An assistive technology design framework for ADHD

In this paper, we present a design framework for ADHD assistive technologies that aims to give researchers grounding in the background research on the condition, to provide a lingua franca, and to highlight potential research directions for HCI researchers within assistive technology. The design framework couples ADHD patient challenge areas to technological opportunities and it provides a set of practical design strategies for developing successful assistive technologies for people with ADHD. The framework is based on empirical studies, ADHD research, and related work on assistive technologies. We map existing assistive technologies and potential new research efforts to the framework concepts. This way we show how it is used to support and advance the research and development of novel assistive technologies for the ADHD domain

A randomised controlled trial of cognitive behavioural treatment for obsessive compulsive disorder in children and adolescents

Cognitive behaviour therapy (CBT) for young people with obsessive compulsive disorder (OCD) has become the treatment of first choice. However, the literature is largely based on studies emphasising exposure and response prevention. In this study, we report on a randomised controlled trial of CBT for young people carried out in typical outpatient clinic conditions which focused on cognitions. A randomised controlled trial compares 10 sessions of manualised cognitive behavioural treatment with a 12-week waiting list for adolescents and children with OCD. Assessors were blind to treatment allocation. 21 consecutive patients with OCD aged between 9 and 18 years were recruited. The group who received treatment improved more than a comparison group who waited for 3 months. The second group was treated subsequently using the same protocol and made similar gains. In conclusion, CBT can be delivered effectively to young people with OCD in typical outpatient settings

Imaging in the time of NFD/NSF: do we have to change our routines concerning renal insufficiency?

To date there are potential chronology-based but not conclusive reasons to believe that at least some of the gadolinium complexes play a causative role in the pathophysiology of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). Still, the exact pathogenesis and the risk for patients is unclear beside the obvious connection to moderate to severe renal insufficiency. So far, MR imaging with Gd-enhancement was regarded as the safest imaging modality in these patients—the recent development creates tremendous uncertainty in the MR-community. Nevertheless, one should remember that, despite the over 200 cases of NSF and about 100 with proven involvement of Gd3+, the vast majority of over 200 million patients exposed to gadolinium since the 1980s have tolerated these agents well. Importantly, NSF is a rare disease and does not appear to occur in patients without renal impairment. Many patients and researchers have undergone MR investigations with Gd exposure in the past. For those, it is essential to know about the safety of the agents at normal renal function. We can hope that pharmacoepidemiological and preclinical studies will allow us to better understand the pathophysiology and role of the various MR contrast agents in the near future

