Van Pelt Amelia E, Lipow Matthew I, Scott J Cobb, Lowenthal Elizabeth D
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, Pennsylvania, United States 19104-6021.
Department of Pediatrics (Global Health Center), Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd, Philadelphia, Pennsylvania, United States 19104.
Child Youth Serv Rev. 2020 Nov;118. doi: 10.1016/j.childyouth.2020.105393. Epub 2020 Aug 25.
Many children and adolescents around the world suffer from neurocognitive deficits due to chronic disorders, such as Human Immunodeficiency Virus (HIV) and malaria. Resource-limited settings exacerbate the risk of negative cognitive outcomes due to high prevalence of associated disorders, poverty, and limited access to interventions. Current literature does not provide consensus regarding the efficacy of interventions to support children with cognitive impairments in low-resource settings. This research aimed to identify and evaluate interventions for youth with neurocognitive deficits in resource-limited settings. A systematic review of peer-reviewed literature was conducted within five databases (PubMed, Web of Science, CINAHL, PsycInfo, and WHO Index Medicus). Cognitive impairment was broadly defined to be inclusive of aspects of intellectual and cognitive functioning (e.g., working memory, attention, executive function). The income status of the country or countries in which each study was located was determined according to World Bank Income Status. Studies conducted in countries classified as low- or middle-income were included. Since low-resource areas exist within high-income countries, the resource availability within study settings in high-income countries was systematically evaluated for inclusion. The search yielded 19 articles that met all inclusion criteria. Interventions included strategies involving caregiver training, computerized and non-computerized cognitive training, physical activity, and nutritional supplementation. Interventions were administered in medical facilities, educational facilities, or the home. The majority of the interventions targeted the domains of memory and attention. Overall, the efficacy of interventions was inconsistent. Further, results indicated that the relationship between cognitive improvement and intervention types was not consistent across cognitive domains. However, when evaluating studies on an individual basis, some strategies demonstrated clinically- and statistically-significant improvement in cognitive function among specific groups of children. The low article yield highlights that few researchers have evaluated pediatric cognitive support interventions in low-resource contexts. This review suggests support strategies that should be considered for future studies as neurocognitive screening capacity improves in resource-limited settings.
世界各地许多儿童和青少年因慢性疾病，如人类免疫缺陷病毒（HIV）和疟疾，而患有神经认知缺陷。资源有限的环境因相关疾病的高流行率、贫困以及获得干预措施的机会有限，加剧了产生负面认知结果的风险。目前的文献对于在资源有限的环境中支持认知障碍儿童的干预措施的有效性尚未达成共识。本研究旨在识别和评估资源有限环境中患有神经认知缺陷的青少年的干预措施。我们在五个数据库（PubMed、科学网、护理学与健康领域数据库、心理学文摘数据库和世界卫生组织医学索引）中对同行评审文献进行了系统综述。认知障碍被广泛定义为包括智力和认知功能的各个方面（例如，工作记忆、注意力、执行功能）。根据世界银行的收入状况确定每项研究所在国家或国家的收入状况。纳入在被归类为低收入或中等收入国家进行的研究。由于高收入国家也存在资源有限的地区，因此对高收入国家研究环境中的资源可用性进行了系统评估以确定是否纳入。检索结果产生了19篇符合所有纳入标准的文章。干预措施包括涉及照顾者培训、计算机化和非计算机化认知训练、体育活动以及营养补充的策略。干预措施在医疗设施、教育设施或家庭中实施。大多数干预措施针对记忆和注意力领域。总体而言，干预措施的效果并不一致。此外，结果表明认知改善与干预类型之间的关系在不同认知领域并不一致。然而，在对个体研究进行评估时，一些策略在特定儿童群体中显示出认知功能在临床和统计学上的显著改善。文章产量低凸显出很少有研究人员在资源有限的背景下评估儿科认知支持干预措施。本综述提出了随着资源有限环境中的神经认知筛查能力提高，未来研究应考虑的支持策略。
