BackgroundDigital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and efficacious in randomized controlled trials. They show potential for improving access to therapy and improving population mental health. However, their use in the real world, ie, as implemented (disseminated) outside of research settings, may differ from that reported in trials, and implementation data are seldom reported.ObjectiveThis study aimed to review peer-reviewed articles reporting user uptake and/or ongoing use, retention, or completion data (hereafter usage data or, for brevity, engagement) from implemented pure self-help (unguided) digital interventions for depression, anxiety, or the enhancement of mood.MethodsWe conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake and/or usage data from implemented digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Additionally, we screened the reference lists of included articles, citations of these articles, and the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. We extracted data indicating the number of registrations or downloads and usage of interventions.ResultsAfter the removal of duplicates, 970 papers were identified, of which 10 met the inclusion criteria. Hand searching identified 1 additional article. The included articles reported on 7 publicly available interventions. There was little consistency in the measures reported. The number of registrants or downloads ranged widely, from 8 to over 40,000 per month. From 21% to 88% of users engaged in at least minimal use (eg, used the intervention at least once or completed one module or assessment), whereas 7-42% engaged in moderate use (completing between 40% and 60% of modular fixed-length programs or continuing to use apps after 4 weeks). Indications of completion or sustained use (completion of all modules or the last assessment or continuing to use apps after six weeks or more) varied from 0.5% to 28.6%.ConclusionsAvailable data suggest that uptake and engagement vary widely among the handful of implemented digital self-help apps and programs that have reported this, and that usage may vary from that reported in trials. Implementation data should be routinely gathered and reported to facilitate improved uptake and engagement, arguably among the major challenges in digital health.

Regular exercise was associated with lower birth weights and reduced cord concentrations of growth-related peptides, suggesting an influence of exercise on endocrine regulation of fetal growth. These effects on offspring growth were not associated with an exercise training effect on maternal insulin sensitivity.

An increase in leptin in exercising pregnant women may reflect subtle changes within the placenta in response to regular exercise and may contribute to the reduction in offspring size previously reported in this cohort.

BackgroundNew Zealand youth, especially those of Māori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement.ObjectiveWe aimed to carry out preliminary scoping to understand adolescents’ current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers.MethodsInteractive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach.ResultsParticipants (N=58) engaged in 2 whānau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face.ConclusionsDefining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health–need groups. This study demonstrates the importance of scoping possible user needs to inform design processes.

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mHealth interventions promise the economic delivery of evidence-based mental health treatments like cognitive behavioural therapy (CBT) to populations that struggle to access health services, such as adolescents and in New Zealand, Māori and Pasifika youth. Unfortunately engagement with digital therapies is poor; modularisation and gamification have potential to increase their appeal. Gamifying CBT involves selecting suitable interventions, adapting them to a digital format while applying gamification principles. We describe the design and development of Quest - Te Whitianga, an app that encourages the user to learn CBT skills via a series of activities and games. A variety of approaches including consultation with clinicians, reference to best-practice literature, focus groups and interactive workshops with youth were used to inform the co-design process. Clinicians worked iteratively with experienced game designers to co-create a youth CBT digital intervention. The Quest modular app is set on an ocean and the user travels between islands to learn six evidence-based skills. These include a relaxation/mindfulness activity, activity planning, a gratitude journal plus problem solving and communication skills training. We describe the theoretical and design aspects of each module detailing the gamified features that aim to increase user engagement. In the near future we will be testing the app and the principles discussed in this paper via a randomised-controlled trial.

More than 25% of US women are obese when they become pregnant, which contributes to several known adverse outcomes. This population-based, cohort study was undertaken to determine the impact of interpregnancy body mass index (BMI) change in obese pregnant women on the risk of delivering a large-or small-for-gestational age (LGA, SGA) infant in the next pregnancy.Data from the Missouri maternally linked birth and fetal death registry were used. During the study years (1998Y2005), 10,672 women started their first pregnancy with a BMI of 30 kg/m 2 or greater. The final cohort included 10,444 women whose data were complete. The study groups included women who decreased their BMI by 2 or more units (weight loss group), women who increased their BMI by 2 or more units (weight gain group), and women who maintained their BMI within a 2-unit loss or gain (reference group). The prepregnancy BMI of the first pregnancy was categorized as class I (30Y34.9 kg/m 2 ), class II (35Y39.9 kg/m 2 ), or class III (Q40 kg/m 2 ). Gestational weight gain (GWG; in pounds) for the second pregnancy was determined. Demographic, medical, and obstetric characteristics in the second pregnancy were compared across interpregnancy BMI change groups with the W 2 test for categorical variables. The incidence of LGA by interpregnancy BMI change was assessed by linear-by-linear W 2 test for trend. P G 0.05 denoted statistical significance.The final cohort included 1739 women (16.6%) who lost 2 or more BMI units between pregnancies, 4743 women (45.4%) who maintained their BMI (gain or loss, G2 BMI units), and 3962 women (38.9%) who gained 2 or more BMI units between pregnancies. Compared with the reference group, the weight gain group had higher GWG in their first pregnancy (median of 32 lb [interquartile range {IQR}, 22Y42 lb] vs reference group 25 lb [IQR, 16Y34 lb]; P G 0.001) and a longer interpregnancy interval (23.8 months [IQR, 14Y37 months] vs 19.3 months [IQR, 12Y29 months]; P G 0.001). Women in the weight loss group had a higher BMI at the start of their first pregnancy (34.5 kg/m 2 [IQR, 30.2Y38.8 kg/m 2 ] vs reference group 33.7 kg/m 2 [IQR, 31.6Y37.3 kg/m 2 ]; P G 0.001) but lost weight between pregnancies, resulting in a significantly lower BMI at the start of their second pregnancy (29.8 kg/m 2 [IQR, 27.4Y33.7 kg/m 2 ] vs reference group 34.0 kg/m 2 [IQR, 31.8Y37.6 kg/m 2 ] and weight gain group 39.0 kg/m 2 [IQR, 36.1Y 42.8 kg/m 2 ]; P G 0.001). Compared with the reference group, diabetes mellitus and preeclampsia were more and less prevalent in the weight gain and weight loss groups, respectively. Interpregnancy weight change was not associated with alterations in gestational age at delivery, risk for cardiac disease or chronic hypertension, history of LGA or SGA infant, or adequacy of prenatal care. The overall incidence of LGA and SGA infants in the second pregnancy was 18.1% and 5.2%, respectively. Infant birth weight increased with parity, but despite this increase, second pregnancy offspring of women in the weight loss group were ...