Extensive Internet Involvement—Addiction or Emerging Lifestyle?

In the discussions for the future DSM-5, the Substance-Related Disorders Work Group has been addressing “addiction-like” behavioral disorders such as “Internet addiction” to possibly be considered as potential additions for the diagnostic system. Most research aiming to specify and define the concept of Internet addiction (or: Excessive/Compulsive/Problematic Internet Use—PIU), takes its point of departure in conventional terminology for addiction, based in established DSM indicators. Still, it is obvious that the divide between characteristics of addiction and dimensions of new lifestyles built on technological progress is problematic and far from unambiguous. Some of these research areas are developing from the neurobiological doctrine of addiction as not being tied to specific substances. The concept of “behavioral addictions”, based on biological mechanisms such as the reward systems of the brain, has been launched. The problems connected to this development are in this study discussed and reflected with data from a Swedish survey on Internet use (n = 1,147). Most Swedes (85%) do use the Internet to some degree. The prevalence of excessive use parallels other similar countries. Respondents in our study spend (mean value) 9.8 hours per week online at home, only 5 percent spend more than 30 hours per week. There are both positive and negative social effects at hand. Many respondents have more social contacts due to the use of Internet, but there is a decline in face-to-face contacts. About 40% of the respondents indicate some experience of at least one problem related to Internet use, but only 1.8% marked the presence of all problems addressed. Most significant predictors for problem indicators, except for age, relate to “time” and time consuming activities such as gaming, other activities online or computer skills

Dose-response relationships of intestinal organs and excessive mucus discharge after gynaecological radiotherapy

Background The study aims to determine possible dose-volume response relationships between the rectum, sigmoid colon and small intestine and the ‘excessive mucus discharge’ syndrome after pelvic radiotherapy for gynaecological cancer. Methods and materials From a larger cohort, 98 gynaecological cancer survivors were included in this study. These survivors, who were followed for 2 to 14 years, received external beam radiation therapy but not brachytherapy and not did not have stoma. Thirteen of the 98 developed excessive mucus discharge syndrome. Three self-assessed symptoms were weighted together to produce a score interpreted as ‘excessive mucus discharge’ syndrome based on the factor loadings from factor analysis. The dose-volume histograms (DVHs) for rectum, sigmoid colon, small intestine for each survivor were exported from the treatment planning systems. The dose-volume response relationships for excessive mucus discharge and each organ at risk were estimated by fitting the data to the Probit, RS, LKB and gEUD models. Results The small intestine was found to have steep dose-response curves, having estimated dose-response parameters: γ : 1.28, 1.23, 1.32, D : 61.6, 63.1, 60.2 for Probit, RS and LKB respectively. The sigmoid colon (AUC: 0.68) and the small intestine (AUC: 0.65) had the highest AUC values. For the small intestine, the DVHs for survivors with and without excessive mucus discharge were well separated for low to intermediate doses; this was not true for the sigmoid colon. Based on all results, we interpret the results for the small intestine to reflect a relevant link. Conclusion An association was found between the mean dose to the small intestine and the occurrence of ‘excessive mucus discharge’. When trying to reduce and even eliminate the incidence of ‘excessive mucus discharge’, it would be useful and important to separately delineate the small intestine and implement the dose-response estimations reported in the study

A Preparatory Study for a Randomized Controlled Trial of Dietary Fiber Intake During Adult Pelvic Radiotherapy

Background: Patients undergoing pelvic radiotherapy are often advised to omit fiber-rich foods from their diet to reduce the adverse effects of treatment. Scientific evidence supporting this recommendation is lacking, and recent studies on animals and humans have suggested that there is a beneficial effect of dietary fiber for the alleviation of symptoms. Randomized controlled studies on dietary fiber intake during pelvic radiotherapy of sufficient size and duration are needed. As preparation for such a large-scale study, we evaluated the feasibility, compliance, participation rate, and logistics and report our findings here in this preparatory study. Methods: In this preparatory study of a fiber intervention trial, Swedish gynecological cancer patients scheduled for radiotherapy were recruited between January 2019 and August 2020. During the intervention, the participants filled out questionnaires and used an application. They also consumed a fiber supplement at first in powder form, later in capsules. Blood- and fecal samples were collected. The study is registered in clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04534075?cond=fidura&draw=2&rank=1). Results: Among 136 approached patients, 57 started the study and the participation rate for primary outcomes was 63% (third blood sample) and 65% (third questionnaire). Barely half of the participants provided fecal samples. Providing concise and relevant information to the patients at the right time was crucial in getting them to participate and stay in the study. The most common reasons for declining participation or dropping out were the expected burden of radiotherapy or acute side effects. Tailoring the ambition level to each patient concerning the collection of data beyond the primary endpoints was an important strategy to keep the dropout rate at an acceptable level. Using capsules rather than psyllium in powder form made it much easier to document intake and to create a control group. During the course of the preparatory study, we improved the logistics and for the last 12 participants included, the participation rate was 100% for the earliest primary outcome. Conclusion: A variety of adjustments in this preparatory study resulted in an improved participation rate, which allowed us to set a final protocol and proceed with the main study

