The female side of pharmacotherapy for ADHD-A systematic literature review

ObjectiveThis comprehensive review examined sex differences in prescription rates and efficacy or effectiveness of pharmacotherapy treatment in girls and women with attention deficit hyperactivity disorder (ADHD), while identifying gaps in the scientific knowledge on this topic.MethodA rigorous electronic database search was carried out in order to identify all published studies on female-specific effects of stimulants and non-stimulants in the treatment of ADHD. In total, 2672 studies were screened of which 21 studies (seven on prescription rates, 14 on effects of pharmacotherapy) met the inclusion criteria and were included for analysis.ResultsIn all seven studies on ADHD prescription rates, girls received significantly less prescriptions than boys, a difference however no longer seen in adults with the exception of one study. Each of the 14 studies on effectiveness / efficacy found at least one sex-difference in the effects of ADHD pharmacotherapy.ConclusionSeveral sex-differences are demonstrated in the prescription, usage and efficacy /effectiveness of both stimulant and non-stimulant ADHD pharmacotherapy. A single daily use of MPH may possibly not be optimal for girls with ADHD and ATX may be a promising medication for girls and women with ADHD. The robustness of this result requires further investigation

Self-reported empathy in adult women with Autism Spectrum Disorders:A systematic mini review

IntroductionThere is limited research on Autism Spectrum Disorders (ASD) in females. Although the empathy construct has been examined thoroughly in autism, little attention has been paid to empathy in adult women with this condition or to gender differences within the disorder.ObjectiveSelf-reported empathy in adult women with ASD was examined and compared to that of typically developed men and women as well as to men with this condition.MethodsOnline databases were searched for articles investigating self-reported empathy among adult women with ASD. Only six studies comparing women to men were identified.ResultsAll studies found women with an ASD to report lower levels of empathy than typically developed women, and typically developed men, but similar levels to men with this condition.ConclusionThe self-reported empathic ability of women diagnosed with ASD resembles that of their male counterparts most closely; they show a hypermasculinisation in empathy. This is particularly surprising considering the large gender difference in empathy in the general population.DiscussionOne of the limitations of this review is that the current diagnostic criteria for ASD are oriented towards male-specific behaviour and fail to integrate gender specific characteristics. Hence, women diagnosed with ASD are likely to be at the male end of the continuum. The suggested hypermasculinisation of women on the spectrum, as evident from this review, may therefore be exaggerated due to a selection bias

Nine everyday situations, nine different forms of attention

1. ObjectivesThe aim of the present study was to develop a questionnaire for the assessment of everyday attentional capacities in adults: the Everyday Life Attention Scale (ELAS). Its developmental was inspired by multi-component theories of attention and clinical neuropsychology guidelines for the assessment of attention. The items ask about multiple components of attention in nine common everyday situations, including Reading, Movie, Activity, Lecture, Conversation, Assignment, Cooking, Cleaning up, and Driving.2. MethodsTwo validation studies were conducted. Study 1 investigated the factor structure, validity, and reliability of the ELAS in 1206 healthy participants by means of an online survey. Study 2 further investigated the sensitivity of the ELAS in 80 adults with ADHD compared to 80 matched healthy controls and a mixed clinical group of 56 patients diagnosed with other psychiatric disorders. 3. ResultsStudy1: Confirmatory factor analysis supported a situation-specific approach which categorizes everyday attention into nine situation scales. Within each of these nine situations, ratings of sustained, selective, focused, and divided attention as well as motivation constituted reliable subscales. Study 2: We found convincing evidence that adult patients with ADHD have clearly reduced attention scores (with large effect sizes) on all nine situation scales of the ELAS compared to matched healthy controls. Instead, a mixed clinical group of psychiatric patients (including depression and schizophrenia) without ADHD deviated from the healthy sample only on three situations with medium to large effect sizes (Assignment, Cooking, and Cleaning up). Patients with ADHD showed particularly strong attentional difficulties in comparison to both the control and the mixed clinical group regarding Reading, Assignment, Activity, and Conversation. 4. ConclusionsTesting the psychometric properties of the ELAS revealed that attention in everyday life can be reliably measured by situation-specific scales (Study 1) and that these scales are sensitive for attentional difficulties in patients with ADHD (Study 2), particularly for Reading, Assignment, Activity, and Conversation. The ELAS can be used as part of a battery assessment approach or in the context of treatment evaluation.<br/

