A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment

ABSTRACT: BACKGROUND: In childhood, attention deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate levels of inattentiveness/disorganization, hyperactivity/impulsiveness, or a combination thereof. Although the criteria for ADHD are well defined, the long-term consequences in adults and children need to be more comprehensively understood and quantified. We conducted a systematic review evaluating the long-term outcomes (defined as 2 years or more) of ADHD with the goal of identifying long-term outcomes and the impact that any treatment (pharmacological, non-pharmacological, or multimodal) has on ADHD long-term outcomes. METHODS: Studies were identified using predefined search criteria and 12 databases. Studies included were peer-reviewed, primary studies of ADHD longterm outcomes published between January 1980 to December 2010. Inclusion was agreed on by two independent researchers on review of abstracts or full text. Published statistical comparison of outcome results were summarized as poorer than, similar to, or improved versus comparators, and quantified as percentage comparisons of these categories. RESULTS: Outcomes from 351 studies were grouped into 9 major categories: academic, antisocial behavior, driving, non-medicinal drug use/addictive behavior, obesity, occupation, services use, self-esteem, and social function outcomes. The following broad trends emerged: (1) without treatment, people with ADHD had poorer long-term outcomes in all categories compared with people without ADHD, and (2) treatment for ADHD improved long-term outcomes compared with untreated ADHD, although not usually to normal levels. Only English-language papers were searched and databases may have omitted relevant studies. CONCLUSIONS: This systematic review provides a synthesis of studies of ADHD long-term outcomes. Current treatments may reduce the negative impact that untreated ADHD has on life functioning, but does not usually 'normalize' the recipients.     

Characteristics of older adults living with HIV accessing home and community care services in British Columbia,Canada

ABSTRACT

Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n?=?503) and rehabilitation (7.73%, n?=?433). Those who received HCC were more likely to be female (aOR?=?1.56, 95% CI?=?1.24, 1.98), have a history of injection drug use (aOR?=?1.88, 95% CI?=?1.57, 2.25), have a higher Charlson comorbidity score (aOR?=?1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR?=?2.17, 95% CI?=?1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.     

Red grape (Vitis vinifera L.) flavonoids down‐regulate collagen type III expression after UV‐A in primary human dermal blood endothelial cells

Red grape (Vitis vinifera L.) flavonoids including flavan‐3‐ols (eg, catechin and epicatechin), flavonols (eg, quercetin) and anthocyanins (eg, malvidin) exert anti‐inflammatory and antioxidant activities. In the skin they also have a photoprotective action, and their effects have been extensively investigated in keratinocytes, melanocytes and fibroblasts. Despite their known effects also on blood vasculature, little is known on their activities on human dermal blood endothelial cells (HDBECs), which are critically involved in skin homeostasis as well as in the pathogenesis of neoplastic and inflammatory skin diseases. We sought to study the biological effects of selected red grape flavonoids in preventing the consequences of ultraviolet (UV)‐A irradiation in vitro. Our results show that red grape flavonoids prevent UV‐A‐induced sICAM‐1 release in HDBECs, suggesting that this cell type could represent an additional target of the anti‐inflammatory activity of flavonoids. In addition, flavonoids effectively inhibited UV‐A‐induced synthesis of collagen type III at both RNA and protein level, indicating that dermal blood microvasculature could be actively involved in ECM remodelling as a consequence of skin photo‐ageing, and that this can be prevented by red grape flavonoids.     

Case for diagnosis

Idiopathic Atrophoderma of Pasini and Pierini (IAPP) is a rare, exclusively cutaneous disease. It is more frequent in females, with incidence peak in the second and third decades of life. The etiopathogenesis remains unknown. IAPP most commonly affects the back, abdomen and proximal regions of the limbs. Lesions may be rounded, oval or circular; single or multiple. The evolution is variable and the course is initially progressive. Collagen changes such as atrophy, thinning, condensation and sclerosis may be observed in the papillary dermis. This paper describes a case of Idiopathic Atrophoderma of Pasini and Pierini with histopathologic findings.     

Psychosocial health concerns among service-seeking orphans in the slums of Kampala

Orphans have many unmet needs. The purpose of the current study is to briefly examine the psychosocial correlates linked to being an orphan among service-seeking youth in the slums of Kampala in order to provide guidance for service provision for youth. The current analysis is based on a cross-sectional survey conducted in 2011 which consisted of a convenience sample of youth living in the slums (ages 14–24 years) attending a drop-in center, Uganda Youth Development Link. Bivariate and multivariable analyses were used to determine psychosocial correlates with being an orphan. Among the youth participants (N = 444), 23.65% (n = 105) reported both of their parents died, 37.39% (n = 166) reported one parent died, and the remaining 38.96% (n = 173) reported both of their parents are living. In the multivariable model, reporting both parents dead was significantly associated with being a female (adjusted odds ratio [AOR]: 2.79, 95% confidence interval [CI]: 1.27, 6.12) and parental abuse (AOR: 0.14; 95% CI: 0.07, 0.27). A large percentage of youth living in the slums of Kampala are orphans. This study presents important findings that inform interventions and policies that can be targeted toward the dire needs of youth living in the streets and slums of Kampala.