Influence of Executive Function Training on BMI, Food Choice, and Cognition in Children with Obesity: Results from the TOuCH Study.

BACKGROUND: Children with obesity have a higher risk of future health and psychological problems. Executive functions (EFs) play a key role in successful dietetic and exercise planning; therefore, new treatments aimed at improving EFs may optimize outcomes. OBJECTIVES: This study evaluates the impact of EF training on body mass index (BMI), food choice, and cognition in children with obesity. We also examine their real-life executive functioning, emotional state, and quality of life. METHODS: Randomized controlled double-blind trial. Forty-six children with obesity were randomly allocated into an executive functions training or a control task training group and attended 30-45 min of daily training (5/week over 6 weeks), with both groups receiving counseling on diet and wearing an activity/sleep tracker. Participants were evaluated at baseline and after treatment. RESULTS: BMI decreased over time in the whole sample, although there were no differences between groups at post-training in BMI, food choice, and cognition. Both groups showed significant improvements in attention, speed, cognitive flexibility, and inhibitory control. Additionally, there were some benefits in real-life executive functioning and self-esteem. Over the 6 weeks, participants showed worse food choices in both groups. CONCLUSIONS: EFs training showed a lack of significant effects. The executive function enhancement alone did not explain these changes, as there were no significant differences between the experimental groups. It might be that the control task training could also produce some benefits, and multi-component interventions might be useful for weight loss.

Alterations in Brain Network Organization in Adults With Obesity as Compared With Healthy-Weight Individuals and Seniors.

OBJECTIVE: Life expectancy and obesity rates have drastically increased in recent years. An unhealthy weight is related to long-lasting medical disorders that might compromise the normal course of aging. The aim of the current study of brain connectivity patterns was to examine whether adults with obesity would show signs of premature aging, such as lower segregation, in large-scale networks. METHODS: Participants with obesity (n = 30, mean age = 32.8 ± 5.68 years) were compared with healthy-weight controls (n = 33, mean age = 30.9 ± 6.24 years) and senior participants who were stroke-free and without dementia (n = 30, mean age = 67.1 ± 6.65 years) using resting-state magnetic resonance imaging and graph theory metrics (i.e., small-world index, clustering coefficient, characteristic path length, and degree). RESULTS: Contrary to our hypothesis, participants with obesity exhibited a higher clustering coefficient compared with senior participants (t = 5.06, p < .001, d = 1.23, 95% CIbca = 0.64 to 1.88). Participants with obesity also showed lower global degree relative to seniors (t = -2.98, p = .014, d = -0.77, 95% CIbca = -1.26 to -0.26) and healthy-weight controls (t = -2.92, p = .019, d = -0.72, 95% CIbca = -1.19 to -0.25). Regional degree alterations in this group were present in several functional networks. CONCLUSIONS: Participants with obesity displayed greater network clustering than did seniors and also had lower degree compared with seniors and individuals with normal weight, which is not consistent with the notion that obesity is associated with premature aging of the brain. Although the cross-sectional nature of the study precludes causal inference, the overly clustered network patterns in obese participants could be relevant to age-related changes in brain function because regular networks might be less resilient and metabolically inefficient.

Executive Function Training in Childhood Obesity: Food Choice, Quality of Life, and Brain Connectivity (TOuCH): A Randomized Control Trial Protocol.

Background: Individuals with obesity are known to present cognitive deficits, especially in executive functions. Executive functions play an important role in health and success throughout the whole life and have been related to food decision-making and to the ability to maintain energy balance. It is possible to improve executive functions through targeted training. This would involve brain plasticity changes that could be studied through connectivity MRI. The general hypothesis of this study is that executive functions training in children with obesity can improve food choices and produce cognitive and neuroimaging changes (structural and functional connectivity), as well as improve emotional state and quality of life. Methods: Randomized controlled double-blind trial with 12-month follow-up. Thirty children with obesity will be randomly allocated into "executive training" (Cognifit with adaptive difficulty + Cogmed) or "control task" group (Cognifit without adaptive difficulty). Both groups will attend 30-45 min of individual gamified training (Cogmed and/or Cognifit systems) by iPad, five times per week during 6 weeks. Cogmed and Cognifit software are commercially available from Pearson and Cognifit, respectively. Participants will receive an iPad with both apps installed for a 6-week use. Participants will also receive counseling diet information via presentations sent to the iPad and will wear a Fitbit Flex 2 tracker to monitor daily activity and sleep patterns. Main outcomes will be cognitive, emotional, food decision, and quality-of-life measures, as well as neuroimaging measures. Participants are evaluated at baseline (T0), after treatment (T1), and 12 months since baseline (T2). Discussion: Longitudinal study with active control group and 3 time points: baseline, immediately after treatment, and 1 year after baseline. Threefold treatment: executive function training, psychoeducation, and feedback on activity/sleep tracking. We will evaluate the transfer effects of the intervention, including emotional and functional outcomes, as well as the effects on neural plasticity by connectivity MRI. Trial registration: This project has been registered in ClinicalTrials.gov (trial registration number NCT03615274), August 3, 2018.