Nine everyday situations, nine different forms of attention

1. ObjectivesThe aim of the present study was to develop a questionnaire for the assessment of everyday attentional capacities in adults: the Everyday Life Attention Scale (ELAS). Its developmental was inspired by multi-component theories of attention and clinical neuropsychology guidelines for the assessment of attention. The items ask about multiple components of attention in nine common everyday situations, including Reading, Movie, Activity, Lecture, Conversation, Assignment, Cooking, Cleaning up, and Driving.2. MethodsTwo validation studies were conducted. Study 1 investigated the factor structure, validity, and reliability of the ELAS in 1206 healthy participants by means of an online survey. Study 2 further investigated the sensitivity of the ELAS in 80 adults with ADHD compared to 80 matched healthy controls and a mixed clinical group of 56 patients diagnosed with other psychiatric disorders. 3. ResultsStudy1: Confirmatory factor analysis supported a situation-specific approach which categorizes everyday attention into nine situation scales. Within each of these nine situations, ratings of sustained, selective, focused, and divided attention as well as motivation constituted reliable subscales. Study 2: We found convincing evidence that adult patients with ADHD have clearly reduced attention scores (with large effect sizes) on all nine situation scales of the ELAS compared to matched healthy controls. Instead, a mixed clinical group of psychiatric patients (including depression and schizophrenia) without ADHD deviated from the healthy sample only on three situations with medium to large effect sizes (Assignment, Cooking, and Cleaning up). Patients with ADHD showed particularly strong attentional difficulties in comparison to both the control and the mixed clinical group regarding Reading, Assignment, Activity, and Conversation. 4. ConclusionsTesting the psychometric properties of the ELAS revealed that attention in everyday life can be reliably measured by situation-specific scales (Study 1) and that these scales are sensitive for attentional difficulties in patients with ADHD (Study 2), particularly for Reading, Assignment, Activity, and Conversation. The ELAS can be used as part of a battery assessment approach or in the context of treatment evaluation.<br/

The Empathy and Systemizing Quotient:The Psychometric Properties of the Dutch Version and a Review of the Cross-Cultural Stability

The 'Empathy Quotient' (EQ) and 'Systemizing Quotient' (SQ) are used worldwide to measure people's empathizing and systemizing cognitive styles. This study investigates the psychometric properties of the Dutch EQ and SQ in healthy participants (n = 685), and high functioning males with autism spectrum disorder (n = 42). Factor analysis provided support for three subscales of the abridged 28-item EQ: Cognitive Empathy, Emotional Empathy and Social Skills. Overall, the Dutch EQ and SQ appeared reliable and valid tools to assess empathizing and systemizing cognitive style in healthy adults and high functioning adults with autism. The literature showed good cross-cultural stability of the SQ and EQ in Western countries, but in Asian countries EQ is less stable and less sensitive to sex differences

Everyday Life Attention Scale (ELAS):Normative data of n = 1,874 Dutch participants

The Everyday Life Attention Scale (ELAS) is a sensitive and reliable self-report questionnaire assessing attentional capacities of respondents in nine different situations of daily life. The ELAS has the potential to add relevant information to the clinical evaluation of attention deficits, to guide treatment planning, as well as to evaluate treatment outcome. The present study provides normative data of 1,874 Dutch speaking participants, ranging from 18 to 76 years of age, with mixed levels of education and a roughly equal distribution in gender. Normative data are calculated based on multiple linear regression models for each of the nine ELAS situations. In this article, the ELAS questionnaire as well as norm data are offered free of use. Use of normative ELAS data as presented in this study enables its use in clinical practice and research. Potential applications of the ELAS and future directions are discussed

How activists and target organizations collaborate in the face of emerging contingencies:setbacks and inaction: constraining or enablers of change?

