The impact of COVID-19 on mental health and well-being in critical care nurses - a longitudinal, qualitative study.

BACKGROUND: The COVID-19 pandemic has had both a psychological and physiological effect on the human race. For those working in health care, particularly in critical care, the pandemic has put unprecedented strain on staff. Witnessing suffering during crisis in an organizational setting can be a traumatic experience and critical care nurses often risked, not only their own lives, but their psychological well-being, so that those infected with the virus might have a better chance at survival. AIM: The aim of this study was to explore the challenges to mental health and psychological well-being experienced by Critical Care Nurses during the COVID-19 pandemic. STUDY DESIGN: A longitudinal, qualitative study involving semi-structured interviews with 54 critical care nurses across 38 hospitals in the United Kingdom and Ireland. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Four key themes were identified which represent the challenges faces by critical care nurses during the COVID-19 pandemic: Lack of control, Psychological trauma, Unexpected leadership, Public-political betrayal. CONCLUSIONS: While public-political praise may lead to a short-term lift in morale for front line workers; where it is not accompanied by practical support in terms of appropriate equipment, leadership, emotional support and renumeration it is likely to be damaging in the longer term. RELEVANCE TO CLINICAL PRACTICE: This study has provided a greater understanding of the factors which affected the well-being and mental health of critical care nurses during a global pandemic.

Benefits for African American and white low-income 7-10-year-old children and their parents taught together in a community-based weight management program in the rural southeastern United States.

BACKGROUND: Low-income children and parents are at increased risk for developing overweight and obesity. Therefore, the purpose of this exploratory study was to compare whether African American and white children and parents benefitted equally from a community-based weight management intervention delivered in two rural counties in southeastern North Carolina (N.C.). METHODS: We compared the efficacy of the Family Partners for Health intervention for African American and white children and their parents by testing the three-way interaction of the intervention group according to visit and race. RESULTS: African American children in the intervention group weighed significantly (P = 0.027) less than those in the control group, while white children in the intervention group weighed less than those in the control group, but the difference did not reach statistical significance. African American and white parents in the intervention group weighed less than their respective control groups across all three data collections, but the difference was only significant in the group of white parents (P = 0.010) at the completion of the study. At the completion of the study, African American children in the intervention group received significantly (P = 0.003) more support for physical activity than African American children in the control group. At both time points, white children in the intervention group were not significantly different from those in the control group. African American parents in the intervention group scored slightly worse in the stress management assessment compared to those in the control group, while white parents in the intervention group showed a significantly (P = 0.041) better level of stress management than those in the control group. At the completion of the study, African American parents in the intervention group scored somewhat worse in emotional eating self-efficacy compared to the scores of the African American parents in the control group, while white parents in the intervention group scored significantly (P < 0.001) better than those in the control group. CONCLUSIONS: We were successful in affecting some outcomes in both African American and white children and parents using the same intervention. TRIAL REGISTRATION: NCT01378806 Registered June 22, 2011.

Ventilatory Responses During Submaximal Exercise in Children With Prader-Willi Syndrome.

PURPOSE: Prader-Willi syndrome (PWS) is a genetic neurobehavioral disorder presenting hypothalamic dysfunction and adiposity. At rest, PWS exhibits hypoventilation with hypercapnia. We characterized ventilatory responses in children with PWS during exercise. METHODS: Participants were children aged 7-12 years with PWS (n = 8) and without PWS with normal weight (NW; n = 9, body mass index ≤ 85th percentile) or obesity (n = 9, body mass index ≥ 95th percentile). Participants completed three 5-minute ambulatory bouts at 3.2, 4.0, and 4.8 km/h. Oxygen uptake, carbon dioxide output, ventilation, breathing frequency, and tidal volume were recorded. RESULTS: PWS had slightly higher oxygen uptake (L/min) at 3.2 km/h [0.65 (0.46-1.01) vs 0.49 (0.34-0.83)] and at 4.8 km/h [0.89 (0.62-1.20) vs 0.63 (0.45-0.97)] than NW. PWS had higher ventilation (L/min) at 3.2 km/h [16.2 (13.0-26.5) vs 11.5 (8.4-17.5)], at 4.0 km/h [16.4 (13.9-27.9) vs 12.7 (10.3-19.5)], and at 4.8 km/h [19.7 (17.4-31.8) vs 15.2 (9.5-21.6)] than NW. PWS had greater breathing frequency (breaths/min) at 3.2 km/h [38 (29-53) vs 29 (22-35)], at 4.0 km/h [39 (29-58) vs 29 (23-39)], and at 4.8 km/h [39 (33-58) vs 32 (23-42)], but similar tidal volume and ventilation/carbon dioxide output to NW. CONCLUSION: PWS did not show impaired ventilatory responses to exercise. Hyperventilation in PWS may relate to excessive neural stimulation and metabolic cost.