Astatine-211 based radionuclide therapy: Current clinical trial landscape

Astatine-211 (211At) has physical properties that make it one of the top candidates for use as a radiation source for alpha particle-based radionuclide therapy, also referred to as targeted alpha therapy (TAT). Here, we summarize the main results of the completed clinical trials, further describe ongoing trials, and discuss future prospects

A weak scientific basis for gaming disorder: let us err on the side of caution

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization

Sexual dysfunction and other distressful symptoms in cervical cancer survivors

Background: The majority of cervical cancer survivors are young or middle-aged women who will live many years with their treatment-induced sequelae. The effects of preoperative brachytherapy are unclear and treatment traditions vary - in Sweden and internationally. The relative occurrence of long- term distressful symptoms related to different treatments and the extent to which the women want to trade off optimal survival chances are not known. Methods: The effects of radical hysterectomy were studied in a comparison with population controls, and the effects of additional brachytherapy could be studied due to various treatment policies at different centres. We used an anonymous postal questionnaire, studying the nature, occurrence and intensity of the symptoms and, separately, the corresponding symptominduced distress. Results: We obtained information from 256 of 332 (77%) cervical cancer survivors and 350 of 495 (72%) population controls. Radical hysterectomy alone caused insufficient lubrication (relative risk [RR] 2.8 as compared to controls), reduced genital swelling at arousal (RR 1.5), reduced vaginal length (RR 6.1) and vaginal elasticity (RR 7.1), dyspareunia (RR 4.4), straining to void (RR 21.8), lymphoedema (RR 8.1) and distress from vaginal changes (RR 3.0). The addition of preoperative brachytherapy yielded RR 3.1 for defecation urgency, RR 8.5 for frequent nocturia and RR 1.6 for moderate and severe anxiety, but no excess risk concerning vaginal changes. The addition of external radiotherapy yielded, e.g., RR 13.1 for frequent nocturia and RR 4.8 for frequent defecation. A history of sexual abuse and cervical cancer gave RR 30.0 for superficial dyspareunia as compared to population controls with no history of sexual abuse. The majority of women were not prepared to forgo brachytherapy (even at a possible risk of 1% decreased survival) to avoid its long-term side effects. Conclusion: Sexual dysfunction is the most distressful symptom in cervical cancer survivors, thus emphasising efforts to avoid it and interventions to relieve it. The excess risk of distressful treatment- induced symptoms from preoperative brachytherapy is low, if any, and the majority of women prioritise optimal survival over freedom from treatment-induced symptoms. To meet the needs of women with early cervical cancer, a valid (randomised) study of the effects of preoperative brachytherapy is warranted. The long-term situation for cervical cancer survivors can be improved by clinical application of the data from this and other studies, and a number of areas for future research that may better the situation even more have been specified

Internet Addiction : The Making of a New Addiction

The body of Internet addiction research articles has grown rapidly during the last years. Critics claim that the bulk of this research is more confirmatory than scrutinizing, in spite of weak evidence for the label of addiction. A study on excessive Internet use in Sweden has been cited repeatedly in Internet addiction studies. The present study takes a closer look at these citations and combines the presentation with a systematic review of methods and theoretical approaches in Internet addiction studies, published between January 2000 and July 2013

Behavioral addictions - A social science perspective

This conceptual review and analysis discusses the development of the addiction concept, a development that entails a marked expansion of what is considered to constitute an addiction. <br><br>During the last decade, following the introduction of DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, APA 2013) and the opening up of new terrains, many bad habits and behavioral problems are in the process of being transferred to and renamed as addictions, endorsing a continued or rather reinforced medicalization of social problems. <br><br>In this paper a social science viewpoint is suggested as a more appropriate perspective on these matters