Feasibility of improving the motor development of toddlers with congenital heart defects using a home-based intervention.

This study investigated the feasibility of administering motor assessments, delivering rehabilitation via parent-led activities, and enhancing motor function in children with complex congenital heart defects. Gross and fine motor development were evaluated in 20 toddlers ages 12 to 26 months after either a superior cavopulmonary connection (SCPC) procedure or an arterial switch operation (ASO) using the Peabody developmental scale, version 2 (PDMS-2). Feasibility of assessment and program delivery were examined using open-ended interviews with parents. The ASO group scored consistently higher than the SCPC group in every subscore of the PDMS-2 (ASO gross motor quotient, 96.78 ± 7.396 vs SCPC gross motor quotient, 77.56 ± 7.715 [P < 0.001]; ASO fine motor quotient, 101.20 ± 6.512 versus SCPC fine motor quotient, 87.70 ± 9.945 [P = 0.002]; ASO total motor quotient, 98.78 ± 6.515 versus SCPC total motor quotient, 79.56 ± 8.095 [P < 0.001]). A lower total motor quotient was associated with the use of anticoagulant medication (-20.3 ± 4.6; P < 0.001), longer and more frequent hospital stays (respectively, -3.6 ± 1 .4; P = 0.01 and -0.8 ± 0.4; P = 0.02), and shorter times between the most recent surgery and the assessment date (2.1 ± 0.5; P < 0.001). Age-standardized scores were constant between baseline and follow-up evaluation (baseline gross motor quotient, 87 ± 12 vs. post-intervention gross motor quotient, 88 ± 15 [P = 0.89]; baseline fine motor quotient, 94 ± 11 vs. post-intervention fine motor quotient, 94 ± 12 [P = 0.55]; baseline total motor quotient, 89 ± 12 vs. post-intervention total motor quotient, 90 ± 14 [P = 0.89]), indicating achievement of the expected rate of development. The most common barrier to home activity completion was illness in the SCPC group and lack of interest in the ASO group. Providing enjoyable activities and incorporating the activities into the participants' schedules were keys to compliance. All the children were able to complete the assessments, and the parents reported a positive impact of the intervention on family life. Children who have had the SCPC procedure experience significant motor delays early in life. However, toddlers after ASO have age-appropriate motor skills. Completion of the rehabilitation program enables post-SCPC children to increase their rate of development to age-appropriate norms.

Somatic and affective anxiety symptoms and menopausal hot flashes.

OBJECTIVE: Menopausal hot flashes have been associated with increased scores on measures of anxiety. Anxiety measures are typically composed of items measuring somatic and affective symptoms. Because hot flash symptoms are similar to symptoms of somatic anxiety, we wanted to examine the differential contribution of somatic anxiety and affective anxiety to hot flash scores. METHODS: A total of 80 psychologically well-functioning postmenopausal women aged 50 to 64 years were administered the Zung Anxiety Index (ZAI), from which total score, somatic anxiety subscale score, and affective anxiety subscale score were calculated. The outcome measure was a hot flash score that incorporated both frequency and severity based on a 7-day diary. A linear regression analysis examined the association between hot flashes and the two anxiety subscales controlling for age, education, and sleep quality. RESULTS: Higher score on somatic anxiety was significantly associated with higher hot flash score (P = 0.04), whereas the association with affective anxiety was not significant (P = 0.80). Higher total score on the ZAI was also significantly associated with higher hot flash score (P = 0.02). CONCLUSIONS: These results suggest that the positive association between higher ZAI scores and hot flashes in recently postmenopausal women may be due to the overlap between the somatic manifestation of hot flashes and anxiety symptoms rather than to an affective anxiety disturbance. These results have potential implications for the care and treatment of postmenopausal women, but replication is required in other samples including women at different transition stages of menopause and women with psychiatric comorbidities.

Intensity of recreational physical activity throughout life and later life cognitive functioning in women.

Long-term physical activity may affect risk of cognitive impairment but few studies have examined later life cognition in relation to intensity of life-long physical activity. We examined the associations between the intensity of long-term recreational physical activity and neuropsychological functioning in 90 healthy postmenopausal women on tests found to be useful in the early identification of dementia. Information was collected about their participation in strenuous and moderate activities between high school and menopause. Summary measures of long-term strenuous and moderate activity were constructed for each participant. All analyses were adjusted for relevant covariates. The six linear regression analyses showed significant positive associations between moderate activity and Wechsler Adult Intelligence Scale Revised (WAIS-R), Digit Span backward, WAIS-R Digit Symbol, and Trail Making Test Part B. Significant negative relationships were found between strenuous activity and Rey Auditory Verbal Learning Test delayed verbal recall, Complex Figure Test delayed visual memory, WAIS-R Digit Span backward, category fluency, and WAIS-R Digit Symbol. The associations found in the present study suggest that while moderate activity may be protective, long-term strenuous activity before menopause may lower cognitive performance later in life. These results support further investigation of the effects of life-long exercise intensity on cognition in later life.