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STUDY OBJECTIVES: Hypoglossal nerve stimulation (HGNS) therapy has historically had strict eligibility requirements including a body mass index (BMI) < 32 kg/m2. However, recent Food and Drug Administration approval expanded indications to a BMI < 40 kg/m2. There is a wide variability in body fat distribution. This study sought to determine if neck circumference is a better surrogate predictive variable for HGNS outcomes than BMI. METHODS: A retrospective chart review was conducted at a tertiary care center on adults who underwent HGNS implantation by a single surgeon from March 2017 to October 2021. Baseline demographic data including neck circumference, diagnostic sleep studies and post-implantation HGNS titration studies were collected. Linear regression and Spearman's Correlation Coefficient (SCC) analysis were utilized to compare neck circumference (NC), percentage of predicted neck circumference (PPNC) and BMI with the apnea-hypopnea index at effective voltage (AHI-v). RESULTS: This study included 43 patients who were middle aged (61.1 years), predominantly male (76.7%), with severe obstructive sleep apnea (median AHI 35) and mean neck circumference of 15.3 inches. Utilizing the NC and PPNC, positive correlations with AHI-v were observed (p = 0.0033, SCC = .438, and p = 0.0029, SCC = .444). While controlling for BMI, a 1-inch increase in neck circumference was associated with a 35% increase in AHI-v (p = 0.0411). CONCLUSIONS: A larger neck circumference was independently associated with worse HGNS outcomes. Further research is needed to support and confirm these findings, particularly across sexes.
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BACKGROUND: The objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity. METHODS: Using a proof of concept study design, we collected pre/post outcomes from a single intervention cohort of urban low-income in a single community area. A community-based participatory research approach was employed. Forty-six children and their caregivers were recruited. Children were 5-12 years old with physician-diagnosed asthma and body mass index (BMI) > 85%. Families were offered 12 home visits from CHWs that integrated asthma and obesity core curriculums. The primary asthma outcome was asthma control, measured via the Childhood Asthma Control Test (cACT). The primary obesity outcome was child body mass index (BMI). RESULTS: Families received a median of 10 out of the 12 home visits over 1 year. At 1 year, there was a significant improvement in the number of children with controlled asthma as measured via cACT (85.7% at 1 year compared to 61.9% at baseline, p = 0.01). Activity limitations and emergency utilization were reduced while inhaler technique improved (p < 0.01 for all). Child BMI z-score was reduced: mean = 1.97 (SD 0.79) at 1 year compared to mean = 2.13 (SD 0.40) at baseline, p < 0.01. No association was seen between change in child BMI and change in asthma control. Worse baseline child depression scores were associated with less improvement in asthma control (p = 0.003) and higher baseline caregiver post-traumatic stress disorder scores were associated with increased child BMI (p = 0.012). CONCLUSIONS: The CHW intervention has promise for improving asthma and weight outcomes in high-risk children with comorbid asthma and obesity; this model warrants further development and investigation.
Assuntos
Asma/terapia , Agentes Comunitários de Saúde , Serviços de Assistência Domiciliar , Obesidade Infantil/terapia , Asma/complicações , Criança , Pré-Escolar , Pesquisa Participativa Baseada na Comunidade , Estudos de Viabilidade , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Obesidade Infantil/complicações , Autocuidado/métodos , Resultado do TratamentoRESUMO
Introducción. En la unidad de neuropsicología del Instituto Neurológico de Colombia (INDEC), la atención a niños y adolescentes con trastornos del neurodesarrollo constituye el principal motivo de consulta en diagnóstico y rehabilitación neuropsicológica. Objetivo. Caracterizar los pacientes niños y adolescentes que han consultado en la unidad de neuropsicología del INDEC. Métodos. Se seleccionaron 5747 pacientes menores de 18 años que consultaron, entre 2009 y 2012, en la unidad de neuropsicología del INDEC. Se estudiaron las variables de edad, sexo y diagnóstico. Resultados. Los diagnósticos principales de la población infantil fueron perturbación de la actividad y de la atención, retraso mental leve, y trastorno mixto de ansiedad y depresión. Se empleó la Clasificación internacional de Enfermedades (CIE-10). Conclusiones. Estos resultados muestran los principales tipos de enfermedad neurológica infantil y de adolescentes en la población perteneciente a la ciudad de Medellín, Colombia que consulta a neuropsicología, lo que aporta en la búsqueda de mejores mecanismos de prevención, control, diagnóstico y tratamiento, que faciliten una mejor incorporación social, familiar y escolar en los niños y adolescentes con alteraciones en el neurodesarrollo.
Introduction: In the neuropsychology ward of the Neurological Institute of Colombia (INDEC), children and adolescents's care with neurodevelopmental disorders is one of the main reasons for consultation about diagnosis and neuropsychological rehabilitation. Aim: Characterize both adolescent and children patients who have consulted in the neuropsychology ward INDEC. Patients and methods: 5.747 patients under 18, who were evaluated or received neuropsychological rehabilitation in the INDEC between the years 2009 and 2012 were selected. Also, the variables of age, sex and diagnosis were studied. Results: Disturbance of activity and attention were diagnosed in children, as well as mild mental retardation, mixed anxiety disorder and depression. International Classification of Diseases (ICD -10) was used. The diagnosis was made on the neuropsychology ward. Conclusion: the main consulted types of childhood neurological disease in Antioquia population were identified, in order to implement control strategies, diagnosis and treatment mechanisms that allow children with neurodevelopmental disorders are incorporated into society, family and school.
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La Enfermedad de Alzheimer es un problema neurodegenerativo cuyas causas aún no están bien definidas, sin embargo, existen distintas relaciones entre cambios genéticos y la presencia de los síntomas y signos de la enfermedad. Entre ellos están los genes ya conocidos APP, PSEN1 y PSEN2. Con los nuevos avances científicos, se conocen nuevos genes relacionados a esta enfermedad como lo son el gen CHAT, APOE, 5-HTTLPR, SORLI, NINJ2, CST3, EXOC3L2, CLU, NGFR, TREM2, APOC1, ACE, SLC2A14, entre otros. La relación entre estos genes y la enfermedad es muy estrecha y podría ser la brecha en encontrar una posible cura.
Alzheimer's disease is a neurodegenerative problem which cause is not well defined, however, there are different relationships between genetic changes and the presence of symptoms and signs of the disease. Among them, there are some well known such as the APP gene, PSEN 1 and PSEN2. With new scientific advances now we know new genes associated with the disease such as the CHAT, APOE, 5-HTTLPR, SORLI, NINJ2, CST3, EXOC3L2, CLU, NGFR, TREM2, APOCI, ACE, SLC2A14 genes, among others. The knowledge about these genes and the disease could help to find the cure.
