The External Validity of Sluggish Cognitive Tempo Versus Inattention in Behavioral, Social Interaction, and Academic Performance Measures

BACKGROUND

The main objective was to replicate data on the external validity of the Sluggish Cognitive Tempo (SCT) dimension, versus ADHD Inattention (IN), with the Spanish version of the Child and Adolescent Behavior Inventory (CABI) SCT subscale [ Cuestionario sobre el Comportamiento de Niños ] (Burns et al., 2015).

METHOD

273 mothers and 255 fathers evaluated their 9 to13 year old children on SCT, IN and other CABI internalizing externalizing, academic impairment and social interaction measures.

RESULTS

As hypothesized, the relationship between SCT and externalizing measures, in contrast to IN, was practically nonexistent, whereas both measures were related to internalizing and social interaction measures. Thus, the unique predictive capacity of SCT and IN was significant and similar on internalizing measures, except in the case of shyness, where SCT was better, while IN was better on externalizing measures.

CONCLUSIONS

The data largely replicated previous results: SCT, despite its relationship with IN, is capable of predicting a significant proportion of anxiety, depression, and excessive shyness problems and, unlike IN, functions as a protective measure for externalizing problems.

The impact of insomnia disorder on adult attention-deficit/hyperactivity disorder severity: A six-month follow-up study

BACKGROUND AND OBJECTIVES

The longitudinal relationship between insomnia disorder and adult attention-deficit/hyperactivity disorder (ADHD) has been scarcely investigated. This study aimed to evaluate the relationship between the remission of insomnia disorder and adult ADHD clinical severity, psychiatric and medical comorbidities, and the health-related quality of life (HRQoL) in a 6-month follow-up.

METHODS

Ninety-two adult patients with ADHD and insomnia disorder (52.2% males; mean age 39.5 ± 11.0 years) were comprehensively assessed at baseline, 3 months, and 6 months of a follow-up period. The evaluation included semi-structured interviews (for ADHD and comorbidity assessment), the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of ADHD and insomnia disorder was performed according to DSM-5 criteria. At baseline and follow-up, psychoeducation/sleep hygiene and, if necessary, pharmacological were prescribed for insomnia.

RESULTS

Eighty-seven patients completed the 6-month follow-up. Insomnia disorder remission was reported in 72.4% of cases and was related to a greater improvement in ADHD symptoms and severity throughout the follow-up period. Additionally, an improvement in psychiatric comorbidities and better HRQoL were associated with insomnia disorder remission.

CONCLUSION

The current study highlights that the treatment of insomnia disorder in ADHD adult patients may have an important role in the outcome of ADHD therapeutic approaches by reducing their severity.

Feasibility of a virtual reality program to treat children with fear of darkness with nonexpert therapists

Fear of darkness is highly prevalent and stable in children and often ends up becoming a specific situational phobia. The aim of this study is to analyze the feasibility of adapting and applying it through a Virtual Reality (VR) tool by nonexpert therapists. A pre-experimental study was carried out with six participants between the ages of 8 and 12 years old using pre- and posttreatment scales for assessing the fear of darkness. Statistically significant differences with large effects were found in all posttreatment measures: EMO (Roshenthal’s r = 0.64), WCDAN (r = 0.52), and Global item of current fear of darkness (r = 0.59). Using the Reliable Change Index (RCI) as a measure of clinically significant change, four participants improved satisfactorily, one acceptably, and the other did not improve. The results support the feasibility of using an adapted VR program to treat fear of darkness without being an expert therapist. However, more detailed experimental studies need to be carried out in order to analyze its efficacy.

