An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study.

INTRODUCTION: The socio-economic impact of critical illnesses on patients and their families in Europe has yet to be determined. The aim of this exploratory study was to estimate changes in family circumstances, social and economic stability, care requirements and access to health services for patients during their first 12 months after ICU discharge. METHODS: Multi-center questionnaire-based study of survivors of critical illness at 6 and 12 months after ICU discharge. RESULTS: Data for 293 consenting patients who spent greater than 48 hours in one of 22 UK ICUs were obtained at 6 and 12 months post-ICU discharge. There was little evidence of a change in accommodation or relationship status between pre-admission and 12 months following discharge from an ICU. A negative impact on family income was reported by 33% of all patients at 6 months and 28% at 12 months. There was nearly a 50% reduction in the number of patients who reported employment as their sole source of income at 12 months (19% to 11%) compared with pre-admission. One quarter of patients reported themselves in need of care assistance at 6 months and 22% at 12 months. The majority of care was provided by family members (80% and 78%, respectively), for half of whom there was a negative impact on employment. Amongst all patients receiving care, 26% reported requiring greater than 50 hours a week. Following discharge, 79% of patients reported attending their primary care physician and 44% had seen a community nurse. Mobility problems nearly doubled between pre-admission and 6 months (32% to 64%). Furthermore, 73% reported moderate or severe pain at 12 months and 44% remained significantly anxious or depressed. CONCLUSIONS: Survivors of critical illness in the UK face a negative impact on employment and commonly have a care requirement after discharge from hospital. This has a corresponding negative impact on family income. The majority of the care required is provided by family members. This effect was apparent by 6 months and had not materially improved by 12 months. This exploratory study has identified the potential for a significant socio-economic burden following critical illness

Conditional survival with increasing duration of ICU admission: an observational study of three intensive care databases.

OBJECTIVES: Prolonged admissions to an ICU are associated with high resource utilization and personal cost to the patient. Previous reports suggest increasing length of stay may be associated with poor outcomes. Conditional survival represents the probability of future survival after a defined period of treatment on an ICU providing a description of how prognosis evolves over time. Our objective was to describe conditional survival as length of ICU stay increased. DESIGN: Retrospective observational cohort study of three large intensive care databases. SETTING: Three intensive care databases, two in the United States (Medical Information Mart for Intensive Care III and electronic ICU) and one in United Kingdom (Post Intensive Care Risk-Adjusted Alerting and Monitoring). PATIENTS: Index admissions to intensive care for patients 18 years or older. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 11,648, 38,532, and 165,125 index admissions were analyzed from Post Intensive Care Risk-Adjusted Alerting and Monitoring, Medical Information Mart for Intensive Care III and electronic ICU databases respectively. In all three cohorts, conditional survival declined over the first 5-10 days after ICU admission and changed little thereafter. In patients greater than or equal to 75 years old conditional survival continued to decline with increasing length of stay. CONCLUSIONS: After an initial period of 5-10 days, probability of future survival does not appear to decrease with increasing length of stay in unselected patients admitted to ICUs in United Kingdom and United States [corrected]. These findings were consistent between the three populations and suggest that a prolonged admission to an ICU is not a reason for a pessimism in younger patients but may indicate a poor prognosis in the older population

A review of factors affecting the acute exercise-cognition relationship in children and adolescents

It is well documented that an acute bout of exercise has a positive effect on subsequent cognitive function in children and adolescents. However, the effect of: the exercise characteristics (i.e. intensity, duration and modality), the cognitive domain assessed, and moderating variables (such as the participant's age, physical fitness and baseline cognitive abilities); all of which affect this relationship are poorly understood. Therefore, the purpose of this review is to examine the impact of these variables on the acute exercise-cognition relationship in children (aged 6-11 years) and adolescents (aged 12-18 years). Searching the published literature from 2008 to date yielded 22 relevant studies in children and 14 relevant studies in adolescents. This review examines the effects of exercise characteristics (section 2), the cognitive domain assessed (section 3), and the time course of the effects (section 4), alongside the moderating effects of participant characteristics (section 5). The findings indicate that moderate intensity of ~ 30 min duration has positive effects across cognitive domains in children, whilst moderate-high intensity exercise of 10-30 min duration appears most beneficial in adolescents. Findings also suggest that the beneficial effects last for ~ 45 min post-exercise and, tentatively, may be more pronounced in children and adolescents with higher physical fitness levels. Future research in this area should continue to explore the factors (e.g. exercise characteristics, cognitive domains assessed and moderating variables) affecting the acute exercise-cognition relationship in children and adolescents. Where possible these factors should be controlled (or at the very least measured and reported), to allow a more complete interpretation of the findings and extending our understanding of this complicated relationship