Energy Cost Expression for a Youth Compendium of Physical Activities: Rationale for Using Age Groups.

PURPOSE: This study compared the accuracy of physical activity energy expenditure (PAEE) prediction using 2 methods of accounting for age dependency versus 1 standard (single) value across all ages. METHODS: PAEE estimates were derived by pooling data from 5 studies. Participants, 6-18 years (n = 929), engaged in 14 activities while in a room calorimeter or wearing a portable metabolic analyzer. Linear regression was used to estimate the measurement error in PAEE (expressed as youth metabolic equivalent) associated with using age groups (6-9, 10-12, 13-15, and 16-18 y) and age-in-years [each year of chronological age (eg, 12 = 12.0-12.99 y)] versus the standard (a single value across all ages). RESULTS: Age groups and age-in-years showed similar error, and both showed less error than the standard method for cycling, skilled, and moderate- to vigorous-intensity activities. For sedentary and light activities, the standard had similar error to the other 2 methods. Mean values for root mean square error ranged from 0.2 to 1.7 youth metabolic equivalent across all activities. Error reduction ranged from -0.2% to 21.7% for age groups and -0.23% to 18.2% for age-in-years compared with the standard. CONCLUSIONS: Accounting for age showed lower errors than a standard (single) value; using an age-dependent model in the Youth Compendium is recommended.

The influence of physical characteristics on the resting energy expenditure of youth: A meta-analysis.

OBJECTIVE: To examine the literature on resting energy expenditure (REE) of youth and determine the influence of age, sex, BMI, and body composition on REE. METHODS: A literature search was conducted using PubMed, BIOSIS Previews, NTIS, EMBASE, MEDLINE, and Pascal databases for studies with data on resting metabolic rate, REE, resting oxygen uptake (or VO2 ) in healthy children, youth, or adolescents (age = 1-18 years). Over 200 publications were identified; sixty-one publications met criteria and were included in the meta-analyses, resulting in 142 study population estimates (totaling 5,397 youth) of REE. RESULTS: Pooled mean was 1414 kcal·day-1 with a significant and moderate-to-high between-study heterogeneity [Q(140) = 7912.42, P < 0.001; I2 = 98.97%]. A significantly greater (P < 0.001) pooled mean kcal·day-1 was estimated for studies with male participants (1519 kcal·day-1 ) comparing to studies with female participants (1338 kcal·day-1 ). Age, height, and body mass resulted in the highest R2 of 86.4 for males and 83.9% for females. Fat free mass and body mass index (BMI) did not improve total R2 . CONCLUSIONS: These data suggest that using a linear equation including age, height, and body mass to estimate REE based on kcal·day-1 is more accurate than estimates based on body mass kcal·kg-1 ·h-1 . Further, if kcal·kg-1 ·h-1 is used, including a quadratic component for the physical characteristics improves the predictive ability of the equation. Regardless of the metric, separate equations should be used for each sex.

Relationships of physical activity and sedentary time in obese parent-child dyads: a cross-sectional study.

BACKGROUND: Research suggests physical activity is linked to obesity. Further, the physical activity of healthy parents and their children is associated with each other. However, this relationship has not been examined in obese parents and their obese children. METHODS: The purpose of this study was to compare the physical activity and sedentary time of obese, low-income, ethnic minority parents and their children on weekdays and weekend days using accelerometry. Data were obtained from eight rural sites in the middle and eastern part of North Carolina (N.C.), United States (U.S.) from 2007-2010 using a rolling enrollment. One hundred and ninety-nine obese parents (94 % female) and their obese children (54 % female) wore accelerometers simultaneously for three weekdays and one weekend day. Total physical activity, moderate-to-vigorous physical activity (MVPA) and sedentary time and proportions were determined. RESULTS: Parents' and children's total physical activity and MVPA levels were lower on weekend days than weekdays. Total counts per minute for children on weekdays and weekend days were greater than for parents (p < 0.001). Total counts per minute were more highly correlated on weekend days than weekdays (r = 0.352, p < 0.0002 versus r = 0.165, p < 0.025). Parents' performed MVPA for 14 (SD = ±25) and 9 (SD = ±16) minutes/day on weekdays and weekend days, respectively; children performed MVPA for 37 (SD = ±25) and 31(SD = ±38) minutes/day for weekdays and weekend days, respectively. Correlations between parents and children for MVPA were higher on weekend days versus weekdays (r = 0.253 and 0.177, respectively; p < 0.015). Associations for sedentary time followed a similar trend, with r = 0.33 (p < 0.0002) for weekend days and r = 0.016 (p < 0.026) for weekdays. Associations between obese parent-child dyads on sedentary time were stronger for girls, while associations between dyads on MVPA were stronger for boys. However, formal interaction analyses were not significant (p > 0.13). DISCUSSION: Since physical activity levels of obese parents and their obese child are somewhat related, especially on weekend days, combined parent-child obesity programs focused on reducing sedentary time could be beneficial, particularly for the child. CONCLUSION: In conclusion, this study of the physical activity levels of obese parents and their obese children found some relationships between the parents' and children's physical activity and sedentary behavior patterns, especially on weekend days. TRIAL REGISTRATION: NCT01378806 .