Der frühe Beginn der Zwangsstörung

Einleitung: Die vorliegende Untersuchung geht der Fragestellung nach, ob sich eine Zwangsstörung, die bereits im Kindes- bzw. Jugendalter beginnt, von einer Zwangsstörung, die erst im Erwachsenenalter beginnt, hinsichtlich Schweregrad und Symptomatik unterscheidet. Patienten und Methoden: Eine Stichprobe von 370 Patienten mit Zwangsstörung (ICD-10 F42), die sich zwischen 1998 und 2002 stationär in der Psychosomatischen Klinik Windach befanden, wurde in eine Early-Onset-Gruppe (Störungsbeginn ≤15 Jahre) und in eine Late-Onset-Gruppe (Störungsbeginn ≥16 Jahre) aufgeteilt. Die Gruppen wurden über ICD-10-Diagnosen und Y-BOCSWerte verglichen. Ergebnisse: Beim Schweregrad zeigte sich, dass 20,5% der Early-Onset-Gruppe, aber lediglich 8,7% der Late-Onset-Gruppe unter einer «massiven Zwangsstörung» leiden. Bei der Symptomatik zeigte sich, dass die Early-Onset-Gruppe häufiger die Diagnose «Zwangsgedanken und -handlungen gemischt» (76,9%)erhält als die Late-Onset-Gruppe (61,8%). Außerdem nennt die Early-Onset-Gruppe sowohl für die Gegenwart als auch für die Vergangenheit mehr Symptome als die Late-Onset-Gruppe (Gegenwart 8,2 vs. 7,0; Vergangenheit 5,5 vs. 3,9 Symptomgruppen). Weiter ergaben sich inhaltliche Unterschiede der Zwangsgedanken und Zwangshandlungen. Schlussfolgerungen: Early-Onset-Patienten scheinen häufiger von einer massiven Form der Zwangsstörung und einer größeren Symptomvielfalt betroffen zu sein als Late-Onset-Patienten. Ob es sich bei der Zwangsstörung mit Beginn im Kindes- und Jugendalter um einen abgrenzbaren Subtypus handelt, konnte jedoch in dieser Untersuchung nicht eindeutig geklärt werden und bedarf weiterer Forschungen.Introduction: This study investigates if obsessive compulsive disorder with early onset differs in severity and symptomatology from that with late onset. Patients and Methods: A sample of 370 patients with obsessive compulsive disorder (OCD; ICD 10 F42) who received in-patient treatment at the psychosomatic clinic of Windach between 1998 and 2002 were divided into an early-onset group (onset ≤15 years) and a late-onset group (onset ≥16 years). Groups were compared regarding ICD-10 diagnosis and Y-BOCS scores. Results: Considering severity of the disorder 20.5% of the early-onset group but merely 8.7% of the late-onset group suffered from an extreme form of OCD. With respect to symptomatology, the early-onset group was diagnosed with ‘obsessions and compulsions, mixed’ (76.9%) more often than the lateonset group (61.8%). Also, the early-onset group reported a wider variety of symptoms both for the present and for the past than the late-onset group (present 8,2 vs 7.0; past 5.5 vs 3.9 types of symptoms). There were also differences in the content of rumination and types of compulsive rituals. Conclusions: Patients with early-onset OCD seem to be more frequently affected by an extreme form of OCD and to experience a higher variety of symptoms than patients with late-onset OCD. If early-onset OCD can be considered a distinct subtype could not be answered unequivocally by the results of this study. This question needs additional research

Congenital bovine spinal dysmyelination is caused by a missense mutation in the SPAST gene

Bovine spinal dysmyelination (BSD) is a recessive congenital neurodegenerative disease in cattle (Bos taurus) characterized by pathological changes of the myelin sheaths in the spinal cord. The occurrence of BSD is a longstanding problem in the American Brown Swiss (ABS) breed and in several European cattle breeds upgraded with ABS. Here, we show that the disease locus on bovine chromosome 11 harbors the SPAST gene that, when mutated, is responsible for the human disorder hereditary spastic paraplegia (HSP). Initially, SPAST encoding Spastin was considered a less likely candidate gene for BSD since the modes of inheritance as well as the time of onset and severity of symptoms differ widely between HSP and BSD. However, sequence analysis of the bovine SPAST gene in affected animals identified a R560Q substitution at a position in the ATPase domain of the Spastin protein that is invariant from insects to mammals. Interestingly, three different mutations in human SPAST gene at the equivalent position are known to cause HSP. To explore this observation further, we genotyped more than 3,100 animals of various cattle breeds and found that the glutamine allele exclusively occurred in breeds upgraded with ABS. Furthermore, all confirmed BSD carriers were heterozygous, while all affected calves were homozygous for the glutamine allele consistent with recessive transmission of the underlying mutation and complete penetrance in the homozygous state. Subsequent analysis of recombinant Spastin in vitro showed that the R560Q substitution severely impaired the ATPase activity, demonstrating a causal relationship between the SPAST mutation and BSD

Five-year stability in associations of health-related quality of life measures in community-dwelling older adults: the Rancho Bernardo Study

