Physical Activity Participation among Children and Youth with Mental Health Symptoms: Clinician Perspectives.

BACKGROUND/OBJECTIVES: Physical activity supports mental health and well-being in children and youth. However, there are significant barriers to physical activity participation among individuals impacted by mental health disorders. This study investigates these barriers through the perspective of mental health clinicians who support children and youth. METHODS: Fourteen mental health clinicians, including registered professional psychologists, psychotherapists, and social workers, were interviewed in a semi-structured format. Qualitative content analysis was performed to identify key themes, including both barriers and facilitators to physical activity. RESULTS: Content analysis revealed that clinicians perceive both internal and external barriers and facilitators to their clients' participation in physical activity. Barriers included intrapersonal factors, such as the presence of depression, anxiety, or eating disorder symptoms; lack of motivation; and negative self-talk, as well as factors related to the influence of caregivers, financial limitations, screen time use, environmental and cultural factors, and lack of time. Facilitators included enjoyment of physical activity, knowledge about the benefits of physical activity, and caregiver participation. CONCLUSIONS: Mental health clinicians demonstrated clear knowledge about the barriers to and facilitators of their clients' participation in physical activity. These findings provide valuable insights that can be used to support children and youth experiencing mental health difficulty to access the beneficial effects of physical activity.

Impact of COVID-19 on Physical Activity in Families Managing ADHD and the Cyclical Effect on Worsening Mental Health.

Physical activity supports symptom management in children with ADHD and reduces the mental health burden associated with caregiving for children with ADHD. Survey-based research shows that COVID-19 reduced physical activity among diverse populations. This study used a qualitative approach situated within a socioecological framework to (1) understand how COVID-19 impacted physical activity of children with ADHD and their caregivers, to (2) identify barriers to their physical activity, and to (3) identify potential areas of support. Thirty-three participants were interviewed between October 2020 and January 2021. Content analysis revealed that physical activity declined for children and caregivers; significant barriers were social isolation and rising intrapersonal difficulties such as diminishing self-efficacy and energy levels and increased mental health difficulties. Worsening mental health further alienated caregivers and children from physical activity, undermining its protective effects on ADHD symptom management and mental wellbeing. Participants identified needing community support programs that offer virtual, live physical activity classes as well as psycho-emotional support groups. There is vital need to support physical activity opportunities during high-stress situations in families managing ADHD to buffer against diminishing mental wellbeing. This will promote further physical activity engagement and allow families to reap the cognitive, psychological, and emotional benefits.

Greater amount of visual feedback decreases force variability by reducing force oscillations from 0-1 and 3-7 Hz.

The purpose was to determine the relation between visual feedback gain and variability in force and whether visual gain-induced changes in force variability were associated with frequency-specific force oscillations and changes in the neural activation of the agonist muscle. Fourteen young adults (19-29 years) were instructed to accurately match the target force at 2 and 10% of their maximal voluntary contraction with abduction of the index finger. Force was maintained at specific visual feedback gain levels that varied across trials. Each trial lasted 20 s and the amount of visual feedback was varied by changing the visual gain from 0.5 to 1,474 pixels/N (13 levels; equals approximately 0.001-4.57 degrees ). Force variability was quantified as the standard deviation of the detrended force data. The neural activation of the first dorsal interosseus (FDI) was measured with surface electromyography. The mean force did not vary significantly with the amount of visual feedback. In contrast, force variability decreased from low gains compared to moderate gains (0.5-4 pixels/N: 0.09 +/- 0.04 vs. 64-1,424 pixels/N: 0.06 +/- 0.02 N). The decrease in variability was predicted by a decrease in the power of force oscillations from 0-1 Hz (approximately 50%) and 3-7 Hz (approximately 20%). The activity of the FDI muscle did not vary across the visual feedback gains. These findings demonstrate that in young adults force variability can be decreased with increased visual feedback gain (>64 pixels/N vs. 0.5-4 pixels/N) due to a decrease in the power of oscillations in the force from 0-1 and 3-7 Hz.

Acute agitated delirious state associated with Taser exposure.

