Introduction: Patients with autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) show more symptoms of ADHD. Since there are more adverse events caused by psychostimulants compared to non-psychostimulants, the use of a non-psychostimulant such as atomoxetine might prove more beneficial for younger patients and/or those with comorbid ADHD. Objective: The aim of this thesis is to determine the efficacy and tolerability of atomoxetine in ASD patients presenting with ADHD, by examining (a) differences in ADHD symptoms for participants receiving atomoxetine versus those receiving placebos, and (b) risk differences in adverse events between these participants. Methods: An electronic search of both PubMed.gov and ClinicalTrials.gov were conducted. To be deemed eligible, studies had to (a) be randomized, double-blind, placebo-controlled trials comparing atomoxetine with a placebo, (b) administer atomoxetine for at least 1 week, and (c) include data on either ADHD outcomes or adverse events. Effect sizes for ADHD outcomes were calculated using Cohen's d, whereas risk differences were calculated for adverse events. For each of these two meta-analyses, effect sizes were aggregated across studies using a random effects method. Results: Overall ADHD outcomes were better for participants who received atomoxetine than for participants who received placebo, =0.297. Participants who received atomoxetine also demonstrated better outcomes in terms of attention and hyperactivity-impulsivity symptoms, =0.345 and 0.393, respectively. Though there were more adverse events for patients taking atomoxetine than placebo, the results were not statistically significant. Discussion: This thesis extends the findings of previous meta-analyses of pharmacological treatments for ASD and ADHD, while addressing the concerns raised in the critique of existing meta-analyses presented in this thesis, e.g., limited studies, length of treatment weeks, and dichotomization of data. It provides evidence that atomoxetine improves ADHD symptoms, with an overall frequency of adverse events that did not sufficiently differ from placebo beyond chance.

Background: Global health is a complex, interdisciplinary, and contested field. It is rapidly growing and undergoing ideological and methodological changes. Despite many theoretical claims over what global health research ought to be, there are few empirical reports on what global health is, as a present field of research. The aim of this study is to: 1) determine patterns in global health research, based on key research characteristics; and 2) determine relationships between these characteristics to identify and define conceptual frameworks in global health research. Methodology: A systematic review of research in global health journals was conducted for papers published in the years 2010, 2015, and 2020. Categorical data on 17 research characteristics was extracted from all studies included in the analysis. The relationships between these characteristics was analyzed and visualized using multiple correspondence analysis, as implemented in the R’s ca package. Significance tests of independence determined relationships between pairs of variables. Results: The final analysis was done on 1033 included studies from 14 journals. 56% of the studies used a quantitative observational methodology. While 82% of research had at least one author affiliated with a high-income country, 96% of research funded (at least partially) by the Bill & Melinda Gates Foundation had at least one author affiliated with a high-income country. There was a significant relationship between the use of social and structural determinants of health and the authors’ affiliations (X2=59.06, p < 0.001), with the use of social and structural determinants of health lower among lower-income authors than high-income authors. The first and second dimensions of multiple correspondence analysis explained 38% of the variables’ deviation from independence. Conclusion: Multiple correspondence analysis offers a novel way of understanding global health research, contributing empirical data to the discourse on what lies ahead for the field of global health. The relationship between the use of social and structural determinants of health, authorship, and research methodologies point to the need for important conversations on the direction of global health research, starting from where we are at now. / Thesis / Master of Science (MSc) / While the importance of the field of global health is more prominent than ever, it is a field of uncertainty, controversy, contested merit, and often disreputable history. Conversations abound on the strengths and weaknesses of the field and what needs to change; yet, there is a lack of empirical grounding for these discussions. In this study, I reviewed global health research literature, identifying 17 key characteristics that surface in theoretical conversations on global health, and scored 1033 global health research studies according to these characteristics. Using multiple correspondence analysis, the 17 characteristics were analyzed together and visualized to elucidate the relationships between the characteristics. I found that: over half of the studies were quantitative observational; most research in global health had at least one author from a high-income country; and middle-income authors were less likely to study social and structural determinants of health than high-income authors. These findings lend important empirical evidence to conversations on the direction of the field, starting from where we are at now.

