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Bidirectional associations between video game playing and ADHD symptoms among school-aged children
No full textPast research has suggested associations between gaming and symptoms of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents. Yet, little research has been conducted to clarify the directionality of this association during middle childhood when ADHD issues typically emerge. Clarifying directionality is key to understanding whether gaming precedes and predicts ADHD symptoms, or the opposite. To shed light on this topic, this study investigates this association longitudinally during middle childhood. We employed a Random Intercept Cross-Lagged Panel Model to estimate longitudinal bidirectional associations between child gaming and ADHD symptoms from ages 6 to 10. Variables were derived from parent-reported child weekly hours of gaming and teacher-reported child ADHD symptoms. Data are from the Quebec Longitudinal Study of Child Development, a population-based cohort of Canadian children (N = 1749). We hypothesized a bidirectional association. Our results revealed that higher levels of ADHD symptoms at age 6 predicted more time gaming at age 7. Likewise, more ADHD symptoms at age 7 predicted more gaming at age 8. However, later in development, this association reverses direction: higher levels of gaming at age 8 predicted more ADHD symptoms at age 10. Additional analyses of separated dimensions of ADHD revealed that associations with gaming were stronger for the hyperactivity/impulsivity dimension. These findings suggest that children with more ADHD symptoms tend to devote more time to gaming during the early years of middle childhood. In turn, this increase in gaming during early school years contributes to worsening ADHD symptoms later in development, particularly hyperactivity/impulsivity symptoms
New horizons in systemic sclerosis treatment: advances and emerging therapies in 2025
Get PDFSystemic sclerosis (SSc) is a rare, multisystem autoimmune disease characterised by vasculopathy, immune dysregulation, and progressive fibrosis, leading to significant morbidity and mortality. While recent EULAR recommendations have updated the standard of care for SSc, the field is rapidly evolving with novel therapeutic strategies and precision medicine approaches.Traditional immunosuppressive therapies-including mycophenolate mofetil, cyclophosphamide and rituximab-remain essential for controlling skin and lung involvement while autologous haematopoietic stem cell transplantation offers a proven disease-modifying option for selected high-risk patients. Tocilizumab and nintedanib have established roles in lung preservation in SSc-associated interstitial lung disease (SSc-ILD). In pulmonary arterial hypertension (PAH), early combination therapy with endothelin receptor antagonists and phosphodiesterase-5 inhibitors, complemented by newer agents such as selexipag and riociguat, has improved survival and quality of life. Advances in gastrointestinal, renal and musculoskeletal management continue to evolve, with promising roles for intravenous immunoglobulin and novel prokinetics.Crucially, emerging therapies-including CD19-targeted CAR-T cells, bispecific antibodies and agents targeting interferon pathways, BAFF, melanocortin, FcRn and PDE4B-reflect a shift towards personalised and biomarker-driven approaches. These innovations offer the potential to alter disease trajectory and support early, targeted intervention in SSc.This review provides an up-to-date synthesis of both current organ-based treatment strategies in major organ domains-skin, ILD, PAH, scleroderma renal crisis, raynaud's phenomenon and digital ulcers, gastrointestinal and musculoskeletal involvement-and emerging therapies in SSc, with an emphasis on disease-modifying approaches and future directions in personalised care
Lung function and skin fibrosis changes as predictors of survival in SSc-associated interstitial lung disease: a EUSTAR study
Get PDFObjectives
This study assessed how changes in lung function, skin fibrosis and digital ulceration (DU) burden predict mortality in patients with SSc-associated interstitial lung disease (SSc-ILD), the leading cause of death in SSc.
Methods
Adult SSc-ILD patients from the European Scleroderma Trials and Research (EUSTAR) database enrolled since January 2009 with a date of diagnosis, a follow-up visit for change evaluation within 12 months plus a further visit or mortality information were eligible. Twelve-month changes in lung function (per cent predicted forced vital capacity [FVC%pred] and diffusing capacity of the lungs for carbon monoxide [DLCO%pred]), modified Rodnan skin score (mRSS) and change in DU burden were assessed for associations with survival, using multivariable Cox regression analyses adjusted for age, sex, smoking status and immunosuppressive therapy.
