study will yield information on the effectiveness of movement-to-music video exercise in reducing sedentary behavior. Intervention-based methods have proven effective in increasing physical activity in home environments. Music may improve exercise adherence, which creates a possibility of achieving long-term health benefits.

Trial Registration: The study is registered at ClinicalTrials.gov, as NCT02270138. It was registered on October 2, 2014.
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http://dx.doi.org/10.1186/s12889-015-2347-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595194PMC
October 2015

Long-term effect of physical activity on health-related quality of life among menopausal women: a 4-year follow-up study to a randomised controlled trial.

BMJ Open 2015 Sep 11;5(9):e008232. Epub 2015 Sep 11.

UKK Institute for Health Promotion Research, Tampere, Finland.

Objectives: The aim of the study was to explore the long-term effects of physical activity intervention on quality of life (QoL) 4 years after an original randomised controlled trial (RCT).

Design: Cohort study after an RCT.

Setting: 95 of the 159 women from the original RCT participated in weight, height and waist circumference measurements, performed the UKK 2 km Walk Test and completed the SF-36 Health Survey questionnaire. Multilevel mixed regression models were performed in order to compare the original and current group in an RCT setting.

Participants: There were 159 participants in the original RCT; 2.5 years later, 102 of the women responded to a questionnaire and 4-year after the trial, there were 95 respondents. The inclusion criteria in the original RCT were: being symptomatic, experiencing daily hot flushes, age between 40 and 63 years, not using hormone therapy now or in the past 3 months, sedentary lifestyle and having last menstruated 3-36 months earlier.

Main Outcome Measure: Health-related QoL as measured with the SF-36 instrument.

Results: Women in the intervention group had a significantly higher probability of improved physical functioning (OR 1.41; 95% CI 1.00 to 1.99) as compared with women in the control group. In addition, women in the intervention group had higher odds of good role functioning (OR 1.21; 95% CI 0.88 to 1.67), physical health (OR 1.33; 95% CI 0.96 to 1.84) and general health (OR 1.14; 95% CI 0.81 to 1.62), relative to women in the control group, although the differences did not reach statistical significance.

Conclusions: Women in the intervention group showed positive long-term effects on physical and mental dimensions of QoL after 4 years.

Trial Registration Number: ISRCTN54690027.
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http://dx.doi.org/10.1136/bmjopen-2015-008232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567675PMC
September 2015

Cost-effectiveness of physical activity among women with menopause symptoms: findings from a randomised controlled trial.

PLoS One 2015 10;10(8):e0135099. Epub 2015 Aug 10.

UKK Institute for Health Promotion; Tampere, Finland.

Menopause is a period that may predispose one to a decrease in muscle strength, cardiorespiratory fitness, and quality of life. A study was carried out to evaluate the cost-effectiveness of physical activity among women displaying symptoms of menopause. The cost-effectiveness analysis was based on data from a six-month randomised controlled trial (n = 151). The women in the intervention group engaged in an unsupervised session of at least 50 minutes of physical activity four times a week. The control group continued their physical activity as before. An incremental cost-effectiveness ratio (ICER) was calculated in terms of maximal oxygen consumption, lean muscle mass, and quality-adjusted life years (QALYs) gained. A bootstrap technique was utilised to estimate uncertainty around the point estimate for ICER associated with the intervention. The mean total cost in the intervention group was €1,307 (SEM: €311) and in the control group was €1,253 (SEM: €279, p = 0.10) per person. The mean intervention cost was €208 per person. After six months of the behaviour-change intervention, the ICER was €63 for a 1 ml/kg/min improvement in cardiorespiratory fitness, the additional cost per one-gram increase in lean muscle mass was €126, and the cost per QALY gained was €46. According to the findings, physical activity among menopausal women was cost-effective for cardiorespiratory fitness, for lean muscle mass, and for QALYs gained, since the intervention was more effective than the actions within the control group and the additional effects of physical activity were gained at a very low price. From the societal perspective, the intervention used may promote ability to work and thereby save on further costs associated with early retirement or disability pension if the physical-activity level remains at least the same as during the intervention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135099PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530885PMC
May 2016

Short- and Long-term Effects of a Physical Exercise Intervention on Work Ability and Work Strain in Symptomatic Menopausal Women.

Saf Health Work 2014 Dec 16;5(4):186-90. Epub 2014 Sep 16.

School of Health Sciences, University of Tampere, Tampere, Finland.

Background: Physical exercise during leisure time is known to increase physical capacity; however, the long-term effects on work ability and work strain are inconclusive. The aim of this study was to investigate the effects of a 6-month physical exercise program on work ability and work strain after 6 months and 30 months, among women with menopausal symptoms at baseline.

Methods: A questionnaire including questions on work ability and work strain was mailed in the beginning, at 6 months and after 30 months after the intervention to occupationally active women participating in a randomized controlled study on physical exercise and quality of life. The intervention included aerobic exercise training 4 times per week, 50 minutes per session. Work ability was measured with the Work Ability Index (WAI) and with questions about physical and mental work strain.

Results: Women aged 47-62 years (N = 89) who were occupationally active at baseline were included in the analyses. The increase in WAI from baseline to the end of the exercise intervention (6 months) was statistically significantly greater among the intervention group than among the control group (regression coefficient 2.08; 95% confidence interval 0.71-3.46). The difference between the groups persisted for 30 months. No significant short- or long-term effects on physical and mental work strain were found.

Conclusion: A 6-month physical exercise intervention among symptomatic menopausal women had positive short-term as well as long-term effects on work ability.
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http://dx.doi.org/10.1016/j.shaw.2014.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266772PMC
December 2014

Physical activity and menopause-related quality of life - a population-based cross-sectional study.

Maturitas 2015 Jan 30;80(1):69-74. Epub 2014 Sep 30.

UKK Institute for Health Promotion, Tampere, Finland; National Institute for Health and Welfare, Helsinki, Finland.

The aim of the research was to study the association between engagement in the recommended level of physical activity and quality of life (QoL) among middle-aged women. In total, 2606 Finnish women aged 49 years responded to a postal questionnaire on lifestyle, quality of life, and health, wherein QoL was assessed with a shorter version of the menopause-specific Women's Health Questionnaire (WHQ). Proportional odds ratios (PORs) from ordered logistic regression models were used to test the association between the physical-activity and WHQ domains or three quality-of-life variables. Physically inactive women had an increased probability of anxiety/depressed mood (POR 1.44; 95% confidence interval (CI) 1.26-1.65), of decreased well-being (POR 1.96; 95% CI 1.71-2.25), of somatic symptoms (POR 1.61; 95% CI 1.40-1.85), of memory/concentration problems (POR 1.48; 95% CI 1.29-1.70), and of vasomotor symptoms (POR 1.19; 95% CI 1.03-1.36) as compared to physically active women. Women with the recommended level of physical activity had a higher self-perceived health level, better relative health, and better global quality of life in relation to other women their age. Physically active women showed higher quality of life in four menopause-specific WHQ dimensions and in global quality of life when compared to inactive women.
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http://dx.doi.org/10.1016/j.maturitas.2014.09.009DOI Listing
January 2015
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