ABSTRACT
BACKGROUND: Almost 30% of Chilean women report cigarette smoking with important repercussions on their health. OBJECTIVE: Design and test a mobile phone intervention for smoking cessation in young women. STUDY DESIGN: A mobile application (app) was created using the best available evidence and consumer input. Its effectiveness was assessed through a randomized clinical trial. STUDY PARTICIPANTS: Women 18 to 44 years old from middle-class neighborhoods in Santiago, Chile. Inclusion criteria were intention to quit cigarette smoking in the following month and having a smartphone cell phone. Women with positive screening for risky alcohol consumption were excluded. INTERVENTION: App with content to support cigarette smoking cessation over 6 months. The control arm included an app that delivered general messages to promote permanence in the study. Telephone follow-up was performed at 6 weeks, and at 3 and 6 months after randomization. MAIN OUTCOME MEASURE: No smoking in the past 7 days at 6 weeks from enrolment. Intention-to-treat analysis was carried out using SPSS 17.0 with a significance level set at .05. RESULTS: 309 women entered the study. Mean number of cigarettes smoked in a day was 8.8. 58.6% of the participants (n = 181) completed the follow-up for the primary outcome. With intention-to-treat analysis, 9.7% of participants in the intervention group reported not having smoked any cigarettes in the last 7 days vs 3.2% in the control group (RR 2.98 CI 95% 1.11-8.0, P = .022). Additionally, 12.3% vs 1.9% of the participants in the intervention group and control group reported continuous abstinence at 6 weeks, respectively (RR 6.29 95% CI 1.9-20.8, P < .001). Continuous abstinence was also significant at 6 months (P-value of .036). CONCLUSIONS: The "Appagalo" app is an effective tool to support smoking cessation in young women. It is a simple mHealth alternative for smoking cessation that can contribute to improving women's health in the Americas and worldwide.
ABSTRACT
Attention deficit hyperactivity disorder (ADHD) is the most prevalent and frequent neurodevelopmental disorder in neuropediatrics, child psychiatry and child psychology consultations. The greater awareness of this condition, the information and, above all, the socio-cultural acceptance, has led to an earlier diagnosis, leading to more timely and effective treatment. Individualizing each case through systematic tools such as neuropsychological studies and their neuroanatomical and neurobiochemical correlation, related to ADHD, together with algorithms that analyze executive functions, is essential to indicate the optimal pharmacological treatment, together with the application of appropriate non-pharmacological therapies. Multimodal treatment, with cognitive behavioral intervention and pharmacological treatment, is the most effective therapeutic approach.
El trastorno por déficit de atención e hiperactividad (TDAH) es el trastorno del neurodesarrollo más prevalente y frecuente en las consultas de neuropediatría, psiquiatría y psicología infantiles. La mayor sensibilización ante esta condición, la información y sobre todo la aceptación socio cultural, ha provocado que se diagnostique más precozmente, implicando ello un tratamiento más oportuno y eficaz. El individualizar cada caso mediante herramientas sistemáticas como los estudios neuropsicológicos y su correlación neuroanatómica y neurobioquímica, relacionados con el TDAH, junto con los algoritmos que analizan las funciones ejecutivas, es primordial para indicar el tratamiento farmacológico óptimo, unido a la aplicación de las terapias no farmacológicas apropiadas. El tratamiento multimodal, con intervención cognitivo conductual y tratamiento farmacológico, es el enfoque terapéutico más efectivo.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/therapy , Child , Executive Function , Humans , Treatment OutcomeABSTRACT
Theta-Beta (T / B) ratio of the quantified electroencephalogram (EEGQ) in patients with attention deficit hyperactivity disorder (ADHD) constitutes a characteristic EEG variable of the primary disorder with an overall accuracy of 89%. The objective of this study was to measure the T/B ratio in a sample of patients with ADHD and the effects of the treatment with psychostimulants and non-psychostimulants on the T/B ratio. The sample consisted of 85 children between 6 and 18 years (68 males and 17 females) with the diagnosis of the inattentive and combined subtype of ADHD, according to the criteria of the DSM-V. An EEGQ was performed with measurement of the T/B ratio before and after 6 months of treatment with psychostimulant and non-psychostimulant drugs. Both groups were compared using the Wilcoxon signed range test for related samples. The results showed that 86% of the cases had a T/B ratio above the normal values for the age of them. The reduction in the T/B ratio was statistically significant in the group of patients treated with psychostimulants. The reduction of non-psychostimulants was not significant. In conclusion, we confirmed the high T/B ratio in patients with ADHD. Psychostimulant drugs decrease the elevated T/B ratio in patients with ADHD after 6 months of treatment.
