Exploring issues surrounding mental health and wellbeing across two continents: A preliminary cross-sectional collaborative study between the University of California, Davis, and University of Pretoria.

Mental health and wellness research continue to be a topic of importance among veterinary students in the United States of America (US). Limited peer reviewed literature focusing on South African veterinary students is available. South African veterinary medical students might benefit from approaches to improve mental health and wellness similar to those recommended in the US. However, these recommendations may not address the underlying risk factors for mental health and wellness concerns or mismatch resources available to South African veterinary medical students. The purpose of this collaborative study was to compare the mental health and wellness among veterinary students enrolled at the University of California, Davis (UCD), and the University of Pretoria (UP), the only veterinary school in South Africa. Our primary research question was; Are the measures of mental health and wellness for students at similar stages in the veterinary curriculum different between the two schools? We hypothesized that mental health and wellness as determined by assessment of anxiety, burnout, depression, and quality of life between the two schools is different. A cross-sectional study of 102 students from UCD and 74 students from UP, at similar preclinical stages (Year 2 for UCD and Year 4 for UP) of the veterinary curriculum was performed. Anxiety, burnout, depression, and quality of life were assessed using the Generalized Anxiety Disorder (GAD-7), Maslach Burnout Inventory (MBI), Patient Health Questionnaire (PHQ-9), and Short Form-8 (SF-8), respectively. Students from both schools had moderate levels of anxiety, high levels of burnout, mild to moderate levels of depression, poor mental health, and good physical health. Our results suggest that similar mental health and wellness concerns in South African veterinary students is comparable with concerns in veterinary medical students in the US. Recommendations and resources to improve mental health and wellness in US veterinary medical students might be applicable to South African veterinary medical students.

The incidence of pediatric acute kidney injury is increased when identified by a change in a creatinine-based electronic alert.

A prospective national cohort study was undertaken to collect data on all cases of pediatric (under 18 yrs of age) acute kidney injury (AKI) identified by a biochemistry-based electronic alert using the Welsh National electronic AKI reporting system. Herein we describe the utility and limitation of using this modification of the KDIGO creatinine-based system data set to characterize pediatric AKI. Of 1,343 incident episodes over a 30-month period, 34.5% occurred in neonates of which 83.8% were AKI stage 1. Neonatal 30-day mortality was 4.1%, with 73.3% of this being accounted for by patients treated in an Intensive Care Unit. In the non-neonatal group, 76.1% were AKI stage 1. Hospital-acquired AKI accounted for 40.1% of episodes while community-acquired AKI represented 29.4% of cases within which 33.9% were admitted to hospital and 30.5% of cases were unclassified. Non-neonatal 30-day mortality was 1.2%, with half of this accounted for by patients treated in the Intensive Care Unit. Nonrecovery of renal function at 30 days occurred in 28% and was significantly higher in patients not admitted to hospital (45% vs. 20%). The reported incidence of AKI in children was far greater than previously reported in studies reliant on clinical identification of adult AKI or hospital coding data. Mortality was highest in neonates and driven by those in the Intensive Care Unit. Nonrecovery of renal function and persistent renal impairment was more common in non-neonates and was especially high in patients with community-acquired AKI who were not hospitalized.

Acute Kidney Injury in the Era of the AKI E-Alert.

BACKGROUND AND OBJECTIVES: Our aim was to use a national electronic AKI alert to define the incidence and outcome of all episodes of community- and hospital-acquired adult AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A prospective national cohort study was undertaken in a population of 3.06 million. Data were collected between March of 2015 and August of 2015. All patients with adult (≥18 years of age) AKI were identified to define the incidence and outcome of all episodes of community- and hospital-acquired AKI in adults. Mortality and renal outcomes were assessed at 90 days. RESULTS: There was a total of 31,601 alerts representing 17,689 incident episodes, giving an incidence of AKI of 577 per 100,000 population. Community-acquired AKI accounted for 49.3% of all incident episodes, and 42% occurred in the context of preexisting CKD (Chronic Kidney Disease Epidemiology Collaboration eGFR); 90-day mortality rate was 25.6%, and 23.7% of episodes progressed to a higher AKI stage than the stage associated with the alert. AKI electronic alert stage and peak AKI stage were associated with mortality, and mortality was significantly higher for hospital-acquired AKI compared with alerts generated in a community setting. Among patients who survived to 90 days after the AKI electronic alert, those who were not hospitalized had a lower rate of renal recovery and a greater likelihood of developing an eGFR<60 ml/min per 1.73 m2 for the first time, which may be indicative of development of de novo CKD. CONCLUSIONS: The reported incidence of AKI is far greater than the previously reported incidence in studies reliant on clinical identification of adult AKI or hospital coding data. Although an electronic alert system is Information Technology driven and therefore, lacks intelligence and clinical context, these data can be used to identify deficiencies in care, guide the development of appropriate intervention strategies, and provide a baseline against which the effectiveness of these interventions may be measured.

Appropriateness of the metabolic equivalent (MET) as an estimate of exercise intensity for post-myocardial infarction patients.

