Assessing severity of problem gambling–confirmatory factor and Rasch analysis of three gambling measures

The comparative psychometric properties of self-report measures for gambling are insufficiently evaluated, in particular regarding factor structure and item response properties. Confirmatory factor and Rasch analyses were tested for three widely used gambling measures assessing problem gambling and related constructs, that is, the Problem Gambling Severity Index (PGSI), the Problem and Pathological Gambling Measure (PPGM), and the NORC Diagnostic Screen for Gambling Problems (NODS). Psychometric data was analyzed, including help-seeking and recreational gambling samples (N = 598). Compared to the PPGM and the NODS, the PGSI performed worse in the confirmatory factor analysis, and showed poor fit for the theoretically assumed unidimensional model. The Rasch analysis indicated that the PPGM had an adequate difficulty range (i.e. lowest to highest item difficulty) to detect gambling problems across a severity continuum. Compared to the PPGM, the PGSI and NODS had smaller item difficulty ranges, indicating detection of higher gambling severity problems. We conclude that using the PGSI for detection of low severity problems, such as at-risk gambling, might be problematic. The PPGM can be used in general populations and clinical contexts to detect problem gambling and pathological gambling. The NODS is suitable for use in clinical samples for identification of pathological gambling.publishedVersio

Estimating the size of hidden populations from register data

BACKGROUND: Prevalence estimates of drug use, or of its consequences, are considered important in many contexts and may have substantial influence over public policy. However, it is rarely possible to simply count the relevant individuals, in particular when the defining characteristics might be illegal, as in the drug use case. Consequently methods are needed to estimate the size of such partly ‘hidden’ populations, and many such methods have been developed and used within epidemiology including studies of alcohol and drug use. Here we introduce a method appropriate for estimating the size of human populations given a single source of data, for example entries in a health-care registry. METHODS: The setup is the following: during a fixed time-period, e.g. a year, individuals belonging to the target population have a non-zero probability of being “registered”. Each individual might be registered multiple times and the time-points of the registrations are recorded. Assuming that the population is closed and that the probability of being registered at least once is constant, we derive a family of maximum likelihood (ML) estimators of total population size. We study the ML estimator using Monte Carlo simulations and delimit the range of cases where it is useful. In particular we investigate the effect of making the population heterogeneous with respect to probability of being registered. RESULTS: The new estimator is asymptotically unbiased and we show that high precision estimates can be obtained for samples covering as little as 25% of the total population size. However, if the total population size is small (say in the order of 500) a larger fraction needs to be sampled to achieve reliable estimates. Further we show that the estimator give reliable estimates even when individuals differ in the probability of being registered. We also compare the ML estimator to an estimator known as Chao’s estimator and show that the latter can have a substantial bias when applied to epidemiological data. CONCLUSIONS: The population size estimator suggested herein complements existing methods and is less sensitive to certain types of dependencies typical in epidemiological data

Neurocognitive and Seizure Outcomes of Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy.

Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student's t-test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted

Impacts of alcohol consumption by mothers and fathers, parental monitoring, adolescent disclosure and novelty-seeking behaviour on the likelihood of alcohol use and inebriation among adolescents

The aim of this prospective cohort study was to examine how alcohol consumption by mothers and fathers, parental monitoring (knowledge, control, and solicitation), adolescent disclosure and novelty seeking were associated with the likelihood of alcohol use and inebriation among adolescents in three different age groups (13–14 years, 14–15 years, and 17 years). The results showed that alcohol consumption by parents is of significance for adolescent alcohol consumption (odds ratio mothers: 1.47 [1.17–1.84], odds ratio fathers 1.33 [1.08–1.65]) and inebriation, especially in the 17-year-old age group. The results showed that novelty seeking was a strong risk factor in all three age groups, while parental control and knowledge had no impact. This study shows that parental solicitation increased the odds at age 17 for alcohol consumption (2.64 [1.02–6.83]) and inebriation, while adolescent disclosure decreased the odds (0.18 [0.05–0.68]). In summary, the study shows that parents should be particularly attentive to adolescents with high novelty-seeking behaviour and that parental alcohol consumption influences adolescent alcohol habits.publishedVersio

