Impact of a structured, group-based running programme on clinical, cognitive and social function in youth and adults with complex mood disorders: a 12-week pilot study.

BACKGROUND: Individuals with mood disorders often report lingering health-related quality of life (HRQOL) and social and cognitive impairments even after mood symptoms have improved. Exercise programmes improve mood symptoms in patients, but whether exercise improves functional outcomes in patients with difficult-to-treat mood disorders remains unknown. DESIGN: We evaluated the impact of a 12-week structured running programme on cognitive, social and quality-of-life outcomes in participants with difficult-to-treat mood disorders. METHODS: In a prospective, open-label study, patients referred to the St Joseph's Healthcare Hamilton Team Unbreakable running programme for youth and adults with mood disorders completed a comprehensive assessment battery before and after the 12-week exercise intervention. RESULTS: We collected preintervention and postintervention data from 18 participants who improved on the general health, vitality, role of emotions, social functioning and mental health (all p≤0.01) HRQOL subscales. Performance improved on cognitive tests that assessed working memory and processing speed (p≤0.04); there were no improvements in complex executive functioning tasks. Regression analyses indicated that younger age, shorter illness duration and reduced bodily pain predicted social and cognitive outcomes. CONCLUSION: Participation in a group-based, structured running programme was associated with improved HRQOL and social and cognitive function.

Effects of a 12-week running programme in youth and adults with complex mood disorders.

OBJECTIVE: Although numerous studies suggest a salutary effect of exercise on mood, few studies have explored the effect of exercise in patients with complex mental illness. Accordingly, we evaluated the impact of running on stress, anxiety and depression in youth and adults with complex mood disorders including comorbid diagnoses, cognitive and social impairment and high relapse rates. METHODS: Participants were members of a running group at St Joseph Healthcare Hamilton's Mood Disorders Program, designed for clients with complex mood disorders. On a weekly basis, participants completed Cohen's Perceived Stress Scale, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires, providing an opportunity to evaluate the effect of running in this population. RESULTS: Data collected for 46 participants from April 2012 to July 2015 indicated a significant decrease in depression (p<0.0001), anxiety (p<0.0001) and stress (p=0.01) scores. Whereas younger participant age, younger age at onset of illness and higher perceived levels of friendship with other running group members (ps≤0.04) were associated with lower end-of-study depression, anxiety and stress scores, higher attendance was associated with decreasing BDI and BAI (ps≤0.01) scores over time. CONCLUSIONS: Aerobic exercise in a supportive group setting may improve mood symptoms in youth and adults with complex mood disorders, and perceived social support may be an important factor in programme's success. Further research is required to identify specifically the mechanisms underlying the therapeutic benefits associated with exercise-based therapy programmes.

Health care provider and caregiver preferences regarding nasogastric and intravenous rehydration.

OBJECTIVE: Despite evidence supporting its use, nasogastric rehydration is rarely used in North America. We conducted a prospective, cross-sectional, 3-phase study to evaluate current perspectives. METHODS: We compared the proportions of respondents in favor of nasogastric (as opposed to intravenous) rehydration, should oral rehydration fail, between clinicians and caregivers. Phase 1: caregivers of children aged 3 to 48 months, who presented to a Canadian pediatric emergency department with symptoms of gastroenteritis, were invited to complete a survey. Phase 2: phase 1 participants administered intravenous or nasogastric rehydration had the procedure observed and outcome data recorded. Phase 3: pediatric emergency medicine physicians, fellows, and nurses completed a survey. RESULTS: Four hundred thirty-five children-parent dyads and 113 health care providers participated. If oral rehydration were to fail, 10% (47 of 435) of caregivers and 14% (16 of 113) of clinicians would choose nasogastric rehydration (difference = 3.4%; 95% confidence interval: -2.8 to 11.4). Caregivers were more familiar with the term intravenous than nasogastric rehydration (80% vs 20%; P < .001). Sixty-four children (15%) received intravenous rehydration; none received nasogastric rehydration. Participating nurses have inserted 90 (interquartile range: 25-150) intravenous cannulas compared with 4 (interquartile range: 2-10) nasogastric tubes during the preceding 6 months (P < .001). After a brief educational intervention, the proportion recommending nasogastric rehydration increased to 27% (117 of 435) among caregivers (P < .001) and 43% (49 of 113) among health care providers (P < .001). CONCLUSIONS: In keeping with caregiver desires, health care providers in a Canadian emergency department employ intravenous rehydration when oral rehydration fails. Enhanced change management strategies will be required for nasogastric rehydration to become adopted in this environment.