El cociente Theta-Beta (T/B) del electroencefalograma cuantificado (EEGQ) de los pacientes con trastorno por déficit de atención e hiperactividad (TDAH) constituye una variable del EEG característica del trastorno primario con una precisión global del 89%. El objetivo de este estudio es medir el cociente T/B de una población de con TDAH y los efectos del tratamiento farmacológico con psicoestimulantes y no psicoestimulantes sobre el cociente T/B. La muestra estaba formada por 85 sujetos de entre 6 y los 18 años (68 niños y 17 niñas) con el diagnóstico de TDAH de subtipo inatento y combinado, según los criterios del DSM-V. Se les realizó un EEGQ con medición del cociente T/B antes y después de 6 meses de tratamiento con fármacos psicoestimulantes y no psicoestimulantes. Se compararon ambos grupos mediante la prueba de rangos con signo de Wilcoxon para muestras relacionadas. En el 86% de los casos el cociente T/B fue elevado respecto de los valores normales para la edad. La reducción en el cociente T/B fue significativa en el grupo tratado con psicoestimulantes aunque la reducción con los no psicoestimulantes no fue significativa. En conclusión, se confirma la elevación del cociente T/B en los pacientes con TDAH. Los fármacos psicoestimulantes disminuyen de forma significativa el cociente T/B elevado en los pacientes con TDAH tras 6 meses de tratamiento.
Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/physiopathology , Beta Rhythm/physiology , Central Nervous System Stimulants/therapeutic use , Electroencephalography/methods , Theta Rhythm/physiology , Adolescent , Age Factors , Child , Female , Humans , Male , Reference Values , Statistics, Nonparametric , Treatment OutcomeABSTRACT
El cociente Theta-Beta (T/B) del electroencefalograma cuantificado (EEGQ) de los pacientes con trastorno por déficit de atención e hiperactividad (TDAH) constituye una variable del EEG característica del trastorno primario con una precisión global del 89%. El objetivo de este estudio es medir el cociente T/B de una población de con TDAH y los efectos del tratamiento farmacológico con psicoestimulantes y no psicoestimulantes sobre el cociente T/B. La muestra estaba formada por 85 sujetos de entre 6 y los 18 años (68 niños y 17 niñas) con el diagnóstico de TDAH de subtipo inatento y combinado, según los criterios del DSM-V. Se les realizó un EEGQ con medición del cociente T/B antes y después de 6 meses de tratamiento con fármacos psicoestimulantes y no psicoestimulantes. Se compararon ambos grupos mediante la prueba de rangos con signo de Wilcoxon para muestras relacionadas. En el 86% de los casos el cociente T/B fue elevado respecto de los valores normales para la edad. La reducción en el cociente T/B fue significativa en el grupo tratado con psicoestimulantes aunque la reducción con los no psicoestimulantes no fue significativa. En conclusión, se confirma la elevación del cociente T/B en los pacientes con TDAH. Los fármacos psicoestimulantes disminuyen de forma significativa el cociente T/B elevado en los pacientes con TDAH tras 6 meses de tratamiento.
