Inability to start or complete upper secondary school strongly predicts unemployment and psychosocial and psychiatric adversities - A register-based follow-up study from southwestern Sweden.

AIM: To study academic, social and psychiatric outcomes among adults in the general population in southwestern Sweden. Groups of individuals born in 1998 and ineligible, eligible but not completed, and eligible and completed upper secondary school were followed in 2020. METHODS: Data were retrieved from Statistics Sweden, the Swedish National Agency for Education, the Longitudinal Integrated Database for Health Insurance and Labour Market Studies, the Swedish National Crime Register and the National Patient Register. The four adverse outcomes neither engaging in post-secondary studies nor having a regular salary, needing social benefits, having any criminal conviction, and having a psychiatric disorder at age ≥16 were examined. RESULTS: Of the final sample of 2706 individuals who had attended 9th grade of compulsory school in 2014, 273 (10%) were ineligible for upper secondary school. Of eligible individuals, 82 (3%) never started, 282 (10%) did not complete and 2065 (77%) completed upper secondary school. Compared with completers, the odds ratios for adverse outcomes were markedly increased for all other groups up to 22 years old. CONCLUSION: Inability to start or complete upper secondary school strongly predicted unemployment and psychosocial and psychiatric adversities. School authorities should consider offering vocational programmes post compulsory school without grade restrictions.

Automated data extraction of electronic medical records: Validity of data mining to construct research databases for eligibility in gastroenterological clinical trials.

BACKGROUND: Electronic medical records (EMRs) are adopted for storing patient-related healthcare information. Using data mining techniques, it is possible to make use of and derive benefit from this massive amount of data effectively. We aimed to evaluate validity of data extracted by the Customized eXtraction Program (CXP). METHODS: The CXP extracts and structures data in rapid standardised processes. The CXP was programmed to extract TNFα-native active ulcerative colitis (UC) patients from EMRs using defined International Classification of Disease-10 (ICD-10) codes. Extracted data were read in parallel with manual assessment of the EMR to compare with CXP-extracted data. RESULTS: From the complete EMR set, 2,802 patients with code K51 (UC) were extracted. Then, CXP extracted 332 patients according to inclusion and exclusion criteria. Of these, 97.5% were correctly identified, resulting in a final set of 320 cases eligible for the study. When comparing CXP-extracted data against manually assessed EMRs, the recovery rate was 95.6-101.1% over the years with 96.1% weighted average sensitivity. CONCLUSION: Utilisation of the CXP software can be considered as an effective way to extract relevant EMR data without significant errors. Hence, by extracting from EMRs, CXP accurately identifies patients and has the capacity to facilitate research studies and clinical trials by finding patients with the requested code as well as funnel down itemised individuals according to specified inclusion and exclusion criteria. Beyond this, medical procedures and laboratory data can rapidly be retrieved from the EMRs to create tailored databases of extracted material for immediate use in clinical trials.

miR-1933-3p is upregulated in skeletal muscles of MuSK+ EAMG mice and affects Impa1 and Mrpl27.

MuSK antibody seropositive (MuSK+) Myasthenia Gravis (MG) typically affects skeletal muscles of the bulbar area, including the omohyoid muscle, causing focal fatigue, weakness and atrophy. The profile of circulating extracellular microRNA (miRNA) is changed in MuSK + MG, but the intracellular miRNA profile in skeletal muscles of MuSK + MG and MuSK + experimental autoimmune MG (EAMG) remains unknown. This study elucidated the intracellular miRNA profile in the omohyoid muscle of mice with MuSK + EAMG. The levels of eleven mouse miRNAs were elevated and two mouse miRNAs were reduced in muscles of MuSK + EAMG mice. Transient expression of miR-1933-3p and miR-1930-5p in mouse muscle (C2C12) cells revealed several downregulated genes, out of which five had predicted binding sites for miR-1933-3p. The mRNA expression of mitochondrial ribosomal protein L27 (Mrpl27) and Inositol monophosphatase I (Impa1) was reduced in miR-1933-3p transfected C2C12 cells compared to control cells (p = 0.032 versus p = 0.020). Further, transient expression of miR-1933-3p reduced Impa1 protein accumulation in C2C12 cells. These findings provide novel insights of dysregulated miRNAs and their intracellular pathways in muscle tissue afflicted with MuSK + EAMG, providing a possible link to mitochondrial dysfunction and muscle atrophy observed in MuSK + MG.

Har alla barn i grundskolan förutsättningar att klara nya läroplanens krav?

