Prevalence of cocaine use and cocaine use disorder among adult patients with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

We conducted this systematic review and meta-analysis (registered with PROSPERO CRD42020142039) of the literature to estimate the lifetime prevalence of cocaine use and cocaine use disorder among adult patients with attention-deficit/hyperactivity disorder (ADHD). The literature search was performed on the electronic databases PubMed and PsychINFO without date or language restrictions. Additional studies were identified by hand searching of citations. Inclusion criteria were: studies involving adult patients with ADHD and reporting cocaine use and/or cocaine use disorders. Data were pooled in the meta-analyses using a generalized linear mixed model with random effects. Statistical heterogeneity was assessed using the Cochran Q test. Sensitivity analyses were conducted. Twelve studies were included in the review: six in the meta-analysis of cocaine use and nine in the meta-analysis of cocaine use disorder. The estimated prevalence of cocaine use was 26.0% (95% CI 0.18–0.35) and the estimated prevalence of cocaine use disorder was 10.0% (95% CI 0.08–0.13). Heterogeneity in both meta-analyses was high but decreased to non-significance in the meta-analysis on cocaine use disorder after excluding the outlier study. In conclusion, one out of four adult patients with ADHD use cocaine and one out of ten develop a lifetime cocaine use disorder. Since cocaine use can lead to more severe and complex disorders of impaired systemic functioning, adult patients with ADHD should be assessed for cocaine use disorder and promptly referred for treatment

A simple toll to predict excercise capacity in obese patients with ischemic heart disease

Objective: To define an equation that predicts exercise capacity taking into account body mass index (BMI). Design: Retrospective analysis and validation study of a multidisciplinary programme aimed at weight loss and physical rehabilitation. Setting: Tertiary referral hospital. Patients and methods: 372 consecutive obese participants (249 men) with stable ischaemic heart disease, aged mean 60.1 (SD 8.7) years, underwent a treadmill exercise test. BMI was 37.8 (4.5) kg/m2. In the validation study the model was tested in 87 patients with similar characteristics. Results: Mean exercise intensity was 6.6 (SD 2.4) metabolic equivalents (METs). Multivariate linear regression analysis defined two simple models that considered exercise intensity as the dependent variable and a set of independent variables such as anthropometric measures, age and sex in the first one, plus associated clinical conditions and drug treatment in the second one. The correlation coefficients of the two models were R = 0.630 and R = 0.677, respectively. Age, BMI and sex were the strongest predictors of exercise capacity. The first derived equation efficiently predicted exercise capacity: in the validation study predicted exercise intensity was 6.3 (1.6) METs and attained exercise intensity was 6.3 (2.4) METs (p = 0.903) with a highly significant correlation (R = 0.534, p < 0.001 ). Conclusion: BMI is an important determinant of exercise capacity of obese people with ischaemic heart disease. The use of a simple equation may help in predicting exercise capacity, in individualising exercise protocol and in setting up rehabilitation programs for obese patients

The myth of QT shortening by weight loss and physical training in obese subjects with coronary heart disease.

This study aims to describe the changes that a period of low-calorie diet and physical training determines in heart rate and in corrected QT (QTc) interval in obese patients with coronary heart disease (CHD) and to verify whether it is effective in shortening the QT interval using three different methods for QT correction. Two hundred and seventy obese white patients (162 males60%) affected with stable CHD and treated with Β-blockers were retrospectively studied in the setting of a program aimed at losing weight through training (aerobic activity strength exercise) and diet (80% of estimated resting energy expenditure). Age was related to RR interval, QTc was related to left ventricular ejection fraction (EF) while sex exerted no effects. At the end of the study period heart rate decreased by 8.3% and noncorrected QT increased by 3.0%; QT corrected with the Bazett formula decreased by 0.7% (P = 0.007), QT corrected with the Fridericia formula increased by 0.5% (P = 0.023), whereas the modifications were nonsignificant when the Framingham correction was used. In conclusion, contrary to the current views, physical training and diet, which are effective in reducing heart rate, produced no clinically relevant change in the QT interval

Short-term effects of a multi-disciplinary cardiac rehabilitation programme on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: a practice-level study.