Optimal Items for Assessing Sluggish Cognitive Tempo in Children Across Mother, Father, and Teacher Ratings

A recent meta-analysis identified optimal items for assessing sluggish cognitive tempo (SCT) as distinct from attention deficit/hyperactivity disorder inattention (ADHD-IN), and a preliminary study with teacher ratings of children in the United States found strong support for the convergent and discriminant validity of 15 SCT items. The current study evaluated whether the same 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN in a large, community-based sample of children in Spain, and whether validity results were replicated across mother, father, and teacher ratings. Mothers, fathers, and teachers completed measures of SCT, ADHD-IN, ADHD-hyperactivity/impulsivity, oppositional defiant disorder, limited prosocial emotions, anxiety, depression, shyness, peer rejection, social impairment, and academic impairment on 2,142 Spanish children (49.49% girls; ages 8-13). The 15 SCT symptoms demonstrated convergent validity along with discriminant validity with ADHD-IN across all three informants. The SCT symptom ratings also showed measurement invariance across the informants. In addition, SCT and ADHD-IN factors had different and unique associations with the other symptom and impairment factors. The 15 SCT symptoms identified in this study-consistent across mother, father, and teacher ratings-appear appropriate to serve as a standard symptom set for assessing SCT in children. Use of a common set of symptoms in future studies will advance our understanding of the SCT construct, including its etiology and developmental progression, associations with ADHD and other psychopathologies, links to impairment, and implications for clinical intervention.

Advancing the Multi-Informant Assessment of Sluggish Cognitive Tempo: Child Self-Report in Relation to Parent and Teacher Ratings of SCT and Impairment

Despite increasing interest in sluggish cognitive tempo (SCT) in children and advancements in its measurement, little research has examined child self-reported SCT. Child self-report of SCT is important for the multi-informant assessment of SCT. The current study used a large, school-based sample of children and a multi-informant design to examine child self-reported SCT using the Child Concentration Inventory - Version 2 (CCI-2) which was recently revised based on meta-analytic findings and parallels the item content of validated parent and teacher rating scales. The study involved 2142 unique children (ages 8-13 years, 50.51% males). Children (n = 1980) completed measures of SCT, loneliness, and preference for solitude. Mothers (n = 1648), fathers (n = 1358), and teachers (n = 1773) completed measures of SCT, attention-deficit/hyperactivity disorder-IN (ADHD-IN), academic impairment, social impairment, and conflicted shyness. Children's self-reported SCT demonstrated good reliability with the 15 SCT symptoms showing moderate to strong loadings on the SCT factor. The child self-report SCT factor also showed moderate convergent validity with mother, father, and teacher ratings of children's SCT. In addition, higher child-reported SCT predicted greater mother, father, and teacher ratings of children's academic impairment even after controlling for mother, father, and teacher ratings of children's SCT and ADHD-IN. Higher child-rated SCT also predicted greater mother ratings of children's social impairment after controlling for mother ratings of children's SCT and ADHD-IN. The present study provides initial empirical support for the reliability and validity of child-reported SCT as part of the multi-informant assessment of SCT. A key direction for future research includes evaluating the unique contributions of different informants and their utility within specific contexts to guide evidence-based recommendations for assessing SCT.

Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children

This study (a) determined whether clinical elevations of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) symptom distributions in a large community sample of children would allow for identifying SCT-only, ADHD-only, and SCT + ADHD clinical groups; (b) examined co-occurrence of clinically elevated SCT and ADHD; (c) evaluated whether these clinical groups differed in their gender distribution, co-occurring mental health symptoms, or impairment in academic and social functioning; and (d) explored patterns of independence and overlap when clinically elevated depressive symptoms were considered in tandem with SCT and ADHD. Participants were mothers, fathers, and teachers of 2,142 children (50.51% boys, ages 8-13 years) from 32 schools in Spain. All three groups of informants completed measures of SCT, ADHD, oppositional defiant disorder (ODD), anxiety, depression, shyness, social impairment, and academic impairment. Cut-off scores for the top 5% of the sample were used to create SCT-only, ADHD-only, SCT + ADHD, and comparison groups. Across informants, 4.97%-5.53% met criteria for clinically elevated ADHD-only, and 2.30%-2.80% met criteria for clinically elevated SCT-only; 27%-35% of the ADHD group also met the criteria for the SCT group, whereas 44%-54% of the SCT group met the criteria for the ADHD group (primarily based on inattentive symptoms). The ADHD-only group had higher ODD scores than the SCT-only group, whereas the SCT-only group generally had higher shyness and internalizing scores (particularly depression) than the ADHD-only group. Additional analyses that also included clinically elevated depression revealed that 28-46% of the children with elevated SCT had elevations in neither ADHD nor depression. This study moves the field toward examining both the empirical and clinical differentiation of SCT and ADHD. Findings are discussed regarding how SCT may fit in diagnostic nosologies and models of psychopathology. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Resistance to Targeted Therapies in Renal Cancer: The Importance of Changing the Mechanism of Action