Pupils in the 6th grade of compulsory schools (age 11-12 years) in representative municipalities in Sweden, participated in a study of cognitive capacity and "neurodevelopmental functioning" in relation to the new Swedish educational goals, set up by the National Agency for Education. Results from four subtests of the WISC-IV, the ESSENCE-Questionnaire, covering concerns regarding different developmental areas, information about educational support and about final subject grades were analysed. Of a total of 396 pupils, 229 (58%) agreed to participate. Pupils who had failed at least one subject had significantly lower cognitive test results and significantly more ESSENCE concerns, compared to those who passed in all subjects. In the group of pupils who had at least one failed subject, 89% had been given special educational support. The knowledge requirements in the new national curriculum need to be reviewed and adapted to these circumstances.

Adolescents with type 1 diabetes mellitus and attention-deficit/hyperactivity disorder require specific support from healthcare professionals.

AIM: Managing type 1 diabetes mellitus requires efficient cognitive and executive skills, and adolescents who have attention-deficit/hyperactivity disorder (ADHD) may face specific challenges. This study explored young people's experiences of diabetes treatment and care. METHOD: In a population-based study, comprising 175 patients aged 5-16 years with type 1 diabetes mellitus in two Swedish counties, we found that eight also met criteria for ADHD. Six of these, aged 14.5-16 years, participated 2013-2014 in interviews that targeted aspects of their diabetes treatment. Conducted by two psychologists, these used the inductive qualitative, semi-structured interview format. RESULTS: The two boys and four girls all reported difficulties in creating routines for their diabetes treatment and that problems were aggravated during stress. They had been criticised by their parents and the diabetes team when their blood levels indicated inadequate diabetes control. They requested ongoing information, involvement of their friends, group meetings and easy access to the healthcare system during difficult times. CONCLUSION: Patients with type 1 diabetes mellitus and concomitant ADHD faced problems with their diabetes management, especially during stressful situations. Diabetes care provision should pay particular attention to patients with co-existing neuropsychiatric and neurodevelopmental disorders such as ADHD.

Adaptive skills are useful for evaluating the effect of pharmacological treatment in children with attention-deficit/hyperactivity disorder.

AIM: There are few long-term studies of adaptive functions as an outcome measure of pharmacological treatment in attention-deficit/hyperactivity disorder (ADHD). This study assessed the adaptive abilities of children with ADHD before and after several years of pharmacological treatment. METHOD: We studied 12 children with a mean age of 15 years - seven boys and five girls - who had continued pharmacological treatment for ADHD for more than four years. The Adaptive Behaviour Assessment Scales - Second Edition ratings by their teachers were compared before and after they had received treatment for ADHD. RESULTS: On a group level, the conceptual, practical and general adaptive composite domains improved significantly between the baseline and follow-up study. There were clear individual variations: more than half of the group increased from an adaptive level far below average to average, a minority displayed no major changes, and one individual deteriorated. The girls tended to have better outcomes than the boys. CONCLUSION: This study was nonrandomised and only analysed within-group changes in a small number of participants. However, the findings suggest that four to five years of stimulant treatment had markedly positive effects on adaptive functioning in more than half of the school-age children with ADHD.

Physical exercise in myasthenia gravis is safe and improves neuromuscular parameters and physical performance-based measures: A pilot study.

INTRODUCTION: Due to the shortage of exercise-related research in Myasthenia Gravis (MG), there are no consensus guidelines on physical exercise for MG patients. METHODS: In this prospective pilot study, 10 MG patients with mild disease performed supervised aerobic and resistance training twice weekly for 12 weeks. The Myasthenia Gravis Composite (MGC) score, compound motor action potential (CMAP), repetitive nerve stimulation, muscle force, physical performance-based measures, serum levels of interleukin-6, muscle enzymes, and immuno-microRNAs miR-150-5p and miR-21-5p were assessed before and after the training period. RESULTS: Physical exercise was well tolerated, and the MGC score was unchanged. Muscle resistance weights and CMAP amplitudes increased for biceps brachii and rectus femoris muscles, and physical performance-based measures improved. Muscle enzymes remained normal, whereas disease-specific microRNAs miR-150-5p and miR-21-5p were reduced after the training period. CONCLUSIONS: We propose that general recommendations regarding physical exercise can be applied safely to well-regulated MG patients. Muscle Nerve 56: 207-214, 2017.

A register study of life events in young adults born to mothers with mild intellectual disability.