Results
Of 893 SSc-ILD patients included, 94 (10.5%) died over a mean follow-up of 39.0 ± 23.9 months. Absolute deterioration in FVC >10%pred within 12 months (n = 78/638 evaluable) was predictive for decreased survival (hazard ratio [HR] 3.81; 95% CI 1.67–8.66), as were composite measures combining (i) >10% FVC decline or mRSS worsening (HR 2.82; 95% CI 1.43–5.56) and (ii) FVC decline ≥10% or 5–9% with DLCO decline ≥15% (HR 3.42; 95% CI 1.68–7.00), but not changes in DLCO, mRSS or DU burden alone.
Conclusions
Changes in lung function and skin fibrosis within 12 months should be considered when evaluating risk of mortality. The effect of pharmacological treatments aiming at stabilization of these variables should be evaluated prospectively in clinical trials
Revision Rates for Aseptic Loosening in the Obese Patient: A Comparison Between Stemmed, Uncemented, and Unstemmed Tibial Total Knee Arthroplasty Components
Get PDFBackground
Total knee arthroplasty (TKA) is an effective treatment option for high body mass index (BMI) patients achieving similar outcomes to nonobese patients. However, increased rates of aseptic loosening in patients with a high BMI have been reported. Component fixation is a concern when performing TKA in the obese patient. To address this concern in cemented TKA, extended tibial stems have been used. Uncemented implants that take advantage of biologic osseointegration have also been advocated. This retrospective study examined the use of and revision rates of extended cemented tibial stems and uncemented implants compared with conventional cemented implants in our high BMI patient population.
Methods
We retrospectively reviewed a prospectively maintained database of 3239 primary Attune TKAs (Depuy, Warsaw, Indiana). All obese patients (BMI > 30 kg/m2) with > 30 months of follow-up were included in our analysis. Those who underwent cemented TKA using a tibial stem extension (Group 1) (n = 145) and those where cementless implants were used (Group 2) (n = 100) were compared to a control group (n = 1243) using a standard cemented implant. Primary outcome measures were all-cause revision, revision for aseptic loosening, and revision for tibial loosening. Kaplan-Meier survival analysis and Cox regression models were used to compare the primary outcomes between groups.
Results
In total, there were 1512 knees that met the inclusion criteria. The mean follow-up was 6.8, 5.1, and 5.3 years for cemented, stemmed, and cementless groups, respectively. There were 37 all-cause revisions identified. Seven were for aseptic loosening (2 tibial, 1 femoral, and 4 involving both components); all of these were in the standard cemented implant group. There were no revisions in the stemmed or cementless implant groups. Survival analysis did not show any significant differences between groups for either all-cause revision or for aseptic loosening.
Conclusions
This retrospective analysis showed that there were no revisions required for aseptic loosening when a cemented, stemmed, or uncemented implant was used in obese patients. These findings show that cementless and extended stem implants are a reasonable option in obese patients
A novel framework for analyzing rainy season dynamics in semi-arid environments: a case study in the Peruvian Rio Santa basin
Get PDFIn semi-arid regions, the timing and duration of the rainy season determines plant water availability, which directly impacts food security. Rainy season metrics, which aim to define and, in some cases, predict the onset and end of seasonal rains, can support agricultural planning, such as scheduling planting dates and managing water resources. However, these metrics based on precipitation time series do not always accurately reflect plant water availability, and the variety of available metrics can complicate the selection of the most suitable one. Furthermore, a metric's ability to capture observed vegetation variability can indicate its applicability over larger spatial or temporal scales. This study introduces a new bucket-type metric that incorporates a simplified water balance, accounts for both accumulation and storage, and also takes interannual legacy effects into account. We evaluate its performance against seven commonly used rainy season metrics, both calibrated and uncalibrated, using 18 years of the satellite-derived Normalized Difference Vegetation Index (NDVI) from the semi-arid Rio Santa basin in the Peruvian Andes. Our results demonstrate that calibrating metrics using vegetation data significantly enhances their ability to capture rainy season dynamics, with the bucket metric outperforming others in both accuracy and robustness. Furthermore, we examine the sensitivity of all metrics to variations in rainfall intensity and frequency under future climate scenarios, using a previously published high-resolution dataset specifically designed for the Rio Santa basin which provides historical (1981–2018) rainfall data and future projections (2019–2100) based on 30 statistically downscaled CMIP5 models for the Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios, respectively. While most rainy season metrics exhibit expected correlations