ADHD diagnosis requires the presence of symptoms before the age of twelve. In clinical assessment of adults, the most frequent strategy to check this criterion is investigating self-report recall of ...symptoms, despite little evidence on the validity of this approach. We aim to evaluate the recall accuracy and factors associated with its reliability in a large population-based sample of adults.
Individuals from the 1993 Pelotas Birth Cohort were followed-up from childhood to adulthood. At the age of 22, 3810 individuals were assessed through structured interviews by trained psychologists regarding mental health outcomes, including ADHD diagnosis and ADHD symptoms in childhood. The retrospective recall was compared with available information on ADHD childhood symptoms at the age of eleven. We also assessed factors related to recall accuracy through multiple regression analyses.
Self-reported recall of childhood symptoms at 22 years of age had an accuracy of only 55.4%, with sensitivity of 32.8% and positive predictive value of 40.7%. Current inattention symptoms were associated with lower risk and social phobia with higher risk for false-positive endorsement, while higher levels of schooling correlated with lower risk and male gender with higher risk for false-negative endorsement.
Clinicians treating male patients with social phobia and ADHD symptoms should assess even more carefully retrospective recall of ADHD childhood symptoms. Moreover, characteristics associated with recall improvement do not impact accuracy robustly. In this context, the recall of childhood ADHD symptoms seems an unreliable method to characterize the neurodevelopmental trajectory in adults with currently-impairing ADHD symptomatology.
There are still uncertainties on the psychometric validity of the DSM-5 attention deficit hyperactivity disorder (ADHD) criteria for its use in the adult population. We aim to describe the adult ADHD ...phenotype, to test the psychometric properties of the DSM-5 ADHD criteria, and to calculate the resulting prevalence in a population-based sample in their thirties.
A cross-sectional evaluation using the DSM-5 ADHD criteria was carried out in 3574 individuals from the 1982 Pelotas Birth Cohort. Through receiver operator curve, latent and regression analyses, we obtained parameters on construct and discriminant validity. Still, prevalence rates were calculated for different sets of criteria.
The latent analysis suggested that the adult ADHD phenotype is constituted mainly by inattentive symptoms. Also, inattention symptoms were the symptoms most associated with impairment. The best cut-off for diagnosis was four symptoms, but sensitivity and specificity for this cut-off was low. ADHD prevalence rates were 2.1% for DSM-5 ADHD criteria and 5.8% for ADHD disregarding age-of-onset criterion.
The bi-dimensional ADHD structure proposed by the DSM demonstrated both construct and discriminant validity problems when used in the adult population, since inattention is a much more relevant feature in the adult phenotype. The use of the DSM-5 criteria results in a higher prevalence of ADHD when compared to those obtained by DSM-IV, and prevalence would increase almost threefold when considering current ADHD syndrome. These findings suggest a need for further refinement of the criteria for its use in the adult population.
Course and predictors of persistence of attention deficit hyperactivity disorder (ADHD) in adults are still largely unknown. Neurobiological and clinical differences between child and adult ADHD ...raise the need for follow-up studies of patients diagnosed during adulthood. This study investigates predictors of ADHD persistence and the possibility of full remission 7 years after baseline assessment.
A 7-year follow-up study of adults with ADHD (n = 344, mean age 34.1 years, 49.9% males) was conducted. Variables from different domains (social demographics, co-morbidities, temperament, medication status, ADHD measures) were explored with the aim of finding potential predictors of ADHD persistence.
Retention rate was 66% (n = 227). Approximately a third of the sample (n = 70, 30.2%) did not maintain ADHD criteria and 28 (12.4%) presented full remission (<4 symptoms), independently of changes in co-morbidity or cognitive demand profiles. Baseline predictors of diagnostic persistence were higher number of inattention symptoms odds ratio (OR) 8.05, 95% confidence interval (CI) 2.54-25.45, p < 0.001, number of hyperactivity/impulsivity symptoms (OR 1.18, 95% CI 1.04-1.34, p = 0.01), oppositional defiant disorder (OR 3.12, 95% CI 1.20-8.11, p = 0.02), and social phobia (OR 3.59, 95% CI 1.12-11.47, p = 0.03).
Despite the stage of brain maturation in adults suggests stability, approximately one third of the sample did not keep full DSM-IV diagnosis at follow-up, regardless if at early, middle or older adulthood. Although full remission is less common than in childhood, it should be considered as a possible outcome among adults.
