Neuropsychological Stimulation Program for Children from Low Socioeconomic Backgrounds: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Guatemala remains one of the poorest countries in Central America and suffers from high rates of social inequality and violence. In addition to the negative impact that two years without attending school has had on Guatemalan children due to the consequences of the COVID-19 pandemic, this unfavourable socioeconomic context poses a risk to children's emotional and cognitive development. This work presents a protocol for implementing a cognitive and emotional stimulation program aimed at increasing the academic performance of these children and consequently improving their quality of life. METHODS: The protocol proposes the implementation of a randomized controlled trial to assess the efficacy of a 24-session-long stimulation program. It targets the cognitive functions of attention, language, executive functions, and social cognition, using the digital neurorehabilitation platform NeuronUP. The participants (n = 480) will be randomly assigned to an Experimental or Control group. Pre- and post-intervention assessments will be carried out, together with a follow-up in the next academic year, in which both groups will change roles. Results will be compared for the first and second years, looking for differences in academic and cognitive performance between groups. DISCUSSION: Mid- and long-term outcomes are still unknown, but effective interventions based on this protocol are expected to facilitate the following benefits for participants: (1) improved cognitive and emotional development; (2) improved academic performance; (3) improved well-being. We expect to create a validated neuropsychological stimulation program that could be applied in similar socioeconomically disadvantaged contexts around the world to help these children improve their life chances.

'Mens sana in corpore Sano': Home food consumption implications over child cognitive performance in vulnerable contexts.

Diet directly affects children's physical and mental development. Nonetheless, how food insecurity and household food consumption impact the cognitive performance of children at risk of social exclusion remains poorly understood. In this regard, children in Guatemala face various hazards, mainly related to the socioeconomic difficulties that thousands of families have in the country. The main objective of this study was to analyze the differences in cognitive performance considering food insecurity and household food consumption in a sample of rural and urban Guatemalan children and adolescents at risk of social exclusion. Child cognitive performance was assessed in 134 children and adolescents (age M = 11.37; SD = 3.54) from rural and urban settings. Language, attention, and executive functions were assessed using neuropsychological tasks. Differences in cognitive performance in each level of food insecurity and household diet consumption were compared using the Mann-Whitney U test. A stepwise multivariate regression analysis was conducted to determine which factors may influence cognitive scores. The results showed that rural and urban groups did not differ in terms of food insecurity. However, considering just rural areas, differences were found between groups with food security and insecurity in attention and executive function tasks. Moreover, differences were found in food consumption for certain groups of food (e.g., meat, U = 1,146, p < 0.001, g = 0.72). Regarding regressions, protein food consumption (e.g., meat and fish), which is related to having a more balanced diet, was a relevant factor in executive performance. Contrary to what we expected, performance in attentional tasks was not related to the consumption of any food group. These findings could help politicians and decision-makers to select actions focused on improving diet balance and food security in families at risk of social exclusion. It is necessary to carry out more specific studies on the factors related to diet that affect the cognitive development of minors at risk of social exclusion. In addition, it is necessary to study the implementation of alternative interventions that include low-cost nutrients, thus ensuring that minors have access to a more balanced diet.

Cognitive Intervention Programs in Minors Belonging to Disadvantaged Contexts in Spain: A Systematic Review.

Research studies show a strong influence of socioeconomic status (SES) on human development, and how the exposure to risk contexts in the earliest stages translates into dangers in the cognitive development of children and adolescents. To alleviate these consequences and favour development, different cognitive training programs have contributed to this field by identifying the criteria of efficacy. This systematic review identifies and synthesizes the evidence of cognitive intervention studies implemented with psychosocial risk groups carried out in Spain. The search strategy was adapted to different databases. Only studies published in English or Spanish and developed in Spain that included interventions applied in populations aged 5 to 18 years with a low SES were included. The analysis of the literature showed nine interventions that indicated an improvement in those cognitive functions worked with low SES children. The cognitive domains that most worked were executive functions, followed by social cognition and language. After reviewing the available literature, a clear scarcity of interventions carried out in Spain was observed. Variables such as age, cognitive functions or personal vulnerability were identified as factors to be taken into account in future lines of research due to their influence on minors. These findings indicate the relevance of this review to help decision-making in relation to the actions to be carried out by the competent bodies in Spain.

Neuropsychological profile associated to PKAN in its initial phase: a case series report.

