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- Ozgen, H, et al.
(författare)
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International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder
- 2020
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Ingår i: European addiction research. - : S. Karger AG. - 1421-9891 .- 1022-6877. ; 26:4-5, s. 223-232
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. <b><i>Objective:</i></b> The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. <b><i>Method:</i></b> A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. <b><i>Results:</i></b> After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (<i>n</i> = 4), risk of developing SUD (<i>n</i> = 3), screening and diagnosis (<i>n</i> = 7), psychosocial treatment (<i>n</i> = 5), pharmacological treatment (<i>n</i> = 11), and complementary treatments (<i>n</i> = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. <b><i>Conclusion:</i></b> This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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2. |
- Ozgen, H, et al.
(författare)
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[International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder]
- 2022
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Ingår i: Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie. - : Hogrefe Publishing Group. - 1422-4917 .- 1664-2880. ; 50:1, s. 54-67
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Tidskriftsartikel (refereegranskat)abstract
- Zusammenfassung. Hintergrund: Eine Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindesalter stellt einen Risikofaktor für Substanzmissbrauch und Störungen durch Substanzgebrauch (Substance Use Disorder, SUD) in der Pubertät und dem (frühen) Erwachsenenalter dar. ADHS und SUD treten auch häufig bei therapiesuchenden Jugendlichen auf, was die Diagnosestellung und Therapie erschwert sowie mit schlechten Behandlungsergebnissen verbunden ist. Forschungsergebnisse über die Wirkung der Behandlung von ADHS im Kindesalter auf die Prävention von SUD im Jugendalter sind nicht eindeutig und Studien über die Diagnose und Behandlung von Jugendlichen mit ADHS und SUD sind selten. Daher reicht die verfügbare Evidenz allgemein nicht aus, um starke Behandlungsempfehlungen zu rechtfertigen. Fragestellung: Ziel dieser Arbeit war es, eine Konsenserklärung auf der Grundlage von wissenschaftlichen Daten und klinischen Erfahrungen zu erhalten. Methodik: Es wurde eine modifizierte Delphi-Studie durchgeführt, um basierend auf der Kombination von wissenschaftlichen Daten und klinischer Erfahrung mit einer multidisziplinären Gruppe von 55 Expert_innen aus 17 Ländern einen Konsens zu erzielen. Die Expert_innen wurden gebeten, eine Reihe von Aussagen über die Wirkung der Behandlung von ADHS im Kindesalter auf die SUD bei Jugendlichen sowie über das Screening, die Diagnostik und die Behandlung von Jugendlichen mit komorbidem ADHS und SUD zu bewerten. Ergebnisse: Nach drei iterativen Bewertungsrunden und der Anpassung von 37 Aussagen wurde ein Konsens über 36 dieser Aussagen erzielt, die sechs Bereiche repräsentieren: allgemein ( n = 4), Risiko der Entwicklung einer SUD ( n = 3), Screening und Diagnostik ( n = 7), psychosoziale Behandlung ( n = 5), pharmakologische Behandlung ( n = 11) und komplementäre Behandlungen ( n = 7). Der Einsatz von Routinescreenings auf ADHS wird bei adoleszenten Patient_innen in einer Suchtbehandlung ebenso wie Routinescreenings auf SUD bei jugendlichen Patient_innen mit ADHS in allgemeinpsychiatrischen Therapiesettings empfohlen. Langwirksame Stimulanzien werden als Behandlung der ersten Wahl von ADHS bei Jugendlichen mit gleichzeitiger ADHS und SUD empfohlen. Die Pharmakotherapie sollte vorzugsweise in psychosoziale Behandlung eingebettet werden. Die einzige nichtkonsentierte Aussage betraf die Notwendigkeit von Abstinenz vor Beginn einer pharmakologischen Behandlung bei Jugendlichen mit ADHS und gleichzeitigem SUD. Im Gegensatz zur Mehrheit verlangten einige Expert_innen eine vollständige Abstinenz vor Beginn einer pharmakologischen Behandlung, einige waren gegen die Verwendung von Stimulanzien bei der Behandlung dieser Patient_innen (unabhängig von Abstinenz), während einige sich gegen die alternative Anwendung von Bupropion aussprachen. Schlussfolgerungen: Diese internationale Konsenserklärung kann von Kliniker_innen und Patient_innen zusammen in einem gemeinsamen Entscheidungsprozess genutzt werden, um die besten Interventionen auszuwählen und die bestmöglichen Ergebnisse bei adoleszenten Patient_innen mit gleichzeitiger ADHS und SUD zu erzielen.
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4. |
- Crunelle, CL, et al.