Given that many patients referred to cardiac rehabilitation (CR) are obese, diet therapy, exercise training, nutritional and psychological counselling for both obesity and psychological distress should be included as important components in all CR programmes. In this practice-level, observational study we evaluated the short-term within-group effects of a four-week multi-factorial inpatient CR programme specifically addressed to weight loss, fitness improvement and psychological health increase on 176 obese in-patients with coronary heart disease (CHD). Outcome measures were exercise capacity measured with estimated metabolic equivalents (METs), body mass index (BMI) and psychological well-being (PGWBI). Results show statistically significant improvements in all the PGWBI sub-scales and total score, except in general health (p=0.393). No moderation effects were found for BMI class, age, diabetes and ejection fraction (EF). METs significantly increased by 30.3% (p0.001) and BMI decreased by 1.37 points (p0.001). Significant correlations were found between BMI and weight reductions with PGWBI anxiety and total score improvements. This multi-disciplinary CR programme including diet therapy, exercise training and psychological counselling provides indication for short-term within-group effectiveness on functional exercise capacity, BMI and PGWBI in a sample of obese in-patients with CHD. However, controlled studies are needed to corroborate the results we found

Psycho-educational support interventions for patients with an implantable cardioverter defibrillator

The implantable cardioverter defibrillator (ICD) has established superiority in reducing mortality for survivors of cardiac arrest or patients at high risk of sudden death. However, because of the nature of their spontaneous, chronic, and potentiality life-treating condition, patients with an ICD are at risk of developing mild to serious psychological distress. Critical events, such as ICD shocks or ICD recalls may occur, significantly altering the course of individuals' psychosocial adjustment; a number of studies from different countries demonstrate that patients with an ICD that experience higher emotional difficulties undergo a greater incidence of shock therapy. A proper biopsychosocial assessment and conceptualization of the needs of patients with an ICD, and the delivery of tailored interventions is, therefore, mandatory for ensuring optimal clinical care. Brief education sessions are effective in reducing concerns among patients with mild levels of psychosocial distress, and a continuum of treatment strategies is available as the recipients' severity of psychological distress and associated maladaptive behavior grows, spanning in ICD support groups, individual consultations using cognitive behavioral techniques and pharmacotherapy. Yet, while short-term positive outcomes are usually achieved, applicable and effective long-term management of psychological symptoms secondary to ICD implantation is still a challenge for healthcare providers, and the high degree of heterogeneity in content and methodology across studies has made it difficult to formulate broad conclusions on the feasibility and effectiveness of existing interventions. Further research producing valid and reliable data needs to be undertaken in order to maximize positive patient outcomes

Comparison of numerical methods for modeling of superconductors

Different finite-element method (FEM) formulations have been developed in order to model the electromagnetic behavior of type-II superconductors. This paper presents a comparison between simulations with A-V formulation models implemented in two FEM software packages (FLUX2D and FLUX3D) and a numerical method based on analytical model for superconductors in applied magnetic field. These models can be used for superconductors with complex geometry and power-law current-voltage characteristics. Simulated is a 37-filamentary tape with applied transport current in self-field and alternating current (ac) magnetic field parallel to the wide side of the tape. A good agreement is found between the ac-loss and current distributions obtained with the different model

Supplementary Material for: Gender Differences in Anxiety and Depression before and after Alcohol Detoxification: Anxiety and Depression as Gender-Related Predictors of Relapse

<b><i>Background/Aims:</i></b> The aim of this prospective study was to estimate gender differences in anxiety, depression, and alcohol use severity among patients with alcohol use disorder (AUD) before and after detoxification program and within 12 months after discharge. <b><i>Methods:</i></b> AUD severity, state and trait anxiety, and depression were assessed in 187 patients entering an inpatient alcohol detoxification program. Follow-up assessments were performed at 6 and 12 months after discharge. A between- and within-subjects analyses explored gender differences. The predictive value of anxiety and depression for alcohol relapse was analyzed by logistic and linear regression in both genders. <b><i>Results:</i></b> Females had higher levels of anxiety and depression than males both at admission and after discharge. Trait anxiety and depression significantly increased 6 months after discharge in males and females respectively. Both state and trait anxiety levels at the 6-month follow-up predicted alcohol relapse at the 12-month follow-up in males. Conversely, in females, depression level at the 6-month follow-up was a predictor of relapse at the 12-month follow-up. <b><i>Conclusions:</i></b> In both genders, the psychopathological dimension that showed the most significant worsening at 6-month follow-up (i.e., anxiety in males and depression in females) was found to be a significant predictor of relapse at the 12-month follow-up