The present study investigates characteristics of treatment seeking problem gamblers with adult ADHD (n = 39) and those without ADHD (n = 87). Patients completed self-report questionnaires about gambling behaviors, impulsivity (UPPS-P), substance abuse (AUDIT/DAST), emotional dysregulation (PHQ-4), illegal activities, and gambling consequences. Each patient received a structured diagnostic interview (MINI) to assess for psychopathology, adult ADHD (ACDS), and gambling disorder (NODS). Results revealed that problem gamblers with adult ADHD encounter unique challenges above those common among problem gamblers including more problems with alcohol/drug abuse and higher levels of impulsivity. Earlier age for first gambling activities, onset of gambling problems, and higher severity of gambling problems was found among gamblers with ADHD. Gamblers with ADHD pawned more items to obtain money for gambling, were more likely to have debt, had significantly higher rates of bankruptcy and domestic violence arising from conflict with family members about their gambling. Interestingly, groups did not differ significantly on their time spent gambling prior to treatment, their win-to-loss ratio, and a number of other gambling-related consequences. These findings are discussed with their clinical ramifications for treatment.
We have recently shown that human epididymis protein 4 (HE4) levels correlate with the severity of cystic fibrosis (CF) lung disease. However, there are no data on how HE4 levels alter in patients receiving CFTR modulating therapy.
Methods
In this retrospective clinical study, 3 independent CF patient cohorts (US-American: 29, Australian: 12 and Irish: 19 cases) were enrolled carrying at least one Class III CFTR CF-causing mutation (p.Gly551Asp) and being treated with CFTR potentiator ivacaftor. Plasma HE4 was measured by immunoassay before treatment (baseline) and 1–6?months after commencement of ivacaftor, and were correlated with FEV1 (% predicted), sweat chloride, C-reactive protein (CRP) and body mass index (BMI).
Results
After 1?month of therapy, HE4 levels were significantly lower than at baseline and remained decreased up to 6?months. A significant inverse correlation between absolute and delta values of HE4 and FEV1 (r?=??0.5376; P?<?.001 and r?=??0.3285; P?<?.001), was retrospectively observed in pooled groups, including an independent association of HE4 with FEV1 by multiple regression analysis (β?=??0.57, P?=?.019). Substantial area under the receiver operating characteristic curve (ROC-AUC) value was determined for HE4 when 7% mean change of FEV1 (0.722 [95% CI 0.581–0.863]; P?=?.029) were used as classifier, especially in the first 2?months of treatment (0.806 [95% CI 0.665–0.947]; P?<?.001).
Conclusions
This study shows that plasma HE4 levels inversely correlate with lung function improvement in CF patients receiving ivacaftor. Overall, this potential biomarker may be of value for routine clinical and laboratory follow-up of CFTR modulating therapy. 相似文献
ABSTRACTGrowing trees on farmland continues to be a promising land-use option for smallholders in Indonesia as they look to diversify their enterprises beyond the main agricultural sector. While most smallholders integrate trees into their farming systems, selling timber and other tree products has usually been infrequent and opportunistic. Because of this infrequent trade, most smallholders rarely adopt silvicultural practices that would increase the commercial value of their trees. A research project trialled an alternative approach to forestry extension in Indonesia, known as the Master TreeGrower (MTG) training course. The MTG training courses used a farmer-centred approach to teach smallholders about forest science and took participants to market hubs so they could better understand how different forest products were valued by traders. The MTG training approach was trialled in 2014 in five districts in Indonesia and involved 118 smallholders and 27 non-farmers as course participants. This article reports on a recent evaluation of the MTG training courses held about three years earlier to explore the enduring impacts of the training approach and whether it can be scaled-out to other areas of Indonesia. The evaluation data were collected via focus group discussions (FGDs), in-depth interviews, household surveys and observations at three project sites: Pati (Central Java), Gunungkidul (Yogyakarta) and Bulukumba (South Sulawesi). A questionnaire was distributed among the participants of the FGDs to assess the extent different knowledge and skills of tree management that had been adopted by them following the MTG courses. The evaluation of the MTG approach revealed that the courses were effective in increasing smallholders’ knowledge of commercial forestry and their silvicultural skills. Many participants were more active with silviculture and planned to invest further in commercial forestry following the MTG training. In effect, the MTG training appeared to change the hearts and minds of the farmers about how commercial forestry could enhance their livelihoods. 相似文献
Epigenetics refers broadly to processes that influence medium to long‐term gene expression by changing the readability and accessibility of the genetic code. The Neurobiology Commission of the International League Against Epilepsy (ILAE) recently convened a Task Force to explore and disseminate advances in epigenetics to better understand their role and intersection with genetics and the neurobiology of epilepsies and their co‐morbidities, and to accelerate translation of these findings into the development of better therapies. Here, we provide a topic primer on epigenetics, explaining the key processes and findings to date in experimental and human epilepsy. We review the growing list of genes with epigenetic functions that have been linked with epilepsy in humans. We consider potential practical applications, including using epigenetic signals as biomarkers for tissue‐ and biofluid‐based diagnostics and the prospects for developing epigenetic‐based treatments for epilepsy. We include a glossary of terms, FAQs and other supports to facilitate a broad understanding of the topic for the non‐expert. Last, we review the limitations, research gaps and the next challenges. In summary, epigenetic processes represent important mechanisms controlling the activity of genes, providing opportunities for insight into disease mechanisms, biomarkers and novel therapies for epilepsy. 相似文献
The Combined Aerobic and Resistance Exercise (CARE) Trial compared different types and doses of exercise performed during breast cancer chemotherapy. Here, we report the longer-term follow-up of patient-reported outcomes, health-related fitness and exercise behavior at 6, 12 and 24 months postintervention. A multicenter trial in Canada randomized 301 breast cancer patients initiating chemotherapy to thrice weekly, supervised exercise consisting of a standard dose of 25–30 min of aerobic exercise (STAN; n = 96), a higher dose of 50–60 min of aerobic exercise (HIGH; n = 101) or a combined dose of 50–60 min of aerobic and resistance exercise (COMB; n = 104) performed for the duration of chemotherapy (median of 17 weeks). Primary outcomes were patient-reported outcomes including quality of life, cancer-related symptoms and psychosocial outcomes. Secondary outcomes were objective health-related fitness (assessed at 12 months only) and self-reported exercise behavior. A total of 269 (89.4%) participants completed patient-reported outcomes at all three follow-up time points and 263 (87.4%) completed the health-related fitness assessment at 12-month follow-up. COMB was significantly superior to (i) STAN for sleep quality at 6-month follow-up (p = 0.027); (ii) HIGH for upper body muscular endurance at 12-month follow-up (p = 0.020); and (iii) HIGH for meeting the resistance exercise guideline at 6-month follow-up (p = 0.006). Moreover, self-reported meeting of the combined exercise guideline during follow-up was significantly associated with better patient-reported outcomes and health-related fitness. Performing combined exercise during and after breast cancer chemotherapy may result in better longer-term patient-reported outcomes and health-related fitness compared to performing aerobic exercise alone. 相似文献