(författare)
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International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder
- 2018
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Ingår i: European addiction research. - : S. Karger AG. - 1421-9891 .- 1022-6877. ; 24:1, s. 43-51
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Tidskriftsartikel (refereegranskat)abstract
- Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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5. |
- Sarmiento, Luis, et al.
(författare)
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Comparing net zero pathways across the Atlantic A model inter-comparison exercise between the Energy Modeling Forum 37 and the European Climate and Energy Modeling Forum
- 2024
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Ingår i: Energy and Climate Change. - : Elsevier BV. - 2666-2787. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Europe and North America account for 32 % of current carbon emissions. Due to distinct legacy systems, energy infrastructure, socioeconomic development, and energy resource endowment, both regions have different policy and technological pathways to reach net zero by the mid-century. Against this background, our paper examines the results from the net zero emission scenarios for Europe and North America that emerged from the collaboration of the European and American Energy Modeling Forums. In our analysis, we perform an inter-comparison of various integrated assessments and bottom-up energy system models. A clear qualitative consensus emerges on five main points. First, Europe and the United States reach net zero targets with electrification, demand-side reductions, and carbon capture and sequestration technologies. Second, the use of carbon capture and sequestration is more predominant in the United States due to a steeper decarbonization schedule. Third, the buildings sector is the easiest to electrify in both regions. Fourth, the industrial sector is the hardest to electrify in the United States and transportation in Europe. Fifth, in both regions, the transition in the energy mix is driven by the substitution of coal and natural gas with solar and wind, but to a different extent.
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- Dekker, Mark M., et al.
(författare)
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Identifying energy model fingerprints in mitigation scenarios
- 2023
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Ingår i: Nature Energy. - : Springer Nature. - 2058-7546. ; 8:12, s. 1395-1404
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Tidskriftsartikel (refereegranskat)abstract
- Energy models are used to study emissions mitigation pathways, such as those compatible with the Paris Agreement goals. These models vary in structure, objectives, parameterization and level of detail, yielding differences in the computed energy and climate policy scenarios. To study model differences, diagnostic indicators are common practice in many academic fields, for example, in the physical climate sciences. However, they have not yet been applied systematically in mitigation literature, beyond addressing individual model dimensions. Here we address this gap by quantifying energy model typology along five dimensions: responsiveness, mitigation strategies, energy supply, energy demand and mitigation costs and effort, each expressed through several diagnostic indicators. The framework is applied to a diagnostic experiment with eight energy models in which we explore ten scenarios focusing on Europe. Comparing indicators to the ensemble yields comprehensive ‘energy model fingerprints’, which describe systematic model behaviour and contextualize model differences for future multi-model comparison studies.
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7. |
- Osterman, Julia, et al.
(författare)
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Mason bees and honey bees synergistically enhance fruit set in sweet cherry orchards
- 2023
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Ingår i: Ecology and Evolution. - 2045-7758. ; 13:7
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Tidskriftsartikel (refereegranskat)abstract
- Mason bees (Osmia spp.) are efficient fruit tree pollinators that can be encouraged to occupy and breed in artificial nesting material. In sweet cherry orchards, they are occasionally used as an alternative managed pollinator as a replacement for or in addition to honey bees (Apis mellifera). Yet, the lack of practical guidelines on management practices, for example optimal stocking rates, for both mason bee nesting material and honey bees might compromise pollination service provision. In this study, we assessed the relationship between stocking rates (honey bee hives and mason bee nesting material) and the abundance of honey bees and mason bees in 17 sweet cherry (Prunus avium) orchards in Central Germany. We furthermore performed a pollination experiment to explore the interactive effect of mason bees and honey bees on sweet cherry fruit set. In the orchards, both honey bee and mason bee abundance increased with increasing stocking rates of hives or nesting material, respectively. Honey bee abundance increased linearly with stocking rates. In contrast, mason bee abundance asymptoted at 2-3 nesting boxes per ha, beyond which more boxes resulted in little increase in visitation rate. Our pollination experiment demonstrated that orchards were pollen limited, with only 28% of insect-pollinated flowers setting fruit versus 39% of optimally hand-pollinated flowers. Honey bees and mason bees enhanced sweet cherry fruit set, but only when both were present and not when either was present alone in an orchard. Our findings demonstrate that offering nesting material for mason bees and employing honey bee hives can enhance bee abundance in sweet cherry orchards. By increasing honey bee abundance in combination with enhanced mason bee abundance, farmers can substantially boost fruit set and potentially sweet cherry yield. To enhance pollination services, farmers should consider the benefits of increasing pollinator biodiversity as an immediate benefit to improve crop yields.
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