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SAMMANFATTNING  Bakgrund: Muskuloskeletal smärta är en av de främsta orsakerna till både sjukskrivning och hälso- och sjukvårdskonsumtion i de flesta västerländska samhällen. Muskuloskeletal smärta definieras som smärta i rörelseorgan såsom muskler, leder, skelettdelar eller tillhörande mjukdelar. I behandling av muskuloskeletal smärta ingår ofta fysisk aktivitet. Fysisk aktivitet definieras, som all kroppsrörelse som ökar energiförbrukningen utöver den energiförbrukning som vi har i vila. För att fysisk aktivitet skall ha önskad effekt krävs följsamhet till den fysiska aktiviteten.  Syfte: Syftet är att med hjälp av andra studiers resultat sammanställa effekt av interventioner vars syfte är att öka följsamhet till behandling med fysisk aktivitet hos patienter med muskuloskeletal smärta.  Metod: Systematisk litteraturstudie. Sökning genomfördes i databaserna PUB Med, CINAHL, AMED och PEDRO. Artiklarna granskades med mall för kvalitetsgranskning av randomiserade studier samt att en GRADE bedömning utfördes med bedömningsunderlag från Statens beredning för medicinsk och social utvärdering (SBU).  Resultat: Vid litteratursökning återfanns 514 artiklar som motsvarade syfte och frågeställningar. Efter genomgång av titel samt abstract fanns 38 artiklar kvar, efter genomläsning av hela studien fanns 10 artiklar kvar som inkluderades i litteraturstudien.De 10 artiklarna hade varierande grad av kvalitet. Ingen av studierna hade fullgod kvalitet på samtliga delar som ingår vid kvalitetsgranskningen. Evidensgradering enligt GRADE visar måttligt underlag för beteendemedicinska interventioner för att öka följsamheten till fysisk aktivitet för vuxna patienter med muskuloskeletal smärta.  Konklusion: Denna litteraturstudie visar ett svagt sambandavseende om beteendemedicinska interventioner kan öka följsamhet till fysisk aktivitet hos vuxna med muskuloskeletal smärta. Vid stödjande aktiviteter fann man inte någon positiv effekt på följsamhet till fysisk aktivitet hos vuxna patienter med muskuloskeletal smärta. / ABSTRACT  Background: Musculoskeletal pain is one of the leading causes of both sick leave and health care consumption in most western societies. Musculoskeletal pain is defined as pain in organs such as muscles, joints, skeletal parts or associated soft tissues. Treatment of musculoskeletal pain often includes physical activity. Physical activity is defined as all body movement that increases energy consumption in addition to the energy consumption we have at rest. In order for physical activity to have the desired effect, compliance with the physical activity is required.  Objective: The aim is to use the results of other studies to compile the effect of interventions whose purpose is to increase adherence to treatment with physical activity in patients with musculoskeletal pain. Methods: Systematic review. The search was conducted in the databases PubMed, CINAHL, AMED and PEDRO. The studies were assessed according to template for quality review of randomized studies and GRADE from Statens beredning för medicinsk och social utvärdering.  Results: A literature search found 514 articles that corresponded to purpose and issues. After reviewing the title and abstract, there were 38 articles left, after reading the entire study, there were 10 articles left that were included in the literature study. The 10 articles had varying degrees of quality. None of the studies had full quality on all parts included in the quality review. Evidence grading according to GRADE shows a moderate basis for behavioral medicine interventions to increase adherence to physical activity for adult patients with musculoskeletal pain.  Conclusion: This literature study shows a weak correlation regarding whether behavioral drug interventions can increase adherence can increase adherence to physical activity in adults with musculoskeletal pain. In supportive activities, no positive effect was found on compliance with physical activity in adult patients with musculoskeletal pain.

Background: Canada continues to face an opioid epidemic with 5,368 opioid apparent related deaths occurring between January and September of 2021. Methadone Maintenance Treatment (MMT), a form of Medication Assisted Treatment used to treat Opioid Use Disorder (OUD), has been reported to decrease opioid cravings and opioid use, however, individual differences exist in the effective dose of methadone. Further, individuals living with an OUD have higher rates of substance use including cannabis. A genetic component has been suggested to exist for both cannabis use and MMT outcomes, however inconsistent findings have been reported. Methods: Knowledge synthesis and primary genetic association studies were conducted. A protocol was prepared for the planning of a systematic review for Genome-Wide Association Studies (GWASs) of cannabis use. The full systematic review was then conducted, providing an assessment of the literature and a description of studies quality. A GWAS and Polygenic Risk Score (PRS) was then conducted for cannabis use and MMT outcomes, separately, in Europeans only. The top Single Nucleotide Polymorphisms (SNPs) were then analyzed separately by sex and sex interactions were conducted. Results: The systematic review included 6 studies, identifying 96 genetic variants associated with cannabis use. The GWASs for both cannabis use and MMT outcomes did not identify any significant results. A significant PRS was found for regular cannabis use and methadone dose. No sex-specific results were identified. Discussion: This thesis summarised the evidence on the genetics of cannabis use as well as employed GWASs and PRSs to investigate cannabis use and MMT outcomes within a European population. We were able to highlight gaps within the genetic literature of cannabis and MMT outcomes as well as identify areas of interest for future research. / Dissertation / Doctor of Philosophy (PhD) / Cannabis use rates in Canada are increasing, with Opioid Use Disorder (OUD) patients having high rates of cannabis use despite inconsistent findings on the impacts. To combat the opioid crisis, Methadone Maintenance Treatment (MMT) is utilized to reduce opioid cravings and use. However, individuals on MMT are likely to use other substances, including cannabis. This thesis explores the genetic literature on cannabis use and conducts a Genome-Wide Association Study (GWAS) and a Polygenetic Risk Score (PRS). The GWAS investigates genetic variants throughout the whole genome associated with a trait, while the PRS creates a genetic weight risk score. GWAS and PRS methods were used to investigate cannabis use and MMT outcomes within Europeans with OUD. While no significant GWAS results were found, a statistically significant PRS was found for regular cannabis use and methadone dose, suggesting each respective score can estimate an individual’s risk of that trait.