Nitya Jayaram-Lindström

The number of people diagnosed with autism spectrum disorder (ASD) in childhood or adulthood has strongly increased over the past decades. While research demonstrates that people with ASD are at risk of adverse health outcomes including preterm mortality, scientific knowledge on the pathways leading to adverse health outcomes and an increased health care consumption, along with the effectiveness of different pharmacotherapies, is limited.The overall aim is to characterize pathways to increased health care consumption and adverse health outcomes in individuals with ASD diagnosed in childhood, as compared to those diagnosed in adulthood, and to examine the influence of various individual factors as well as treatment effectiveness in lowering the risk of adverse health outcomes and elevated health care needs.Data and method: The studies build on linked register data in Sweden and Finland. The study populations in Sweden include 84,012 individuals diagnosed with ASD during 2003-2018 as well as two comparison groups: 1) individuals from the general population

and 2) full-siblings. Cutting edge methodology such as network- and machine learning models as well as novel methods in pharmacoepidemiology will be applied. The five-year project involves interdisciplinary collaboration including clinicians and epidemiologists.This project provides crucial scientific knowledge necessary to design optimal health care and pharmacological treatment for patients with ASD.

Research problem and specific questionsProblem gambling (PG) is considered a serious public health concern, with approximately 2% of the adult population estimated to have gambling problems. For every person with PG, an additional six persons are negatively affected, which goes to demonstrate the severity of the problem for the individual, for the immediate family and society. The consequences of problem gambling are often economically and psychologically dire for those affected.There are evidence-based treatments, such as cognitive behavioral therapy (CBT) for PG, but treatment-seeking is generally low. Problem gamblers tend to seek treatment when gambling has become unmanageable and has already led to a life crisis. This calls for evaluation and implementation of more effective measures at an earlier stage, to prevent the development of PG and to mitigate its consequences.The Swedish National Gambling Helpline offers support and advice through telephone, chat and via their website. As a part of responsible gambling measures required by Swedish law, gambling operators often refer customers to the helpline, both through their gambling products, websites, and advertisements.Data and methodThe needs and experiences of gamblers and CSOs will be evaluated in both a survey study, and an interview study. After that, three screening based interventions will be evaluated in a pragmatically randomized study.Plan for project realizationWe will utilize the only existing national service for problem gamblers, the National Gambling Helpline, and its website in Sweden, to reach gamblers and their concerned significant others (CSOs). The website is visited by a large number of gamblers and CSOs. For the interview study, and the survey study, we will recruit gamblers and CSOs through advertisements on the helpline’s website.The evaluation of the screening based interventions will be integrated on the helpline’s website, thereby providing automatic randomization when the participants choose to test their gambling habits. Subsequently, we will monitor the participants for one year.Societal relevance and utilisationThis will be the first study that evaluates the general referral of people to the Swedish National Gambling Helpline. By offering early interventions in this population, it is possible to prevent an escalation of gambling problems, and its negative consequences on mental health, CSOs, and other gambling-related harms.

Research problem and specific questionsWorldwide increases in longevity and falling fertility rates have created significant demographic transformations in society. As a consequence, the proportion of older adults (defines as &gt

65 years) in the world is greater than ever before. We purport to develop an accessible, preventive intervention that can be delivered to older adults with early, subclinical/mild symptoms of varying forms of mental health problems. When developed, it could be easily implemented in primary care, in geriatric clinics and all other sites frequented by older adults, whether in India or Sweden.Research questions are:Is the culturally adapted digital intervention Healthy Ageing with Mental Health safe and feasible to use among older adults in Sweden and India?What is the experience of older adults in Sweden and India using the digital intervention?What preliminary effect does the digital intervention have on outcomes (e.g. quality of life, depression, anxiety, sleep problems, alcohol use, somatic health)?Data and methodWe propose to develop and systematically evaluate the digital intervention Healthy Ageing with Mental Health which aims to provide psychoeducation and prevention of common mental health problems among older adults in Sweden and India. Plan for project realisationThe intervention will be based on cognitive behavior therapy and consist of four weekly self-help modules focusing on 1) low mood 2) anxiety and somatic symptom preoccupation, 3) sleep and circadian rhythm and 4) addictive habits (including use of prescription medications). Psychoeducation about the importance of physical activity, nutrition and how these may interact with mental health problems will be an integral part of the intervention, as will information about ageism.RelevanceThe intervention developed in this project will address not one but several common mental health problems among older adults. The bilateral aspect of the project will provide further important insights into how digital interventions may be adapted to older adults in both collectivist and individualistic cultures, where one central difference is the view on older adults.

Attention deficit hyperactivity disorder (ADHD) is a common co-morbidity in substance use disorders (SUD) that negatively impacts the course of the SUD. Opioid antagonists such as naltrexone (NTX) are useful in the treatment of opiate and alcohol dependence, and, as shown recently by our group, also for amphetamine dependence. Recommended pharmacotherapy for ADHD includes central stimulants but clinicians are reluctant to prescribe these due to lack of data on their efficacy and safety in ADHD/SUD. This study investigates if extended release (XR)NTX (380 mg) reduces drug use in individuals with SUD also concurrently receiving central stimulant pharmacotherapy for ADHD. Participants meet DSM-5 criteria for SUD and ADHD. Alcohol, stimulant and opioid use disorder will all be included to increase the ecological validity. Hypothesis: XR-NTX will increase the percentage of drug negative samples in urine (incl alcohol biomarker EtG), increase the retention in treatment and improve the clinical condition of patients. Design: double-blind, randomized, placebo controlled, 12 weeks treatment + 12 weeks follow-up with continuous supervised urine testing, females/males

n=128 [see protocol for power calculation]. Twice weekly supervised urine test (24 weeks) and contingency management. Primary outcome: ITT analysis of the proportion of urine samples free of drugs and alcohol biomarker [THC analyzed separately]

missing tests defined as positive. EudraCT 2016-004710-95

Ethics 2020-00558.