in response to climatic changes, some established metrics display physically inconsistent behavior due to methodological artifacts, highlighting their limitations in assessing hydroclimatic changes. In addition to the sensitivity analysis, we evaluate long-term trends in rainy season characteristics. Statistically downscaled CMIP5 ensemble projections for the future period suggest only a slight delay in the rainy season end, with no consistent trends in onset timing. Instead, interannual variability and ensemble spread remain the dominant influences. Our findings emphasize the need for careful calibration of metrics across diverse climate scenarios and different locations to ensure their reliability for agricultural planning, policymaking, and climate adaptation strategies. By providing a novel framework for evaluating rainfall metrics, this study offers a scalable approach that can be readily applied to other semi-arid regions
Updating the Scientific Advisory Committee on Nutrition’s Framework for the evaluation of evidence
Get PDFThe Scientific Advisory Committee on Nutrition (SACN) provides independent advice on nutrition and related health matters to UK government organisations. In keeping with its commitment to openness and transparency, SACN follows a set ‘Framework’ to ensure a prescribed and consistent approach is taken in all its evidence evaluations. Following an update of the SACN Framework in 2020, which addressed some straightforward issues, the SACN Framework subgroup was established in 2021 to consider more complex matters that were not addressed in the 2020 update. The SACN Framework subgroup considered four main topics for update: (1) the different types of evidence evaluations produced by SACN, (2) interpretation of statistical data, (3) tools for assessment of study quality and (4) tools to assess the certainty of a body of evidence for exposure–outcome relationships. The Framework subgroup agreed clear definitions and processes for the different types of evidence evaluations produced by SACN and agreed that interpretation of P values should be informed by consideration of study size, power and methodological quality. The subgroup recommended use of the AMSTAR 2 tool for quality assessment of evidence from systematic reviews and use of the Grading of recommendations, assessment, development and evaluation approach to assess the certainty of evidence. The updated Framework was published in January 2023. This was followed by publication of a further update in October 2024. As a ‘living’ document, the Framework will be subject to regular review by the Framework subgroup and continue to evolve in line with best practice
POS0497 12 MONTHS SENSITIVITY TO CHANGE AND CLINICAL IMPORTANT DIFFERENCES OF EULAR ScleroID: A COMPREHENSIVE PRO MEASURING IMPACT OF SYSTEMIC SCLEROSIS ON HOW PATIENTS FEEL AND FUNCTION
No full textAssessing the affordance, equity and wellbeing implications of mobility provision, governance and operation in East African cities
Get PDFIntroduction Delivering enhanced inclusive and safe mobility choices addresses many elements of the inclusive city concept. Urban mobility is a key factor supporting health and wellbeing and is linked to infrastructure quality, governance, and individuals’ behaviours particularly in the context of dynamic rapidly changing cities. This paper investigates from a multidisciplinary perspective how the quality of urban environments interacts with mobility, health and wellbeing. Setting Addressing recent calls for African mobility research focussed on socio-economic equity this paper presents mixed methods research from low-income communities in two Kenyan cities. Methods Using combinations of participatory mapping, transect walks, subjective and physiological wellbeing measurements alongside recording of environmental conditions we consider the interactions of mobility on health and wellbeing for vulnerable travellers typically excluded from mobility planning considerations. We assess our findings in relation to a new framework combining dimensions of mobility, wellbeing and inclusion. This framework incorporates elements of physical infrastructure provision; mobility systems and governance; and the influence of other user behaviour. Results Our findings highlight how focussing on infrastructure provision and not overall journey experiences could result in investments that do not support healthy mobility choices. Collecting better (spatially explicit) environmental measurements and diverse wellbeing data would enable decision makers to understand existing environments more holistically to identify the most appropriate mobility investments. Overall, the framework and results forefront how inclusive and equitable mobility solutions that actively support people’s health and wellbeing should go beyond provision of adequate and safe infrastructure. They should include user awareness and behaviour changes that are effectively governed ensuring the benefits of any improvements are not undermined thereby risking exposing travellers to more dangerous pollution or hazardous road safety environments
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