Pantothenase kinase-associated neurodegeneration (PKAN) is characterized by an abnormal accumulation of iron in basal ganglia and progressing varied extrapyramidal clinical symptoms. There are few studies on the cognitive symptoms and their development. The aim of this study is to explore the neuropsychological profile of PKAN patients in the initial stages of the disorder, when there are relatively fewer motor limitations. we present a full neuropsychological examination of three female cases (two early and one late onset). perception and spatial cognition were within normal range. Performance on other tasks were mixed, except for primary impairments in inhibition, flexibility, and cognitive fluency, which were consistent across cases. unlike most previous studies which report adults with major motor impairment, we present cases of young participants with minor motor difficulties. The results of the neuropsychological assessment - potentially less confounded by poor motor functioning during examination - are compatible with impairments in the fronto-subcortical circuits in the early phases of the disease. This could explain frequent misdiagnoses (e.g., with attention deficit hyperactivity disorder) in initial referrals.

Análisis de las variaciones del equilibrio y propiocepción en relación con la práctica del surf: estudio piloto / Analysis of the balance and proprioception in the practice of surfing: a pilot study

Introducción: El surf es un deporte que requiere un nivel de equilibrio ya que se desarrolla en un entorno cambiante. Hi­pótesis: Se espera que los ejercicios que valoran la propiocepción muestren mejores resultados en surfistas avanzados que en principiantes y no surfistas. Objetivo: Evaluar cómo la práctica del surf interviene en la propiocepción comparando a los surfistas principiantes y avan­zados entre sí, y con los no surfistas. Material y método: Una muestra de 30 participantes, 10 surfistas principiantes, 10 surfistas avanzados y 10 no surfistas, fue analizada en Valencia (“Mediterranean Surf School”) y Zarautz (“ESSUS”). Se realizó un cuestionario y 6 pruebas que evaluaban: el equilibrio estático, Balance Error Scoring System (BESS) y el dinámico, Y-Balance Test (YBT); la flexibilidad de la espalda, Schober’s Modified-modified-Test, y la fuerza y resistencia lumbar, Biering-Sorensen test (BSTT); el esfuerzo percibido, la escala de Borg; y la fuerza del cuádriceps, ChronoJump® kit. Resultados: En el test BESS hubo diferencias significativas (p = 0,02) en el resultado total de errores en superficie inestable, siendo menor en los surfistas avanzados que en los no surfistas. En las puntuaciones totales del YBT, en el test de Schober y en el BSTT, no se obtuvieron diferencias. Los surfistas mejoraron en la fuerza isométrica del cuádriceps y en el test de Borg (p = 0,008). Conclusiones: No se obtuvieron diferencias en las estrategias de equilibrio. Observamos una mejora del equilibrio estático en los surfistas avanzados en comparación con los no surfistas, cuando la demanda de equilibrio es máxima.(AU)

Introduction: Surfing is a sport that requires a level of balance since it takes place in a changing environment. Hypothesis: Exercises that value proprioception are expected to show better results in advanced surfers than in beginners and non-surfers. Objective: To assess how the practice of surfing intervenes in proprioception by comparing beginners and advanced surfers with each other, and with non-surfers. Material and method: A sample of 30 participants, 10 surf beginners, 10 advanced surfers and 10 non-surfers, was tested in Valencia (“Mediterranean Surf School”) and Zarautz (“ESSUS”). A questionnaire and 6 tests were performed evaluating: the static balance, Balance Error Scoring System (BESS) and dynamic, Y-Balance Test (YBT); back flexibility, Schober’s Modified-modified-Test, and lumbar strength and resistance, Biering-Sorensen test (BSTT); perceived effort, the Borg scale; and quadriceps strength, ChronoJump® kit. Results: In the BESS test there were significant differences (p = 0.02) in the total result of errors on unstable surface, being lower in advanced surfers than in non-surfers. In the total scores of the YBT, in the Schober test and in the BSTT, we did not obtain differences. Surfers improved in quadriceps isometric strength and on the Borg test (p = 0.008). Conclusions: No differences in balance strategies were obtained. We observed improvement of the static balance in advanced surfers compared to non-surfers, when the demand for balance is at its highest.(AU)

Socioeconomic Status, Culture, and Reading Comprehension in Immigrant Students.