Renal cell carcinoma (RCC) is a complex disease characterized by mutations in several genes. Loss of function of the von Hippel-Lindau (VHL) tumour suppressor gene is a very common finding in RCC and leads to up-regulation of hypoxia-inducible factor (HIF)-responsive genes accountable for angiogenesis and cell growth, such as platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF). Binding of these proteins to their cognate tyrosine kinase receptors on endothelial cells promotes angiogenesis. Promotion of angiogenesis is in part due to the activation of the phosphatidylinositol-3-kinase (PI3K)/AKT/mechanistic target of rapamycin (mTOR) pathway. Inhibition of this pathway decreases protein translation and inhibits both angiogenesis and tumour cell proliferation. Although tyrosine kinase inhibitors (TKIs) stand as the main first-line treatment option for advanced RCC, eventually all patients will become resistant to TKIs. Resistance can be overcome by using second-line treatments with different mechanisms of action, such as inhibitors of mTOR, c-MET, programmed death 1 (PD-1) receptor, or the combination of an mTOR inhibitor (mTORi) with a TKI. In this article, we briefly review current evidence regarding mechanisms of resistance in RCC and treatment strategies to overcome resistance with a special focus on the PI3K/AKT/mTOR pathway.

Mother-father agreement and one-year stability of children's sleep functioning

OBJECTIVES

To (1) evaluate mother-father agreement of total sleep problems and specific sleep problem domains and (2) examine the one-year stability of children's sleep functioning, including cross-rater stability.

METHODS

A community-based sample of 519 children (51% boys) in Spain was assessed in third grade and again 1 year later. At each time-point, both mothers and fathers provided ratings of sleep functioning using the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

Sleep scores did not differ between mothers' and fathers' ratings. Cross-sectionally (at both time-points) and longitudinally (from grade 3 to grade 4), strong agreement was found between mothers' and fathers' ratings of total sleep problems, sleep habits, night wakings, and parasomnias. Lower agreement was found for daytime sleepiness and sleep onset delay. There was large effect size stability for both mothers' and fathers' ratings over the one-year period on the total sleep disturbance scale and most sleep subscales.

CONCLUSIONS

This study provides the first evidence of strong mother-father agreement on subjective ratings of children's sleep functioning, both concurrently and over a one-year period, for overall sleep problems and certain sleep domains. However, agreement was far from identical, and further studies are needed to evaluate reasons for discrepancy and whether mother-father discrepancy in sleep functioning predicts children's functioning. More studies are needed that systematically include both mothers' and fathers' perspectives regarding children's sleep.

Epidemiology and Immediate Indirect Effects of Respiratory Viruses in Lung Transplant Recipients: A 5-Year Prospective Study

The epidemiology of respiratory viruses (RVs) in lung transplant recipients (LTRs) and the relationship of RVs to lung function, acute rejection (AR) and opportunistic infections in these patients are not well known. We performed a prospective cohort study (2009-2014) by collecting nasopharyngeal swabs (NPSs) from asymptomatic LTRs during seasonal changes and from LTRs with upper respiratory tract infectious disease (URTID), lower respiratory tract infectious disease (LRTID) and AR. NPSs were analyzed by multiplex polymerase chain reaction. Overall, 1094 NPSs were collected from 98 patients with a 23.6% positivity rate and mean follow-up of 3.4 years (interquartile range 2.5-4.0 years). Approximately half of URTIDs (47 of 97, 48.5%) and tracheobronchitis cases (22 of 56, 39.3%) were caused by picornavirus, whereas pneumonia was caused mainly by paramyxovirus (four of nine, 44.4%) and influenza (two of nine, 22.2%). In LTRs with LRTID, lung function changed significantly at 1 mo (p = 0.03) and 3 mo (p = 0.04). In a nested case-control analysis, AR was associated with RVs (hazard ratio [HR] 6.54), Pseudomonas aeruginosa was associated with LRTID (HR 8.54), and cytomegalovirus (CMV) replication or disease was associated with URTID (HR 2.53) in the previous 3 mo. There was no association between RVs and Aspergillus spp. colonization or infection (HR 0.71). In conclusion, we documented a high incidence of RV infections in LTRs. LRTID produced significant lung function abnormalities. Associations were observed between AR and RVs, between P. aeruginosa colonization or infection and LRTID, and between CMV replication or disease and URTID.

