Compensatory changes in physical activity and sedentary time in children and adolescents with cystic fibrosis

Physical activity (PA) is a key element in Cystic Fibrosis (CF) treatment strategies, yet little is known as to whether activity compensation occurs. This study examined whether PA and/or sedentary time on one day were temporally associated with time spent in these intensities the following day in youth with CF. Time spent sedentary and in different PA intensities were objectively-measured for seven consecutive days in 50 youth (22 boys; 12.0 ± 2.7 years); 25 with mild-to-moderate CF and 25 age- and sex-matched controls. Multilevel analyses (day and child) were conducted using generalised linear latent and mixed models. On any given day, every additional 10 minutes spent in sedentary time or moderate-to-vigorous physical activity (MVPA) were associated with 1.9 (95%CI: ?3.6 to ?1.2) and 12.4 (95%CI: ?22.1 to ?2.9) minutes less sedentary time the following day, respectively. These temporal associations were also observed when split by group (3.1 vs. 1.9 minutes for healthy and CF, respectively). These findings indicate that youth do not compensate their PA, irrespective of disease status, between days, but may compensate their sedentary time between days. Experimental studies are warranted to fully elucidate whether compensatory responses to PA and sedentary time occur, which is fundamental for informing PA promotion strategies.     

混合式教学在儿科护理教学中的应用初探

目的:探讨混合式教学模式在儿科护理学教学中的应用效果。方法:抽取我校2017级护理(1)班47名护生为观察组,2017级护理(2)班48名护生为对照组。选取呼吸系统疾病患儿的护理这个单元作为教学实践内容,观察组护生采用混合式教学模式,对照组护生采用传统教学模式。课程结束后比较两组护生该单元的理论成绩和操作成绩。结果:观察组护生的理论成绩、操作成绩均高于对照组(P<0.05)。结论:混合式教学模式更有利于激发学生的学习热情,提高教学效果。     

Seasonal variation in physical activity and sedentary time in different European regions. The HELENA study

Abstract

This report aims (1) to examine the association between seasonality and physical activity (PA) and sedentary time in European adolescents and (2) to investigate whether this association was influenced by geographical location (Central-North versus South of Europe), which implies more or less extreme weather and daylight hours. Valid data on PA, sedentary time and seasonality were obtained in 2173 adolescents (1175 females; 12.5–17.5 years) included in this study. Physical activity and sedentary time were measured by accelerometers. ANCOVA was conducted to analyse the differences in PA and sedentary time across seasons. Results showed that girls had lower levels of moderate to vigorous PA (MVPA) and average PA, and spent more time in sedentary activities in winter compared with spring (all P < 0.05). Stratified analyses showed differences in PA and sedentary time between winter and spring in European girls from Central-North of Europe (P < 0.05 for sedentary time). There were no differences between PA and sedentary time across seasonality in boys. In conclusion, winter is related with less time spent in MVPA, lower average PA and higher time spent in sedentary activities in European adolescent girls, compared with spring. These differences seem to mainly occur in Central-North Europe.     

Education for children with a chronic health condition: an evidence‐informed approach to policy and practice decision making

Children managing chronic health conditions face many obstacles which can impede their learning during periods of hospitalisation. In one particular hospital, a team of educators deemed it necessary to take a personalised learning approach in order to maintain students’ educational progress, namely making use of individual learning plans (ILPs). This team adopted an evidence‐informed practice (EIP) approach to the issue in order to persuade administrators of the need for change. The successful implementation of the EIP approach led to the inclusion of the ILP form in patients’ medical records, which is thought to be a first for Australia. Although EIP is regarded highly by practitioners and policy makers, there can be difficulties when implementing this approach. This study aims to identify the enabling features that permit EIP to be successfully implemented and to examine the ways in which EIP can lead to improved practice.     