Effect of football activity and physical fitness on information processing, inhibitory control and working memory in adolescents

Background: Whilst an acute bout of exercise has been shown to enhance subsequent cognition, including in adolescents, the effects of team games (of which Football is the most popular) has received little attention. Therefore, this study examined: the effect of an acute bout of outdoor Football activity on information processing, inhibitory control, working memory and circulating brain-derived neurotrophic factor (BDNF) in adolescents; the effect of physical fitness on cognition and; the moderating effect of physical fitness on the acute exercise responses. Methods: Following familiarisation, 36 adolescents (16 girls) took part in two trials (60-min Football and 60-min seated rest) separated by 7-d in a counterbalanced, crossover design. Information processing and inhibitory control (Stroop Test), and working memory (Sternberg Paradigm) were assessed 30-min before exercise/rest and immediately, 45- and 90-min post-exercise/rest. Capillary blood samples were obtained before exercise/rest and up to 120-min post-exercise/rest. The median split of distance covered on the MSFT was used to divide the group into high- and low-fit groups. Results: Performance on the cognitive function tasks was similar between Football and seated rest (trial*time interactions; all p > .05). However, the high-fit group had overall quicker response times on both levels of the Stroop Task and all three levels of the Sternberg Paradigm (main effect of fitness; all p  .05). Conclusion: The present study shows that higher levels of physical fitness are beneficial for cognitive function and provides novel evidence that an ecologically valid, and popular, form of exercise is beneficial for working memory following exercise, in high-fit participants only

Effect of differing durations of high-intensity intermittent activity on cognitive function in adolescents

Exercise duration may influence the acute effects on cognition. However, only one study to date has explored the dose-response relationship between exercise duration and cognition in adolescents. Thus, the purpose of this study was to investigate the effect of differing durations of high-intensity intermittent running on cognition in adolescents. Thirty-eight adolescents (23 girls) completed three trials separated by 7 d: 30 min exercise, 60 min exercise, and rest; in a randomised crossover design. The exercise was a modified version of the Loughborough Intermittent Shuttle Test (LIST), which elicited high-intensity intermittent exercise. Cognitive function tests (Stroop test, Sternberg paradigm, Flanker task) were completed 30 min pre, immediately post, and 45 min post exercise. Response times on the incongruent level of the Flanker task improved to a greater extent 45 min following the 30 min LIST, compared to rest (p = 0.009). Moreover, response times improved to a greater extent on the three-item level of Sternberg paradigm 45 min following the 30 min LIST, compared to the 60 min LIST (p = 0.002) and rest (p = 0.013), as well as on the five-item level 45 min following the 30 min LIST, compared to the 60 min LIST (p = 0.002). In conclusion, acute exercise enhanced subsequent cognition in adolescents, but overall, 30 min of high-intensity intermittent running is more favourable to adolescents’ cognition, compared to 60 min

Activity patterns of primary school children during participation in The Daily Mile

The Daily Mile is a popular physical activity initiative in primary schools, yet little is known regarding the activity patterns of children during The Daily Mile. Eighty children (10.4 ± 0.7 years) participated in The Daily Mile (20-min). Activity patterns were assessed using global positioning systems (total distance and age-specific speed zones), alongside heart rate. Cardiorespiratory fitness was assessed using the Multi-Stage Fitness Test. Participants covered a distance of 2511 ± 550 m during The Daily Mile, and heart rate was 163 ± 27 beats.min−1. Participants travelled the furthest distance, and were most intermittent, during the first 5 min (main effect of time, both p < 0.001). Boys ran further and their activity was more intermittent compared to girls (main effect of sex, both p < 0.001). Moreover, the highest fit children ran further than less fit children (main effect of fitness, p < 0.001). This study provides novel evidence of the nature of physical activity during The Daily Mile; demonstrating that children covered, on average, 1.5-miles and exercised at a moderate-to-vigorous intensity. Furthermore, boys covered a greater distance and were more intermittent than girls; whilst higher fit children ran further than lower fit children. In summary, The Daily Mile makes a valuable contribution to in-school physical activity targets in all children

Effect of acute football activity and physical fitness on glycaemic and insulinaemic responses in adolescents