In this paper, we attempt to examine the sources of agency of target organizations when engaged in collective change processes organized by activists concerned with environmental issues and sustainable development in the eastern part of the Netherlands. In combining social movement and institutional entrepreneurship literature, we examine why and how target organizations engage in collective action, change their practices, and adopt new ones in the pursuit of solving a common issue with the help of activists. We found that motivations and intentions to contribute to collective action were instrumental in the beginning of their participation. However, as the project evolves, intentions changed through a reorientation of existing practices and positions in the collective change process of target organizations. This shift was caused by inaction and other setbacks where target organizations and activists were exposed. These changes in turn, set in new practice development and organizational forms necessary to continue collective change. With these findings, we contribute to an understanding of network mobilization by showing the emergent and dynamic character of collective change and especially indicate setbacks and inaction as both constraining and necessary condition for change

Impaired trophoblast invasion and increased numbers of immune cells at day 18 of pregnancy in the mesometrial triangle of type 1 diabetic rats

AbstractIntroductionType 1 diabetes (T1D) is associated with adverse pregnancy outcome, usually attributed to hyperglycemia. Recently, we showed that pregnancy outcome in normoglycemic T1D rats was characterized by decreased fetal and placental weight, suggesting impaired placental development. In the present study, we tested the hypothesis that trophoblast invasion and spiral artery (SA) remodeling is impaired in T1D rats ant that this is associated with aberrant local presence of NK cells and macrophages in the mesometrial triangle (MT).MethodsPlacentae with MT from pregnant biobreeding diabetes-prone (BBDP; T1D model) rats, control biobreeding diabetes-resistant (BBDR) and Wistar-rats were dissected at day 18 of gestation and stained for trophoblast invasion, SA remodeling, uNK cells and macrophages.ResultsInterstitial trophoblast invasion and SA remodeling was impaired in BBDP-rats vs. control rats, coinciding with increased presence of NK cells and an increased iNOS+/CD206+ ratio of macrophages.DiscussionDecreased fetal and placental weight in BBDP-rats was associated with diminished interstitial trophoblast invasion and less optimal SA remodeling, increased numbers of NK cells and increased iNOS+/CD206+ macrophage ratio in the MT of BBDP-rats.ConclusionsThe impaired trophoblast invasion and SA remodeling may be due to an aberrant local immune-response and may result in damage to the fetal placenta and insufficient supply of nutrients towards the fetus with eventually decreased fetal weight as a consequence

Cost-effectiveness of medically assisted reproduction or expectant management for unexplained subfertility:when to start treatment?