Research on reading comprehension in immigrant students is heterogeneous and conflicting. Differences in socioeconomic status and cultural origins are very likely confounds in determining whether differences to native pupils can be attributed to immigrant status. We collected data on 312 Spanish students of Native, of Hispanic origin-therefore with the same family language as native students- and Non-Hispanic origin, while controlling for socioeconomic status, non-verbal reasoning and school membership. We measured reading comprehension, knowledge of syntax, sentence comprehension monitoring, and vocabulary. Differences among groups appeared only in vocabulary and syntax (with poorer performance in the non-Hispanic group), with no differences in reading comprehension. However, regression analyses showed that most of the variability in reading comprehension was predicted by age, socioeconomic status, non-verbal reasoning, and comprehension monitoring. Group membership did not significantly contribute to explain reading comprehension variability. The present study supports the idea that socioeconomically disadvantaged students, both native and immigrants from diverse cultural backgrounds, irrespective of the language of origin, are probably equally at risk of poor reading comprehension.

Psychotherapeutic Interventions to Improve Psychological Adjustment in Type 1 Diabetes: A Systematic Review.

Background: International clinical practice guidelines highlight the importance of improving the psychological and mental health care of patients with Type 1 diabetes mellitus (T1DM). Psychological interventions can promote adherence to the demands of diabetes self-care, promoting high quality of life and wellbeing. Methods: A systematic review was carried out to determine whether psychological treatments with a specific focus on emotional management have an impact on glycemic control and variables related to psychological adjustment. Comprehensive literature searches of PubMed Medline, Psycinfo, Cochrane Database, Web of Science, and Open Grey Repository databases were conducted, from inception to November 2019 and were last updated in December 2020. Finally, eight articles met inclusion criteria. Results: Results showed that the management of emotions was effective in improving the psychological adjustment of patients with T1DM when carried out by psychologists. However, the evidence regarding the improvement of glycemic control was not entirely clear. When comparing adolescent and adult populations, findings yielded slightly better results in adolescents. Conclusions: More rigorous studies are needed to establish what emotional interventions might increase glycemic control in this population.

Normative Data for Ten Neuropsychological Tests for the Guatemalan Pediatric Population Updated to Account for Vulnerability.

The Guatemalan pediatric population is affected by a high incidence of poverty and violence. The previous literature showed that these experiences may ultimately impact cognitive performance. The aim of this article is to update the standardized scores for ten neuropsychological tests commonly used in Guatemala considering vulnerability. A total of 347 healthy children and adolescents from 6 to 17 years of age (M = 10.83, SD = 3) were assessed, controlling for intelligence, mental health and neuropsychological history. The standard scores were created using multiple linear regression and standard deviations from residual values. The predictors included were the following: age, age squared (age2), mean parental education (MPE), mean parental education squared (MPE2), gender, and vulnerability, as well as their interaction. The vulnerability status was significant in the scores for language, attention and executive functions. To the best of our knowledge, this is the first study that includes the condition of vulnerability in the calculation of neuropsychological standard scores. The utility of this update is to help in the early detection of special needs in this disadvantaged population, promoting more accurate interventions in order to alleviate the negative effects that living in vulnerable conditions has on children and adolescents.

Cognitive interventions in children and adolescents from low socioeconomic status backgrounds: a systematic review protocol of randomized controlled trials.

BACKGROUND: Many studies have evaluated the effects that a lack of resources has in children's physical and cognitive development. Although there are reviews that have focused on applied interventions from different perspectives, there is still a need for a comprehensive review of what has been attempted with these children from the cognitive intervention field. The aim of this paper is to present a protocol for a systematic review collecting randomized controlled trials (RCTs) studies whose purpose was to enhance cognitive development through the implementation of cognitive interventions in children and adolescents (< 18 years old) from low socioeconomic Status (SES) settings. METHODS: The following databases will be searched: Web of Science (WoS core collection), PsycINFO, Cochrane Central Register of Controlled Trial, ERIC, PubMed, ICTRP and Opengrey Register (System for Information of Grey Literature in Europe). Searches will be adapted for each database. Additionally, the reference list of articles included in the review will also be searched. As part of this process, two reviewers will determine, independently, the suitability of each article taking into account predefined inclusion/exclusion criteria. Pertinent data will then be extracted, including sample characteristics, specifics of the intervention, and outcomes, as well as follow-up measures. Internal validity will be assessed using the Cochrane Risk of Bias Tool. A quantitative synthesis of results will be conducted using a meta-analysis. However, if a meta-analysis is difficult to implement due to the diversity of the studies (for example, in terms of measures used to estimate the effect size, intervention types, outcomes, etc.), the technique synthesis without meta-analysis (SWiM) will be used. A description of outcome measures will be provided, as measured by validated neuropsychological instruments of any cognitive function. DISCUSSION: The systematic review will offer a framework based on evidence to organisations, institutions, and experts who want to implement or promote interventions aimed at enhancing cognitive domains in children and adolescents who live in disadvantaged contexts. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 16 March 2020 (registration number: CDR42020150238).