Theta-Beta (T / B) ratio of the quantified electroencephalogram (EEGQ) in patients with attention deficit hyperactivity disorder (ADHD) constitutes a characteristic EEG variable of the primary disorder with an overall accuracy of 89%. The objective of this study was to measure the T/B ratio in a sample of patients with ADHD and the effects of the treatment with psychostimulants and non-psychostimulants on the T/B ratio. The sample consisted of 85 children between 6 and 18 years (68 males and 17 females) with the diagnosis of the inattentive and combined subtype of ADHD, according to the criteria of the DSM-V. An EEGQ was performed with measurement of the T/B ratio before and after 6 months of treatment with psychostimulant and non-psychostimulant drugs. Both groups were compared using the Wilcoxon signed range test for related samples. The results showed that 86% of the cases had a T/B ratio above the normal values for the age of them. The reduction in the T/B ratio was statistically significant in the group of patients treated with psychostimulants. The reduction of non-psychostimulants was not significant. In conclusion, we confirmed the high T/B ratio in patients with ADHD. Psychostimulant drugs decrease the elevated T/B ratio in patients with ADHD after 6 months of treatment.
Subject(s)
Humans , Male , Female , Child , Adolescent , Attention Deficit Disorder with Hyperactivity/physiopathology , Attention Deficit Disorder with Hyperactivity/drug therapy , Theta Rhythm/physiology , Beta Rhythm/physiology , Electroencephalography/methods , Central Nervous System Stimulants/therapeutic use , Reference Values , Age Factors , Treatment Outcome , Statistics, NonparametricABSTRACT
The development and establishment of the normal sleep patterns are very important processes in the final anatomical and physiological architecture of the central nervous system. The relationship between sleep disturbances during childhood with neurodevelopmental disorders is complex and potentially synergistic. Sleep patterns are present since the fetal period but their structure and physiology is modified according with the maturation of the central nervous system. Sleep disorders and their relationship with attention deficit hyperactivity disorders(ADHD), autism spectrum disorders(ASD) and other neurodevelopmental disorders (TDN) are not well understood yet, but significant progresses have been made in understanding associations and potential etiological correlations. We reviewed sleep disturbances in NDT, in ADHD and in ASD. A greater understanding of the pleiotropic functions of the genes involved in sleepwake cycle disorders and deviations from neurological developme nt could lead to new diagnostic and therapeut ic strategies in an early stage in order to improve the quality of life of the patient, relatives and caregivers.
El sueño es uno de los actos fisiológicos más importantes para la estructuración funcional y anatómica de áreas del sistema nervioso central. Las alteraciones del sueño durante la infancia y su relación con trastornos del neurodesarrollo es compleja y sumam ente interesante, donde destaca la multiplicidad de causas de estos trastornos. Bajo esta premisa se realiza una revisión sobre las alteraciones del sueño en los trastornos del neurodesarrollo (TND), por déficit de atención e hiperactividad (TDAH) y del espectro autista (TEA). El sueño está presente desde la etapa fetal y va modificando su expresión en sintonía con la madurez del sistema nervioso central. Los trastornos del sueño y su relación con TDAH, TEA y otros TND son complejos, pero existen avances sobre la etiología de los mismos. Una mayor compresión de las funciones pleiotrópicas de los genes implicados en los trastornos del ciclo vigilia-sueño y en las desviaciones del desarrollo neurológico podría conducir a nuevas estrategias diagnósticas y terapéuticas de manera precoz con el fin de mejorar la calidad de vida del paciente, familiares y cuidadores.
Subject(s)
Attention Deficit Disorder with Hyperactivity/complications , Autism Spectrum Disorder/complications , Sleep Wake Disorders/complications , Attention Deficit Disorder with Hyperactivity/genetics , Autism Spectrum Disorder/genetics , Child, Preschool , Circadian Rhythm , Humans , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/geneticsABSTRACT
El sueño es uno de los actos fisiológicos más importantes para la estructuración funcional y anatómica de áreas del sistema nervioso central. Las alteraciones del sueño durante la infancia y su relación con trastornos del neurodesarrollo es compleja y sumam ente interesante, donde destaca la multiplicidad de causas de estos trastornos. Bajo esta premisa se realiza una revisión sobre las alteraciones del sueño en los trastornos del neurodesarrollo (TND), por déficit de atención e hiperactividad (TDAH) y del espectro autista (TEA). El sueño está presente desde la etapa fetal y va modificando su expresión en sintonía con la madurez del sistema nervioso central. Los trastornos del sueño y su relación con TDAH, TEA y otros TND son complejos, pero existen avances sobre la etiología de los mismos. Una mayor compresión de las funciones pleiotrópicas de los genes implicados en los trastornos del ciclo vigilia-sueño y en las desviaciones del desarrollo neurológico podría conducir a nuevas estrategias diagnósticas y terapéuticas de manera precoz con el fin de mejorar la calidad de vida del paciente, familiares y cuidadores.
