The effect of a one-year vigorous physical activity intervention on fitness, cognitive performance and mental health in young adolescents: the Fit to Study cluster randomised controlled trial.

BACKGROUND: Physical activity (PA) may positively stimulate the brain, cognition and mental health during adolescence, a period of dynamic neurobiological development. High-intensity interval training (HIIT) or vigorous PA interventions are time-efficient, scalable and can be easily implemented in existing school curricula, yet their effects on cognitive, academic and mental health outcomes are unclear. The primary aim of the Fit to Study trial was to investigate whether a pragmatic and scalable HIIT-style VPA intervention delivered during school physical education (PE) could improve attainment in maths. The primary outcome has previously been reported and was null. Here, we report the effect of the intervention on prespecified secondary outcomes, including cardiorespiratory fitness, cognitive performance, and mental health in young adolescents. METHODS: The Fit to Study cluster randomised controlled trial included Year 8 pupils (n = 18,261, aged 12-13) from 104 secondary state schools in South/Mid-England. Schools were randomised into an intervention condition (n = 52), in which PE teachers delivered an additional 10 min of VPA per PE lesson for one academic year (2017-2018), or into a "PE as usual" control condition. Secondary outcomes included assessments of cardiorespiratory fitness (20-m shuttle run), cognitive performance (executive functions, relational memory and processing speed) and mental health (Strength and Difficulties Questionnaire and self-esteem measures). The primary intention-to-treat (ITT) analysis used linear models and structural equation models with cluster-robust standard errors to test for intervention effects. A complier-average causal effect (CACE) was estimated using a two-stage least squares procedure. RESULTS: The HIIT-style VPA intervention did not significantly improve cardiorespiratory fitness, cognitive performance (executive functions, relational memory or processed speed), or mental health (all p > 0.05). Subgroup analyses showed no significant moderation of intervention effects by sex, socioeconomic status or baseline fitness levels. Changes in cardiorespiratory fitness were not significantly related to changes in cognitive or mental health outcomes. The trial was marked by high drop-out and low intervention compliance. Findings from the CACE analysis were in line with those from the ITT analysis. CONCLUSION: The one-academic year HIIT-style VPA intervention delivered during regular school PE did not significantly improve fitness, cognitive performance or mental health, but these findings should be interpreted with caution given low implementation fidelity and high drop-out. Well-controlled, large-scale, school-based trials that examine the effectiveness of HIIT-style interventions to enhance cognitive and mental health outcomes are warranted. TRIAL REGISTRATION: ISRCTN registry, 15,730,512 . Trial protocol and analysis plan for primary outcome prospectively registered on 30th March 2017. ClinicalTrials.gov , NCT03286725 . Secondary measures (focus of current manuscript) retrospectively registered on 18 September 2017.

Evaluation of PEETER V1.0 urine sensors for measuring individual urination behavior of dairy cows.

Due to environmental concerns around N leaching and NO2 emissions from intensive pastoral dairying systems, there has been an increase in research focused on mitigation strategies and on-animal technologies to evaluate urination behavior of grazing dairy cows. Nitrogen leaching and NO2 emissions are associated with urine nitrogen loading onto pasture, which is a function of urine nitrogen concentration and urine volume per urination event. The PEETER V1.0 urine sensor (Lincoln University, Christchurch, New Zealand) is a promising on-animal measurement technology; however, it has yet to be validated in vivo. The objective of this work was to validate the PEETER V1.0 urine sensor's estimations of individual urination events (i.e., urine volume). We fitted 15 Holstein-Friesian × Jersey lactating dairy cows (506 ± 35 kg of live weight, body condition score of 3.75 ± 0.25, and 150.4 ± 20.7 d in milk) with individual PEETER V1.0 sensors and placed them in metabolism crates for 72 h. Every urination event (n = 480) was collected manually and compared with the urine volume estimated by the PEETER V1.0 sensor to determine precision and accuracy using Lin's concordance correlation coefficient (CCC). The CCC is calculated as a function of the Pearson's correlation (precision) and bias correction factor (Cb; Cb = 1 is perfect), and it demonstrates how far the values of the 2 methods are from perfect agreement (accuracy; i.e., a 45° line). The mean urination event volume (mean ± standard deviation) was 2.7 ± 0.94 and 2.6 ± 0.92 L for the actual and PEETER V1.0 sensor, respectively. The PEETER V1.0 sensor showed excellent precision (r = 0.90) with near-perfect accuracy (Cb = 1.00), and the CCC value was high (CCC = 0.90), indicating excellent agreement. Based on these results, the PEETER V1.0 urine sensor provides estimates that are precise and accurate. We conclude that the PEETER V1.0 sensor can be used to evaluate urination behavior of grazing dairy cows.