Insights into physical activity and cardiovascular disease risk in young children: IDEFICS study.

The association between physical activity and cardiovascular disease risk factors in children has been the focus of research for over two decades. The majority of this research has focused on children over 10 years of age with little information on very young children. The data recently published in BMC Medicine by Jiménez-Pavón and colleagues suggest that adverse cardiovascular disease (CVD) risk profiles, as indicated by a clustered risk score for the metabolic syndrome, are evident in very young children (two to six years of age), but differ between the sexes. The authors evaluated the relationship of CVD risk profiles and protective levels of moderate-to-vigorous physical activity (MVPA) and concluded that boys aged six years or younger needed >60 minutes of MVPA per day, whereas boys from six to nine years of age needed >80 minutes of MVPA per day; girls in either age group needed approximately 15 minutes less. Therefore, when clinicians recommend physical activity for children they should evaluate "at risk" children on a case-by-case basis rather than using generalized guidelines.

Tracking of clustered cardiovascular disease risk factors from childhood to adolescence.

BACKGROUND: Clustering of cardiovascular disease (CVD) risk factors has been found in children as young as 9 y of age. However, the stability of this clustering over the course of childhood has yet to be determined. The purpose of this study was to determine the tracking of clustered CVD risk from young school age through adolescence and to examine differences in tracking between levels of overweight/obesity and cardiorespiratory fitness (VO(2peak)). METHODS: Beginning at 6 y, children (n = 434) were measured three times in 7 y. Anthropometrics, blood pressure, and VO(2peak) were measured. Fasting blood samples were analyzed for CVD risk factors. A clustered risk score (z-score) was constructed by adding sex-specific z-scores for blood pressure, homeostatic model assessment (HOMA-IR), triglyceride (TG), skinfolds, and negative values of high-density lipoprotein cholesterol (HDLc) and VO(2peak). RESULTS: Significant tracking coefficients were found between clustered z-score at all time intervals (r = 0.514, 0.559, and 0.381 between ages 6-9, 9-13, and 6-13 y, respectively, all P < 0.0001). Tracking was higher for low-fit children, whereas no clear pattern was found for different levels of body fat. CONCLUSION: We found that clustered z-score is a fairly stable characteristic through childhood. Implementation of preventive strategies could therefore start at early school age.

Assessment of the tracer delay effect in whole-brain computed tomography perfusion: results in patients without known neuroanatomic abnormalities.

OBJECTIVE: Whole-brain computed tomography perfusion (CTP) data sets generated by tracer delay-insensitive singular value decomposition plus (SVD+) and standard singular value decomposition (sSVD) deconvolution algorithms were evaluated to quantify relatedness and discrepancies in CTP results. METHODS: Twenty females with symmetrical hemispheric CTP maps indicative of brain tissue without apparent abnormalities were studied. Tissue-specific CTP values were analyzed. RESULTS: Standard SVD values were higher than SVD+ for cerebral blood flow. Other CTP values had minimal differences across brain regions. All simple linear regression models were statistically significant (P < 0.05) except for cerebral blood flow in white matter (P = 0.06). Cerebral blood volume had a good model fit, and mean transit time, a poor fit. CONCLUSIONS: Corresponding fitted CTP values for sSVD and SVD+ based on regression equations for brain-tissue types are presented. Additional research is required to compare SVD+ and sSVD in disease states when significant hemodynamic brain alterations are present.

Scaling of VO2max and its relationship with insulin resistance in children.

The relationship between insulin resistance (HOMA-IR), percent body fat, and aerobic fitness (VO2max per unit fat free mass; mL/kgFFM/min) was examined in 1,710 children. Percent body fat was estimated from sum of skinfolds, and VO2max was estimated from submaximal cycle ergometer tests. Overnight fasting blood samples were obtained. VO2max (mL/kgFFM/min) and percent body fat were correlated with HOMA-IR (r = -0.076, p < .002; r = .420, p < .001, respectively); as was VO2max in units of mL/kg/min (r = -0.264, p < .001). When VO2max in mL/kg/min was used, a progressive increase in HOMA-IR was found with decreasing fitness (p < .05). However, when mL/kgFFM/min was used, HOMA-IR scores remained similar between moderate-fit and low-fit group. The stronger association between aerobic fitness (mL/kg/min) and HOMA-IR is partially due to the significant association of fat mass to HOMA-IR. Therefore, our recommendation is to express aerobic fitness in units of mL/kgFFM/min to eliminate the confounding factor of adiposity and better understand the influence of muscle on insulin resistance.