| 1. |
- Andrén, Per, et al.
(author)
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Internet-Delivered Exposure and Response Prevention for Pediatric Tourette Syndrome : 12-Month Follow-Up of a Randomized Clinical Trial
- 2024
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In: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 7:5
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Journal article (peer-reviewed)abstract
- IMPORTANCE: Behavior therapy is a recommended intervention for Tourette syndrome (TS) and chronic tic disorder (CTD), but availability is limited and long-term effects are uncertain.OBJECTIVE: To investigate the long-term efficacy and cost-effectiveness of therapist-supported, internet-delivered exposure and response prevention (ERP) vs psychoeducation for youths with TS or CTD.DESIGN, SETTING, AND PARTICIPANTS: This 12-month controlled follow-up of a parallel group, superiority randomized clinical trial was conducted at a research clinic in Stockholm, Sweden, with nationwide recruitment. In total, 221 participants aged 9 to 17 years with TS or CTD were enrolled between April 26, 2019, and April 9, 2021, of whom 208 (94%) provided 12-month follow-up data. Final follow-up data were collected on June 29, 2022. Outcome assessors were masked to treatment allocation throughout the study.INTERVENTIONS: A total of 111 participants were originally randomly allocated to 10 weeks of therapist-supported, internet-delivered ERP and 110 participants to therapist-supported, internet-delivered psychoeducation.MAIN OUTCOMES AND MEASURES: The primary outcome was within-group change in tic severity, measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS), from the 3-month follow-up to the 12-month follow-up. Treatment response was defined as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement scale. Analyses were intention-to-treat and followed the plan prespecified in the published study protocol. A health economic evaluation was performed from 3 perspectives: health care organization (including direct costs for treatment provided in the study), health care sector (additionally including health care resource use outside of the study), and societal (additionally including costs beyond health care [eg, parent's absenteeism from work]).RESULTS: In total, 221 participants were recruited (mean [SD] age, 12.1 [2.3] years; 152 [69%] male). According to the YGTSS-TTSS, there were no statistically significant changes in tic severity from the 3-month to the 12-month follow-up in either group (ERP coefficient, -0.52 [95% CI, -1.26 to 0.21]; P = .16; psychoeducation coefficient, 0.00 [95% CI, -0.78 to 0.78]; P > .99). A secondary analysis including all assessment points (baseline to 12-month follow-up) showed no statistically significant between-group difference in tic severity from baseline to the 12-month follow-up (coefficient, -0.38 [95% CI, -1.11 to 0.35]; P = .30). Treatment response rates were similar in both groups (55% in ERP and 50% in psychoeducation; odds ratio, 1.25 [95% CI, 0.73-2.16]; P = .42) at the 12-month follow-up. The health economic evaluation showed that, from a health care sector perspective, ERP produced more quality-adjusted life years (0.01 [95% CI, -0.01 to 0.03]) and lower costs (adjusted mean difference -$84.48 [95% CI, -$440.20 to $977.60]) than psychoeducation at the 12-month follow-up. From the health care organization and societal perspectives, ERP produced more quality-adjusted life years at higher costs, with 65% to 78% probability of ERP being cost-effective compared with psychoeducation when using a willingness-to-pay threshold of US $79 000.CONCLUSIONS AND RELEVANCE: There were no statistically significant changes in tic severity from the 3-month through to the 12-month follow-up in either group. The ERP intervention was not superior to psychoeducation at any time point. While ERP was not superior to psychoeducation alone in reducing tic severity at the end of the follow-up period, ERP is recommended for clinical implementation due to its likely cost-effectiveness and support from previous literature.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03916055.
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| 2. |
- Gabrielson, Marike, et al.
(author)
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Baseline breast tissue characteristics determine the effect of tamoxifen on mammographic density change
- 2024
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In: International Journal of Cancer. - 0020-7136 .- 1097-0215.
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Journal article (peer-reviewed)abstract
- Tamoxifen prevents recurrence of breast cancer and is also approved for preventive, risk-reducing, therapy. Tamoxifen alters the breast tissue composition and decreases the mammographic density. We aimed to test if baseline breast tissue composition influences tamoxifen-associated density change. This biopsy-based study included 83 participants randomised to 6 months daily intake of placebo, 20, 10, 5, 2.5, or 1 mg tamoxifen. The study is nested within the double-blinded tamoxifen dose-determination trial Karolinska Mammography Project for Risk Prediction of Breast Cancer Intervention (KARISMA) Study. Ultrasound-guided core-needle breast biopsies were collected at baseline before starting treatment. Biopsies were quantified for epithelial, stromal, and adipose distributions, and epithelial and stromal expression of proliferation marker Ki67, oestrogen receptor (ER) and progesterone receptor (PR). Mammographic density was measured using STRATUS. We found that greater mammographic density at baseline was positively associated with stromal area and inversely associated with adipose area and stromal expression of ER. Premenopausal women had greater mammographic density and epithelial tissue, and expressed more epithelial Ki67, PR, and stromal PR, compared to postmenopausal women. In women treated with tamoxifen (1–20 mg), greater density decrease was associated with higher baseline density, epithelial Ki67, and stromal PR. Women who responded to tamoxifen with a density decrease had on average 17% higher baseline density and a 2.2-fold higher PR expression compared to non-responders. Our results indicate that features in the normal breast tissue before tamoxifen exposure influences the tamoxifen-associated density decrease, and that the age-associated difference in density change may be related to age-dependant differences in expression of Ki67 and PR.