Quality of life in children with chronic kidney disease-patient and caregiver assessments.

BACKGROUND: Children with chronic kidney disease (CKD) require strict dietary and lifestyle modifications, however, there is little information on their quality of life. Our objective was to compare health-related quality of life (HRQOL) in children with different stages of CKD to each other and to a control population. METHODS: A cross-sectional assessment of HRQOL for physical, emotional, social and school domains was performed using the PedsQL Generic Core Scale. Data were collected from 20 children with chronic renal insufficiency (CRI; creatinine > 200 micromol/l), 12 on maintenance haemodialysis or peritoneal dialysis (DIAL) and 27 with renal transplants (TX). Caregiver proxy reports were obtained for CRI (n = 20), DIAL (n = 17) and TX (n = 21). Between-group differences were assessed with ANOVA for the CKD groups; t-tests compared our CKD samples with controls. RESULTS: Children with CKD scored lower than the controls in all subscales, however, only TX compared with controls was significant (P < 0.02). DIAL children scored equal to or higher than the TX group in all domains. Analysis of covariance with number of medications as covariate yielded a significant result for the physical subscale (F = 8.95, df = 3, 53, P = 0.004). Proxy caregiver scores were lower than patient scores in all four domains. CONCLUSIONS: Children with CKD rate their HRQOL lower than the healthy controls do. It may be reassuring to caregivers that children on dialysis rate their HRQOL higher than would be expected. However, it is of some concern that caregiver perception of improved HRQOL following transplantation was not shared by their children in the present study.

The use of darbepoetin in infants with chronic renal impairment.

Darbepoetin is a newer analogue of epoetin, with a longer half-life, that allows less frequent administration. There are currently no published data available for its use in infants. We report our experience with this drug in infants with chronic renal impairment, weighing less than 8 kg. Infants had baseline haemoglobin (Hb), iron, ferritin and transferrin levels measured. They were started on approximately 0.5 microg/kg per week of darbepoetin. Hb levels were checked every 2-4 weeks, and iron studies were performed every 4 weeks. Iron supplementation was prescribed to maintain ferritin levels>100 microg/l and transferrin saturation levels>20%. Follow up was for 20 weeks. Six infants with a mean weight of 4.08 kg and a mean creatinine of 259 micromol/l were included. Three infants were medically stable throughout the study, and the mean darbepoetin dose was decreased to 0.25 microg/kg per week. Their dosing interval was increased to every 3-4 weeks. The other three infants were less stable and had multiple medical problems, including periods of haemodialysis and surgery. These infants failed to reach target Hb level, despite an increase in the mean dose of darbepoetin to 1.2 microg/kg per week. In conclusion, darbepoetin can be successfully administered to infants with chronic renal insufficiency, but the dose needs to be tailored to each individual. Administration would be facilitated by smaller unidose syringes.

Darbepoetin alfa (Aranesp) in children with chronic renal failure.

BACKGROUND: Darbepoetin alfa use has been reported in 7 children with chronic renal failure (CRF). Our objective was to evaluate the efficacy and safety of darbepoetin and determine a therapeutic dose in a larger sample of children with CRF. METHODS: Twenty-six children with chronic renal insufficiency (CRI) GFR <30 mL/min/1.73 m(2), on peritoneal dialysis (PD) or hemodialysis (HD) entered a prospective, open-label study of darbepoetin. Seven ineligible children who underwent the same evaluation were analyzed retrospectively. The starting dose was 0.45 microg/kg/week. IRB/REB approval and informed consent were obtained. The primary outcome measure was hemoglobin (Hb) response within a target range of 10.0 to 12.5 g/dL between 8 and 12 and 20 and 28 weeks. RESULTS: Thirty-three children (15 CRI, 9 HD, 9 PD; aged 1-17 years) were enrolled in the study. Ten patients dropped out (3 before 12 weeks and 7 before 28 weeks), none due to darbepoetin. Mean Hbs were 11.8 and 11.4 between weeks 8 and 12 and 20 and 28, respectively; the proportion of patients with Hb values >10.0 g/dL was 97% and 91% in the same intervals. No effect of grouping patients into CRI, HD, or PD or prospective versus retrospective was observed. One of 13 serious adverse events (hypertension) was possibly related to darbepoetin; 8/14 children reported injection-site pain. At 12 and 28 weeks, respectively, 73% and 87% were receiving darbepoetin less than once weekly. CONCLUSION: A dose approximating 0.5 microg/kg/week of darbepoetin effectively treats anemia in children with chronic renal failure; for many, this may be proportionately increased and injected less than once weekly.