Evaluation of the SUNHEART Cardiology Outreach Programme

Introduction: The demand for advanced cardiac care and specialised interventions is on the increase and this results in bottlenecks and increased waiting times for patients who require advanced cardiac care. By decentralising cardiac care, and using a hub-and-spoke model, the SUNHEART Outreach Programme of cardiovascular care aims to improve access to advanced cardiac care in the Western Cape. Tygerberg Hospital is the central hub, with the fi rst spoke being Paarl Hospital. Objective: To determine the value of the SUNHEART Outreach Programme to the public health care system. Methods: An audit of patients accessing the OutreachProgramme was performed for the period May 2013 - May 2014 and consequently compared to a historical cohort of patients accessing the health care system during the preceding 6 months, from October 2012 -April 2013. Access to advanced cardiac care was measured in time to initial evaluation, time to defi nitive diagnosis or intervention and patient compliance with appointments. The value to the health care system was also assessed by performing a cost analysis of transport of patients and health care workers, as well as compliance with appointments. We documented the spectrum of disease requiring advanced cardiac care toguide future interventions. Results: Data of 185 patients were included in the audit. Sixty four patients were referred to tertiary care from October 2012 - April 2013 and 121 patients were referred to the outreach facility from May 2013 - May 2014. There was a signifi cant reduction in waiting times with the median days to appointment of the historical cohort being 85 days compared to 18 days in the Outreach Programme cohort (p<0.01). Patient compliance with appointments was signifi cantly superior in the Outreach Programme cohort (90% vs. 56%: p<0.01). Valvular (36.5%) and ischaemic heart disease (35.5%) were the major pathologies requiring access to cardiac care services. Transport costs per patient treated was signifi cantly reduced in the outreach programme cohort (R118,09 vs. R308,77). Conclusion: Decentralisation of services in the form of an Outreach Programme, with a central hub, improves access to advanced cardiac care by decreasing waiting time, improving compliance with appointments and decreasing travel costs

Motor dysfunctions in ADHD and DCD: an examination of the error correction mechanisms

A high incidence of overlap between ADHD and DCD suggests that they may be related. However, different deficits may underlie the disorders. ADHD has response inhibition deficit whereas DCD has efference copy deficit. The present study examines the presence of these deficits in the respective disorders and within the ADHD subtypes. The ability of children to amend their hand movements during target perturbation is investigated in a double-step tracking task. Participants were children aged 10 to 12. The ADHD symptoms were screened by Australian Disruptive Behaviours Scale, Conner's Parent Rating Scale-Revised:L and Conner's Parent Rating Scale-Revised:L; DCD symptoms were screened by Developmental Coordination Disorder Questionnaire and McCarrson Assessment of Neuromuscular Development measure. ADHD-PI only, ADHD-C only, ADHD-PI with DCD, ADHD-C with DCD, DCD only, and a comparison group were studied. The participants were required to capture a target that skipped twice in succession. Compared to other groups, control children were able to adjust the initial response amplitude as a function of the time between a superseding stimulus and initiation of a response. The corrective response furthermore was accurate with respect to the final step position. The results are discussed in terms of an error averaging mechanism underlying tracking performance

The use of the Developmental Coordination Disorder Questionnaire in Australian children

The effectiveness of the Developmental Coordination Disorder Questionnaire (DCDQ) as a screening tool was investigated in an Australian sample. Using the DCDQ, 129 children aged 9 to 12 years old were screened for Developmental Coordination Disorder (DCD), with a follow-up assessment of movement ability using the McCarron Assessment of Neuromuscular Development (MAND) as the criterion measure. The overall decision agreement between the two measures in identifying DCD was .64. The DCDQ had a sensitivity of .55 and a specificity of .74. The low sensitivity suggests that many children with DCD are not being identified by the DCDQ despite the inclusion of children with a suspect score on the DCDQ. As a screening tool, the DCDQ was accurate in identifying children with moderate or severe DCD but identified less than half of the children with mild DCD

