A Descriptive Study of the Caregiver's Experience of Managing Care for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder During the COVID-19 Pandemic: The UNCOVER Study

Objective: To assess the perceived impact of the COVID-19 pandemic on treatment and quality of life for children and adolescents in the United States who have attention-deficit/hyperactivity disorder (ADHD).

Methods: An online survey of members of PatientsLikeMe was conducted via the health-tracking platform between March 10 and April 2, 2021. Participants were adult caregivers of dependents aged 6-18 years with diagnosed ADHD and who were taking or not taking prescription medication for ADHD.

Results: The study enrolled 37 adult caregivers of 37 children/adolescents; 36 caregivers responded to treatment questions for children/adolescents. Twenty were caregivers to dependents currently being treated for ADHD. Compared with before the pandemic, there was a decrease in the percentage of children/adolescents using prescription ADHD medication from 65% to 54% during the pandemic. At least 1 switch in ADHD medication and a dosage change were reported by 5 and 8 caregivers, respectively. Seven caregivers reported their dependents had had difficulty adhering to their medication regimen during the pandemic, which caregivers ascribed to a lack of a structured routine. Telehealth visits for their dependents were reported by 13 caregivers. None of the caregivers of dependents taking ADHD medication reported a major impact of the pandemic on ADHD-related medical care. Irrespective of treatment status, 17 caregivers reported that their dependents had ADHD management goals and agreed that the pandemic had a negative impact on progress toward those goals.

Conclusions: Many caregivers of children/adolescents with ADHD found it challenging to manage their dependents' symptoms and treatment during the pandemic.

Prim Care Companion CNS Disord 2024;26(1):23m03587.

Author affiliations are listed at the end of this article.

The Experience of Adults With Attention-Deficit/Hyperactivity Disorder in 2021 During the COVID-19 Pandemic: The UNCOVER Study

Background: This study surveyed adults with attention-deficit/hyperactivity disorder (ADHD) to understand the impact of the COVID-19 pandemic on aspects of their disorder, quality of life, and treatment experience.

Methods: A cross-sectional survey of US-resident members of PatientsLikeMe (PLM) was conducted through the PLM health tracking platform between March 10 and April 2, 2021. Adult participants with self-reported ADHD currently taking prescription medication (treated) and those not taking medication (untreated) were enrolled.

Results: The study included 93 adults, of whom 48 patients were taking medication for ADHD. Most of the 45 untreated patients were not taking medication for reasons unrelated to the pandemic. Of the 47 treated patients who also completed the survey, 22 patients had ≥ 1 switch in ADHD medication type, and nearly half had a dosage change during the pandemic. Further, 29 treated patients reported a negative impact of the pandemic on their daily ADHD medication routine, primarily due to a "lack of schedule" and "changes to structured routine," and 16 patients reported "increased difficulty" adhering to prescribed ADHD medication during the pandemic compared with before the pandemic. Of the total study population, 52 patients reported having a telehealth visit during the pandemic, and 38 patients had an ADHD management goal. All but 1 patient with an ADHD management goal reported a negative impact of the pandemic on progress toward their goal. More treated patients than untreated adults reported having control over bothersome ADHD symptoms.

Conclusions: Adults with ADHD reported increased difficulty in managing their symptoms during the COVID-19 pandemic.

Prim Care Companion CNS Disord 2023;25(4):22m03474.

Author affiliations are listed at the end of this article.

Design of a real-world, prospective, longitudinal, observational study to compare vortioxetine with other standard of care antidepressant treatments in patients with major depressive disorder: a PatientsLikeMe survey

BACKGROUND

Major depressive disorder (MDD) is a recurrent psychiatric condition that presents challenges in responding to treatment and achieving long-term remission. To improve outcomes, a shared decision-making treatment approach with patient and healthcare practitioner (HCP) engagement is vital. PatientsLikeMe (PLM), a peer community of patients, provides information on MDD, symptoms, and treatment through forums and resources, helping patients stay engaged in their treatment journey. Data on PLM can be harnessed to gain insights into patient perspectives on MDD symptom management, medication switches, and treatment goals and measures.

