The impact of high and low-intensity exercise in adolescents with movement impairment

Five to six percent of young people have movement impairment (MI) associated with reduced exercise tolerance and physical activity levels which persist into adulthood. To better understand the exercise experience in MI, we determined the physiological and perceptual responses during and following a bout of exercise performed at different intensities typically experienced during sport in youth with MI. Thirty-eight adolescents (11±18 years) categorised on the Bruininks-Oseretsky Test of Motor Proficiency-2 Short-Form performed a peak oxygen uptake bike test (V_ O2peak) test at visit 1 (V1). At visits 2 (V2) and 3 (V3), participants were randomly assigned to both low-intensity (LI) 30min exercise at 50% peak power output (PPO50%) and high-intensity (HI) 30s cycling at PPO100%, interspersed with 30s rest, for 30min protocol (matched for total work). Heart rate (HR) and rating of perceived exertion (RPE) for legs, breathing and overall was measured before, during and at 1, 3 and 7-min post-exercise (P1, P3, P7). There was a significant difference in V_ O2peak between groups (MI:31.5±9.2 vs. NMI:40.0±9.5ml.kg-1.min-1, p0.05). Both groups experienced similar RPE for breathing and overall (MI:7.0±3.0 vs. NMI:6.0±2.0, p>0.05) at both intensities, but reported higher legs RPE towards the end (p<0.01). Significant differences were found in HRrecovery at P1 post-HI (MI:128±25.9 vs. NMI:154±20.2, p<0.05) but not for legs RPE. Perceived fatigue appears to limit exercise in youth with MI in both high and low-intensity exercise types. Our findings suggest interventions reducing perceived fatigue during exercise may improve exercise tolerance and positively impact on engagement in physical activities

Early career teacher mentoring in England: a case study of compliance and mediation

This paper reports the findings from a small-scale study of ten mentors’ experiences of supporting Early Career Teachers (ECTs) in secondary schools in England following the introduction of the Early Career Framework (ECF) in 2021. Data were collected via semi-structured interviews with individual mentors based in London, Manchester and York, UK. The findings suggest that mentors experience some challenges supporting ECTs through the use of mandated training materials. The data report the contradictions of being required to support trainees through a programme governed by the statutory requirements of the Department for Education (DfE) in England, whilst also being part of a complex, nuanced school community. The authors examine mentors’ experiences as they balance the compliance requirements of the ECF alongside seeking to support ECTs with the realities of classroom life in their own settings. The paper discusses the emergence of a mediated mentor professionalism as mentors seek to navigate competing demands. We argue that this case study illustrates the potential for the international sector to challenge postulated solutions of homogenised mentoring curricula and practices to the recruitment and retention of ECTs

Evaluation of the non-auditory neurocognitive test MoCA-HI for hearing-impaired

BackgroundSince hearing loss and cognitive decline often co-occur among older adults, a cognitive screening test suitable for hearing-impaired people is of high clinical relevance. We report the first evaluation of a German language version of the Montreal Cognitive Assessment—Hearing Impaired version (MoCA-HI).ObjectiveThe aim of the present study was to compare cognitively healthy participants with and without hearing loss, to examine the impact of age, sex, educational level and degree of hearing impairment on the German MoCA-HI performance, and to develop normative data.Material and methodsThe German MoCA-HI was tested in 94 participants with normal or mild hearing impairment (group 1: 4PTA ≤ 40 dB on the better hearing ear) and 81 participants with moderate to profound hearing loss (group 2: 4PTA &gt; 40 dB on the better hearing ear). Additionally, all participants performed the standard MoCA (version 8.2).ResultsNo significant group difference between group 1 and 2 was found in the MoCA-HI total score (p = 0.05). In contrast, group 1 performed significantly better than group 2 on the standard MoCA (p &lt; 0.001). There was no difference between the MoCA and the MoCA-HI performance in group 1 (p = 0.12), whereas individuals of group 2 performed significantly better on the MoCA-HI than on the standard MoCA (p &lt; 0.001). Test-retest reliability of the MoCA-HI was high (p &lt; 0.001). Higher age (p &lt; 0.001), male sex (p = 0.009) and lower education (p &lt; 0.001) were associated with a lower overall MoCA-HI score. Based on the demographic data normative data were developed by a regression-based approach.ConclusionThe MoCA-HI is a cognitive screening test which is suitable for people with hearing impairment

Practice Inquiry: Clinical Uncertainty as a Focus for Small-Group Learning and Practice Improvement