Pediatric Obesity and Perceived Exertion: Difference Between Weight-Bearing and Non-Weight-Bearing Exercises Performed at Different Intensities

Excess body weight composes an important limitation to exercise in obese youth. The aim of this study was to compare the perceived exertion of obese adolescents between weight-bearing (WB; running) and non-weight-Bearing (NWB; cycling) exercises performed at moderate (55%VO_2max) and high (75%VO_2max) intensities. Twenty-four obese adolescents were recruited. After assessment of their body composition and physical capacities, they had to complete four isoenergetic exercise sessions: (1) a cycling session performed at 55% of their maximal capacities (NWB-55%); (2) a cycling session set at 75% (NWB-75%); (3) a running session at 55% (WB-55%); and (4) a running session at 75% (WB-75%). Perceived exertion was assessed using a visual scale at regular interval. While no significant difference between WB and NWB modalities was observed, the adolescents expressed a significantly lower rate of perceived exertion (RPE) during exercises at 55%VO_2max (P < 0.0001). An intensity × modality interaction revealed that RPE was lower at 75% VO_2max during NWB exercises (P < 0.05). While obese adolescents expressed lower RPE during exercise at moderate intensity whatever its modality, low level of perceived exertion has been observed during high-intensity exercises and especially during NWB. High-intensity exercise appears well tolerated in adolescents when their body weight is supported.     

Evaluation of body composition with bioimpedence. A comparison between athletic and non-athletic children

Purpose: Conventional Bioelectrical Impedance Analysis (BIA) or Bioelectrical Impedance Vector Analysis (BIVA) can provide direct evaluations of body composition. The purpose of this study was to evaluate lean and fat mass (FM), and hydration of children involved in daily competitive sports. Methods: 190 non-athletic [8.2–10.5 years] and 29 competitive children [8.0–10.5 years] were enrolled. They were evaluated: at baseline (t0), 6 months (t1) and one year (t2). Anthropometric, BIA and BIVA, lean and FM, and hydration evaluations were performed. Results: Resistance (R/h) and reactance (Xc/h) were lower at t0 in competitive individuals when compared to controls. Xc/h (+3.28) significantly increases in competitive when compared to non-competitive individuals (+0.66, p for difference: 0.011), while phase angle (PA) was lower at t0 (5.72 vs. 6.17, p?<?.001) and after 6 months (p?=?.001). Total body water adjusted for height (TBW/h) significantly increased only in non-athletes (+0.50?±?0.13, p?<?.001) between t0 and t1. At t1, extracellular water (ECW) significantly decreased (p?=?.026) in the two groups: ?0.45?±?0.19% in non-competitive, ?1.63?±?0.49% in competitive subjects, while intracellular water (ICW) increased. At one-year follow-up (t2), there were no statistically significant differences in R/h, Xc/h and PA in competitive individuals when compared to baseline and t1. Furthermore, we observed at t2 that hours/week of training, age, male gender and body mass index can influence FFM/h and FM/h in both competitive and non-competitive subjects. In particular, a direct correlation was for hours/week and FFM/h, inverse for hours/week and FM/h. Conclusions: Body mass index does not allow evaluating differences in lean body mass and FM between athletes and non-athletes. BIA and BIVA can give more reliable details about body composition differences in competitive adolescents and non-competitive, outlining a progressive decline in ECW and increase in ICW without affecting TBW composition of athletes.     

The effectiveness of a high-intensity games intervention on improving indices of health in young children

This study assessed the effectiveness of a 6-week, high-intensity, games-based intervention on physiological and anthropometric indices of health, in normal weight (n = 26; 32.5 ± 8.9 kg) and obese (n = 29; 49.3 ± 8.9 kg) children (n = 32 boys, 23 girls), aged 8–10 years. Children were randomised into an exercise or control group. The exercise group participated in a twice-weekly, 40 min active games intervention, alongside their usual school physical education classes. The control group did not take part in the intervention. Before and after the intervention, participants completed both a maximal and submaximal graded exercise test. The submaximal exercise test comprised of a 6 min, moderate- and 6 min heavy-intensity bout, interspersed with a 5 min recovery. The exercise group demonstrated improvements in maximal oxygen uptake (51.4 ± 8.5 vs 54.3 ± 9.6 ml · kg^?1 · min^?1) and peak running speed (11.3 ± 1.6 vs 11.9 ± 1.6 km · h^?1), and a reduction in the oxygen cost of submaximal exercise between assessments (P < .05). A decrease in waist circumference and increase in muscle mass were observed between assessments for the obese participants randomised to the intervention (both P < .05). This study demonstrates that a short-term, high-intensity games intervention may elicit positive changes in physiological and anthropometric indices of health in normal weight and obese children.     