BACKGROUND: Young adults, born to population-representative mothers with intellectual disability (ID), were targeted for psychosocial/life event follow-up. METHODS: The whole group originally comprised 42 individuals but 3 had died and 1 had moved abroad. The remaining 38 were approached and 10 consented to participate in an interview study. However, of the remaining 28, it was not possible to establish contact with 21 who were instead searched for in various official registers. RESULTS: Most (n = 18) individuals in the study group had been in contact with different authorities and clinics. Of the 21 individuals, 10 had contact with social services since childhood and 4 of these had been taken into care (foster family) and 6 had had contact families during childhood. One individual had been taken into a treatment centre and one grew up mainly with the father. Altogether 12 (57%) of 21 individuals did not grow up full-time with their biological mother. Twelve (57%) had major neurodevelopmental/neuropsychiatric conditions, including five with ID and seven with attention-deficit hyperactivity disorder (ADHD). Four individuals were registered within the Prison and Probation Service due to various types of crimes. CONCLUSION: Individuals born to mothers with ID in our study group were at high risk of adverse experiences and negative outcomes, such as increased childhood mortality, a relatively large proportion of children taken into care, high rates of ID and ADHD in the children and of criminality in young adulthood. Taken together with the results obtained in an in-depth interview study of those in the originally targeted sample with whom it was possible to obtain contact, the present findings suggest that it will be important to provide early support and longitudinal developmental follow-up in groups of children growing up with a mother with ID. Children in this situation appear to be at a number of risks, probably related both to hereditary factors and to social disadvantage.

An interview study of young adults born to mothers with mild intellectual disability.

A group of 10 young adults from a population-based series in Sweden, of originally 42 individuals, born to mothers with mild intellectual disability (ID), were interviewed with regard to their experiences during childhood, adolescence, and their current situation. The interview revealed that 6 of the 10 individuals had been removed from their biological parents during childhood, 6 reported clear child abuse and/or neglect, and 6 individuals had mild ID. The majority of the individuals reported difficulties in their relations with family and in school. The small number of participants (n = 10) who could be personally interviewed reflected the major problems that were encountered in the process of making contact with this group of young individuals. In conclusion, this study adds to other reports that children of mothers with ID constitute an extremely vulnerable group. Therefore, these families need full and continuous attention from the supportive systems in society.

Mild intellectual disability and ADHD; a comparative study of school age children's adaptive abilities.

AIM: To compare adaptive functioning in children with mild intellectual disability (MID) with that of children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Thirty-three children with MID were contrasted with 27 children with ADHD with regard to adaptive functioning as measured by the Adaptive Behaviour Assessment System (ABAS-II). The group with MID was population-based, and the group with ADHD was considered representative of a clinically referred group with that diagnosis. The two groups were subdivided into those ≤11 years and those ≥12 years. RESULTS: The group with ADHD had lower adaptive functioning, but differences were not significant at total group levels. In children 12 years or older, the group with ADHD had significantly lower adaptive functioning. CONCLUSION: Older children with ADHD had poorer adaptive functioning than those with MID, a finding which should be of interest to school and other authorities mapping out education and intervention plans for children with special needs.

ADHD and other associated developmental problems in children with mild mental retardation. The use of the "Five-To-Fifteen" questionnaire in a population-based sample.

The aim was to examine the rates and types of parent reported neuropsychiatric problems in children and adolescents with mild mental retardation (MMR) (mild intellectual disability/UK) using the Five-To-Fifteen questionnaire (FTF). The target group comprised all pupils with clinically diagnosed MMR, aged between 7 and 15 years, attending the special schools for children with MMR in two municipalities in a region in the South-West of Sweden. The FTF is a 181-item parent questionnaire with age and gender specific Swedish norms covering eight domains, including the phenomenology of early symptomatic syndromes eliciting neurodevelopmental examinations (ESSENCE), including ADHD, autism, tic syndromes, and various kinds of language, memory, and learning problems. Parents of 63% (39/62) of the eligible target group completed the FTF. After scrutiny of the medical records, 6 of the 39 children were found not to meet criteria for MR. Scores exceeding the 90th centile of the norm group were considered indicative of neuropsychiatric problems. Such high scores are strongly associated with clinically valid ESSENCE/neuropsychiatric disorders. All the examined children with validated MR were reported by their parents to have learning problems. There were very high rates of problems reported in all the other seven FTF domains: perception (88%), language (79%), social skills/autism (76%), memory (67%), emotional problems (58%), motor skills (55%) and executive functions/ADHD (55%). School age children with MMR are all in need of a comprehensive work-up covering not only general cognitive abilities, but also many other areas, including motor skills, executive function/attention, social and emotional/behavioural symptoms/functioning. Such broad assessment (including child screening by parent report with the FTF) will enable a better basis for understanding their special needs of support through life.