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Pre-attention and working memory in ADHD: A 25-year follow-up study
Get PDFObjective: The aim of the study was to compare the development of working memory and preliminary stages of attentional processing in individuals with ADHD over a 23- to 25-year period. Method: Individuals with ADHD (n = 19) and healthy controls (n = 26) were followed up after 13 years (T2) and 23 to 25 years (T3) after initial assessment (T1). They were reassessed with diagnostic measures and the Backward masking task (pre-attention) and the Digit span distractibility test with and without distraction conditions (working memory). Results: The ADHD group performed below the healthy controls on all time points on the Digit span distractibility test. On the distractibility condition, we found a selective decline in performance from T2 to T3 for the ADHD group. Conclusion: The results highlight that ADHD individuals continue to display working memory deficits, also in adulthood, thus creating an imperative for cognitive rehabilitation techniques to help address attention difficulties.The project was (partly) financed by the Extra Foundation through The Norwegian Council
for Mental Health and from the Regional Network for Psychosis Research.acceptedVersio
People with dementia attending farm-based day care in Norway – Individual and farm characteristics associated with participants’ quality of life
Get PDFAbstractFarm-based day care for people with dementia is supposed to improve the partici-pants quality of life by using activities and resources of the farm environment to promote mental and physical health. In this paper, we describe the characteristics of those attending farm-based day care services in Norway and explore the associa-tion between individual and farm characteristics and the quality of life. A sample of 94 people with dementia who attended farm-based day care was recruited from 25 farms between January 2017 and January 2018. The data collection was performed using standardized instruments. Information about the farms was retrieved from a former study. The association between the participants’ quality of life and their indi-vidual and/or farm characteristics was examined with a linear multilevel regression model. The participants had a mean age of 76 years, 62% were men, and 68% had ad-ditional education after primary school. Most of them had mild (54.3%) or question-able dementia (18.3%). A few participants used antipsychotics (3.7%), tranquilizers (9.9%) and painkillers (13.6%), while a higher number used antidepressants (30.9%). Quality of life was associated with the experience of having social support (p = .023), a low score on depressive symptoms (p < .001), and spending time outdoors at the farm (p < .001). The variation between the farm-based day care services in the par-ticipants’ reported quality of life was related to time spent outdoors at the farm. In light of the present study, it seems as farm-based day care is addressing people with dementia in an early stage, dominated by men, with quite good physical and medical condition. The strong association between quality of life and spending time outdoors underscores that facilitation for outdoor activity should be prioritized in all types of dementia care. KEYWORDSactivity outdoors, care farms, day care, dementia, farm-based day care, quality of lifeThe trial is funded by a grant from the Research Council of Norway (N0: 255033).publishedVersio
Predictors of problematic substance use 18 years after treatment: a longitudinal cohort study of persons with substance use disorders
Get PDFObjective: To examine the extent of substance use and explore which baseline factors predicted current problematic substance use 18 years after treatment in surviving patients. Methods: This longitudinal cohort study used a mailed self-report questionnaire on a group of patients with long-term problematic substance use, and high psychiatric comorbidity, 18 years after they received treatment for substance use disorders. A consecutive sample of patients with substance use disorders (n = 287, mean age 38.6 years, 72% male; 45% alcohol use disorder only and 55% other substance use disorders) was recruited in 1997 and 1998. Baseline measurements included the Composite International Diagnostic Interview, the Millon Clinical Multiaxial Inventory II, the Hopkins Symptom Checklist 25 and demographic data. In the 18-year follow-up study (n = 91), the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test were used. A multivariate logistic regression analysis was used to identify predictors of having current problematic substance use 18 years after treatment for participants with full data collection at baseline (n = 75). Results: Of the 91 participants who responded at the 18-year follow-up study, 47 (52%) had no current problematic substance use and 44 (48%) had current problematic substance use during the past 12 months. Of participants with no current problematic substance use, 17 (36%) reported total abstinence from alcohol, illicit substances and misuse of pharmaceuticals during the past 5 years. Mental distress measured with the Hopkins Symptom Checklist 25 at baseline predicted having current problematic substance use 18 years after treatment (n = 75). Conclusions: In a group of patients with long lasting substance use disorders and high psychiatric comorbidity that entered treatment, close to half of those participating at a follow-up study had current problematic substance use during the past 12 months 18 years later. Mental distress at baseline predicted having current problematic substance use 18 years after treatment, adjusted for other factors. Self-reported general mental health symptoms can be a relevant predictor of the long-term course of substance use disorders.This work was funded by Innlandet Hospital Trust, Norway.publishedVersio