Head and neck size and neck strength predict linear and rotational acceleration during purposeful soccer heading

There is increasing societal concern about the long-term effects of repeated impacts from soccer heading, but there is little information about ways to reduce head impact severity. The purpose of this study was to identify factors that contribute to head acceleration during soccer heading. One-hundred soccer players completed 12 controlled soccer headers. Peak linear (PLA) and rotational (PRA) accelerations were measured using a triaxial accelerometer and gyroscope. Head acceleration contributing factors were grouped into 3 categories: size (head mass, neck girth), strength (sternocleidomastoid, upper trapezius) and technique [kinematics (trunk, head-to-trunk range-of-motion), sternocleidomastoid and upper trapezius activity]. Multiple regression analyses indicated size variables explained 22.1% of the variance in PLA and 23.3% of the variance in PRA; strength variables explained 13.3% of the variance in PLA and 17.2% of the variance in PRA; technique variables did not significantly predict PLA or PRA. These findings suggest that head and neck size and neck strength predict PLA and PRA. Anthropometric and neck strength measurements should be considered when determining an athlete’s readiness to begin soccer heading.     

Lipoproteins and cholesterol homeostasis in paediatric nephrotic syndrome patients

IntroductionThe aim of this study was to investigate lipoprotein particle distributions and the likelihood of achieving cholesterol homeostasis in the remission phase of nephrotic syndrome (NS) in paediatric patients. We hypothesized that lipoprotein particle distributions moved toward less atherogenic profile and that cholesterol homeostasis was achieved.Materials and methodsThirty-three children, 2 to 9 years old with NS were recruited. Blood sampling took place both in the acute phase and during remission. Serum low-density lipoprotein particles (LDL) and high-density lipoprotein particles (HDL) were separated using non-denaturing polyacrylamide gradient gel (3-31%) electrophoresis. Serum non-cholesterols sterols (NCSs), desmosterol, lathosterol, 7-dehydrocholesterol (7-DHC), campesterol and β-sitosterol were measured by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS).ResultsAll patients had desirable serum HDL cholesterol concentrations during remission. The dominant lipoprotein diameters and LDL subclass distribution did not change significantly during follow-up. In contrast, HDL lipoprotein particle distribution shifted towards larger particles. The absolute concentration of desmosterol was significantly lower during remission (P = 0.023). β-sitosterol concentration markedly increased during remission (P = 0.005). Desmosterol/β-sitosterol (P < 0.001) and 7-DHC/β-sitosterol (P = 0.005) ratios significantly declined during disease remission.ConclusionsFavourable changes in the serum lipid profiles, HDL particle subclass distribution and cholesterol metabolism in paediatric patients with NS during remission took place. For the first time, we found that cholesterol homeostasis changed in favour of increased cholesterol absorption during disease remission. Nevertheless, complete cholesterol homeostasis was not achieved during disease remission.     

Evaluation and management of leukolysis-mediated pseudohyperkalemia in paediatric leukemic samples

IntroductionLeukolysis-related pseudohyperkalemia due to preanalytical procedures may lead to erroneous (or absence of) treatment based on an invalid lab test result. We aimed to obtain a leukocyte threshold above which leukolysis-related pseudohyperkalemia becomes clinical relevant. Secondly, temporal dynamics of treatment-induced leukocyte decrease were studied to allow tailored implementation of laboratory information system (LIS) decision rules based on the leukocyte threshold to avoid leukolysis-related pseudohyperkalemia.Materials and methodsPotassium results of AU5811 routine chemistry (Beckman Coulter, Brea, California, USA) and iStat point of care (POC) (Abbott Diagnostics, Chicago, Illinois, USA) analysers were compared, the latter method being insensitive to leukolysis caused by pre-analytical procedures. Potassium results were combined with leukocyte counts obtained using a Cell-Dyn Sapphire haematology analyser (Abbott Diagnostics, Santa Clara, California, USA), resulting in 132 unique data triplets. Regression analysis was performed to establish a leukocyte threshold. The Reference Change Value (√2 x Z x √(CV_a² + CV_i²)) was used to calculate maximum allowable difference between routine analyser and POC potassium results (delta_max + 0.58 mmol/L). Temporal analysis on the treatment-induced leukocyte decrease was performed by plotting leukocyte counts in time for all patients above the threshold leukocyte count (N = 41).ResultsEstablished leukocyte threshold was 63 x10⁹/L. Temporal analysis showed leukocyte counts below the threshold within 8 days of treatment for all patients.ConclusionsBased on performed analyses we were able to implement LIS decision rules to reduce pseudohyperkalemia due to preanalytical procedures. This implementation can contribute to a reduction in erroneous (or absence of) treatments in the clinic.