Effects of a programme of vigorous physical activity during secondary school physical education on academic performance, fitness, cognition, mental health and the brain of adolescents (Fit to Study): study protocol for a cluster-randomised trial.

BACKGROUND: Early adolescence is a period of dynamic neurobiological change. Converging lines of research suggest that regular physical activity (PA) and improved aerobic fitness have the potential to stimulate positive brain changes, improve cognitive function and boost academic attainment in this age group, but high-quality studies are needed to substantiate these findings. The primary aim of the Fit to Study trial is to investigate whether short infusions of vigorous PA (VPA) delivered during secondary school physical education (PE) can improve attainment in maths, as described in a protocol published by NatCen Social Research. The present protocol concerns the trial's secondary outcome measures, which are variables thought to moderate or mediate the relationship between PA and attainment, including the effect of the intervention on cardiorespiratory fitness, cognitive performance, mental health and brain structure and function. METHOD: The Fit to Study project is a cluster-randomised controlled trial that includes Year 8 pupils (aged 12-13) from secondary state schools in South/Mid-England. Schools were randomised into an intervention condition in which PE teachers delivered an additional 10 min of VPA per PE lesson for one academic year, or a 'PE as usual' control condition. Intervention and control groups were stratified according to whether schools were single-sex or co-educational. Assessments take place at baseline (end of Year 7, aged 11-12) and after 12 months (Year 8). Secondary outcomes are cardiorespiratory fitness, objective PA during PE, cognitive performance and mental health. The study also includes exploratory measures of daytime sleepiness, attitudes towards daily PA and PE enjoyment. A sub-set of pupils from a sub-set of schools will also take part in a brain imaging sub-study, which is embedded in the trial. DISCUSSION: The Fit to Study trial could advance our understanding of the complex relationships between PA and aerobic fitness, the brain, cognitive performance, mental health and academic attainment during adolescence. Further, it will add to our understanding of whether school PE is an effective setting to increase VPA and fitness, which could inform future PA interventions and education policy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03286725 . Retrospectively registered on 18 September 2017. ClinicalTrials.gov, NCT03593863 . Retrospectively registered on 19 July 2018.

Anaesthetic management of an obstetric patient with idiopathic acute transverse myelitis.

Idiopathic acute transverse myelitis is a rare focal inflammatory disorder of the spinal cord causing motor, sensory and autonomic dysfunction. We report the successful use of general anaesthesia for caesarean section in a patient with this disease. Potential anaesthetic concerns include autonomic dysreflexia and hyperkalaemia following the use of suxamethonium. Further complicating issues with this patient included psychotic depression and new-onset neuropathic pain on a background of chronic pain symptoms.

Effect of epidural volume extension on dose requirement of intrathecal hyperbaric bupivacaine at Caesarean section.