Earthquake exposure and post-traumatic stress among nepalese mothers after the 2015 earthquakes
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Introduction: Nepal suffered from major earthquakes in April 2015 resulting in great damage to the society. The objective of the current study is to describe the earthquake exposure, the impact on family's daily life and the symptoms of post-traumatic stress disorder (PTSD) and their association in Nepalese mothers 20 months following the earthquakes. Methods: In a clinical trial in Bhaktapur, Nepal, 558 mothers responded to an inventory on earthquake exposure and the Impact of Event Scale - Revised (IES-R) 20 months after the earthquakes. In multiple linear regression models, we estimated the associations between the earthquake exposure and the impact on the families' life and the IES-R score. Results: Over 60% reported that the earthquakes had a great deal of negative impact on their family's life. In 4.7%, close family members died, and in 10.5%, family members were injured. 24% had IES-R scores indicating PTSD symptoms within clinical concern or a possible diagnosis. Lower levels of education were associated with higher scores on the total IES-R. Mothers who report that the earthquakes had a great deal of negative impact had higher total IES-R scores [9.8, 95% CI (5.9, 13.6)] compared to mothers that reported no such negative impact. Mothers with family members who were killed had higher IES-R scores [3.6, 95% CI (1.6, 5.5)] than those with no family members who died. Mothers assisting in rescue efforts had lower IES-R scores [2.8, 95% CI (0.8, 4.8)] than those not assisting. Conclusion: Our study demonstrates high levels of exposure to traumatic events, large negative impact on the everyday life of the families, and a high level of PTSD symptoms. There was a consistent and graded association between the exposure variables and PTSD symptoms. The large impact of the earthquakes on these Nepalese mothers underscore the importance of awareness of mental disorders following major natural catastrophes for marginalized families.The study was funded by Thrasher Research Fund (Grant # 11512), Thrasher Early Career Award (Grant # 13988) and the GC Rieber Funds. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.publishedVersio
Medical therapy of patients contaminated with radioactive cesium or iodine
Get PDFFollow-up studies after the Chernobyl and Fukushima accidents have shown that 137Cs and 131I made up the major amount of harmful contaminants in the atmospheric dispersion and fallout. Other potential sources for such radionuclide exposure may be terrorist attacks, e.g., via contamination of drinking water reservoirs. A primary purpose of radionuclide mobilization is to minimize the radiation dose. Rapid initiation of treatment of poisoned patients is imperative after a contaminating event. Internal contamination with radioactive material can expose patients to prolonged radiation, thus leading to short- and long-term clinical consequences. After the patient’s emergency conditions are addressed, the treating physicians and assisting experts should assess the amount of radioactive material that has been internalized. This evaluation should include estimation of the radiation dose that is delivered and the specific radionuclides inside the body. These complex assessments warrant the reliance on a multidisciplinary approach that incorporates regional experts in radiation medicine and emergencies. Regional hospitals should have elaborated strategies for the handling of radiation emergencies. If radioactive cesium is a significant pollutant, Prussian blue is the approved antidote for internal detoxification. Upon risks of radioiodine exposure, prophylactic or immediate treatment with potassium iodide tablets is recommended. Chelators developed from calcium salts have been studied for gastrointestinal trapping and enhanced mobilization after strontium exposure.This research was funded by Regione Autonoma della Sardegna for the financial support grant number
RASSR79857 “Metallo-farmaci innovativi: biotrasformazione e target biologici. Un approccio integrato”.publishedVersio
Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients
Get PDFBackground: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.This work was supported by Health West, Norway #911369; the Norwegian National Research Council #133897/320 and #154642/320, the Norwegian Department of Health and Social Affairs, and the National Council for Mental Health, Health and Rehabilitation #1997/41 and #2002/306, Rogaland County and Oslo County. This work was also funded by the Theodore and Vada Stanley Foundation and the Regional Health Research Foundation for Eastern Region, Denmark; Roskilde County, Helsefonden, Lundbeck Pharma, Eli Lily, and Janssen Cilag Pharmaceuticals Denmark; the National Alliance for Research on Schizophrenia and Depression (NARSAD) distinguished investigator award and NIM grant MH-01654 and a NARSAD young investigator award; and Health South East #2008001 and Health West #200202797-65 and #911313.publishedVersio
Long‐term efficacy and safety of biosimilar infliximab (CT‐P13) after switching from originator infliximab: Open‐label extension of the NOR‐SWITCH trial
Get PDFBACKGROUND AND OBJECTIVES:
The 52-week, randomized, double-blind, noninferiority, government-funded NOR-SWITCH trial demonstrated that switching from infliximab originator to less expensive biosimilar CT-P13 was not inferior to continued treatment with infliximab originator. The NOR-SWITCH extension trial aimed to assess efficacy, safety and immunogenicity in patients on CT-P13 throughout the 78-week study period (maintenance group) versus patients switched to CT-P13 at week 52 (switch group). The primary outcome was disease worsening during follow-up based on disease-specific composite measures.
