Developing a family resilience assessment tool for health visiting/public health nursing practice using virtual commissioning, high-fidelity simulation and focus groups.

UK public health nurse assessment of family resilience is a necessary component of monitoring family health and children's development and identifying areas for change. This research was part of an exploration of Welsh public health nurses' understanding of 'family resilience' as a concept underpinning their practice. From it, the Family Resilience Assessment Instrument Tool (FRAITTM www.frait.wales/) was developed for public health nurses use. We report on a virtual commissioning process using focus groups and an immersive simulation suite to test a FRAIT prototype in a safe environment before field testing. Virtual commissioning design: Hydra-Minerva Immersive Simulation Suite - individual public health nurses presented with a multi-media scenario as they used the prototype FRAIT. Follow-up focus groups for usability insights before field testing. Virtual commissioning raised real-world issues which public health nurses discussed in focus groups. Issues were scoring, absence of information, focusing on family resilience, identifying adults caring for children, potential for use, identifying need and monitoring change, potential impact of using FRAIT and fitting it to everyday practice. Prototype testing like this allowed us to fine tune the FRAIT for field testing.

Time course of changes in immuneoendocrine markers following an international rugby game.

Intense exercise is known to cause temporary impairments in immune function. Few studies, however, have investigated the effects of intense competitive exercise on immunoendocrine variables in elite team sport athletes. The aim of this study was to evaluate the time course of changes in selected immunoendocrine and inflammatory markers following an international rugby union game. Blood samples were taken from players (n = 10) on camp entry, the morning of the game (pre), immediately after (post) and 14 and 38 h into a passive recovery period. Players lost 1.4 +/- 0.2 kg of body mass during the game (ambient conditions, 11 degrees C, 45% RH). An acute phase inflammatory response was observed as reflected through immediate increases in serum cortisol and IL-6 (post) followed by delayed increases in serum creatine kinase (CK; 14 h) activity and C-reactive protein (CRP; 38 h); P < 0.05. Decreases in the number of circulating T lympocytes, NK cells and bacteria-stimulated neutrophil degranulation were also observed post-exercise (P < 0.05), indicative of decreased host immune protection. Following a large decrease in serum testosterone to cortisol (T/C) ratio immediately post and 14 h after exercise, T/C values then increased above those observed at camp entry 38 h into recovery (P < 0.05). This rebound anabolic stimulus may represent a physiological requirement for recovery following intense tissue damage resulting from game collisions. The findings also suggest that a game of international rugby elicits disturbances in host immunity, which last up 38 h into the recovery period.

Plasma volume response to 30-s cycle ergometry: influence on lipid and lipoprotein.

PURPOSE: It has been suggested that exercise-induced changes in plasma volume (PV) confound the interpretation of biochemical data obtained during the recovery period from exercise. No studies have sought to assess the effect of short-duration, high-intensity exercise on PV change and plasma lipid and lipoprotein concentrations. The purpose of this study was to compare power profiles, changes in PV, and plasma lipid and lipoprotein concentrations immediately after and 24 h after exercise. METHODS: Subjects undertook two 30-s, high-intensity cycle ergometer protocols after optimization of resistive loads calculated from total body mass (TBM) and fat-free mass (FFM). Power output indices were recorded and blood samples were analyzed before, immediately after, and 24 h after exercise. RESULTS: Peak power outputs were significantly greater in FFM (1020+/-134 vs 953+/-114 W for FFM and TBM, respectively, P<0.05). No differences were found between TBM and FFM for mean power output, fatigue index, or work done. Significant decreases (P<0.05) in PV of 12.0+/-5.7 and 12.3+/-6.7% were recorded immediately after exercise for both TBM and FFM, respectively. At 24 h after exercise, a significant (P<0.05) increase in PV of 4.2+/-10.3% was recorded for TBM only. Significant increases (P<0.01) were recorded for serum triglyceride, cholesterol, HDL cholesterol, and LDL cholesterol immediately after exercise for both TBM and FFM. These increases disappeared when corrected for PV changes, with the exception of LDL cholesterol in TBM, which still displayed a significant increase compared with the preexercise values (2.50+/-0.74 mM (before) vs 2.72+/-0.84 mM (immediately after)). CONCLUSIONS: Our data show that short-duration, high-intensity cycle ergometer exercise tests can induce significant plasma volume decreases in untrained subjects, which may affect the interpretation of bloodborne biochemical parameters.