Motor dysfunctions in ADHD and DCD: an examination of the error correction mechanisms

A high incidence of overlap between ADHD and DCD suggests that they may be related. However, different deficits may underlie the disorders. ADHD has response inhibition deficit whereas DCD has efference copy deficit. The present study examines the presence of these deficits in the respective disorders and within the ADHD subtypes. The ability of children to amend their hand movements during target perturbation is investigated in a double-step tracking task. Participants were children aged 10 to 12. The ADHD symptoms were screened by Australian Disruptive Behaviours Scale, Conner's Parent Rating Scale-Revised:L and Conner's Parent Rating Scale-Revised:L; DCD symptoms were screened by Developmental Coordination Disorder Questionnaire and McCarrson Assessment of Neuromuscular Development measure. ADHD-PI only, ADHD-C only, ADHD-PI with DCD, ADHD-C with DCD, DCD only, and a comparison group were studied. The participants were required to capture a target that skipped twice in succession. Compared to other groups, control children were able to adjust the initial response amplitude as a function of the time between a superseding stimulus and initiation of a response. The corrective response furthermore was accurate with respect to the final step position. The results are discussed in terms of an error averaging mechanism underlying tracking performance

ADHD and DCD comorbidity: the associated problems

Attention Deficit-Hyperactivity Disorder (ADHD) has a high comorbidity with Development Coordination Disorder (DCD). On their own, these disorders are often associated with many other behavioural and emotional problems. However, studies investigating associated problems in this comorbid group are limited. This study examined these associated problems in children with comorbid ADHD and DCD using the Conners' Parent and Teachers' Rating Scales (CPRS-R:L; CTRS-R:L). A total of 109 participants (82 males; 27 females) with age ranging from 9.8 to 12.7 (M=11.16; SD=0.79) participated in this study. Participants were placed into 4 groups: Controls (n=41), ADHD (n=29), DCD (n=17) and comorbid ADHD/DCD (n=22), based on the scores from the Australian Disruptive Behaviours Scale, the Developmental Coordination Disorder Questionnaire and the McCarron Assessment Neuromuscular Development measure. A multivariate analysis of variance was conducted on the parent-rated and the teacher-rated Conners' test variables Anxious-Shy, Perfectionism, Social Problems and Psychosomatic separately. Results revealed that parents reported significant social problems seen in children with ADHD and comorbid ADHD/DCD. These children have few friends, experience low self-esteem and self-confidence, and they also feel emotionally distant from peers. However, teachers only reported significant social problems seen in children with comorbid ADHD/DCD. In addition, parents reported significant psychosomatic symptoms seen in children with ADHD. No significant group differences were found for the variables Anxious-Shy and Perfectionism. These findings imply that children with comorbid ADHD/DCD experience more significant social problems compared to children with only ADHD or DCD

The use of the Developmental Coordination Disorder Questionnaire in Australian children

The effectiveness of the Developmental Coordination Disorder Questionnaire (DCDQ) as a screening tool was investigated in an Australian sample. Using the DCDQ, 129 children aged 9 to 12 years old were screened for Developmental Coordination Disorder (DCD), with a follow-up assessment of movement ability using the McCarron Assessment of Neuromuscular Development (MAND) as the criterion measure. The overall decision agreement between the two measures in identifying DCD was .64. The DCDQ had a sensitivity of .55 and a specificity of .74. The low sensitivity suggests that many children with DCD are not being identified by the DCDQ despite the inclusion of children with a suspect score on the DCDQ. As a screening tool, the DCDQ was accurate in identifying children with moderate or severe DCD but identified less than half of the children with mild DCD

Coupling online control and inhibitory systems in children with Developmental Coordination Disorder: Goal-directed reaching