Objective
There is a lack of available information on the trajectories of attention‐deficit/hyperactivity disorder (ADHD) dimensions during adulthood. This study investigates the course and the ...predictors of change for each ADHD domain in a clinical sample of adults with ADHD.
Method
Adults with ADHD (n = 344) were followed up for 7 years, with a final retention rate of 66.0%. Trajectories of inattention, hyperactivity, and impulsivity and their potential predictors were examined.
Results
On average, symptoms declined in all ADHD domains during follow‐up. Despite this, rises in inattentive, hyperactive, and impulsive symptoms were observed in approximately 13%, 25%, and 17% of patients respectively. Different predictors influenced the trajectory of each ADHD dimension. Oppositional defiant disorder and social phobia were associated with the maintenance of symptoms, while alcohol use disorder was associated with both maintenance and rise of symptoms.
Conclusion
Unexpectedly, a rise in the symptoms after 7 years was not uncommon in adults with ADHD. Prevalent comorbidities have the potential to influence the neurodevelopment and the trajectory of ADHD. Therefore, such predictors should be investigated in population cohorts to better characterize the course of ADHD. Additionally, these findings may be relevant in prevention studies and in strategies for ADHD treatment.
Background: Healthcare professionals commonly exhibit negative attitudes toward people with mental disorders. Few international studies have sought to investigate the determinants of stigma.
...Objective: To conduct an international comparison of pharmacy students’ stigma towards people with schizophrenia, and to determine whether stigma is consistently associated with stereotypical attributes of people with schizophrenia.
Method: Students (n = 649) at eight universities in Australia, Belgium, India, Finland, Estonia and Latvia completed a seven-item Social Distance Scale (SDS) and six items related to stereotypical attributes of people with schizophrenia.
Results: Mean SDS scores were 19.65 (± 3.97) in Australia, 19.61 (± 2.92) in Belgium, 18.75 (± 3.57) in India, 18.05 (± 3.12) in Finland, and 20.90 (± 4.04) in Estonia and Latvia. Unpredictability was most strongly associated with having a high social distance in Australia (β = —1.285), the perception that people will never recover in India (β = — 0.881), dangerousness in Finland (β = —1.473) and the perception of being difficult to talk to in Estonia and Latvia (β = —2.076). Unpredictability was associated with lower social distance in Belgium (β = 0.839).
Conclusion: The extent to which students held stigmatizing attitudes was similar in each country, however, the determinants of stigma were different. Pharmacy education may need to be tailored to address the determinants of stigma in each country.
The objective of the work was to develop a suitable method for covalent immobilization of labile active biomolecules on inert hydrophobic polyvinylidene fluoride (PVDF) membrane, preserving both ...membrane stability and biomolecule activity. PVDF is advantageous over other membrane materials due to its high mechanical strength and excellent chemical resistance. On the other hand, its native structure does not have sites for biomolecules covalent immobilization in mild conditions. The strategy of the present work consisted in grafting reactive groups on the hydrophobic PVDF to which attaching functional groups able to covalently bound biomolecules in mild conditions. Tuning grafting conditions were crucial in order to attack the inert membrane while maintaining suitable membrane chemical and mechanical stability. Therefore, surface modification of native PVDF flat-sheet membranes was performed by wet chemical strategy, under basic conditions, using 1,5-diamino-2-methylpentane (DAMP) as carrier of amino groups. Afterwards, these groups were activated with glutaraldehyde (GA) to which biomolecules were easily attached by covalent bond. Two model proteins having different properties (BSA and Lipase) were selected for immobilization test. DAMP concentration, reaction temperature, and reaction time were studied in order to tune both the degree of modification and the loading capacity of the functionalized membrane taking in account the mechanical stability of the membrane. Modified and native PVDF membranes were characterized by Fourier transform infrared spectroscopy (FT-IR), the ninhydrin test, scanning electron microscopy (SEM) and the mechanical resistance test. Enzymatic activity of immobilized lipase was tested in a biphasic systems using the hydrolysis of triglycerides as model reaction.
Modified membranes showed higher binding capacities compared with unmodified PVDF membrane. Optimal conditions for grafting reactive amino groups able to guarantee membrane stability and enzyme loading suitable to achieve good enzyme specific activity were identified.