How Living in Vulnerable Conditions Undermines Cognitive Development: Evidence from the Pediatric Population of Guatemala.

Low-socioeconomic backgrounds represent a risk factor for children's cognitive development and well-being. Evidence from many studies highlights that cognitive processes may be adversely affected by vulnerable contexts. The aim of this study was to determine if living in vulnerable conditions affects childhood cognitive development. To achieve this, we assessed the performance of a sample of 347 Guatemalan children and adolescents aged from 6 to 17 years (M = 10.8, SD = 3) in a series of 10 neuropsychological tasks recently standardized for the pediatric population of this country. Two-fifths of the sample (41.5%) could be considered to have vulnerable backgrounds, coming from families with low-socioeconomic status or having had a high exposure to violence. As expected, results showed lower scores in language and attention for the vulnerable group. However, contrary to expectations, consistent systematic differences were not found in the executive function tasks. Vulnerable children obtained lower scores in cognitive flexibility compared to the non-vulnerable group, but higher scores in inhibition and problem-solving tasks. These results suggest the importance of developing pediatric standards of cognitive performance that take environmental vulnerable conditions into consideration. These findings, one of the first obtained in the Guatemalan population, also provide relevant information for specific educational interventions and public health policies which will enhance vulnerable children and adolescent cognitive development.

Management of isolated distal deep-vein thrombosis with direct oral anticoagulants in the RIETE registry.

Isolated distal deep-vein thrombosis (DVT, infra-popliteal DVT without pulmonary embolism) is a common presentation of venous thromboembolism (VTE), but was an exclusion criterion from the pivotal trials that validated the use of direct oral anticoagulants (DOACs) for VTE management. Using data from the international RIETE registry, we analyzed and compared trends in DOACs prescription between January 2011 and June 2019 in patients with distal vs. proximal DVT. We also assessed DOACs' prescriptions and compared the outcomes (VTE recurrence, bleeding and death) of distal DVT patients treated with DOACs vs. those on vitamin K antagonists (VKAs). 2308 patients with distal DVT and 11,364 patients with proximal DVT were included in the current analysis. DOACs were more frequently prescribed in patients with distal than proximal DVT (25% vs. 16%, p < 0.001). DOACs use increased sharply during the observation period (P < 0.001 for trend). In 2018, 56% of patients with distal DVT received DOACs. Distal DVT patients treated with rivaroxaban or edoxaban received the dose recommended for VTE management in most (> 85%) cases. Patients treated with apixaban were older, more likely to have underlying conditions than patients treated with rivaroxaban and, in most cases (> 75%), did not receive the recommended 1-week loading dose for acute VTE management. Outcomes between distal DVT patients treated with VKAs or DOACs appeared to be similar. In patients with distal DVT, DOACs have become the most common anticoagulant regimen. Specific trials are needed to determine the optimal DOACs dose regimen for treatment of distal DVT.

Funciones Ejecutivas en Estudiantes con Trastorno Específico del Lenguaje al Comienzo de la Escolarización Básica / Executive Functions in Students with Specific Language Impairment at the Beginning of Elementary Education

Resumen Las funciones ejecutivas (FE) constituyen un conjunto de habilidades implicadas en el control y regulación del funcionamiento cognitivo. La relación entre fe y desarrollo del lenguaje es especialmente relevante en la conceptualización de los trastornos lingüísticos. El objetivo del estudio consistió en explorar el uso diferencial de fe en dos grupos: Desarrollo Lingüístico Típico (DLT) y Trastorno Específico del Lenguaje (TEL). Participaron 44 estudiantes (56,82 % niños), 22 DLT y 22 TEL, con edades entre 6,00-6,92 años (M=6.17, DT=.19). El factor diagnóstico previo mostró efectos significativos en atención ejecutiva (p<.001, η2 parcial =.77), memoria de trabajo (p<.001, if parcial =.67), flexibilidad cognitiva (p<.01, η2 parcial =.15), y planificación (p<.001, η2 parcial =.63). En todos los casos, salvo en flexibilidad cognitiva, el tamaño del efecto fue fuerte. Los resultados avalarían la tesis de no especificidad en TEL y la posible presencia de disfunciones cognitivas generales que subyacen al trastorno.