STUDY QUESTION Over a time period of 3 years, which order of expectant management (EM), IUI with ovarian stimulation (IUI-OS) and IVF is the most cost-effective for couples with unexplained subfertility with the female age below 38 years? SUMMARY ANSWER If a live birth is considered worth Euro32 000 or less, 2 years of EM followed by IVF was the most cost-effective, whereas above Euro32 000 this was 1 year of EM, 1 year of IUI-OS and then 1 year of IVF. WHAT IS KNOWN ALREADY IUI-OS and IVF are commonly used fertility treatments for unexplained subfertility although many couples can conceive naturally, as no identifiable barrier to conception could be found by definition. Few countries have guidelines on when to proceed with medically assisted reproduction (MAR), mostly based on the expected probability of live birth after treatment, but there is a lack of evidence to support the strategies proposed by these guidelines. The increased uptake of IUI-OS and IVF over the past decades and costs related to reimbursement of these treatments are pressing concerns to health service providers. For MAR to remain affordable, sustainable and a responsible use of public funds, guidance is needed on the cost-effectiveness of treatment strategies for unexplained subfertility, including EM. STUDY DESIGN, SIZE, DURATION We developed a decision analytic Markov model that follows couples with unexplained subfertility of which the woman is under 38 years of age for a time period of 3 years from completion of the fertility workup onwards. We divided the time axis of 3 years into three separate periods, each comprising 1 year. The model was based on contemporary evidence, most notably the dynamic prediction model for natural conception, which was combined with MAR treatment effects from a network meta-analysis on randomized controlled trials. We changed the order of options for managing unexplained subfertility for the 1 year periods to yield five different treatment policies in total: IVF-EM-EM (immediate IVF), EM-IVF-EM (delayed IVF), EM-EM-IVF (postponed IVF), IUIOS-IVF-EM (immediate IUI-OS) and EM-IUIOS-IVF (delayed IUI-OS). PARTICIPANTS/MATERIALS, SETTING, METHODS The main outcomes per policy over the 3-year period were the probability of live birth, the average treatment and delivery costs, the probability of multiple pregnancy, the incremental cost-effectiveness ratio (ICER) and finally, which policy yields the highest net benefit in which costs for a policy were deducted from the health effects, i.e. live births gained. We chose the Dutch societal perspective, but the model can be easily modified for other locations or other perspectives. The probability of live birth after EM was taken from the dynamic prediction model for natural conception and updated for Years 2 and 3. The relative effects of IUI-OS and IVF in terms of odds ratios, taken from the network meta-analysis, were applied to the probability of live birth after EM. We applied standard discounting procedures for economic analyses for Years 2 and 3. The uncertainty around effectiveness, costs and other parameters was assessed by probabilistic sensitivity analysis in which we drew values from distributions and repeated this procedure 20 000 times. In addition, we changed model assumptions to assess their influence on our results. MAIN RESULTS AND THE ROLE OF CHANCE From IVF-EM-EM to EM-IUIOS-IVF, the probability of live birth varied from approximately 54-64% and the average costs from approximately Euro4000 to Euro9000. The policies IVF-EM-EM and EM-IVF-EM were dominated by EM-EM-IVF as the latter yielded a higher cumulative probability of live birth at a lower cost. The policy IUIOS-IVF-EM was dominated by EM-IUIOS-IVF as the latter yielded a higher cumulative probability of live birth at a lower cost. After removal of policies that were dominated, the ICER for EM-IUIOS-IVF was approximately Euro31 000 compared to EM-EM-IVF. The range of ICER values between the lowest 25% and highest 75% of simulation replications was broad. The net benefit curve showed that when we assume a live birth to be worth approximately Euro20 000 or less, the policy EM-EM-IVF had the highest probability to achieve the highest net benefit. Between Euro20 000 and Euro50 000 monetary value per live birth, it was uncertain whether EM-EM-IVF was better than EM-IUIOS-IVF, with the turning point of Euro32 000. When we assume a monetary value per live birth over Euro50 000, the policy with the highest probability to achieve the highest net benefit was EM-IUIOS-IVF. Results for subgroups with different baseline prognoses showed the same policies dominated and the same two policies that were the most likely to achieve the highest net benefit but at different threshold values for the assumed monetary value per live birth. LIMITATIONS, REASONS FOR CAUTION Our model focused on population level and was thus based on average costs for the average number of cycles conducted. We also based the model on a number of key assumptions. We changed model assumptions to assess the influence of these assumptions on our results. The change in relative effectiveness of IVF over time was found to be highly influential on results and their interpretation. WIDER IMPLICATIONS OF THE FINDINGS EM-EM-IVF and EM-IUIOS-IVF followed by IVF were the most cost-effective policies. The choice depends on the monetary value assigned to a live birth. The results of our study can be used in discussions between clinicians, couples and policy makers to decide on a sustainable treatment protocol based on the probability of live birth, the costs and the limitations of MAR treatment. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the ZonMw Doelmatigheidsonderzoek (80-85200-98-91072). The funder had no role in the design, conduct or reporting of this work. B.W.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck KGaA and Guerbet and travel and research support from ObsEva, Merck and Guerbet. TRIAL REGISTRATION NUMBER N/A