The role of perceptual information in familiarity-based scene recognition

A method to analyze the role of familiarity in recognizing pictures of everyday scenes is introduced. The idea is to manipulate two within-subjects conditions: an experimental condition where the scenes repeat perceptual information (e.g. buildings and/or vehicles) and a control condition. The results show the two conditions did not differ in terms of hit rates, but in the experimental condition there were significantly fewer false alarms, yielding better results, which supports the findings of past research studies that have used verbal materials. This perceptual facilitation was maintained throughout a week-long retention interval. Finally, a detailed analysis of this facilitation shows it was due to a significant reduction in false alarms on know judgments, emphasizing familiarity's role in explaining this effect.

Dendritic cell uptake of iron-based magnetic nanoparticles

We have investigated the internalization of magnetic nanoparticles (NPs) into dendritic cells (DCs) in order to assess both the final location of the particles and the viability of the cultured cells. The particles, consisting of a metallic iron core covered with carbon, showed no toxic effects on the DCs and had no effect in their viability. We found that mature DCs are able to incorporate magnetic nanoparticles in a range of size from 10 nm to ca. 200 nm, after 24 h of incubation. We describe a method to separate cells loaded with NPs, and analyze the resulting material by electron microscopy and magnetic measurements. It is found that NPs are internalized in lysosomes, providing a large magnetic signal. Our results suggest that loading DCs with properly functionalized magnetic NPs could be a promising strategy for improved vectorization in cancer diagnosis and treatment.

Synthesis of antitumor dendritic imides

Dendritic imides were synthesized and evaluated as antitumor compounds. Compounds 8 and 11 showing a promising profile as inhibitors of lck but their antiproliferative activity against HT-29 was not so relevant.

Platelet alpha 2-adrenoceptor density in pregnancy-induced hypertensive patients: effect of epidural analgesia

OBJECTIVES

Although pregnancy induced hypertension (PIH) is an important and relatively common medical problem, its pathophysiology remains unresolved and the search for a biochemical marker that precedes the hemodynamic abnormalities of PIH continues. Since human platelets contain alpha 2-adrenoceptors, these receptors were measured in women with PIH to determine whether patients with PIH have alpha 2-adrenoceptor abnormalities that might cause or exacerbate the hypertensive process. The effect of epidural analgesia upon blood pressure and its relation to changes in platelet alpha 2-adrenoceptor density were also investigated.

DESIGN

Biochemical measurements and radioligand binding assays in platelets were performed on 33 patients with the criteria for PIH and on 26 healthy pregnant women.

RESULTS

Blood pressure was significantly elevated in hypertensive women when compared with normotensive pregnant women although, in this group, blood pressure returned to normal levels in response to epidural analgesia. In drug-free hypertensive patients, the specific binding of 3H-yohimbine to platelet membranes increased significantly compared with that in control pregnant subjects. In contrast, the dissociation constant was not significantly different in the two groups. Furthermore, alpha 2-adrenoceptor density in the group with PIH returned to normal levels in response to epidural analgesia.

CONCLUSION

Our findings indicate that PIH is characterized by an exaggerated response of platelet alpha 2-adrenoceptor density to a rise in blood pressure and that this alteration could be significant in the pathogenesis of hypertension. Furthermore, human alpha 2-adrenoceptors undergo regulatory mechanisms similar to those recently described for adrenergic receptors in a variety of animal models.