Polisomnografía y otros métodos de registro / Polysomnography and other sleep studies

Para el diagnóstico de la mayoría de alteraciones del sueño en los niños se necesita realizar pruebas complementarias. De estas pruebas complementarias, especialmente cuando se quieren estudiar los trastornos respiratorios del sueño en el niño, destacan la polisomnografía nocturna completa, considerada actualmente la prueba de referencia para el diagnóstico de las alteraciones del sueño. Sin embargo, hay otras pruebas simplificadas que, aunque con menos información y fiabilidad, pueden constituir alternativas diagnósticas aceptables, como son la poligrafía respiratoria y el registro de pulsioximetría. En este artículo se explicarán las principales indicaciones, metodología y ventajas e inconvenientes de las diferentes pruebas de sueño(AU)

Additional tests are needed for an accurate diagnosis of most sleep disorders in children. Of these additional tests, especially when study of sleep breathing disorders in children is required, complete overnight polysomnography is currently considered the gold standard for the diagnosis of sleep disorders. There are, however, other simplified tests, although less informative and reliable, which may be acceptable diagnostic alternatives, such as respiratory polygraphy and pulse oximetry recording. This article will explain the main indications, methodology and advantages and disadvantages of the various sleep tests(AU)

Tratamiento con presión positiva continua en los trastornos respiratorios del sueño en los niños / Continuous positive airway pressure treatment in sleep-related respiratory disorders in children

La presión positiva continua (CPAP) es la primera opción en el tratamiento del síndrome de apnea-hipopnea (SAHS) del adulto y, en los últimos años se está considerando la segunda opción tras la cirugía en niños. Es la mejor opción en niños en los que el SAHS persiste a pesar de la intervención quirúrgica. Para muchos autores, el uso de la CPAP en niños y adolescentes es seguro, efectivo y bien tolerado en todas las edades. Es necesario realizar controles frecuentes cada 6–12 meses, pues los requerimientos de presión y talla de la mascarilla cambiarán con el crecimiento y el desarrollo del niño. El éxito en el uso de la CPAP va muy unido a la tolerancia de los niños hacia el mismo. Muchos autores han descrito estrategias para mejorar la tolerancia. Entre ellas, la terapia conductual ha demostrado ser eficaz para aumentar la tolerancia y el cumplimiento a la CPAP(AU)

Continuous positive airway pressure (CPAP) is the first choice in the treatment of apnea-hypopnea syndrome in adults and, in recent years, is considered the second option after surgery in children. CPAP is the best option in children if apnea-hypopnea syndrome persists after surgery. For many professionals in the field, the use of CPAP in all ages of children and adolescents is safe, effective and well tolerated. Follow-up visits are required every 6–12 months, since the mask pressure and size requirements will change depending on children's growth and development. The success of the use of CPAP is closely related to children's tolerance of the CPAP mask. Many professionals have described strategies to improve this tolerance. One of these strategies is to use behavioral therapy, which has been shown be effective in increasing tolerance and performance of the CPAP(AU)

Neurofibromatosis tipo 2 / Neurofibromatosis type 2

La neurofibromatosis tipo 2 es una enfermedad invalidante que se hereda de forma autosómica dominante. A menudo se ha confundido con la neurofibromatosis tipo 1, aunque son patologías distintas. Todos los sujetos que hereden una mutación en el gen de la neurofibromatosis tipo 2 (NF2), desarrollarán dicha enfermedad, caracterizada por el crecimiento de schwanomas, habitualmente vestibulares y de forma bilateral, así como meningiomas u otros tumores benignos del sistema nervioso central, antes de los 30 años de edad. Actualmente, podemos identificar la mutación del NF2 en la mayoría de las familias afectas. Hasta un 20% de los pacientes afectos de NF2 sin historia familiar, aparentemente casos esporádicos, son en realidad individuos con mosaicismo para esa mutación. La morbilidad de esos tumores es en gran medida debida a su tratamiento, que es principalmente quirúrgico. Cuando son pequeños, los schwanomas vestibulares se pueden resecar completamente con preservación tanto de la función auditiva como facial. En caso de tumores grandes se puede colocar un implante coclear o bien de tronco cerebral durante el mismo acto quirúrgico. Los principales factores pronósticos son: la edad media al diagnóstico, la presencia de meningiomas intracraneales y si el paciente fue tratado o no en un centro especializado (AU)

Type 2 neurofibromatosis (NF2) is an invalidating, inherited, dominant, autosomal disease. It is commonly confused with type 1 neurofibromatosis, although the two disorders are different. All subjects who inherit a mutated NF2 gene will develop the disease, which is characterised by the growth of schwannomas, generally affecting the vestibular nerve bilaterally, as well as meningiomas and other benign central nervous system tumours, before their third decade of life. It is currently possible to identify the NF2 mutation in most affected families. Up to about 20% of NF2 patients with no family history, apparently sporadic cases, are actually individuals with mosaicism for this mutation. Much of the morbidity from these tumours results from their treatment, which is primarily surgical. Small vestibular schwannomas can often be completely resected with preservation of both hearing and facial function. In case of large tumours it is possible to place a cochlear or brain stem implant during the schwannoma surgery. Age at diagnosis, the presence of intracranial meningiomas, and whether the patient was treated at a specialty centre or not, have been cited as the strongest prognostic factors (AU)

[Neurofibromatosis type 2]. / Neurofibromatosis tipo 2.