BACKGROUND: The technique of epidural volume extension (EVE) involves the injection of saline into the extradural space immediately following the intrathecal injection, as part of a combined spinal-epidural (CSE) anaesthetic. One of the suggested benefits of EVE is a reduction in local anaesthetic required. The aim of this study was to test this hypothesis by comparing the median effective doses (ED50) of hyperbaric bupivacaine with fentanyl 25 microg with and without EVE for Caesarean section. METHODS: Sixty women were randomized to receive either CSE anaesthesia with EVE (EVE group) or no EVE (NEVE group). Using a double-blinded, up-down sequential technique, varying doses of bupivacaine with fentanyl 25 microg were administered. ED50 was estimated from up-down reversals and probit regression. RESULTS: The ED50 for bupivacaine was similar and not significantly different in the two groups (5.1 mg in the EVE and 6.1 mg in the NEVE group; difference 1.0 mg, 95% CI -0.12 to 2.2, P=0.08). CONCLUSIONS: This study illustrates that whilst low doses of intrathecal bupivacaine can be effectively used for Caesarean section, at such doses EVE does not appear to offer reliable or clinically relevant reductions in dosing with intrathecal bupivacaine.

Does Council Tax Valuation Band (CTVB) correlate with Under-Privileged Area 8 (UPA8) score and could it be a better 'Jarman Index'?

BACKGROUND: Widespread scepticism persists on the use of the Under-Privileged Area (UPA8) score of Jarman in distributing supplementary resources to so-attributed 'deprived' UK general practices. The search for better 'needs' markers continues. Having already shown that Council Tax Valuation Band (CTVB) is a predictor of UK GP workload, we compare, here, CTVB of residence of a random sample of patients with their respective 'Jarman' scores. METHODS: Correlation coefficient is calculated between (i) the CTVB of residence of a randomised sample of patients from an English general practice and (ii) the UPA8 scores of the relevant enumeration districts in which they live. RESULTS: There is a highly significant correlation between the two measures despite modest study size of 478 patients (85% response). CONCLUSIONS: The proposal that CTVB is a marker of deprivation and of clinical demand should be examined in more detail: it correlates with 'Jarman', which is already used in NHS resource allocation. But unlike 'Jarman', CTVB is simple, objective, and free of the problems of Census data. CTVB, being household-based, can be aggregated at will.

Unequal to the task: deprivation, health and UK general practice at the millennium.

The NHS is over 50 years old, but health inequalities remain prevalent in the United Kingdom (UK). Material deprivation may be less apparent; however, social deprivation is becoming worse while the markers of socioeconomic disadvantage remain unsatisfactory. Health is an even more elusive concept; nevertheless, the evidence for an increasing association between deprivation, poor health, and early death is overwhelming. Equally unavoidable is the impact of this social degradation on UK primary care. Service industries have deserted deprived communities but, on the whole, GPs struggle on. Denied the supplementary resources they deserve they become disenchanted, too exhausted to convert incentives into rewards. Clear-headed strategic thinking from the top brass is overdue.

Council tax valuation band as marker of deprivation and of general practice workload.

This study tests the hypothesis that Council Tax Valuation Banding (CTVB) is a measure both of UK socioeconomic status and of general practice workload. It is a retrospective cohort study based in a UK semi-rural general practice, North Wiltshire. The study group is a randomised selection of UK general practice patients. The outcome measures are socio-demographic and primary care workload parameters versus CTVBs by logistic regression analyses in a sample of 378 patients (90% participation rate). People who pay little or no council tax are significantly less likely to live in owner-occupied homes or to have access to a car than their counterparts. There is also a significant inverse association between CTVB and demand for general practitioner services. CTVB could be an accessible, universal, non-census marker of UK socioeconomic status and of general practice workload that would have validity in the context of primary care resource allocation and is a concept worthy of further investigation.

Holiday travel and morbidity reported to general practitioners.

AIM: This study set out to explore the influence that holiday travel might have on the rate at which new episodes of illness are reported to general practitioners. METHOD: The study was carried out in a semi-rural practice of five doctors in Wiltshire in 1989. Details of patients' holiday travel were determined by postal questionnaire. Sociodemographic and clinical data were obtained from the patients' medical records. RESULTS: The response rate to the questionnaire was 85%. The study subjects were divided into those who had taken their holiday abroad (n = 643), those who had taken their holiday in the United Kingdom (n = 973), and those who had taken no holiday (n = 668) during the study year. Interim assessment of clinical results revealed no changes in morbidity indices in relation to holiday intervals in any of the groups except for an apparent rise in the number of new episodes of illness presented in the month before departure by those about to go abroad. Further analysis showed that this was due to a significant 112% increase in the number of episodes of illness presented by this study group in the week before they left home. CONCLUSION: This study suggests that the present focus on the supposed excess morbidity of patients returning from foreign holidays is misplaced.

