Background Short-term trials conducted in adults with type 2 diabetes mellitus (T2DM) showed that reducing sedentary behaviour by performing regular short bouts of light-intensity physical activity enhances health. Moreover, support for reducing sedentary behaviour may be provided at a low cost via mobile health technology (mHealth). There are a wide range of mHealth solutions available including SMS text message reminders and activity trackers that monitor the physical activity level and notify the user of prolonged sitting periods. The aim of this study is to evaluate the effects of a mHealth intervention on sedentary behaviour and physical activity and the associated changes in health in adults with T2DM. Methods A dual-arm, 12-month, randomized controlled trial (RCT) will be conducted within a nationwide Swedish collaboration for diabetes research in primary health care. Individuals with T2DM ( n = 142) and mainly sedentary work will be recruited across primary health care centres in five regions in Sweden. Participants will be randomized (1:1) into two groups. A mHealth intervention group who will receive an activity tracker wristband (Garmin Vivofit4), regular SMS text message reminders, and counselling with a diabetes specialist nurse, or a comparator group who will receive counselling with a diabetes specialist nurse only. The primary outcomes are device-measured total sitting time and total number of steps (activPAL3). The secondary outcomes are fatigue, health-related quality of life and musculoskeletal problems (self-reported questionnaires), number of sick leave days (diaries), diabetes medications (clinical record review) and cardiometabolic biomarkers including waist circumference, mean blood pressure, HbA1c, HDL-cholesterol and triglycerides. Discussion Successful interventions to increase physical activity among those with T2DM have been costly and long-term effectiveness remains uncertain. The use of mHealth technologies such as activity trackers and SMS text reminders may increase awareness of prolonged sedentary behaviour and encourage increase in regular physical activity. mHealth may, therefore, provide a valuable and novel tool to improve health outcomes and clinical management in those with T2DM. This 12-month RCT will evaluate longer-term effects of a mHealth intervention suitable for real-world primary health care settings. Trial registration ClinicalTrials.gov NCT04219800 . Registered on 7 January 2020.

BACKGROUND:Platelets, fibrinogen and factor XIII (FXIII) are required to form a stable clot in case of haemorrhage. The aims of this study were to evaluate a possible association between FXIII activity at the onset of labour and postpartum haemorrhage (PPH), and to ascertain whether FXIII activity at labour onset differs from after delivery. METHODS:FXIII activity in 239 women with PPH (blood loss >1 L) and in 76 women without PPH was compared, as was activity before and after delivery in a third group of 80 women. RESULTS:FXIII activity at onset of labour was significantly lower in the PPH group compared with the control group (mean ± SD 0.98 ± 0.20 vs 1.05 ± 0.17 kIU/L; P=0.0006). The difference was significantly greater in subgroups having vaginal delivery with no oxytocin stimulation or uterine exploration (absolute difference 0.131; 95% CI 0.055 to 0.206), compared with a subgroup experiencing any complication (0.04; 95% CI -0.023 to 0.104; interaction P-value 0.098). There was a weak but statistically significant inverse correlation between FXIII and estimated blood loss (r=-0.25; P=0.030) in the control group but not the PPH group. There was no significant difference between FXIII activity at onset of labour and after delivery (mean ± SD 1.03 ± 0.17 vs 1.04 ± 0.19 kIU/L; P=0.093). CONCLUSIONS:At the onset of labour women with a subsequent PPH had significantly lower mean FXIII activity than that of women without PPH. This difference was small and within normal limits. FXIII activity did not change during normal delivery. The importance of FXIII during PPH requires study.

A. OLSSON,* R. LJUNG,† M. HELLGREN,‡ E. BERNTORP§ and F. BAGHAEI* *Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg; †Department of Paediatrics, Centre for Thrombosis and Haemostasis, Sk ane University Hospital, Lund University, Malm€ o; ‡Department of Obstetrics and Gynaecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg; and §Centre for Thrombosis and Haemostasis, Sk ane University Hospital, Lund University, Malm€ o, Sweden

