UNGE MED ET PROBLEMATISK FORBRUG AF RUSMIDLER - En mulig forståelsesmodel

Danske unge hører til de mest rusmiddelforbrugende unge i Europa. Eftersom et stort forbrug kan knyttes til udvikling af misbrug og afhængighed af rusmidler, kan danske unges forbrug anses som bekymrende. Hverken misbrug eller afhængighed af rusmidler er dog noget stabilt fænomen, og dertil kommer, at mange unges problematiske forbrug ofte ikke har meget med selve rusmidlerne at gøre. For ikke mindst de mest truede må forklaringen på deres forbrug således først og fremmest findes i deres psykosociale problemer. For de storforbrugende, men mindre psykosocialt belastede unge, må forbruget derimod i højere grad forstås ud fra den særlige ungdomskultur og socialisering, som bl.a. ses i Danmark. Der er med andre tale om et mere komplekst problem end blot et spørgsmål om et stort forbrug. Der findes mange forskellige forklaringer på, hvorfor nogle unge udvikler et problematisk forbrug af rusmidler. I denne artikel skelnes der mellem fire hypoteser kaldet henholdsvis dispositions-, socialiserings-, stress- og udbrændthedshypotesen. Ud fra disse hypoteser forklares forskellige grupper af unges forbrug af rusmidler

The impact of poly-traumatization on treatment outcomes in young people with substance use disorders

Background: It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. Methods: Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. Results: Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. Conclusion: Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. Trial registration: ISRCTN88025085 , date of registration: 29.08.2016, retrospectively registered

Personlige livsbarrierer blandt unge i Nuuk

I forskning knyttes psykisk trivsel typisk til internaliserendeproblemer såsom angst, depression og ensomhed, hvorimodeksternaliserende problemer såsom manglende selvkontrol,impulsivitet og konfliktsøgende adfaerd ofte overses. Fælles fordem er dog, at disse problemer begraenser individets samfundsmæssige tilknytning og muligheder og kan derved betragtessom personlige livsbarrierer. Centralt i denne artikel er koblingenmellem sådanne livsbarrierer, stressfyldte/traumatiskeoplevelser og brug af alkohol og cannabis blandt grønlandskeunge i alderen 15-17 år. Resultaterne baseres på en anonymskolebaseret survey (UngMap) fra 2014, der inkluderede 101tiendeklasseselever fra fire kommunale skoler i Nuuk. Resultaterneviste, at 8,91 % af de unge havde brugt cannabis indenfor den sidste måned, mens 10,89 % havde haft et regelmaessigtbrug af alkohol. Disse fund diskuteres i forhold til eksternaliserendeog internaliserende adfaerd, stressfyldte/traumatiskeoplevelser samt begreberne anhedoni og anomi. Det konkluderes,at anhedoni er saerligt karakteristisk for unge i Nuuk, og isaerlig grad kan knyttes til selvmordsforsøg. Kraenkende ogtraumatiske oplevelser kan ikke forklare den staerke anhedoni.Brug af cannabis er derimod overvejende relateret til eksternaliserendeadfaerdsproblemer og til stressfyldte/traumatiskeoplevelser

Impulsivity traits and addiction-related behaviors in youth.

Background and aims Impulsivity is a risk factor for addictive behaviors. The UPPS-P impulsivity model has been associated with substance addiction and gambling disorder, but its role in other non-substance addiction-related behaviors is less understood. We sought to examine associations between UPPS-P impulsivity traits and indicators of multiple substance and non-substance addiction-related behaviors in youth with varying involvement in these behaviors. Methods Participants (N = 109, aged 16-26 years, 69% males) were selected from a national survey based on their level of externalizing problems to achieve a broad distribution of involvement in addiction-related behaviors. Participants completed the UPPS-P Questionnaire and standardized questionnaires assessing problematic use of substances (alcohol, cannabis, and other drugs) and non-substances (Internet gaming, pornography, and food). Regression analyses were used to assess associations between impulsivity traits and indicators of addiction-related behaviors. Results The UPPS-P model was positively associated with indicators of all addiction-related behaviors except problematic Internet gaming. In the fully adjusted models, sensation seeking and lack of perseverance were associated with problematic use of alcohol, urgency was associated with problematic use of cannabis, and lack of perseverance was associated with problematic use of other drugs than cannabis. Furthermore, urgency and lack of perseverance were associated with binge eating and lack of perseverance was associated with problematic use of pornography. Discussion and conclusions We emphasize the role of trait impulsivity across multiple addiction-related behaviors. Our findings in at-risk youth highlight urgency and lack of perseverance as potential predictors for the development of addictions and as potential preventative therapeutic targets.The project was supported by Aarhus University Research Foundation (AUFF), Assistant Professor Starting Grant - R46-A4016 (K.R.T., M.B.C., V.V., M.U.P.); Danish Ministry for Social Affairs and the Interior - 9173-0003 (K.R.T., M.B.C., M.U.P., M.M.P., T.L.K.); and Medical Research Council (MRC), Senior Clinical Fellowship - MR/P008747/1 (V.V.)

Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems

Background: Attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for substance-related problems (SRP) during adolescence, but the nature of this relationship and the importance of co-occurring conduct problems are not fully understood. Methods: Data stem from a linked dataset between a large population-based survey conducted in 2012 of Norwegian adolescents aged 16 to 19, and registry-based data from specialized child and adolescent mental health services (n = 9,411). Results: Adolescents with “ADHD + high conduct problems” had increased risk of SRP (odds ratios = 2.37–10.14). Adolescents with “ADHD only” had very similar risk of SRP as adolescents from the general population with low symptoms of conduct problems. Relative to boys, girls with “ADHD + high conduct problems” appeared to have somewhat higher risk for SRP. Conclusion: The present study suggests that the risk for SRP among adolescent with ADHD is largely driven by co-existing conduct problems.publishedVersio

Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems

Background: Attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for substance-related problems (SRP) during adolescence, but the nature of this relationship and the importance of co-occurring conduct problems are not fully understood. Methods: Data stem from a linked dataset between a large population-based survey conducted in 2012 of Norwegian adolescents aged 16 to 19, and registry-based data from specialized child and adolescent mental health services (n = 9,411). Results: Adolescents with “ADHD + high conduct problems” had increased risk of SRP (odds ratios = 2.37–10.14). Adolescents with “ADHD only” had very similar risk of SRP as adolescents from the general population with low symptoms of conduct problems. Relative to boys, girls with “ADHD + high conduct problems” appeared to have somewhat higher risk for SRP. Conclusion: The present study suggests that the risk for SRP among adolescent with ADHD is largely driven by co-existing conduct problems.publishedVersio

Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems

Background: Attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for substance-related problems (SRP) during adolescence, but the nature of this relationship and the importance of co-occurring conduct problems are not fully understood. Methods: Data stem from a linked dataset between a large population-based survey conducted in 2012 of Norwegian adolescents aged 16 to 19, and registry-based data from specialized child and adolescent mental health services (n = 9,411). Results: Adolescents with “ADHD + high conduct problems” had increased risk of SRP (odds ratios = 2.37–10.14). Adolescents with “ADHD only” had very similar risk of SRP as adolescents from the general population with low symptoms of conduct problems. Relative to boys, girls with “ADHD + high conduct problems” appeared to have somewhat higher risk for SRP. Conclusion: The present study suggests that the risk for SRP among adolescent with ADHD is largely driven by co-existing conduct problems.publishedVersio

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management

Male breast cancer in BRCA1 and BRCA2 mutation carriers : pathology data from the Consortium of Investigators of Modifiers of BRCA1/2

Background: BRCA1 and, more commonly, BRCA2 mutations are associated with increased risk of male breast cancer (MBC). However, only a paucity of data exists on the pathology of breast cancers (BCs) in men with BRCA1/2 mutations. Using the largest available dataset, we determined whether MBCs arising in BRCA1/2 mutation carriers display specific pathologic features and whether these features differ from those of BRCA1/2 female BCs (FBCs). Methods: We characterised the pathologic features of 419 BRCA1/2 MBCs and, using logistic regression analysis, contrasted those with data from 9675 BRCA1/2 FBCs and with population-based data from 6351 MBCs in the Surveillance, Epidemiology, and End Results (SEER) database. Results: Among BRCA2 MBCs, grade significantly decreased with increasing age at diagnosis (P = 0.005). Compared with BRCA2 FBCs, BRCA2 MBCs were of significantly higher stage (P for trend = 2 x 10(-5)) and higher grade (P for trend = 0.005) and were more likely to be oestrogen receptor-positive [odds ratio (OR) 10.59; 95 % confidence interval (CI) 5.15-21.80] and progesterone receptor-positive (OR 5.04; 95 % CI 3.17-8.04). With the exception of grade, similar patterns of associations emerged when we compared BRCA1 MBCs and FBCs. BRCA2 MBCs also presented with higher grade than MBCs from the SEER database (P for trend = 4 x 10(-12)). Conclusions: On the basis of the largest series analysed to date, our results show that BRCA1/2 MBCs display distinct pathologic characteristics compared with BRCA1/2 FBCs, and we identified a specific BRCA2-associated MBC phenotype characterised by a variable suggesting greater biological aggressiveness (i.e., high histologic grade). These findings could lead to the development of gender-specific risk prediction models and guide clinical strategies appropriate for MBC management.Peer reviewe