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79 The Effects of Mobile Based Resonant Frequency Breathing on Cognitive Performance in Healthy Young Adults with Elevated Stress
- Daniel G Saldana, Safa Shehab, Joel R Sneed
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 181-182
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Objective:
Finding effective, innovative, and accessible methods of coping with and mitigating stress has been increasingly relevant in the midst of the COVID-19 pandemic. To do so, it is important to understand the impact of acute stress responses on cognition, behavior, and emotional functioning. The young adult population in particular has been known to show higher levels of stress. Studies have shown that deep breathing interventions are associated with improved affect, decreased stress levels, and improved cognitive functioning. The autonomic nervous system, particularly the functioning of the vagus nerve, has been thought to be a key mechanism in the effect of breathing on stress and mood. Most studies to date investigating the efficacy of breathing practices in stress reduction and mood improvement have lacked appropriate methodology, including adequate control groups, randomization, and cross-sectional designs. This single-blind, randomized, waitlist-controlled study investigated the feasibility of using a mobile application to train in resonance frequency breathing and its efficacy in reducing stress and improving cognitive functioning in a non-clinical sample of young adults with elevated stress.
Participants and Methods:80 healthy young adults with elevated stress levels were recruited from the NY/NJ community and the Queens College undergraduate research subject pool. Inclusion criteria: ages 18-29, Perceived Stress Scale score >13. Exclusion criteria: regular (at least 3 times per week) practice of any form of meditation, yoga, or breathing exercise; severe medical or psychiatric disorder; active suicidal ideation; drug or alcohol abuse within the past year; use of medication with a known negative impact on cognition or autonomic nervous system (ANS) arousal. Participants were randomized to a waitlist control group or breathing group. Participants in the breathing group were instructed to complete 10-minute breathing sessions using the free mobile application “The Breathing App” twice a day for five days per week for four weeks. Cognitive assessments were administered over the phone (pre and post-treatment) and self-report measures were completed online due to quarantine restrictions.
Results:There were no significant main effects of group across any of the neuropsychological variables, including verbal memory, letter fluency, category fluency, cognitive flexibility, processing speed, basic attention span, and working memory. This indicated that breathing training did not significantly impact neuropsychological performance. Mediation analysis also demonstrated that breathing training did not indirectly lead to improvement in basic attention, processing speed, working memory, set-shifting, verbal fluency, category fluency, or cognitive flexibility, through its effects on stress reduction.
Conclusions:These results do not support literature suggesting that breathing at resonance frequency is associated with improved cognitive functioning such as greater cognitive flexibility, improved decision-making, stronger response inhibition, faster processing speed, and increased working memory. Future study designs should consider implementing active control groups (e.g., mindfulness meditation) and differential dosages of the breathing treatment.
4 Norm Selection and Application in Socially Responsible Neuropsychological Practice
- Daniel Saldana, Lucia Cavanagh, Paola Suarez, Mariana Cherner
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 872
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Objective:
In the wake of the national controversy over demographically corrected normative comparisons used in neuropsychological assessment, the field finds itself in need of adopting better practices and providing stronger instruction in norm selection and application when assessing underrepresented populations. Neuropsychologists must employ critical thinking within their clinical decision-making that takes into account patient demographics, analysis of the measures themselves, normative samples, and statistical adjustments employed in normative studies. Not doing so may result in erroneous diagnostic conclusions, exposing underserved patient populations to poor or harmful clinical care and even misdiagnosis. The following case series presents several demographic considerations illustrating how selection and application of different (at times, ill-fitting) normative reference groups can affect treatment outcomes in the Latinx community. We examined the performance of various published norms when applied to monolingual and bilingual Spanish speakers.
Participants and Methods:This study samples three demographically diverse (i.e., education, age, and sex) clinical cases and applies regression-based and stratified norms to raw scores to demonstrate the possible differential outcomes when using different reference groups. One example is Ms. Congeniality, a 69-year-old, Spanish and English bilingual woman with 12 years of education who presented for a third revaluation at our clinic due to progressive memory loss. Her prior Spanish language profiles demonstrated impaired confrontation naming and steadily decreasing letter fluency over the past 10 years.
Results:Her performance on semantic fluency (i.e., animal naming) showed relative stability based on her raw scores (10 in 2012, 11 in 2016, and 12 in 2022). Using the Neuropsi A&M norms, which stratify performance across nine age ranges between ages 6-85 and three education ranges between 0-10+ years, her performance over the past 10 years ranged between the less than 1st percentile to the 9th percentile (1%, 1%, and 9%, respectively). However, using the NP-NUMBRS norms, which use regression-based continuous age (19-60) and education (0-20) predictors of test performance, her scores corresponded to steadily improved performance (8%, 28%, and 86%). Thus, this qualitative comparison demonstrates a likely overcorrection for individuals of advanced age when using norms based on samples that are a poor fit because they lack representation of older adults, as in NP-NUMBRS, and a possible undercorrection when using norms with overly broad education stratifications (e.g., 10-22 years, as in Neuropsi).