METHODS

This ongoing, decentralized, longitudinal, observational, prospective study is being conducted using the PLM platform in two parts, enrolling up to 500 patients with MDD in the United States aged ≥ 18 years to compare vortioxetine with other monotherapy antidepressants. The first qualitative component consists of a webinar and discussion forum with PLM community members with MDD, followed by a pilot for functionality testing to improve the study flow and questions in the quantitative survey. The quantitative component follows on the PLM platform, utilizing patient-reported assessments, over a 24-week period. Three surveys will be conducted at baseline and weeks 12 and 24 to collect data on patient global impression of improvement, depression severity, cognitive function, quality of life (QoL) and well-being, medication satisfaction, emotional blunting, symptoms of anhedonia and resilience, as well as goal attainment. Quantitative results will be compared between groups. The qualitative component is complete; patient recruitment is underway for the quantitative component, with results expected in late 2023.

DISCUSSION

These results will help HCPs understand patient perspectives on the effectiveness of vortioxetine versus other monotherapy antidepressants in alleviating symptoms of MDD and improvements in QoL. Data from the PLM platform will support a patient goal-based treatment approach, as results can be shared by patients with their HCPs, providing them with insights on patient-centric goals, treatment management and adherence, as well as allowing them to observe changes in patient-related outcomes scores. Findings from the study will also help to optimize the PLM platform to build scalable solutions and connectivity within the community to better serve patients with MDD.

Reduced dengue incidence during the COVID-19 movement restrictions in Sri Lanka from March 2020 to April 2021

Background

Dengue is the major mosquito-borne disease in Sri Lanka. After its first detection in January 2020, COVID-19 has become the major health issue in Sri Lanka. The impact of public health measures, notably restrictions on movement of people to curb COVID-19 transmission, on the incidence of dengue during the period March 2020 to April 2021 was investigated.

Methods

The incidence of dengue and COVID-19, rainfall and the public movement restrictions implemented to contain COVID-19 transmission were obtained from Sri Lanka government sources. A Seasonal Autoregressive Integrated Moving Average (SARIMA) model was used to predict the monthly dengue incidence from March 2020 to April 2021 for each of the country’s 25 districts based on five years of pre-pandemic data, and compared with the actual recorded incidence of dengue during this period. Ovitrap collections of Aedes larvae were performed in Jaffna city in the Jaffna district from August 2020 to April 2021 and the findings compared with similar collections made in the pre-pandemic period from March 2019 to December 2019.

Results

The recorded numbers of dengue cases for every month from March 2020 to April 2021 in the whole country and for all 25 districts over the same period were lower than the numbers of dengue cases predicted from data for the five years (2015–2019) immediately preceding the COVID-19 pandemic. The number of dengue cases recorded nationwide represented a 74% reduction from the predicted number of dengue cases for the March 2020 to April 2021 period. The numbers of Aedes larvae collected from ovitraps per month were reduced by 88.6% with a lower proportion of Ae. aegypti than Ae. albopictus in Jaffna city from August 2020 until April 2021 compared with March 2019 to December 2019.

Conclusion

Public health measures that restricted movement of people, closed schools, universities and offices to contain COVID-19 transmission unexpectedly led to a significant reduction in the reported numbers of dengue cases in Sri Lanka. This contrasts with findings reported from Singapore. The differences between the two tropical islands have significant implications for the epidemiology of dengue. Reduced access to blood meals and lower vector densities, particularly of Ae. aegypti, resulting from the restrictions on movement of people, are suggested to have contributed to the lower dengue incidence in Sri Lanka.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12726-8.

Augmented hamate replacement arthroplasty for fracture-dislocations of the proximal interphalangeal joints in 12 patients

We report clinical outcomes in 12 patients with hemi-hamate replacement arthroplasty combined with volar plate arthroplasty. The volar plate was reattached using trans-osseous sutures to reconstruct the ligament-box complex after hamate grafting to augment the stability of the proximal interphalangeal joint. Ten patients had improved joint movement from a mean of 14° before surgery to a mean of 77° at a minimum follow-up of 2 years. Grip strength and pain of the affected hand and patient-rated hand and wrist scores were improved in these 10 patients. Two patients had poor results. One patient developed ankylosis, and one patient had resorption of the grafted bone. We conclude that the augmented hamate replacement arthroplasty is useful in treating chronic proximal interphalangeal joint fracture-dislocations.