Effects of atipamezole on xylazine sedation in ponies.

Atipamezole antagonism of xylazine sedation was evaluated in six ponies. Atipamezole (0.15 mg/kg) or saline was injected intravenously 15 minutes after the ponies had been sedated with xylazine (1.0 mg/kg). Arterial blood pressure and gases, pulse and respiratory rates, the electrocardiogram, nose-to-ground distance and a subjective sedation score were recorded. The pretreatment nose-to-ground distance and PaO2 returned to normal sooner after atipamezole than after saline and the ponies' appetite and normal locomotion also recovered sooner. No significant differences were observed between the effects of saline and atipamezole on the other measurements.

Use made by patients of chronic disease surveillance consultations in general practice.

A prospective, observational study of chronic disease surveillance consultations over a six-month period was performed in one semi-rural general practice in order to determine the content of the consultations, including incidental items not relevant to the chronic disease. At least one incidental item was recorded during 43% of consultations. There was substantial clinical content in these items: 23% of items required a prescription to be issued and 7% referral to a specialist. It is concluded that chronic disease surveillance consultations in general practice are frequently extended by patients who are anxious to discuss issues which may not be relevant to their chronic diseases. General practitioners must be sensitive to such patient expectations when they instigate chronic disease management clinics.

Daily home visiting in one general practice: a longitudinal study of patient-initiated workload.

New requests for home visits performed by one general practitioner were recorded every weekday over 13 years from 1977 to 1989. Overall, a steady reduction in patient-initiated demand for visits was seen. However, longitudinal analysis by age showed that this was statistically significant only in patients aged under 65 years, for whom there was a 71% decrease. There was no significant change in the rates of visits requested for elderly (65-74 years old) and very elderly (75 years and over) patients. In the last year of the study 75% of daily visiting was requested by 18% of the patients, that is by the elderly and very elderly, a sector of the population which is increasing. The findings challenge the prediction that home visits will decline until they eventually disappear. General practitioners in the UK still need to maintain a domiciliary service to their elderly patients.

The nature of unemployment morbidity. 1. Recognition.

The case records of one group practice have been used as the data base for a longitudinal, controlled study of unemployment and health. Previous numerical analyses have shown increases in reported morbidity in families threatened with and experiencing unemployment. The illnesses reported have now been classified by diagnostic category. The illnesses normally most prevalant were presented less frequently when patients' jobs were insecure and lost, contradicting the suggestion that excess morbidity reported by the unemployed results only from lowered symptom tolerance. On reassembling the data according to the number of consultations per episode a genuine unemployment morbidity was indicated. After job loss among the male employees there was a significant increase in the number of episodes for which there were four or more consultations. It is postulated that unemployment leads to chronic ill health.

The nature of unemployment morbidity. 2. Description.

A longitudinal, controlled study on job loss and health using general practice records has concluded that unemployment morbidity among men made redundant can be identified as an increase in those episodes of illness which are associated with many consultations. The possibility that these episodes represent chronic ill health has been tested using the same data base. If chronic illnesses are defined as those requiring active management after one year, their incidence among unemployed men was over six times that among controls (P<0.001). Cardiovascular disorders were frequently detected in the unemployed men and several of the other chronic complaints they suffered may also have had a psychosomatic aetiology related to stress. The consequent workload in terms of consultations, investigations, referrals, outpatient attendances and drug therapy increased significantly after job loss. More frequent, short-lived illnesses showed continuing downward trends in study and control men.The results suggest that unskilled men face a serious health hazard if made redundant. Investigating and treating their chronic disabilities leads to an increased medical workload and must further burden the health service.