PROBLEM: Many primary care physicians in nonacademic settings lack a collegial forum for engaging the clinical uncertainties inherent in their work. PROGRAM DESCRIPTION: “Practice Inquiry” is proposed as a set of small-group, practice-based learning and improvement (PBLI) methods designed to help clinicians better manage case-based clinical uncertainty. Clinicians meet regularly at their offices/clinics to present dilemma cases, share clinical experience, review evidence for blending with experience, and draw implications for practice improvement. From 2001 through 2005, Practice Inquiry was introduced to sites in the San Francisco Bay Area as a demonstration effort. Meeting rosters, case logs, a feedback survey, and meeting field notes documented implementation and provided data for a formative, qualitative evaluation. PROGRAM EVALUATION: Of the 30 sites approached, 14 held introductory meetings. As of summer 2006, 98 clinicians in 11 sites continue to hold regularly scheduled group meetings. Of the 118 patient cases presented in the seven oldest groups, clinician–patient relationship and treatment dilemmas were most common. Clinician feedback and meeting transcript data provided insights into how busy practitioners shared cases, developed trust, and learned new knowledge/skills for moving forward with patients. DISCUSSION: Ongoing clinician involvement suggests that Practice Inquiry is a feasible, acceptable, and potentially useful set of PBLI methods. Two of the Practice Inquiry’s group learning tasks received comparatively less focus: integrating research evidence with clinical experience and tracking dilemma case outcomes. Future work should focus on reducing the methodological limitations of a demonstration effort and examining factors affecting clinician participation. Set-aside work time for clinicians, or other equally potent incentives, will be necessary for the further elaboration of these PBLI methods aimed at managing uncertainty

Trials

Background Optimising hearing and vision function may be important in improving a range of outcomes for people living with dementia (PwD) and their companions. The SENSE-Cog cross-national randomised controlled trial (RCT) is evaluating the effectiveness of a sensory intervention (SI) to improve quality of life for PwD with concurrent hearing and/or vision impairment, in five European countries. To ascertain how or why the intervention will, or will not, achieve its outcomes, we have designed a process evaluation to explore potential discrepancies between expected and observed outcomes. This will also help us to understand how context may influence the outcomes. Here we describe the protocol for this process evaluation, which is embedded within the RCT. Methods/design We will use a mixed methods approach with a theoretical framework derived from the UK Medical Research Council’s’ guidance on process evaluations. It will include the following: (1) evaluating how key aspects of the intervention will be delivered, which will be important to scale the intervention in real world populations; (2) characterising the contextual issues, which may shape the delivery and the impact of the intervention in different countries; and (3) investigating possible causal mechanisms through analyses of potential moderators and mediators. To avoid bias, we will analyse the process data before the analysis of the main effectiveness outcomes. Discussion This evaluation will provide insight into how the complex SENSE-Cog SI will be tailored, enacted and received across the different European contexts, all of which have unique health and social care economies. The findings will provide insight into the causal mechanisms effecting change, and will determine whether we should implement the intervention, if effective, on a wider scale for PwD and concurrent sensory impairment

Abstracts from the NIHR INVOLVE Conference 2017

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Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

PARENTING NUTRITION SKILLS WORKSHOP: AN EVALUATION OF FACILITATED GROUP DISCUSSIONS TO ENHANCE PARENTING NUTRITION SELF EFFICACY

Abstract Parenting Nutrition Skills Workshops: An Evaluation of Facilitated Group Discussions to Enhance Parenting Nutrition Self-Efficacy By: Lisa Dawes, RD, CDE This research study was conducted to determine the effectiveness of using facilitated group discussion (FGD), a less traditional method of nutrition education, for increasing parents’ feelings of self-efficacy in their ability to make nutrition-related decisions, and to set and enforce nutrition-related boundaries with their children. Childhood obesity is on the rise; poor food choices, portion control, and inactivity are identified as contributing causes. Parents play a major role in creating healthy habits and providing a well-balanced diet for their children. Caregivers who act as the nutrition and behavior gatekeepers were targeted in this intervention. The objective of the current study was to enhance parenting nutrition education and identify barriers to healthy feeding practices in order to optimize nutrition and eating behavior. Twenty-one parents and three grandparents (n = 24) of preschool and school-aged children participated in one-hour FGD parenting nutrition skills workshops. Parent volunteers participated in one of four workshops in a Central California community. Prior to the workshop, topics for discussion were chosen from common feeding issues determined in the literature such as food-related decisions at various locations (home, school, dining out, on the road); feeding jags; and dealing with a picky eater. Parents completed validated questionnaires both before and immediately following the workshops. Two weeks after the workshops, parents were interviewed by telephone to measure longer-term impact of the FGD. Pre- and post-workshop questionnaires demonstrated that mean self-confidence levels significantly increased for the ability to set and enforce nutrition-related boundaries for their children directly after, and two weeks after participating in the FGD. Parents also demonstrated an increase in mean self-confidence levels in their ability to purchase nutritious foods and offer those foods to their children two weeks after participating in the FGD. Behaviors associated with an authoritative parenting style—such as modeling healthy eating; encouraging healthy food intake; and offering healthy foods without forcing the child to eat—were significantly higher two weeks after participating in the FGD. Significance may be attributed to the method of information delivery (FGD), the curriculum Feeding the Kids (FtK), or authoritative parents being more receptive to receiving new information, or a combination of all three. Overall, research results suggest that the use of FGD, coupled with a visual tool such as the Chat Mat created for this project, increased parents’ feelings of self-efficacy and elicited positive nutrition-related behaviors in adopting healthy feeding strategies for their children. Keywords: Nutrition education, facilitated group discussion, self-efficacy, parenting styles, feeding strategies, parenting nutrition skill