Conclusions:Application of ill-fitting normative standards can have far-reaching implications for interpretation of neuropsychological test results. Moreover, this case series exemplifies the need for higher-order instruction in norm selection, specifically for underserved communities who run the risk of being misdiagnosed. Through case examples, this study underscores the importance of understanding the unique effects of different demographic corrections in the context of limited available normative reference groups. This abstract is the first illustration in a series of papers aimed at facilitating the decision-making process within the framework of socially responsible neuropsychological practice.
81 Test-retest Reliability of the Oral Trail Making Test Administered on the Telephone
- Daniel G Saldana, Jesus Barreto Abrams, Yessica Rodriguez, Safa Shehab, Joel R Sneed
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 484-485
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Objective:
In the aftermath and continuance of the COVID-19 pandemic, the field of neuropsychology has experienced a burgeoning literature base on remote telehealth practices. These practices include both videoconference and telephone modalities. Several studies to date have proposed evidence suggesting that inperson and remote telehealth assessments demonstrate comparable results. One of the major limitations to telehealth practices is the scarcity of measures of processing speed. A widely used measure is the Oral Trail Making Test, which has two trials (A & B). Oral Trails B is often conceptualized as a measure of set-shifting and cognitive flexibility. And validity studies support Oral Trails B having strong test-retest reliability and correlation to its written counterpart. In contrast, there is contention as to whether Oral Trails A can be conceptualized as a measure of basic attention and speed versus simple numerical automaticity. Importantly, to our knowledge, the test-retest reliability of Oral Trails A administered specifically via telephone has never been reported in a healthy sample. The following study presents test-retest reliability for the Oral Trails A and B (in a healthy control group) administered as part of a larger study investigating the effects of deep diaphragmatic breathing on cognitive functioning.
Participants and Methods:Eighty healthy young adults with elevated stress levels were recruited from a major metropolitan city at a major university. The subjects had to be between the ages of 18 to 29 and self-reported Perceived Stress Scale score >13. The subjects could not practice any form of meditation, yoga, or breathing exercise regularly. Additionally, they could not have any severe medical or psychiatric disorder, be actively suicidal; have a substance use disorder within the past year, or use of medication with a known negative impact on cognition or autonomic nervous system (ANS) arousal. Participants were randomized to a waitlist control group or an intervention group. Cognitive assessments were administered over the phone to both groups (pre and post-treatment) and self-report measures were completed online due to quarantine restrictions.
Results:Among participants in the waitlist control group, the mean difference (MD) between time points on OTMT-A (MD= -0.17, SD= 1.69) was small and not significant (p>0.05). The mean difference for OTMT-B (MD= -13.06, SD=26.99) was large and significant (p=0.01). Bivariate Pearson correlations were computed revealing a significant moderate strength relationship between OTMT-A performance across time points (r=0.6, p<0.001). In contrast, performance on OTMT-B across time points revealed a nonsignificant, weak relationship (r=0.2, p=1.94).
Conclusions:These results do not support literature demonstrating strong test-retest reliability for OTMT-B. Furthermore, this is the first study establishing test-retest reliability for the OTMT-A as administered via a novel telephonic modality. Given the novel and non-standardized method of administration, the data should be interpreted with caution. Nonetheless, given the weak relationship in OTMT-B performance and the only moderate relationship of OTMT-A performance across time points, the results suggest that the OTMT may not be highly reliable as administered via a telephonic modality.
PHARMACOECONOMIC COMPONENT OF A CLINICAL TRIAL CONDUCTED IN LATIN AMERICA: Conceptual and Empirical Considerations
- Daniel Reinharz, Victor Raúl Zurita Saldaña, Wilson Follador, Carl Asche
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 17 / Issue 4 / October 2001
- Published online by Cambridge University Press:
- 20 May 2002, pp. 571-578
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Background: Although pharmacoeconomic studies constitute a valuable tool for better managing drug consumption, the conditions under which such studies would be performed in Latin American countries have not been explored.
Objectives: The aim of this paper is to evaluate the potential advantages of and pitfalls in doing pharmacoeconomic research in Latin America and to propose avenues to facilitate the development of this field in the region.
Methods: The Canadian guidelines for the economic evaluation of pharmaceuticals served as a structured framework to assess, both prospectively and retrospectively, the conditions under which the pharmacoeconomic component of a clinical trial held in Mexico and Brazil would be and actually was conducted.
Results: The conditions under which pharmacoeconomic evaluations are conducted must be improved if studies are to contribute to the better management of scarce resources across the entire health care system.
Conclusions: The creation of a public funding agency, the reappraisal of administrative data as a management tool in both the public and the private sectors, and the establishment of national guidelines should be considered within the framework of reforms aimed at allowing healthcare systems to meet their objectives of efficiency and equity.