The development and establishment of the normal sleep patterns are very important processes in the final anatomical and physiological architecture of the central nervous system. The relationship between sleep disturbances during childhood with neurodevelopmental disorders is complex and potentially synergistic. Sleep patterns are present since the fetal period but their structure and physiology is modified according with the maturation of the central nervous system. Sleep disorders and their relationship with attention deficit hyperactivity disorders(ADHD), autism spectrum disorders(ASD) and other neurodevelopmental disorders (TDN) are not well understood yet, but significant progresses have been made in understanding associations and potential etiological correlations. We reviewed sleep disturbances in NDT, in ADHD and in ASD. A greater understanding of the pleiotropic functions of the genes involved in sleep-wake cycle disorders and deviations from neurological developme nt could lead to new diagnostic and therapeut ic strategies in an early stage in order to improve the quality of life of the patient, relatives and caregivers.
Subject(s)
Humans , Child, Preschool , Attention Deficit Disorder with Hyperactivity/complications , Sleep Wake Disorders/complications , Autism Spectrum Disorder/complications , Attention Deficit Disorder with Hyperactivity/genetics , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/genetics , Circadian Rhythm , Autism Spectrum Disorder/geneticsABSTRACT
The subject of disabilities that include cognition and adaptability will never cease to be interesting and relevant. The genetic etiology has more weight every day. The relationship with other neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) is of clinical, diagnostic and therapeutic importance. The objective was to conduct a review of intellectual development disorder and its implication with ASD and ADHD. From Hippocrates to the present the disorders that affect learning, behavior and socialization skills have been the subject of studies and have varied, above all, in the denomination as an entity and its perception from the human and social point of view. The etiology of intellectual development disorders in most cases is an enigma and genetic advances are the cornerstone to elucidate the origin of this neurodevelopmental disorder, as well as its relationship with others such as ASD and ADHD. The disorder of intellectual development, the oldest one with respect to definition, study and approach, still presents mysteries above all of etiological origin. Its relationship with other neurodevelopmental disorders such as ASD and ADHD is evident by having common areas of involvement, which may be coincident diagnoses.
Subject(s)
Attention Deficit Disorder with Hyperactivity/genetics , Autism Spectrum Disorder/genetics , Intellectual Disability/genetics , Attention Deficit Disorder with Hyperactivity/physiopathology , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/physiopathology , Cognition , Comorbidity , Humans , Intellectual Disability/diagnosis , Intellectual Disability/physiopathologyABSTRACT
Nunca dejará de ser interesante y relevante el tema de las discapacidades que abarcan la cognición y la adaptabilidad. La etiología genética tiene cada día más peso. La relación con otros trastornos del neurodesarrollo como el trastorno del espectro autista (TEA) y el trastorno por déficit de atención e hiperactividad (TDAH), es de importancia clínica, diagnóstica y terapéutica. Realizamos una revisión sobre el trastorno del desarrollo intelectual (TDI) y su implicación con el TEA y el TDAH. Desde Hipócrates hasta la actualidad los trastornos que afectan las habilidades de aprendizaje, conducta y socialización han sido sujeto de estudios y han variado sobre todo en la denominación como entidad y su percepción desde el punto de vista humano y social. La etiología del TDI en la mayoría de los casos es un enigma y los avances genéticos son la piedra angular para dilucidar el origen de este trastorno del neurodesarrollo, así como su relación con otros como el TEA y el TDAH. El trastorno del desarrollo intelectual, el más antiguo con respecto a definición, estudio y abordaje, aún presenta incógnitas sobre todo de origen etiológico. Su relación con otros trastornos del neurodesarrollo como el TEA y el TDAH es evidente por poseer áreas comunes de afectación, pudiendo ser diagnósticos coincidentes.