Type 2 neurofibromatosis (NF2) is an invalidating, inherited, dominant, autosomal disease. It is commonly confused with type 1 neurofibromatosis, although the two disorders are different. All subjects who inherit a mutated NF2 gene will develop the disease, which is characterised by the growth of schwannomas, generally affecting the vestibular nerve bilaterally, as well as meningiomas and other benign central nervous system tumours, before their third decade of life. It is currently possible to identify the NF2 mutation in most affected families. Up to about 20% of NF2 patients with no family history, apparently sporadic cases, are actually individuals with mosaicism for this mutation. Much of the morbidity from these tumours results from their treatment, which is primarily surgical. Small vestibular schwannomas can often be completely resected with preservation of both hearing and facial function. In case of large tumours it is possible to place a cochlear or brain stem implant during the schwannoma surgery. Age at diagnosis, the presence of intracranial meningiomas, and whether the patient was treated at a specialty centre or not, have been cited as the strongest prognostic factors.

[Polysomnography and other sleep studies]. / Polisomnografía y otros métodos de registro.

Additional tests are needed for an accurate diagnosis of most sleep disorders in children. Of these additional tests, especially when study of sleep breathing disorders in children is required, complete overnight polysomnography is currently considered the gold standard for the diagnosis of sleep disorders. There are, however, other simplified tests, although less informative and reliable, which may be acceptable diagnostic alternatives, such as respiratory polygraphy and pulse oximetry recording. This article will explain the main indications, methodology and advantages and disadvantages of the various sleep tests.

[Continuous positive airway pressure treatment in sleep-related respiratory disorders in children]. / Tratamiento con presión positiva continua en los trastornos respiratorios del sueño en los niños.

Continuous positive airway pressure (CPAP) is the first choice in the treatment of apnea-hypopnea syndrome in adults and, in recent years, is considered the second option after surgery in children. CPAP is the best option in children if apnea-hypopnea syndrome persists after surgery. For many professionals in the field, the use of CPAP in all ages of children and adolescents is safe, effective and well tolerated. Follow-up visits are required every 6-12 months, since the mask pressure and size requirements will change depending on children's growth and development. The success of the use of CPAP is closely related to children's tolerance of the CPAP mask. Many professionals have described strategies to improve this tolerance. One of these strategies is to use behavioral therapy, which has been shown be effective in increasing tolerance and performance of the CPAP.

Hábitos de sueño y consumo de tóxicos de los adolescentes / No disponible

No disponible

Efectos de fármacos hipnóticos en el embarazo y la lactancia / Drugs hypnotics in pregnancy and lactation

La utilización de psicofármacos, especialmente hipnóticos y ansiolíticos puede ser necesaria en algunas mujeres gestantes y lactantes. No obstante la escasa información científica existente sobre el tema puede condicionar la correcta administración terapéutica. En parte es totalmente comprensible ya que no se pueden realizar, por cuestiones evidentemente éticas, ensayos clínicos en humanos que nos den alguna información sobre el tema. Lo mejor es conocer que existen algunas de estas sustancias que pueden utilizarse y que el control medico es imprescindible para garantizar la buena alud tanto de la madre como del feto. Por eso hemos creído necesaria la compilación de información acerca de la idoneidad de la administración de estos psicofármacos. Para poder aportar datos científicos contrastados hemos consultado tres organismos que han estudiado y dictado normas sobre estos temas, la FDA (food and drug administration) y la ADEC (australian drug evaluation committee) para el tema de la gestación, y la Escuela Andaluza de Salud Pública, para la lactancia (AU)

The use of psychotropics specially hypnotics and anxiolytics can be necessary in some pregnant and nursing women. Despite the lack of scientific information on the subject it can affect the correct therapeutic administration. The lack of information is understandable due to the impossibility to do, for ethical reasons, clinical tests in humans. The best thing is to know than some of these substances exist that they can be used and that medical control is essential to insure the good health of both the mother and of the fetus. For that reason we have believe necessary an information compilation about the suitability of the administration of these drugs. In order to be able to compare dictated scientific data we have consulted three agencies that have studied and dictated norms on these subjects, the FDA (food and drug administration), the ADEC (Australian Drug Evaluation Committee) in relation to pregnancy and Escuela Andaluza de Salud Pública in relation to breast feeding (AU)