BACKGROUND:Low plasma fibrinogen concentration has been linked to postpartum haemorrhage. The primary aim of this study was to assess whether fibrinogen concentration at admission before labour is associated with severe postpartum haemorrhage. Secondary aims were to describe fibrinogen concentration before and after labour and to identify predictors for severe postpartum haemorrhage.METHODS:1951 healthy women were included in a prospective observational study. Fibrinogen concentration was determined at admission to the labour ward and in a subgroup of women (n=80) also after the placenta was delivered. Bleeding volume postpartum was estimated by weighing surgical sponges and pads and by measuring collected blood. Predictors for severe postpartum haemorrhage (>1000 ml) were identified with bivariate and multivariate regression analyses.RESULTS:Mean fibrinogen concentration was 5.3 (SD 0.8) g litre(-) (1). Median estimated blood loss was 450 (range 70-4400) ml and 250 (12.8%) women bled >1000 ml. Fibrinogen concentration was not correlated with postpartum haemorrhage in the entire cohort (r(s)=0.003, P=0.90) or in any subgroup. Fibrinogen concentration was not associated with bleeding >1000 ml (odds ratio 1.01 (CI 95% 0.85-1.19), P=0.93) and did not differ significantly before and after delivery. Oxytocin stimulation, instrumental delivery, Caesarean section and exploration of uterus were identified as independent predictors of haemorrhage >1000 ml.CONCLUSIONS:Fibrinogen plasma concentration at admission before labour does not predict severe postpartum haemorrhage in a general obstetric population. Fibrinogen concentration does not decrease significantly during normal labour. Excessive postpartum bleeding is mainly as a result of obstetric complications.

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IntroductionCarriers of severe and moderate haemophilia A and B are expected to have approximately 50% of the normal level of factors VIII and IX. However, due to X chromosome inactivation in early embryonic life, factor levels can vary considerably. This can lead to increased bleeding tendency, which may in turn impact on health‐related quality of life (HRQOL).AimThe aim of this study was to assess HRQOL in carriers of severe and moderate haemophilia with and without increased bleeding tendency.MethodsOne hundred and twenty‐four adult carriers and 90 controls were recruited. Bleeding tendency was evaluated using a structured bleeding assessment tool. HRQOL was measured by the short form 36 (SF‐36) questionnaire. The SF‐36 scores were compared with Swedish normative age‐matched data and reported as Z scores.ResultsThere was no significant difference between the whole groups of carriers and controls in the Z scores of the eight SF‐36 domains. The mental component summary (MCS) was lower in carriers, compared with controls (P = 0.048). The subgroup of carriers with an increased bleeding tendency had significantly lower Z scores compared to controls regarding the General Health (P = 0.008), the Social Functioning (P = 0.040) and the Mental Health (P = 0.048) domains. The MCS was significantly lower in this carrier subgroup than in controls (P = 0.033).ConclusionWe conclude that the subgroup of carriers of haemophilia with increased bleeding tendency have impaired HRQOL. The SF‐36 results indicate that this condition affects mental rather than physical health.

HaemophiliaVolume 21, Issue 1 p. e111-e113 Letter to the Editor Bleeding phenotype in carriers of haemophilia A does not correlate with thrombin generation A. Olsson, Corresponding Author A. Olsson Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden Correspondence: Anna Olsson, MD, Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden. Tel: +46 31 3427342; fax: +46 31 820269; e-mail: anna.el.olsson@vgregion.seSearch for more papers by this authorM. Hellgren, M. Hellgren Department of Antenatal Care, Närhälsan Primary Care, Västra Götaland, Sweden Department of Obstetrics and Gynaecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this authorE. Berntorp, E. Berntorp Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, SwedenSearch for more papers by this authorM. Holmström, M. Holmström Coagulation Unit, Haematology Centre, Karolinska University Hospital, Stockholm, SwedenSearch for more papers by this authorF. Baghaei, F. Baghaei Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, SwedenSearch for more papers by this author A. Olsson, Corresponding Author A. Olsson Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden Correspondence: Anna Olsson, MD, Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden. Tel: +46 31 3427342; fax: +46 31 820269; e-mail: anna.el.olsson@vgregion.seSearch for more papers by this authorM. Hellgren, M. Hellgren Department of Antenatal Care, Närhälsan Primary Care, Västra Götaland, Sweden Department of Obstetrics and Gynaecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this authorE. Berntorp, E. Berntorp Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, SwedenSearch for more papers by this authorM. Holmström, M. Holmström Coagulation Unit, Haematology Centre, Karolinska University Hospital, Stockholm, SwedenSearch for more papers by this authorF. Baghaei, F. Baghaei Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, SwedenSearch for more papers by this author First published: 24 November 2014 https://doi.org/10.1111/hae.12585Citations: 11Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume21, Issue1January 2015Pages e111-e113 RelatedInformation