LEVEL OF EVIDENCE

IV.

Abstract LB-225: Combination immunotherapy targeting HSP90 DNA-repair client proteins overexpressed in chemotherapy-resistant melanoma

DNA repair protein (DNA-RP) overexpression has been reported to involve post-translational protein stabilization mediated by the molecular chaperone heat shock protein 90(HSP90), thereby preventing proteasome-dependent degradation of these HSP90 “client” proteins. Overexpression of DNA-RP in a disease-stage associated manner has also been correlated to chemo resistance and poor overall prognosis. Hence, HSP90 inhibitors (HSP90i) have been heralded as co-therapy agents for cancer patients that have developed resistance to first-line treatments such as temozolomide (TMZ). In the presence of HSP90i, HSP90 client proteins rapidly become (poly)ubiquinated and undergo degradation resulting in the improved sensitization of cancer cells to chemo therapy. We observed that HSP90i promote the proteasome-dependent degradation of a broad range of DNA-repair client proteins. We have also identified 9 H-2Kb/Db-presented peptide epitopes derived from DNA-RPs that may be recognized by Type-1 CD8+ T cells after specific vaccination. When combined with adoptive cell therapy using DNA-RP-specific CD8+ T cells, HSP90i cotreatment yielded superior anti-tumor efficacy against established TMZ-resistant B16 tumors in C57BL/6 mice.

Citation Format: Subhara Raveendran, Ronald Fecek, Cara Donahue Carey, Walter J. Storkus. Combination immunotherapy targeting HSP90 DNA-repair client proteins overexpressed in chemotherapy-resistant melanoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-225.

Targeting self-renewal pathways in cancer stem cells: clinical implications for cancer therapy

Extensive cancer research in the past few decades has identified the existence of a rare subpopulation of stem cells in the grove of cancer cells. These cells are known as the cancer stem cells marked by the presence of surface biomarkers, multi-drug resistance pumps and deregulated self-renewal pathways (SRPs). They have a crucial role in provoking cancer cells leading to tumorigenesis and its progressive metastasis. Cancer stem cells (CSCs) are much alike to normal stem cells in their self-renewal mechanisms. However, deregulations in the SRPs are seen in CSCs, making them resistant to conventional chemotherapeutic agents resulting in the tumor recurrence. Current treatment strategies in cancer fail to detect and differentiate the CSCs from their non-tumorigenic progenies owing to absence of specific biomarkers. Now, it has become imperative to understand complex functional biology of CSCs, especially the signaling pathways to design improved treatment strategies to target them. It is hopeful that the SRPs in CSCs offer a promising target to alter their survival strategies and impede their tumorigenic potential. However, there are many perils associated with the direct targeting method by conventional therapeutic agents such as off targets, poor bioavailability and poor cellular distribution. Recent evidences have shown an increased use of small molecule antagonists directly to target these SRPs may lead to severe side-effects. An alternative to solve these issues could be an appropriate nanoformulation. Nanoformulations of these molecules could provide an added advantage for the selective targeting of the pathways especially Hedgehog, Wnt, Notch and B-cell-specific moloney murine leukemia virus integration site 1 in the CSCs while sparing the normal stem cells. Hence, to achieve this goal a complete understanding of the molecular pathways corroborate with the use of holistic nanosystem (nanomaterial inhibition molecule) could possibly be an encouraging direction for future cancer therapy.