AIMS: To explore: (1) whether during exercise metabolic equivalents (METs) appropriately indicate the intensity and/or metabolic cost for post-myocardial infarction (MI) males and (2) whether post-exercise VO2 parameters provide insight into the intensity and/or metabolic cost of the prior exercise. METHODS: 15 male phase-IV post-MIs (64.4±6.5 years) and 16 apparently healthy males (63.0±6.4 years) participated. Participants performed a graded cycle ergometer test (CET) of 50, 75 and 100 W, followed by 10 min active recovery (at 50 W) and 22 min seated recovery. Participants' heart rate (HR, bpm), expired air parameters and ratings of perceived exertion (exercise only) were measured. RESULTS: General linear model analysis showed throughout significantly lower HR values in post-MI participants that were related to ß-blocker medication (F(2,5)=18.47, p<0.01), with significantly higher VCO2/VO2 (F(2,5)=11.25, p<0.001) and gross kcals/LO2/min (F(2,5)=11.25, p<0.001). Analysis comparing lines of regression showed, during the CET: post-MI participants worked at higher percentage of their anaerobic threshold (%AT)/MET than controls (F(2,90)=18.98, p<0.001), as well as during active recovery (100-50 W) (F(2,56)=20.81, p<0.001); during seated recovery: GLM analysis showed significantly higher values of VCO2/VO2 for post-MI participants compared with controls (F(2,3)=21.48, p=0.001) as well as gross kcals/LO2/min (F(2,3)=21.48, p=0.001). CONCLUSION: Since METs take no consideration of any anaerobic component, they failed to reflect the significantly greater anaerobic contribution during exercise per MET for phase-IV post-MI patients. Given the anaerobic component will be greater for those with more severe forms of cardiac disease, current METs should be used with caution when determining exercise intensity in any patient with cardiac disease.

Exploring adaptations to the modified shuttle walking test.

OBJECTIVE: The 10 m modified shuttle walking test (MSWT) is recommended to determine the functional capacity in older individuals and for patients entering cardiac rehabilitation. Participants are required to negotiate around cones set 1 m from the end markers. However, consistent comments indicate that for some individuals manoeuvring around the cones can be quite difficult. Therefore, the objective of this study was to explore differences within and between non-cardiac and postmyocardial infarction (MI) males during MSWT with and without the cones. DESIGN: Comparative study. PARTICIPANTS: 20 post-MI (64.8±6.6, range 51-74 years) and 20 non-cardiac male controls (64.1±5.7, range 52-74 years) participated. METHODS: Participants performed MSWT with and without cones. Throughout, the participants expired air, and the heart rate (bpm) (HR) and ratings of perceived exertion (RPE) were measured. Participant protocol preference was recorded verbatim. RESULTS: One-way analysis of variance found no significant difference in VO2 peak (cones 20.4±5.1 vs no-cones 21.9±4.8 ml/kg/min, p=0.197) or distance ambulated (cones 631.8±132.9 m vs no-cones 662.4±164.1 m, p=0.371) between protocols or groups. Analysis comparing lines of regression showed a significant trajectory difference in VO2 (ml/kg/min) (p<0.01) between protocols with higher HR (p<0.01) and respiratory exchange ratio (RER, p<0.001) values during cones. RPEs were higher for post-MIs versus controls during both protocols (p<0.05). Post-MIs taking ß-blockers produce significantly lower HR values. The χ(2) analysis found no significant difference in protocol preference (no-cones: all n=25, 63%; post-MIs n=13, 65%; and controls n=12, 60%). CONCLUSIONS: Post-MIs found both protocols subjectively harder than controls with no significant difference in the VO2 peak. However, both groups worked at a lesser percentage of their anaerobic threshold during no-cones protocol as indicated by lower RER values. Importantly, for the post-MIs, this would reduce their risk of functional impairment. Therefore, though more research is required, indicators at present are more favourable for the use of the no-cones with post-MIs.

Mapping Patient-Specific Functional Scale (PSFS) items to the International Classification of Functioning, Disability and Health (ICF).

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) provides a common framework for clinical outcome measurement. Because the Patient-Specific Functional Scale (PSFS) is widely used for documenting change over time in individual patients receiving musculoskeletal physical therapy, investigation of the extent to which PSFS items reflect the ICF is needed. OBJECTIVE: The study objective was to investigate the extent to which patient-generated PSFS items reflect ICF domains. DESIGN: This investigation was an observational content validity study. METHODS: A total of 2,911 PSFS items from 1,050 files for patients with musculoskeletal disorders were analyzed. The data were from a random sample of participants in the Otago Outcome Measures Project at 4 clinics of the School of Physiotherapy, University of Otago, situated in 3 New Zealand cities. Patient-nominated PSFS items were categorized and mapped with thematic analysis techniques to ICF components, chapters, and categories. Subgroup analyses were conducted for body region of injury and age ranges. RESULTS: All (100%) of the analyzed items could be mapped to the ICF. Most patient-nominated items mapped to the activity component (80.0%), some items mapped to the participation component (7.7%), other items were related to impairment (7.4%), and the fourth group contained items that overlapped the activity and participation components (4.9%). Similar results were found for each of the 5 body regions and across age ranges in subgroup analyses. LIMITATIONS: These results are limited to individual patients seeking musculoskeletal physical therapy. Patient-generated PSFS items were investigated. CONCLUSIONS: The ICF activity component was most commonly represented by patient-nominated PSFS items, the participation component was moderately represented, and impairment was least represented. Hence, the PSFS would complement impairment-based clinical outcome measures.