Abstract The executive functions (EF) constitute a set of skills involved in the control and regulation of cognitive functioning. The relation between EF and the development of language is especially relevant regarding the conceptualization of linguistic disorders. This study aims to explore the differential use of EF between two groups: Typical Language Development (TLD) and Specific Language Impairment (SLI). The participants were 44 students (56,82% boys), 22 TLD and 22 SLI, with ages between 6,00-6,92 years (M=6.17, SD=.19). The previous diagnostic factor showed significant effects in executive attention (p<.001, η2 partial =.77), working memory (p<.001, η2 partial =.67), cognitive flexibility (p<.01, η2 partial =.15), and planning (p< .001, η2 partial =.63). In every case, except for cognitive flexibility, the effect was strong. The results would support the thesis of non-specificity in the SLI and the possible presence of general cognitive dysfunctions that underlie the disorder.

Mental Health, Quality of Life and Violence Exposure in Low-Socioeconomic Status Children and Adolescents of Guatemala.

Growing up in vulnerable conditions has an impact on children and adolescents' mental health and well-being outcomes. However, this evidence has rarely been obtained in middle and low-income countries like Guatemala, where food insecurity and exposure to violence frequently threaten childhood development. The aim of this study was to analyse the relations that sociodemographic and socioeconomic factors have with psychological adjustment of low-socioeconomic status (SES) Guatemalan children and adolescents, and how these relations were mediated by food insecurity and exposure to violence. A total of 185 participants (50.8% girls; aged between 6 to 17, M = 11.82, SD = 3.7) from three vulnerable schools located in rural and urban areas of Guatemala were assessed. The results indicated that exposure to violence significantly moderates the effect of sociodemographic and socioeconomic variables in measures of depression, anxiety and health-related quality of life. Adolescents more exposed to violence reported higher levels of depression and anxiety, as well as lower levels of health-related quality of life. In contrast, food insecurity did not seem to influence psychological adjustment outcomes in this low-SES sample. These findings highlight the relevance of exposure to violence for mental health and well-being, and is a factor that should be considered when designing public health policies to promote children and adolescents' welfare.

Multivariate Base Rates of Low Scores on Tests of Learning and Memory among Spanish-Speaking Children.

To determine the prevalence of low scores on two neuropsychological tests commonly used to evaluate learning and memory in children. 6,030 healthy children from 10 countries in Latin America and Spain were administered Rey-Osterrieth Complex Figure (ROCF) and the Test de Aprendizaje y Memoria Verbal-Infantil (TAMV-I). Results showed that low scores are common when multiple neuropsychological outcomes (tests and/or scores) are evaluated in healthy individuals. Clinicians should consider the higher probability of low scores in a given individual when evaluating learning and memory using various sets of scores to reduce false-positive diagnoses of cognitive deficits in pediatric populations.

Analysis of the conflicts of interest disclosed by the program reviewers of the scoliosis research society (SRS) congresses, 2010-2014.

BACKGROUND: Conflicts of interest (COI) between industry and surgeons frequently introduce biases into surgical research. The abstracts submitted for presentation in scientific congresses are usually vetted for any indication of commercial bias. Members of review program committees regularly have recognized qualifications, and therefore certain COI are unavoidable. This study aims to determine the prevalence and magnitude of possible COI among those responsible for the selection of presentations at two important international conferences on spine surgery during a five-year period. METHODOLOGY: COI declarations by those responsible for the final programs of the annual SRS (Scoliosis Research Society) and IMAST (International Meeting of Advanced Spine Technologies) conferences from 2010 to 2014 were collected and analyzed from data published by the corresponding scientific programs. The SRS's disclosure index did not contain financial amounts; therefore, this aspect could not be analyzed. RESULTS: Five scientific committees and 117 members (76 individuals) were studied. Of these 76, 41 (53.9%) participated in more than one conflict of interest (>1 COI). Scientific committee members were from 11 countries across 4 continents, but most were from the Unites States (76.9%). Of the 117 program reviewers, 65.8% declared >1 COI and 34.2% reported no COI. The 77 program reviewers who disclosed a potential COI declared a total of 273 COI (mean = 3.54 COI/member). Overall, 36.0%, 26.1%, 10.7%, and 10.7% of the COI corresponded to consultancies, research funds, bureau participation, and advisory board panel participation, respectively. Stockholder reimbursement corresponded to 8.8% of the disclosed COI, and financial or material support were mentioned in 7.4% of COI. Among the COI disclosures, 55 companies were mentioned, and 5 of the top 10 companies involved in spinal device markets were responsible for 65.2% of the COI. CONCLUSIONS: More than two thirds of the members of the SRS and IMAST scientific committees reported COI. Consultancies and research grants account for two thirds of these. Most of the grants and major COI are related to the five companies leading the spinal implant market.