Immunotherapeutic targeting of HSP90 client proteins overexpressed in chemo-/radio-resistant melanoma (TUM2P.1012)

Amongst the numerous genetic alterations that occur in cancer cells, is overexpression of DNA repair proteins (DNA-RP) in a disease-stage associated manner which has also been correlated to chemo/radiotherapy (CRT) resistance and poor overall prognosis. DNA-RP overexpression has been reported to involve post-translational protein stabilization mediated by the molecular chaperone Heat shock protein 90(HSP90), thereby preventing proteasome-dependent degradation of these HSP90 “client” proteins. Hence, HSP90 inhibitors (HSP90i) have been heralded as co-therapy agents for cancer patients that have developed resistance to first-line treatments such as temozolomide (TMZ). Under conditions in which its function is blocked by HSP90i, HSP90 client proteins rapidly become (poly)ubiquinated and undergo degradation resulting in improved sensitization of cancer cells to CRT. We observed that HSP90i promote the proteasome-dependent (i.e. blocked by inhibitors PS-341 and MG-132) degradation of a range of DNA-repair client proteins. We have also identified H-2Kb/Db-presented peptide epitopes derived from these DNA-RPs that may be recognized by Type-1 CD8+ T cells after specific vaccination in C57BL/6 mice. We are currently investigating the capacity of HSP90i to conditionally sensitize melanoma cells to the tumoricidal action of CRT as well as CD8+ T cells reactive against overexpressed DNA-RP that constitute HSP90 client proteins.

Combination Immunotherapy of Melanoma by inhibiting HSP90 and targeting its client proteins. (TUM7P.934)

HSP90 plays a major role in human melanoma progression, by facilitating the over expression of its client proteins, many of which provide growth, survival and migratory advantages to tumor cells and support a pro-angiogenic tumor microenvironment. HSP90-mediated stabilization also limits the proteasome-dependent processing of client proteins and the subsequent presentation of derivative peptides in tumor cell-associated MHC class I complexes which is required for effective host CD8+ T cell recognition of melanoma cells. When considered in the combination of active vaccination, inhibiting HSP90 function might serve as a highly effective anti-tumor therapy. As a consequence, we analyzed the anti-tumor impact of a range of clinically-relevant HSP90 inhibitors (HSP90i; i.e. NVP-AUY922, STA9090, 17-DMAG, Novobiocin) on client protein expression in vitro (human and murine melanoma cell lines) and in vivo (s.c. B16 tumors established in syngenic C57BL/6 mice). We observed that HSP90i promote the proteasome-dependent (i.e. blocked by inhibitors PS-341 and MG-132) degradation of a range of client proteins. We have also identified H-2Kb/Db-presented peptide epitopes derived from these client proteins that may be recognized by Type-1 CD8+ T cells after specific vaccination. We are currently investigating the capacity of NVP-AUY922 and STA9090 to therapeutically sensitize established melanomas to client protein-specific CD8+ T cells in combination therapy approaches.

Use of HSP90 inhibitors in the combination immunotherapy of melanoma (P4272)

The molecular chaperone, HSP90 is commonly overexpressed in human melanomas, where it serves to stabilize a broad range of client proteins providing growth, survival and migratory advantages to tumor cells and conditions a pro-angiogenic tumor microenvironment (TME). HSP90-mediated stabilization also limits the proteasome-dependent processing of client proteins and the subsequent presentation of derivative peptides in tumor cell-associated MHC class I complexes which is required for effective host CD8+ T cell recognition of melanoma cells. As a consequence, we have analyzed the anti-tumor impacts of clinical-grade HSP90 inhibitors (i.e. STA9090, 17-DMAG, Novobiocin) on client protein expression in vitro (human melanoma cell line Mel526, murine melanoma cell line B16) and in vivo (s.c. B16 tumors in C57BL/6 mice). We observed that HSP90 inhibitors promote the proteasome-dependent (i.e. blocked by inhibitors PS-341 and MG-132) degradation of client proteins such as c-MET, EphA2, HER2/neu, PDGFRβ and Survivin, with STA9090 appearing to be most efficient on a molar basis. We are currently investigating the capacity of STA9090 to therapeutically sensitize established melanomas to client protein-specific CD8+ T cells (induced by active vaccination or provided via adoptive cell transfer; ACT) in combination therapy approaches. We believe such protocols may hold translational promise for the treatment of patients with advanced-stage melanoma.