RESUMEN
Numerous prospective studies have shown that children diagnosed with attention deficit/hyperactivity disorder (ADHD) are at higher risk of long-term substance abuse/dependence. However, there are three important limits to these studies: (a) most did not differentiate the role of hyperactivity and inattention; (b) most did not control for associated behavioral problems; and (c) most did not consider females. Our aim was to clarify the unique and interactive contributions of childhood inattention and hyperactivity symptoms to early adulthood substance abuse/dependence. Behavioral problems of 1803 participants (814 males) in a population-based longitudinal study were assessed yearly between 6 and 12 years by mothers and teachers. The prevalence of substance abuse/dependence at age 21 years was 30.7% for nicotine, 13.4% for alcohol, 9.1% for cannabis and 2.0% for cocaine. The significant predictors of nicotine dependence were inattention (odds ratio (OR): 2.25; 95% confidence interval (CI): 1.63-3.11) and opposition (OR: 1.65; 95%: 1.20-2.28). Only opposition contributed to the prediction of cannabis dependence (OR: 2.33; 95% CI: 1.40-3.87) and cocaine dependence (OR: 2.97; 95% CI: 1.06-8.57). The best behavioral predictor of alcohol abuse/dependence (opposition) was only marginally significant (OR: 1.38; 95% CI: 0.98-1.95). Frequent oppositional behaviors during elementary school were clearly the most pervasive predictors of substance abuse/dependence in early adulthood. The association of childhood ADHD with substance abuse/dependence is largely attributable to its association with opposition problems during childhood. However, inattention remained an important predictor of nicotine dependence, in line with genetic and molecular commonalities between the two phenotypes suggested in the literature.
Asunto(s)
Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Atención , Hipercinesia/complicaciones , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto , Déficit de la Atención y Trastornos de Conducta Disruptiva/complicaciones , Estudios de Casos y Controles , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Pronóstico , Factores de Riesgo , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
In cohort studies, variables are measured repeatedly and can be considered as trajectories. A classic way to work with trajectories is to cluster them in order to detect the existence of homogeneous patterns of evolution. Since cohort studies usually measure a large number of variables, it might be interesting to study the joint evolution of several variables (also called joint-variable trajectories). To date, the only way to cluster joint-trajectories is to cluster each trajectory independently, then to cross the partitions obtained. This approach is unsatisfactory because it does not take into account a possible co-evolution of variable-trajectories. KmL3D is an R package that implements a version of k-means dedicated to clustering joint-trajectories. It provides facilities for the management of missing values, offers several quality criteria and its graphic interface helps the user to select the best partition. KmL3D can work with any number of joint-variable trajectories. In the restricted case of two joint trajectories, it proposes 3D tools to visualize the partitioning and then export 3D dynamic rotating-graphs to PDF format.
Asunto(s)
Algoritmos , Estudios de Cohortes , Programas Informáticos , Análisis por Conglomerados , HumanosRESUMEN
INTRODUCTION: Pathological gambling is characterized in the DSM IV-TR as one of the disorders of impulse control. Problem gambling is also part of what is considered as behavioural addictions, the criteria of which have been defined by Goodman, with intrusive thoughts about the game, spending more and more to play, unable to control, reduce or stop gambling despite negative consequences, etc. AIM OF THE STUDY: There is no epidemiological study in France on the prevalence of pathological gambling. We wanted to study the prevalence of pathological gambling in a sample of 529 persons: 368 gamblers of Pari Mutuel Urbain and La Française des Jeux, and 161 persons in the general population. The study took place between January 2008 and June 2009. METHODS: As instruments, we used: the South Oaks Gambling Scale (SOGS) for screening of pathological gambling and the BIS-10 for impulsiveness' evaluation, the HAD scale to assess anxiety and depression and the ASRS for the evaluation of attention deficit disorder/hyperactivity disorder (ADHD). RESULTS: The rate of pathological gambling in the general population is 1.24% (this result is similar to those found in other places, such as in Quebec). In the general population, the rate of play at risk is of 5.59%. Among the population of gamblers, the rate for pathological gambling (JP) amounted to 9.23% and risk gambling to 10.86%. Men are overrepresented in the group of pathological gamblers (88.9%), also with consumption of alcohol and tobacco. Suicide attempts are more important than in the general population, but the difference was statistically significant. Depression and anxiety are particularly high, 40% of gamblers with an anxiety score significantly higher. DISCUSSION: The results indicate rates close to those of other countries, such as Canada. It would be necessary to establish follow-up studies of populations and patients, as well as specific studies on people who frequent casinos, racetracks and internet gambling. The importance of the phenomenon is obvious, because almost 20% of players have a gambling problem or risk and these people do not consult despite their psychological problems, family, work, debts.