The subject of disabilities that include cognition and adaptability will never cease to be interesting and relevant. The genetic etiology has more weight every day. The relationship with other neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) is of clinical, diagnostic and therapeutic importance. The objective was to conduct a review of intellectual development disorder and its implication with ASD and ADHD. From Hippocrates to the present the disorders that affect learning, behavior and socialization skills have been the subject of studies and have varied, above all, in the denomination as an entity and its perception from the human and social point of view. The etiology of intellectual development disorders in most cases is an enigma and genetic advances are the cornerstone to elucidate the origin of this neurodevelopmental disorder, as well as its relationship with others such as ASD and ADHD. The disorder of intellectual development, the oldest one with respect to definition, study and approach, still presents mysteries above all of etiological origin. Its relationship with other neurodevelopmental disorders such as ASD and ADHD is evident by having common areas of involvement, which may be coincident diagnoses.
Subject(s)
Humans , Attention Deficit Disorder with Hyperactivity/genetics , Autism Spectrum Disorder/genetics , Intellectual Disability/genetics , Attention Deficit Disorder with Hyperactivity/physiopathology , Comorbidity , Cognition , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/physiopathology , Intellectual Disability/diagnosis , Intellectual Disability/physiopathologyABSTRACT
El síndrome de Wolf-Hirschhorn es un trastorno cromosómico atribuible a una delección parcial del brazo corto del cromosoma 4 (4p-). Está caracterizado por hallazgos craneofaciales típicos en la infancia (apariencia de guerrero griego de la nariz, microcefalia, frente alta con glabela prominente, hipertelorismo, cejas muy arqueadas, filtrum corto, boca en carpa, y micrognatia, entre otros), retardo del crecimiento pre y postnatal, hipotonía y retardo del desarrollo. Los pacientes también pueden tener epilepsia y anormalidades que involucran otros órganos. El diagnóstico puede ser realizado por análisis citogenético convencional, el cual detecta la mayoría de los casos. El tratamiento incluye rehabilitación, terapia de lenguaje, drogas antiepilépticas cuando son necesarias, alimentación por gavaje o gastrostomía para las dificultades de la alimentación y terapia de soporte. Femenina de 10 meses de edad, quien presenta anomalías craneofaciales características, pie equinovaro bilateral, hipotonía, reflujo gastroesofágico, epilepsia, retardo del crecimiento y del desarrollo. El diagnóstico fue confirmado por detección de una delección de 4p que involucraba a la región crítica para este síndrome. Esta paciente recibe actualmente rehabilitación, medicación antirreflujo y ácido valproico. Esta condición debe ser reconocida por los pediatras, a fin de poder ofrecer un adecuado manejo a estos pacientes y sus familias.
Wolf-Hirschhorn Syndrome is a cromosomal disorder attributable to partial deletion of the short arm of chromosome 4(4p-). It is characterized by typical craneofacial features in infancy (Greek warrior appearance of the nose, microcephaly, high forehead with prominent glabella, hypertelorism, highly arched eyebrows, short philtrum, downturned mouth and micrognathia, among others), pre and postnatal growth retardation, hypotonia and developmental delay. Patients can also have epilepsy and abnormalities that involve other organs. Diagnosis can be made by conventional cytogenetic analysis which detects most of the cases. Treatment includes rehabilitation, speech therapy, antiepileptic drugs when necessary, gavage feeding or gastrostomy for feeding difficulties and standard management of other anomalies. 10 month-old female who presents characteristic craniofacial anomalies, clubfeet, hypotonia, gastroesofageal reflux, epilepsy, growth retardation and developmental delay. Diagnosis was confirmed by detection of a deletion of 4p that involved the critical region of the syndrome. This patient receives rehabilitation, antireflux medication and valproic acid. This condition must be recognized by pediatricians in order to offer adecuated management to these patients and their families.