The present study examined the metabolic responses to an acute bout of football and the overall and moderating role of physical fitness on these responses, in adolescents. Thirty-six adolescents (16 girls, 20 boys; 12.6±0.5 y) completed two trials (60-min football and 60-min seated rest) separated by 7-d. Capillary blood samples were taken at baseline (60-min prior to exercise/rest), immediately, 30- and 60-min post-exercise and 30-, 60- and 120-min following a standardised lunch (1.5-, 2- and 3-h post-exercise), for the determination of blood glucose and plasma insulin concentrations. The median split of distance covered on the multi-stage fitness test was used to define high- and low-fit groups. Overall plasma insulin tAUC following lunch was lower in high-fit participants compared to low-fit (high-fit: 3784.2±1653.1 pmol·L−1x120min, low-fit: 6457.3±3290.7 pmol·L−1x120min; p0.05). Football reduced blood glucose concentration 1-h post-exercise compared to control (exercise: 3.8±0.6 mmol·L−1, rest: 4.6±0.8 mmol·L−1; p0.05). Blood glucose tAUC was not affected by exercise or physical fitness (p>0.05). These data emphasise the importance of physical fitness for metabolic health in adolescents, as well as the utility of football as a popular form of games-based activity for improving glucose regulation

The Daily Mile™: acute effects on children’s cognitive function and factors affecting their enjoyment

The Daily Mile™ is a widely implemented school-based physical activity initiative. However, only two studies have explored the acute effects of participation in The Daily Mile on children’s cognitive functioning, reporting conflicting findings. Moreover, enjoyment of exercise is a determining factor in children’s motivation for, and adherence to, initiatives. However, factors affecting children’s enjoyment of The Daily Mile are unknown. Therefore, this study examined the acute effects of The Daily Mile on cognition and explored children’s enjoyment of participation in the initiative. Following familiarisation, 104 children (10.4 ± 0.7 years) completed a Daily Mile and resting control trial in a randomised, counterbalanced order. Prior to, immediately following and 45 min following The Daily Mile and resting, children completed the Stroop test (inhibitory control), Sternberg paradigm (visual working memory) and Flanker task (inhibitory control and cognitive flexibility). Additionally, 87 children took part in focus groups to explore factors affecting enjoyment. Cognitive data were analysed using two-way (trial*time) and three-way (trial*time*sex; trial*time*fitness) repeated measures analysis of variance (ANOVA). Focus group data were analysed using qualitative content analysis. There were no statistically significant effects of The Daily Mile on cognition, compared to rest (all p > 0.05). However, accuracy on the one-item level of Sternberg paradigm (p = 0.073, ηp2 = 0.028) and complex level of the Stroop test (p = 0.057; ηp2 = 0.031) tended to improve immediately following The Daily Mile, compared to resting; though this did not reach statistical significance. Children enjoyed participating in The Daily Mile, particularly due to its outdoor location, social context, and self-paced nature. However, some children found The Daily Mile boring due to its repetitive nature. Findings suggest that The Daily Mile does not significantly influence children’s immediate or delayed (45 min) cognition. However, there was a tendency for improved accuracy in visual working memory and inhibitory control immediately following The Daily Mile. Moreover, the findings demonstrate that The Daily Mile promotes enjoyment, particularly through social relatedness and autonomy. However, future research could consider whether adding variety into the initiative may help to sustain engagement in the children experiencing boredom

Ecological Modeling of Aedes aegypti (L.) Pupal Production in Rural Kamphaeng Phet, Thailand

Background - Aedes aegypti (L.) is the primary vector of dengue, the most important arboviral infection globally. Until an effective vaccine is licensed and rigorously administered, Ae. aegypti control remains the principal tool in preventing and curtailing dengue transmission. Accurate predictions of vector populations are required to assess control methods and develop effective population reduction strategies. Ae. aegypti develops primarily in artificial water holding containers. Release recapture studies indicate that most adult Ae. aegypti do not disperse over long distances. We expect, therefore, that containers in an area of high development site density are more likely to be oviposition sites and to be more frequently used as oviposition sites than containers that are relatively isolated from other development sites. After accounting for individual container characteristics, containers more frequently used as oviposition sites are likely to produce adult mosquitoes consistently and at a higher rate. To this point, most studies of Ae. aegypti populations ignore the spatial density of larval development sites. Methodology - Pupal surveys were carried out from 2004 to 2007 in rural Kamphaeng Phet, Thailand. In total, 84,840 samples of water holding containers were used to estimate model parameters. Regression modeling was used to assess the effect of larval development site density, access to piped water, and seasonal variation on container productivity. A varying-coefficients model was employed to account for the large differences in productivity between container types. A two-part modeling structure, called a hurdle model, accounts for the large number of zeroes and overdispersion present in pupal population counts. Findings - The number of suitable larval development sites and their density in the environment were the primary determinants of the distribution and abundance of Ae. aegypti pupae. The productivity of most container types increased significantly as habitat density increased. An ecological approach, accounting for development site density, is appropriate for predicting Ae. aegypti population levels and developing efficient vector control program