METHODS:
Patients were recruited from 24 Norwegian hospitals, 380 of 438 patients who completed the main study: 197 in the maintenance group and 183 in the switch group. In the full analysis set, 127 (33%) had Crohn's disease, 80 (21%) ulcerative colitis, 67 (18%) spondyloarthritis, 55 (15%) rheumatoid arthritis, 20 (5%) psoriatic arthritis and 31 (8%) chronic plaque psoriasis.
RESULTS:
Baseline characteristics were similar in the two groups at the time of switching (week 52). Disease worsening occurred in 32 (16.8%) patients in the maintenance group vs. 20 (11.6%) in the switch group (per-protocol set). Adjusted risk difference was 5.9% (95% CI -1.1 to 12.9). Frequency of adverse events, anti-drug antibodies, changes in generic disease variables and disease-specific composite measures were comparable between arms. The study was inadequately powered to detect noninferiority within individual diseases.
CONCLUSION:
The NOR-SWITCH extension showed no difference in safety and efficacy between patients who maintained CT-P13 and patients who switched from originator infliximab to CT-P13, supporting that switching from originator infliximab to CT-P13 is safe and efficacious.Ministry of Health and Care services, NorwaypublishedVersio
Toileting difficulties in older people with and without dementia receiving formal in-home care-A longitudinal study
Get PDFAim:
To estimate the prevalence of toileting difficulties over time among older people (≥70 years) with and without dementia receiving formal in-home care at baseline and to explore whether dementia at baseline was associated with toileting difficulties at the last assessment when adjusting for relevant covariates. We hypothesize that those with dementia have a higher prevalence and that baseline dementia is associated with toileting difficulties at last follow-up.
Design:
A longitudinal observational study with three assessments over 36 months. Older people (≥70 years) from 19 Norwegian municipalities with in-home care needs were included. The participants and their next of kin were interviewed.
Method:
In total, 1,001 (68% women) persons with a mean (SD) age 83.4 (5.7) years participated at baseline. Toileting difficulties were assessed using Lawton and Brody's Physical Self-Maintenance Scale and Individual Nursing and Care Statistics. Information on physical comorbidity, number of prescribed drugs, cognitive function and formal care given was included. Dementia was diagnosed based on all information gathered.
Results:
At all time points, toileting difficulties were more prevalent in people with than without dementia. In adjusted analyses, dementia at baseline was associated with toileting difficulties at the last assessment. Nursing home admission was associated with increased odds for toileting difficulties.The funding of the data collection in the present study came from the Norwegian Directorate of Health and grant 187980 from the Research Council of Norway.publishedVersio
Are the Neuroprotective Effects of Exercise Training Systemically Mediated?
Get PDFTo date there is no cure available for dementia, and the field calls for novel therapeutic targets. A rapidly growing body of literature suggests that regular endurance training and high cardiorespiratory fitness attenuate cognitive impairment and reduce dementia risk. Such benefits have recently been linked to systemic neurotrophic factors induced by exercise. These circulating biomolecules may cross the blood-brain barrier and potentially protect against neurodegenerative disorders such as Alzheimer's disease. Identifying exercise-induced systemic neurotrophic factors with beneficial effects on the brain may lead to novel molecular targets for maintaining cognitive function and preventing neurodegeneration. Here we review the recent literature on potential systemic mediators of neuroprotection induced by exercise. We focus on the body of translational research in the field, integrating knowledge from the molecular level, animal models, clinical and epidemiological studies. Taken together, the current literature provides initial evidence that exercise-induced, blood-borne biomolecules, such as BDNF and FNDC5/irisin, may be powerful agents mediating the benefits of exercise on cognitive function and may form the basis for new therapeutic strategies to better prevent and treat dementia.publishedVersio