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| 3. |
- Hall, Ola, et al.
(author)
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A decade of maize yield gap studies in sub-Saharan Africa : how are farm-level factors considered?
- 2024
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In: International Journal of Agricultural Sustainability. - : Routledge. - 1473-5903 .- 1747-762X. ; 22:1
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Journal article (peer-reviewed)abstract
- The study of yield gaps has become more complex, prompting the use of varied approaches to measure yields and a wider range of factors to explain these gaps. In the Global North, the focus is on precision farming, whereas in sub-Saharan Africa (SSA), a broader perspective is necessary due to pronounced variability in farmland conditions. While biogeophysical and management factors have been traditional focal points in yield gap analyses, socio-economic and institutional factors are increasingly recognized as significant, especially in SSA. This review synthesizes research from the past decade in SSA that integrates biogeophysical, management, farm characteristics, and institutional factors in yield gap discussions. The findings indicate a slow shift in including socio-economic factors, with management, particularly nutrient supply and crop management, remaining predominant. However, there is a growing trend towards methodological diversity, such as the adoption of remote sensing and GIS in recent years. Case studies from Kenya and Ghana, utilizing field surveys, interviews, panel data, and spatial analysis, highlight how a multifaceted approach can enhance our understanding of the various elements influencing maize yield gaps in SSA.
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| 4. |
- O'Brien, Phoebe A. J., 1995, et al.
(author)
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Environmental quality status assessment of three Swedish west coast fjords by foraminifera-based genetic and morphological approaches.
- 2024
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In: TMS – CFFR Joint Foraminifera Spring Meeting, 22-25th May, Köln, Germany. - : The Micropalaeontological Society and Cushman Foundation For Foraminiferal Research.
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Conference paper (other academic/artistic)abstract
- Coastal ecosystems with high environmental variability pose a challenge to environmental assessment techniques. Benthic foraminiferal ecology and population dynamics recovered via observations and genetic metabarcoding (eDNA sequencing) are useful tools for ecosystem quality status (EcoQS) assessment. Conventional microscope-based methodology is constrained only to species with fossilization potential, whilst molecular tools have the capacity to detect both dormant stages (propagules) and soft-bodied individuals (monothalamids) but cannot give quantitative estimates. Foraminifera-based diversity and sensitivity indices like Exp(H’bc) and TSI-med respectively have been shown to reliably estimate EcoQS, however given the novelty of molecular techniques applied to biomonitoring, thorough cross-validation with morphological data is still required. To test the ability of eDNA-based EcoQS techniques to detect foraminiferal response to environmental trends we conducted a spatially comparative study of three fjords on the Swedish west coast (permanently oxic Hake Fjord, seasonally hypoxic Gullmar Fjord and long-term anoxic By Fjord). Surface sediment samples (0-3 cm) taken at stations located at the mouth, centre and head of each fjord in September and October of 2021 provided three sediment sample replicates for eDNA and three sediment sample replicates for the foraminiferal assemblage and sediment geochemistry data. We hypothesize that the substantial variation in abiotic factors (DIC, TOC, TN, pigments, pore water nutrients and bottom water oxygen concentration) observed in the three fjords will impact the alpha and beta diversities reported by traditional (morphology-based) and molecular (DNA-based) techniques. The results will show if trends in foraminiferal diversity and EcoQS revealed by morphological and molecular methods will reflect steep environmental gradients observed in the studied fjord systems.
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| 5. |
- Sjöström, Henrik, et al.
(author)
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Putaminal T1/T2-weighted ratio is increased in PSP compared to PD and healthy controls, a multi-cohort study
- 2024
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In: Parkinsonism and Related Disorders. - 1353-8020 .- 1873-5126. ; 121
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Journal article (peer-reviewed)abstract
- Introduction: Differentiating Parkinson's disease (PD) from progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) is a common clinical problem. We aimed to apply the T1-/T2-weighted ratio imaging technique, based on standard clinical MRI, to reveal differences in neurodegeneration in three large cohorts. Methods: Three cohorts, with a total of 405 participants (269 PD, 44 PSP, 38 MSA, 54 controls), were combined and T1/T2-weighted ratio image analyses were carried out. A combination of automatic segmentation and atlas-based ROI were used in this study. The cohorts were combined using the ComBat batch correction procedure. Results: Group differences were found in the putamen (p = 0.040), with higher T1/T2-weighted ratio in this region in PSP compared to PD and healthy controls (p-values 0.010 and 0.007 respectively). Using putaminal T1/T2-weighted ratio for diagnostic separation, a fair performance was found in separating PSP from healthy controls, with an area under the receiver operating characteristic curve of 0.701. Conclusion: Different patterns of T1/T2-weighted ratio, reflecting differences in underlying pathophysiology, were found between the groups. Since T1/T2-weighted ratio can be applied to standard clinical MRI sequences to allow more quantitative analyses, this seems to be a promising biomarker for diagnostics and treatment evaluation of parkinsonian disorders for clinical trials.
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