Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review

The coexistence of childhood obesity (or its risk) and COVID-19 pandemic put children and adolescents in greater risk to develop respiratory and cardiovascular diseases. In fact, the restrictions introduced to limit the spread of the virus had detrimental effects on various lifestyle components, especially in young population. This resulted in augmented levels of physical inactivity and sedentary behaviors and a reduced time spent in play outdoors or sport practices. Contrariwise, the increased use of technology led clinicians, teachers, and trainers to maintain relations with obese children/adolescents so as to reduce sedentary behaviors and the associated health risks. This narrative review aims to describe the role of Telehealth and Tele-exercise as useful tools in the management of pediatric obesity during COVID-19 pandemic. Telehealth and Tele-exercise were effective in promoting self-monitoring and behavioral changes, including adherence to exercise training programs in children and adolescents. Moreover, tele-exercise platforms such as applications or exergames allowed flexible scheduling, limiting the infection risks

Investigating the generalizability of Economic Evaluations conducted in Italy: a critical review

bstract: Aim. To assess the methodological quality of Italian HEEs and their generalizability or transferability to different settings. Methods. A literature search was performed on Pubmed search engine to identify trial-based, non- experimental prospective studies or model-based full economic evaluations, carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and the quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were re-assigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviews was solved by a senior researcher. Results. One-hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency of methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. On the other hand, often context-specific economic evaluations are carried out and not enough effort is done to assure the transferability of their results to other contexts. In recent studies, Cost- Effectiveness Analyses and the use of the Incremental Cost-Effectiveness Ratio were preferred. Conclusion. Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observe

Economic evaluation of screening programs for hepatitis C virus infection: evidence from literature

Hepatitis C is a liver infection caused by hepatitis C virus. Its main complications are cirrhosis and liver cancer. According to the World Health Organization (WHO), more than 185 million people worldwide are infected with hepatitis C virus and, of these, 350,000 die every year. Due to the high disease prevalence and the existence of effective (and expensive) medical treatments able to dramatically change the prognosis, early detection programs can potentially prevent the development of serious chronic conditions, improve health, and save resources

Assessing and restoring cognitive functions early after stroke

Cognitive impairment is a frequent complication of stroke. The aim of this study was to evaluate the effectiveness of cognitive training performed early after stroke. Ninety-two patients were randomly assigned to either the study group (SG) or the control group (CG). Cognitive rehabilitation consisted of 16 individual one-hour sessions in which patients performed therapist-guided computer exercises. The patients in the CG performed a sham intervention. After four weeks all the patients were re-evaluated. In the SG, significant improvements (p<0.05) were detected in all neuropsychological measures at the post-training evaluation, while the CG showed mild (not statistically significant) improvements on cognitive tests. Between-group analysis revealed statistically significant differences in the domains of memory and visual attention. Cognitive training performed early after stroke seems to be a viable option for improving cognitive outcome in stroke survivors. Further studies should assess whether this may favor their reintegration into everyday life

Self-Reported Physical Fitness in Children and Adolescents with Obesity: A Cross-Sectional Analysis on the Level of Alignment with Multiple Adiposity Indexes

Obesity has been associated with several alterations that could limit physical activity (PA) practice. In pediatrics, some studies have highlighted the importance of enjoyment as a motivation to begin and maintain adherence in PA. Since self-reported physical (SRPF) fitness was related to motivation, the aim of this study was to investigate the existence of differences between SRPF in children with obesity (OB) compared to normal weight (NW). The International Fitness Enjoyment Scale (IFIS) questionnaire was administered to 200 OB and 200 NW children. In all the subjects, height, weight, and BMI and in OB children adiposity indexes including waist circumference (WC), body shape index (ABSI), triponderal mass index (TMI), and fat mass were measured. NW group showed higher IFIS item scores than the OB group (p < 0.01), except in muscular strength. In OB, the anthropometric outcomes were inversely correlated to SRPF outcome except for muscular strength. OB children reported a lower perception of fitness that could limit participation in PA/exercise programs. The evaluation of anthropometric patterns may be useful to prescribe a tailored exercise program considering individual better self-perception outcomes to obtain an optimal PA adherence

Assessing and restoring cognitive functions early after stroke

Cognitive impairment is a frequent complication of stroke. The aim of this study was to evaluate the effectiveness of cognitive training performed early after stroke. Ninety-two patients were randomly assigned to either the study group (SG) or the control group (CG). Cognitive rehabilitation consisted of 16 individual one-hour sessions in which patients performed therapist- guided computer exercises. The patients in the CG performed a sham intervention. After four weeks all the patients were re-evaluated. In the SG, significant improvements (p<0.05) were detected in all neuropsychological measures at the post-training evaluation, while the CG showed mild (not statistically significant) improvements on cognitive tests. Between-group analysis revealed statistically significant differences in the domains of memory and visual attention. Cognitive training performed early after stroke seems to be a viable option for improving cognitive outcome in stroke survivors. Further studies should assess whether this may favor their reintegration into everyday life

Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: a randomized, controlled trial.

Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients and exerts a deep negative impact on quality of life interfering with familiar, social and career-related activities. To test the effectiveness of early cognitive rehabilitation treatment for inpatients affected by primary brain tumors. Out of 109 consecutive patients enrolled in the study, 58 patients were randomly assigned to a rehabilitation group or to a control group. The rehabilitation consisted of 16 one-hour individual sessions of therapist-guided cognitive training, spread over 4 weeks, combining computer exercises and metacognitive training. Patients in the control group received usual care without cognitive training. All patients were evaluated by means of a comprehensive neuropsychological battery at the admission (T0) and after 4 weeks (T1). Patients in the rehabilitation group showed a significant improvement of cognitive functions. In particular, the domains that benefited most from the training were visual attention and verbal memory. The control group exhibited only a slightly, not statistically relevant, enhancement of cognitive performances. Cognitive rehabilitation for neuro-oncological inpatients resulted in a significant enhancement of cognitive performances after the training, also providing a foundation for early administration. Future research should be aimed to clarify the patients’ characteristics that predict neuropsychological improvement, to identify the most effective elements in rehabilitative programs and to study the effects of treatment extension to everyday life

Correction: Six minute walk distance and reference values in healthy Italian children: A cross-sectional study (PLoS ONE (2018) 13, 10 (e0205792) DOI:10.1371/journal.pone.0205792)

.The 6-minute walking test (6MWT) is a simple assessment tool to evaluate exercise capacity. The result of the test is the distance that a subject can walk at a constant and normal pace within 6 minutes (6MWD) and reflects the aerobic/fitness performance related to walking function. Use of 6MWT has been relevant to assess exercise tolerance either in healthy children or in patients with, heart, lung and metabolic diseases. Our aim was to find 6MWT reference values in healthy Italian children. The 6MWT was performed in 5614 children aged 6-11 years recruited from primary Italian schools. Age related reference percentiles of the covered distance were gender-modeled. A linear and quadratic regression model was used to predict 6MWT performance. Males walked longer distances than females, respectively 598.8\ub183.9 m vs 592.1\ub177.6 m (p = 0.0016). According to the regression analysis, 6MWD was positively related to age, gender and height, while it was negatively related to body weight [(6MWD = -160.16 + 93.35 7 age (years) -4.05 7 age2 (years) +7.34 7 gender (m) +2.12 7 weight (kg) -2.50 7 height (cm)]. Reference values were established for the 6MWT in healthy children. The age related 6MWD percentiles provided a useful tool in the assessment of capacity in 6-11 year children, in fact they may be helpful to evaluate the effect of a given treatment or rehabilitation program and represent a feasible measure as to prevention within the primary school context. It was found a substantial difference from other countries for 6mwd values. In our study, factors such as age, weight and height were relevant for the prediction of 6MWD, similarly to other studies. Therefore, these variables should be taken into account in context of exercise performance

Six minute walk distance and reference values in healthy Italian children: A cross-sectional study

The 6-minute walking test (6MWT) is a simple assessment tool to evaluate exercise capacity. The result of the test is the distance that a subject can walk at a constant and normal pace within 6 minutes (6MWD) and reflects the aerobic/fitness performance related to walking function. Use of 6MWT has been relevant to assess exercise tolerance either in healthy children or in patients with, heart, lung and metabolic diseases. Our aim was to find 6MWT reference values in healthy Italian children. The 6MWT was performed in 5614 children aged 6-11 years recruited from primary Italian schools. Age related reference percentiles of the covered distance were gender-modeled. A linear and quadratic regression model was used to predict 6MWT performance. Males walked longer distances than females, respectively 598.8\ub183.9 m vs 592.1\ub177.6 m (p = 0.0016). According to the regression analysis, 6MWD was positively related to age, gender and height, while it was negatively related to body weight [(6MWD =-160.16 + 93.35 7 age (years)-4.05 7 age2 (years) +7.34 7 gender (m) +2.12 7 weight (kg) -2.50 7 height (cm)]. Reference values were established for the 6MWT in healthy children. The age related 6MWD percentiles provided a useful tool in the assessment of capacity in 6-11 year children, in fact they may be helpful to evaluate the effect of a given treatment or rehabilitation program and represent a feasible measure as to prevention within the primary school context. It was found a substantial difference from other countries for 6mwd values. In our study, factors such as age, weight and height were relevant for the prediction of 6MWD, similarly to other studies. Therefore, these variables should be taken into account in context of exercise performance