•A simple method for biomolecules immobilization on PVDF membrane was developed.•PVDF membranes were functionalized by 1,5-diamino-2-methylpentane (DAMP).•Then PVDF was characterized by FT-IR, ninhydrin, SEM and the mechanical resistance test.•Modified membranes demonstrated higher binding capacities for proteins analyzed.•The performance of the biocatalytic membrane is constant during the time.
Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown.
The goal of this ...study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial.
One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure.
Among 4,617 participants, 2,239 (48.5%) were aged <65 years, 1,713 (37.1%) were aged 65 to 74 years, and 665 (14.4%) were aged ≥75 years. Baseline SAQ summary scores were lower in participants aged <65 years. Fully adjusted differences in 1-year SAQ summary scores (invasive minus conservative) were 4.90 (95% CI: 3.56-6.24) at age 55 years, 3.48 (95% CI: 2.40-4.57) at age 65 years, and 2.13 (95% CI: 0.75-3.51) at age 75 years (P
= 0.008). Improvement in SAQ Angina Frequency was less dependent on age (P
= 0.08). There were no age differences between invasive vs conservative management on the composite clinical outcome (P
= 0.29).
Older patients with chronic coronary disease and moderate or severe ischemia had consistent improvement in angina frequency but less improvement in angina-related health status with invasive management compared with younger patients. Invasive management was not associated with improved clinical outcomes in older or younger patients. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches ISCHEMIA; NCT01471522).
•Continuous biocatalytic membrane reactor (BMR) to hydrolyse organophosphates.•Significant improvement of phosphotriesterase stability respect to the free enzyme.•High organophosphate degradation ...(90%) by the BMR.•Long term stability of the BMR (1 year).
Organophosphates (OPs) are highly toxic compounds used as pesticides and nerve agents. The devastating effects, reported in different studies, on the environment and human health indicate a serious scenario for both instantaneous and long terms effects. Bio-based strategies for OPs degradation seem the most promising solutions, particularly when extremophiles enzymes are used. These systems permit OPs degradation with high efficiency and specificity under mild conditions. However, as frequently observed, enzymes can easily lose activity in batch systems, so that a strategy to improve biocatalyst stability is highly needed, in order to develop continuous systems.
In this work, for the first time, a continuous biocatalytic system for organophosphates (OPs) detoxification has been proposed by using a triple mutant of the thermostable phosphotriesterase (named SsoPox) isolated from the hyperthermophilic archaeon Sulfolobus solfataricus.
The enzyme was covalently immobilized on polymeric membranes to develop a biocatalytic membrane reactor (BMR) able to hydrolyse a pesticide (paraoxon) contained in water. High paraoxon degradation (about 90%) and long term stability (1 year) were obtained when the enzyme was covalently immobilized on hydrophilic membranes. On the contrary, the enzyme in batch system completely loses its activity within few months after its solubilisation in buffer.
Objective To determine the association among nonalcoholic fatty liver disease (NAFLD), metabolic function, and cardiac function in obese adolescents. Study design Intrahepatic triglyceride (IHTG) ...content (magnetic resonance spectroscopy), insulin sensitivity and β-cell function (5-hour oral glucose tolerance test with mathematical modeling), and left ventricular function (speckle tracking echocardiography) were determined in 3 groups of age, sex, and Tanner matched adolescents: (1) lean (n = 14, body mass index BMI = 20 ± 2 kg/m2 ); (2) obese with normal (2.5%) IHTG content (n = 15, BMI = 35 ± 3 kg/m2 ); and (3) obese with increased (8.7%) IHTG content (n = 15, BMI = 37 ± 6 kg/m2 ). Results The disposition index (β-cell function) and insulin sensitivity index were ∼45% and ∼70% lower, respectively, and whole body insulin resistance, calculated by homeostasis model of assessment-insulin resistance (HOMA-IR), was ∼60% greater, in obese than in lean subjects, and ∼30% and ∼50% lower and ∼150% greater, respectively, in obese subjects with NAFLD than those without NAFLD ( P < .05 for all). Left ventricular global longitudinal systolic strain and early diastolic strain rates were significantly decreased in obese than in lean subjects, and in obese subjects with NAFLD than those without NAFLD ( P < .05 for all), and were independently associated with HOMA-IR (β = 0.634). IHTG content was the only significant independent determinant of insulin sensitivity index (β = −0.770), disposition index (β = −0.651), and HOMA-IR (β = 0.738). Conclusions These findings demonstrate that the presence of NAFLD in otherwise asymptomatic obese adolescents is an early marker of cardiac dysfunction.
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