For children with Developmental Coordination Disorder (DCD), the real-time coupling between frontal executive function and online motor control has not been explored despite reported deficits in each domain. The aim of the present study was to investigate how children with DCD enlist online control under task constraints that compel the need for inhibitory control. A total of 129 school children were sampled from mainstream primary schools. Forty-two children who metre search criteria for DCD were compared with 87 typically developing controls on a modified double-jump reaching task. Children within each skill group were divided into three age bands: younger (6–7years), mid-aged (8–9), and older (10–12). Online control was compared between groups as a function of trial type (non-jump, jump, anti-jump). Overall, results showed that while movement times were similar between skill groups under simple task constraints (non-jump), on perturbation (or jump) trials the DCD group were significantly slower than controls and corrected trajectories later. Critically, the DCD group was further disadvantaged by anti-jump trials where inhibitory control was required; however, this effect reduced with age. While coupling online control and executive systems is not well developed in younger and mid-aged children, there is evidence of age-appropriate coupling in older children. Longitudinal data are needed to clarify this intriguing finding. The theoretical and applied implications of these results are discussed

Rationale, design and methods for a randomised and controlled trial to evaluate "Animal Fun" - a program designed to enhance physical and mental health in young children

Background: Children with poor motor ability have been found to engage less in physical activities than other children, and a lack of physical activity has been linked to problems such as obesity, lowered bone mineral density and cardiovascular risk factors. Furthermore, if children are confident with their fine and gross motor skills, they are more likely to engage in physical activities such as sports, crafts, dancing and other physical activity programs outside of the school curriculum which are important activities for psychosocial development. The primary objective of this project is to comprehensively evaluate a whole of class physical activity program called Animal Fun designed for Pre-Primary children. This program was designed to improve the child's movement skills, both fine and gross, and their perceptions of their movement ability, promote appropriate social skills and improve social-emotional development. Methods: The proposed randomized and controlled trial uses a multivariate nested cohort design to examine the physical (motor coordination) and psychosocial (self perceptions, anxiety, social competence) outcomes of the program. The Animal Fun program is a teacher delivered universal program incorporating animal actions to facilitate motor skill and social skill acquisition and practice. Pre-intervention scores on motor and psychosocial variables for six control schools and six intervention schools will be compared with post-intervention scores (end of Pre-Primary year) and scores taken 12 months later after the children's transition to primary school Year 1. 520 children aged 4.5 to 6 years will be recruited and it is anticipated that 360 children will be retained to the 1 year follow-up. There will be equal numbers of boys and girls.Discussion: If this program is found to improve the child's motor and psychosocial skills, this will assist in the child's transition into the first year of school. As a result of these changes, it is anticipated that children will have greater enjoyment participating in physical activities which will further promote long term physical and mental health

HE4 Serum Levels Are Associated with Heart Failure Severity in Patients With Chronic Heart Failure

AbstractBackgroundThe novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive value.MethodsSerum HE4 levels in patients (n = 101) with stable CHF with reduced left ventricular ejection fraction (LVEF <45%) from the Vitamin D CHF (VitD-CHF) study (NCT01092130) were compared with those in age- and sex-matched healthy control subjects (n = 58) from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study.ResultsHE4 levels were higher in CHF compared with control subjects (69.2 pmol/L [interquartile range 55.6-93.8] vs 56.1 pmol/L [46.6-69.0]; P < .001) and were higher with increasing New York Heart Association functional class. Levels were associated with HF risk factors, including age, gender, diabetes, smoking and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). HE4 demonstrated strong associations with kidney function and HF fibrosis biomarkers. In a multivariable model, we identified creatinine, NT-proBNP, galectin-3, high-sensitive troponin T, and smoking as factors associated with HE4. Independently from these factors, HE4 levels predicted death and HF rehospitalization (5-year follow-up, hazard ratio 3.8; confidence interval 1.31–11.1; P = .014).ConclusionsHE4 levels are increased in CHF, correlate with HF severity and kidney function, and predict HF outcome