Energy expenditure and perceived effort during brisk walking and running in 8- to 10-year-old children.

There are no previous reports of energy expenditure and perceived effort during brisk-walking and running at speeds self-selected by young children. Fifty four participants (age 8-11 years old) performed 1500 m of brisk-walking and running in a marked school playground, and were given simple instructions to either 'walk quickly' or to 'jog'. During the running the children achieved higher mean speeds and a greater total energy expenditure (p < .001). However, there was no difference in the perceived effort between the two activities (p > .05). These findings suggest that under certain conditions children find it just as easy to run as they do to walk briskly, even though the speed and energy expenditure is significantly higher.

Activity levels, dietary energy intake, and body composition in children who walk to school.

Although differences in daily activity levels have been assessed in cross-sectional walk-to-school studies, no one has assessed differences in body composition and dietary energy intake at the same time. In this study of 239 primary school children, there were no significant differences in daily activity levels, body composition, or estimated dietary energy intake between those who walk to school (WALK) and those who travel by car (CAR; p < .05). WALK children were more active between 8 a.m. and 9 a.m. and 3 p.m. and 4 p.m. than CAR children (p < .05). In addition, there were no significant differences in the main analysis when participants were subgrouped by gender and age.

The effects of 24 weeks of moderate- or high-intensity exercise on insulin resistance.

This study was designed to investigate the effect of exercise intensity on insulin resistance by comparing moderate- and high-intensity interventions of equal energy cost. Maximum oxygen consumption (VO(2max)), insulin, glucose and triglycerides were measured in 64 sedentary men before random allocation to a non-exercise control group, a moderate-intensity exercise group (three 400-kcal sessions per week at 60% of VO(2max)) or a high-intensity exercise group (three 400-kcal sessions per week at 80% of VO(2max)). An insulin sensitivity score was derived from fasting concentrations of insulin and triglycerides, and insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Data were available for 36 men who finished the study. After 24 weeks, insulin concentration decreased by 2.54+/-4.09 and 2.37+/-3.35 mU l(-1), insulin sensitivity score increased by 0.91+/-1.52 and 0.79+/-1.37, and HOMA-IR decreased by -0.6+/-0.8 and -0.5+/-0.8 in the moderate- and high-intensity exercise groups, respectively. When data from the exercise groups were combined, one-way analysis of variance with one-tailed post hoc comparisons indicated that these changes were significantly greater than those observed in the control group (all P<0.05). Twenty-four week changes in insulin concentration, insulin sensitivity score and HOMA-IR were not significantly different between the exercise groups. These data suggest that exercise training is accompanied by a significant reduction in insulin resistance, as indicated by well-validated surrogate measures. These data also suggest that moderate-intensity exercise is as effective as high-intensity exercise when 400 kcal are expended per session.

Changes in cardiorespiratory fitness and coronary heart disease risk factors following 24 wk of moderate- or high-intensity exercise of equal energy cost.

This study was designed to investigate the effect of exercise intensity on cardiorespiratory fitness and coronary heart disease risk factors. Maximum oxygen consumption (Vo(2 max)), lipid, lipoprotein, and fibrinogen concentrations were measured in 64 previously sedentary men before random allocation to a nonexercise control group, a moderate-intensity exercise group (three 400-kcal sessions per week at 60% of Vo(2 max)), or a high-intensity exercise group (three 400-kcal sessions per week at 80% of Vo(2 max)). Subjects were instructed to maintain their normal dietary habits, and training heart rates were represcribed after monthly fitness tests. Forty-two men finished the study. After 24 wk, Vo(2 max) increased by 0.38 +/- 0.14 l/min in the moderate-intensity group and by 0.55 +/- 0.27 l/min in the high-intensity group. Repeated-measures analysis of variance identified a significant interaction between monthly Vo(2 max) score and exercise group (F = 3.37, P < 0.05), indicating that Vo(2 max) responded differently to moderate- and high-intensity exercise. Trend analysis showed that total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and fibrinogen concentrations changed favorably across control, moderate-intensity, and high-intensity groups. However, significant changes in total cholesterol (-0.55 +/- 0.81 mmol/l), low-density lipoprotein cholesterol (-0.52 +/- 0.80 mmol/l), and non-high-density lipoprotein cholesterol (-0.54 +/- 0.86 mmol/l) were only observed in the high-intensity group (all P < 0.05 vs. controls). These data suggest that high-intensity training is more effective in improving cardiorespiratory fitness than moderate-intensity training of equal energy cost. These data also suggest that changes in coronary heart disease risk factors are influenced by exercise intensity.