BACKGROUND: The use of the Taser (Taser International, Scottsdale, Arizona) as a form of nonlethal force is increasingly common because of its safety profile. Tasers have been associated with in-custody mortality particularly in agitated individuals, though potential explanatory mechanisms are poorly understood. While Tasers are often used to subdue acutely agitated individuals, no study has reported Taser exposure precipitating agitation or delirium, even though high-voltage electrical exposure is well documented independently to precipitate acute delirium. OBJECTIVES: We present a case of an acute agitated or delirious state occurring post-Taser exposure in a resting, otherwise nonagitated individual. CASE REPORT: The patient was a 37-year-old African American male with no prior psychiatric history, tasered multiple times during an arrest episode. He became delirious and agitated while in the emergency department, requiring sedation and intubation, followed by 3 days of continued refractory delirium. Toxicology screening demonstrated therapeutic doses of methadone and trace amounts of marijuana, not thought to be associated with the acute onset of the patient's agitated or delirious state. Imaging, neurological, and psychiatric assessments were similarly not contributory. CONCLUSION: The occurrence of acute agitation and delirium in this patient without any prior psychiatric history or significant substance use suggests an association with Taser exposure. This case report is thought to be the first report demonstrating a temporal association between Taser exposure and an acute or delirious state. Further studies to explore the association between Taser exposure and acute agitation are needed.

Removal of visual feedback alters muscle activity and reduces force variability during constant isometric contractions.

The purpose of this study was to compare force accuracy, force variability and muscle activity during constant isometric contractions at different force levels with and without visual feedback and at different feedback gains. In experiment 1, subjects were instructed to accurately match the target force at 2, 15, 30, 50, and 70% of their maximal isometric force with abduction of the index finger and maintain their force even in the absence of visual feedback. Each trial lasted 22 s and visual feedback was removed from 8-12 to 16-20 s. Each subject performed 6 trials at each target force, half with visual gain of 51.2 pixels/N and the rest with a visual gain of 12.8 pixels/N. Force error was calculated as the root mean square error of the force trace from the target line. Force variability was quantified as the standard deviation and coefficient of variation (CVF) of the force trace. The EMG activity of the agonist (first dorsal interosseus; FDI) was measured with bipolar surface electrodes placed distal to the innervation zone. Independent of visual gain and force level, subjects exhibited lower force error with the visual feedback condition (2.53 +/- 2.95 vs. 2.71 +/- 2.97 N; P < 0.01); whereas, force variability was lower when visual feedback was removed (CVF: 4.06 +/- 3.11 vs. 4.47 +/- 3.14, P < 0.01). The EMG activity of the FDI muscle was higher during the visual feedback condition and this difference increased especially at higher force levels (70%: 370 +/- 149 vs. 350 +/- 143 microV, P < 0.01). Experiment 2 examined whether the findings of experiment 1 were driven by the higher force levels and proximity in the gain of visual feedback. Subjects performed constant isometric contractions with the abduction of the index finger at an absolute force of 2 N, with two distinct feedback gains of 15 and 3,000 pixels/N. In agreement with the findings of experiment 1, subjects exhibited lower force error in the presence of visual feedback especially when the feedback gain was high (0.057 +/- 0.03 vs. 0.095 +/- 0.05 N). However, force variability was not affected by the vastly distinct feedback gains at this force, which supported and extended the findings from experiment 1. Our findings demonstrate that although removal of visual feedback amplifies force error, it can reduce force variability during constant isometric contractions due to an altered activation of the primary agonist muscle most likely at moderate force levels in young adults.

Persistent low levels of beta-hCG in a patient with recurrent pregnancy loss.

BACKGROUND: A subset of women with persistent low levels of beta-hCG have undergone potentially harmful treatments despite no evidence of pregnancy or gestational trophoblastic neoplasia. CASE: A 37-year-old woman with a history of recurrent pregnancy loss presented with persistent low levels of beta-hCG. She was treated for ectopic pregnancy and retained products and was later suspected of having a malignancy. However, further evaluation of her human chorionic gonadotropin led to a diagnosis of quiescent gestational trophoblastic disease. CONCLUSION: A diagnosis of quiescent gestational trophoblastic disease should be considered in all patients who present with persistent low levels of beta-hCG, including those with recurrent pregnancy loss.