Objectively measured physical activity levels of young children with congenital heart disease.

UNLABELLED: Physical activity tends to be lower in school-age children with congenital heart disease than in healthy controls. To the best of our knowledge, objectively measured physical activity levels of preschool-age children with congenital heart disease have not been studied. METHODS: A total of 10 children with either coarctation of the aorta (n=6; age 3.8±0.9) or tetralogy of Fallot (n=4, age 4.3±0.9) were recruited from the cardiology unit of McMaster Children's Hospital. Height (103.7±8.2 cm) and weight (17.3±2.7 kg) measurements were recorded, and physical activity was determined using accelerometry over 7 consecutive days. Patients were compared with age-, sex-, and season of data acquisition-matched controls. Parents completed a questionnaire regarding the child's physical activity and sedentary behaviours. RESULTS: Patients spent on average 219.4±39.9 minutes engaged in total physical activity per day at the following intensities: light, 147.5±22.3; moderate, 44.0±11.8; moderate-to-vigorous, 71.9±22.6; and vigorous, 27.9±11.7. No significant differences were observed between patients and controls for total physical activity (p=0.80) or any of the intensities (p=0.71, 0.46, 0.43, and 0.45, respectively). Only 40% of patients and controls met the new Canadian Physical Activity Guidelines for the Early Years of at least 180 minutes of physical activity at any intensity every day. Of the patients' parents, 90% believed that their child was as active, if not more active, than his/her siblings, and 80% of parents reported their child spending 1-3 hours in screen time activities daily. CONCLUSION: Children aged 3-5 years old with congenital heart disease have comparable physical activity levels to age-, sex-, and season-matched controls, and many do not meet Canadian Physical Activity Guidelines.

Adolescents with anxiety and depression: is social recovery relevant?

UNLABELLED: Social recovery has become a prominent aspect of mental health service design and delivery in the past decade. Much of the literature on social recovery is derived from first-person accounts or primary research with adult service users experiencing severe mental illness. There is a lack of both theoretical and empirical work that could inform consideration of how the concept of social recovery might apply to adolescents experiencing common (non-psychotic) mental health problems such as anxiety and depression. The current study was conducted to understand the process of experiencing anxiety and depression in young people. Semi-structured interviews were conducted with nine adolescents with anxiety and depression (seven girls and two boys aged 14-16 years) and 12 mothers who were recruited from a specialist Child and Adolescent Mental Health Service in the South of England. Thematic analysis indicated that young people do experience a process of 'recovery'; the processes participants described have some congruence with the earlier stages of adult recovery models involving biographical disruption and the development of new meanings, in this case of anxiety or depression, and changes in sense of identity. The accounts diverge with regard to later stages of adult models involving the development of hope and responsibility. The findings suggest that services should attend to social isolation and emphasise support for positive aspirations for future selves whilst also attending to young people's and parents' expectations about change. Methodological challenges face enquiry about 'recovery' given its connotations with cure in everyday language. KEY PRACTITIONER MESSAGE: Theoretical and empirical work on social recovery in young people and families is lacking. Using interviews, this study sought to understand the relevance of social recovery for adolescents with anxiety and depression and their mothers. Findings suggest some congruence with the earlier stages of adult recovery models involving meaning and identity. Findings diverge with regard to later stages of adult recovery models involving hope and responsibility. Social recovery in mental health services for young people needs significant empirical attention and critical debate.

The Recovery College: A unique service approach and qualitative evaluation.

OBJECTIVE: This study examined the impact of a Recovery College, an educational service model focusing specifically on health care to engage people's hope, agency, and opportunities for recovery. METHOD: For the purpose of the study, a qualitative approach was used given the absence of research in this area. Eleven people completed semistructured interviews conducted by an independent researcher. Verbatim transcripts were analyzed using thematic analysis. RESULTS: The analyses yielded themes emphasizing the impact of the organizational structure of the college. Coproduction of service delivery was contrasted with traditional provision and identified as fundamental to personal and professional changes made. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Recovery College participants described clear gains. These findings are discussed in relation to the recovery literature and highlight the need for routine coproduction of services to facilitate recovery from the often devastating impact of mental ill-health. (PsycINFO Database Record

Vascular and autonomic function in preschool-aged children with congenital heart disease.

OBJECTIVE: To compare indices of vascular health and heart rate variability in preschool-aged children with repaired congenital heart disease (CHD) including tetralogy of Fallot (n = 6) and coarctation of the aorta (n = 6). DESIGN: A cross-sectional study design was used. All measures were noninvasive and collected over a single testing session under the supervision of a parent/guardian. SETTING: Data collection took place in a quiet, temperature-controlled room (23°± 1°C) with the participant in a supine position. PATIENTS: Twelve (six females, six males) preschool-aged children with repaired CHD (CHD: 4 ± 1 years) and 12 age- and gender-matched healthy controls (CON: 5 ± 1 years) participated in the study. OUTCOME MEASURES: Supine, resting measures of heart rate variability (time, frequency, and nonlinear domains), whole-body pulse wave velocity (ventricular depolarization to dorsalis pedis artery), brachial blood pressures, and carotid artery distensibility, lumen diameter, intima-media thickness, and wall/lumen ratio were collected in both groups. RESULTS: The groups were similar in age, height, and weight; however, CON had significantly higher body mass index values (CON: 16.9 ± 2.2, CHD: 15.1 ± 1.0, P < .05) and body mass index percentiles (CON: 69 ± 27%tile, CHD: 36 ± 24%tile, P < .01) compared to CHD. No group differences were found for resting brachial blood pressures, whole-body pulse wave velocity, heart rate variability, and carotid artery distensibility, lumen diameter, and intima-media thickness (P > .05). Carotid artery pulse pressures (CHD: 38 ± 6 mm Hg, CON: 31 ± 6 mm Hg, P < .05) and wall/lumen ratios (CHD: 0.091 ± 0.007, CON: 0.085 ± 0.006, P < .01) were significantly higher in the CHD group. CONCLUSIONS: These results may indicate that preschool-aged children with repaired CHD display early signs of vascular remodeling, but not autonomic or vascular dysfunction. The effects of larger wall/lumen ratios on cardiovascular disease risk require further investigation.