Ó The Author(s) 2010. This article is published with open access at Springerlink.com Objective This study examines the five-year stability of the association of SF-12 and SF-6D scores with scores on the longer SF-36 and its domains in community-dwelling older men and women. Methods Participants were 653 men and 917 women aged 50 and older who completed mailed surveys of HRQOL (1995, 2000). SF-36 physical (PCS) and mental (MCS) component scores, domain scores; SF-12 PCS and MCS scores; and SF-6D scores were computed. Results Average age in 1995 was 68.2 ± 10.7 for men and 69.8 ± 11.3 for women. In 1995 and 2000, men had significantly higher scores on all measures (P’s \ 0.001). All three authors have contributed to the conception and design of the work and data analysis plan, interpretation of the data, and preparing the manuscript for publication. The second and third authors were in charge of the acquisition of subjects. The first author conducted the data analysis and wrote the first draft which was revised by the second and third authors. All authors were involved with the data in a manner substantial enough to take public responsibility for it. All authors believe the manuscript represents valid work and have reviewed the final version of the manuscript and approve of it for publication

Teacher reports of hypoactivity symptoms reflect slow cognitive processing speed in primary school children

The mediating effect of cognitive processing speed on the ability of a primary school child to achieve his/her full potential of intellectual functioning emphasizes the importance of methods to detect “slow” children. Primary school teachers may be the first to have concerns about inattentive pupils who show symptoms of hypoactivity, but may find the symptoms difficult to interpret. In the present study we ask if a primary school teacher’s report of hypoactivity symptoms can be explained by the child’s performance on tests of processing speed. The 255 children included in the present study were part of the first wave of the Bergen Child Study, in which teachers completed a questionnaire including two hypoactivity items from the Five to Fifteen (FTF) questionnaire. Processing speed was measured by the Processing Speed Index (PSI) from the WISC-III, 1–2 years after the teacher rating. Teachers reported “certainly true” on at least one FTF item of hypoactivity for 11.8% of the children. These children obtained lower scores on the PSI than the remaining children in the sample. The PSI accounted for a considerable proportion of the variance of teacher reports on the FTF item “difficulty getting started on a task/activity”. The risk of a PSI score below 85 was increased in children with teacher-reported hypoactivity symptoms. The results indicate that teacher reports of hypoactivity symptoms reflect slow cognitive processing speed and should be followed up by a psychometric examination. Still, future studies are needed to improve detection and treatment of children with slow processing speed

Tuberculous meningitis in Denmark: a review of 50 cases

<p>Abstract</p> <p>Background</p> <p>Tuberculous meningitis is the most severe manifestation of extrapulmonary tuberculosis with a high mortality rate and a high rate of sequelae among survivors. The aim of this study is to assess the current epidemiology, clinical features, diagnostic procedures, treatment and outcome in patients with tuberculous meningitis in Denmark, a country with a low tuberculosis incidence.</p> <p>Methods</p> <p>A nationwide retrospective study was conducted, comprising all patients notified with tuberculous meningitis (TBM) in Denmark from 2000-2008. Medical records were reviewed using a standardised protocol.</p> <p>Results</p> <p>Fifty patients, including 12 paediatric patients, were identified. 78% of the patients were immigrants from countries of high tuberculosis endemicity. 64% of all patients had a pre-existing immunosuppressive condition; 10% were HIV positive, 48% were HIV seronegative and 42% had an unknown HIV status. Median symptom duration before admission was 14 days in the Danish patient population and 20 days in the immigrant group. Biochemical analysis of cerebrospinal fluid (CSF) samples revealed pleocytosis in 90% with lymphocyte predominance in 66%. Protein levels were elevated in 86%. The most common findings on neuro-radiological imaging were basal meningeal enhancement, tuberculomas and hydrocephalus. Lumbar puncture was performed on 42 patients; 31 of these specimens (74%) had a positive CSF culture for mycobacteria and 9.5% were smear positive for acid-fast bacilli. The overall mortality rate was 19% and 48% of the remaining patients had neurological sequelae of varying degree.</p> <p>Conclusion</p> <p>TBM is a rare but severe manifestation of extrapulmonary TB in Denmark. The clinician must be prepared to treat empirically if the suspicion of TBM has arisen to improve treatment outcome.</p