CDKN2A/p16INK4a expression is associated with vascular progeria in chronic kidney disease

Patients with chronic kidney disease (CKD) display a progeric vascular phenotype linked to apoptosis, cellular senescence and osteogenic transformation. This has proven intractable to modelling appropriately in model organisms. We have therefore investigated this directly in man, using for the first time validated cellular biomarkers of ageing (CDKN2A/p16INK4a, SA-β-Gal) in arterial biopsies from 61 CKD patients undergoing living donor renal transplantation. We demonstrate that in the uremic milieu, increased arterial expression of CDKN2A/p16INK4a associated with vascular progeria in CKD, independently of chronological age. The arterial expression of CDKN2A/p16INK4a was significantly higher in patients with coronary calcification (p=0.01) and associated cardiovascular disease (CVD) (p=0.004). The correlation between CDKN2A/p16INK4a and media calcification was statistically significant (p=0.0003) after correction for chronological age. We further employed correlate expression of matrix Gla protein (MGP) and runt-related transcription factor 2 (RUNX2) as additional pathognomonic markers. Higher expression of CDKN2A/p16INK4a, RUNX2 and MGP were observed in arteries with severe media calcification. The number of p16INK4a and SA-β-Gal positive cells was higher in biopsies with severe media calcification. A strong inverse correlation was observed between CDKN2A/p16INK4a expression and carboxylated osteocalcin levels. Thus, impaired vitamin K mediated carboxylation may contribute to premature vascular senescence

Increased telomere attrition following renal transplantation: impact of anti-metabolite therapy

Background: The uremic milieu exposes chronic kidney disease (CKD) patients to premature ageing processes. The impact of renal replacement therapy (dialysis and renal transplantation [RTx]) or immunosuppressive treatment regimens on ageing biomarkers has scarcely been studied. Methods: In this study telomere length in whole blood cells was measured in 49 dialysis patients and 47 RTx patients close to therapy initiation and again after 12 months. Forty-three non-CKD patients were included as controls. Results: Non-CKD patients had significantly (P <= 0.01) longer telomeres than CKD patients. Telomere attrition after 12 months was significantly greater in RTx patients compared to dialysis patients (P = 0.008). RTx patients receiving mycophenolate mofetil (MMF) had a greater (P = 0.007) degree of telomere attrition compared to those treated with azathioprine. After 12 months, folate was significantly higher in RTx patients than in dialysis patients (P < 0.0001), whereas the opposite was true for homocysteine (P < 0.0001). The azathioprine group had lower levels of folate after 12 months than the MMF group (P = 0.003). Conclusions: The associations between immunosuppressive therapy, telomere attrition, and changes in folate indicate a link between methyl donor potential, immunosuppressive drugs, and biological ageing. The hypothesis that the increased telomere attrition, observed in the MMF group after RTx, is driven by the immunosuppressive treatment, deserves further attention

Well-Being, Mental Health Problems, and Alcohol Experiences Among Young Swedish Adolescents: A General Population Study

The aim of this study was to investigate patterns of self-reported emotional and behavioral problems and self-rated well-being in relation to alcohol experiences among Swedish girls and boys in early adolescence. A general sample of 1383 young people aged 12 to 13 years reported their internalizing and externalizing problem styles, and their well-being and alcohol experiences were measured. Person-oriented analyses were applied to the data to determine specific mental health configurations (“types”) that occurred more frequently than expected by chance. Externalizing problems, in contrast to internalizing problems, oc-curred more commonly in adolescents who reported a high degree of well-being. Girls with low well-being and mental health problems were overrepresented among those with alcohol experiences. Findings suggest that gender and positive psychology perspectives should be taken into account when describing and explaining mental health among adolescents, especially adolescents with an early alcohol debut