Parent coaching intervention for children with suspected autism spectrum disorder: Cost analysis

BackgroundParent coaching interventions for young children suspected of having autism spectrum disorder (ASD) have shown promise. The objectives were to measure the costs of parent coaching and the pre-diagnosis utilization of services and treatments related to autism and to compare costs between families who received parent coaching (PC) and those who received enhanced community treatment (ECT).MethodsThis analysis was conducted prospectively alongside a randomized comparative effectiveness trial of a PC intervention in British Columbia, Canada. Twenty-four participants were randomly assigned to the PC group and received 24 weeks of coaching support and 25 participants were assigned to the ECT group. Families in both groups also received health, education and community services. Parent-reported service utilization was collected for the 6 months prior to initiation of parent coaching and for the period coinciding with receipt of one of the two interventions. Services were costed from the public payer (i.e., provincial government) and societal perspectives; the latter included out-of-pocket family costs, parental time losses due to caregiving, and public payer costs.ResultsFamilies in the PC group used fewer services than did those in the ECT group. The estimated incremental mean cost per family over two time periods for PC compared to ECT was $2515 CAD (95% CI: − 1302, 5071) from the public payer perspective and $6994 CAD (95% CI: − 4395, 19,299) from the societal perspective.ConclusionsThe findings can be used to inform funding and policy decision-making to enhance the treatment options available for young children awaiting an ASD diagnosis.     

The impact of adverse childhood experiences on obesity and unhealthy weight control behaviors among adolescents

BackgroundChildhood abuse and other early-life stressors associate with being overweight or obese later in life. In addition to being overweight, unhealthy weight control behaviors (e.g., vomiting, using diet pills, fasting, and skipping meals) have been shown to be common among adolescents. To our knowledge, the association between these behaviors and adverse childhood experiences (ACEs) remains unexamined.MethodsWe examined the association of ACEs to body mass index (BMI) and unhealthy weight control behaviors among 449 Finnish adolescents aged 12 to 17 years admitted to an acute psychiatric hospital unit between April 2001 and March 2006. We used the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) and the European Addiction Severity Index (EuropASI) to obtain information about ACEs, psychiatric diagnoses and weight control behaviors. BMI was calculated using the weight and height measured for each adolescent upon admission.ResultsGirls who experienced sexual abuse were more likely to be obese (OR: 2.6; 95% CI: 1.1–6.4) and demonstrate extreme weight loss behaviors (EWLB) (OR: 2.2; 95% CI: 1.0–4.7). Among girls, parental unemployment is associated with an increased likelihood of obesity (OR: 3.5; 95% CI: 1.2–9.6) and of being underweight (OR: 3.6; 95% CI: 1.1–11.6). A proneness for excessively exercising was found among girls who had witnessed domestic violence (OR: 3.5; 95% CI: 1.4–9.2) and whose parent(s) had died (OR: 5.4; 95% CI: 1.1–27.7).ConclusionThis study showed that female adolescents with a history of traumatic experiences or difficult family circumstances exhibited an elevated likelihood of being obese and engaging in unhealthy weight control behaviors.     

Polyunsaturated fatty acid supplement alleviates depression-incident cognitive dysfunction by protecting the cerebrovascular and glymphatic systems

IntroductionDepression, the most prevalent mood disorder, has high comorbidity with cerebrovascular disease and cognitive decline. However, there is little understanding of the cellular mechanisms involved in depression and its comorbid cerebrovascular damage and cognition impairment. Here, we tested the prediction that the chronic unpredictable mild stress (CUMS) mouse model would manifest in disturbed glymphatic function and that dietary supplementation with polyunsaturated fatty acids (PUFA) could ameliorate these deficits while alleviating the depression-associated cognitive decline.MethodsTo test the treatment effects of PUFA or Es on behaviours, we applied the tail suspension, open field, and sucrose preference tests to assess depressive symptoms, and applied the Morris water maze test to assess cognition in groups of control, chronic unpredictable mild stress (CUMS), PUFA, and escitalopram (Es) treatment. We measured the extracellular concentrations of dopamine (DA), 5-hydroxytryptamine (5-HT) and noradrenaline (NA) in microdialysates from prefrontal cortex (PFC) by liquid chromatography mass spectrometry. Glia cells and inflammatory factors were analysed with fluorescent immunochemistry and western blot, respectively. We tested brain vasomotor function with two-photon and laser speckle imaging in vivo, and measured glymphatic system function by two-photon imaging in vivo and fluorescence tracer imaging ex vivo, using awake and anesthetized mice. Besides, we monitored cortical spreading depression by laser speckle imaging system. AQP4 depolarization is analysed by fluorescent immunochemistry and western blot.ResultsWe confirmed that CUMS elicited depression-like and amnestic symptoms, accompanied by decreased monoamines neurotransmitter concentration in PFC and upregulated neuroinflammation markers. Moreover, CUMS mice showed reduced arterial pulsation and compliance in brain, and exhibited depolarized expression of AQP4, thus indicating glymphatic dysfunction both in awake and anesthetized states. PUFA supplementation rescued depression-like behaviours of CUMS mice, reduced neuroinflammation and cerebrovascular dysfunction, ultimately improved cognitive performance, all of which accompanied by restoring glymphatic system function. In contrast, Es treatment alleviated only the depression-like behavioural symptoms, while showing no effects on glymphatic function and depression-incident cognitive deficits.ConclusionsThe CUMS depression model entails suppression of the glymphatic system. PUFA supplementation rescued most behavioural signs of depression and the associated cognitive dysfunction by restoring the underlying glymphatic system disruption and protecting cerebral vascular function.     

Parenting behaviours among mothers of pre-schoolers on the autism spectrum: Associations with parenting stress and children’s externalising behaviour problems

BackgroundParents of pre-schoolers diagnosed with Autism Spectrum Disorder (ASD) report increased parenting stress (i.e., stress related to the parent role) and more behaviour problems of the child compared with parents of non-autistic pre-schoolers. Parenting stress and children’s behaviour problems are both associated with parenting behaviours, but have not yet been investigated together.Method42 mothers of autistic and non-autistic pre-schoolers were observed during mother-child interaction and they reported on parenting behaviours, parenting stress, and children’s externalising behaviour problems. Spearman correlations between all variables were calculated for the ASD group and the non-ASD group separately, and Linear Mixed Models were built to investigate whether parenting stress and externalising behaviour problems were similarly associated to parenting behaviours in both groups.ResultsMothers in the ASD group reported more parenting stress and more externalising behaviour problems than mothers in the non-ASD group. In the ASD group only, parenting stress was related to externalising behaviour problems but not to the level of autism characteristics. In both groups, more externalising behaviour problems were associated with more observed negative parenting behaviours (i.e., criticising and ignoring the child), and more parenting stress was associated with less reported autonomy support.ConclusionsOur findings indicate that in the case of possibly problematic parenting behaviours, such as negativity and lack of autonomy support, it is important to investigate associated factors like parenting stress and children’s behaviour problems. An individualised strengths and needs assessment could then offer a tailored intervention to families with an autistic pre-schooler.     

Gender role expectations of pain: relationship to experimental pain perception

The primary purpose of this study was to investigate the influence of an individual's Gender Role Expectations of Pain (GREP) on experimental pain report. One hundred and forty-eight subjects (87 females and 61 males) subjects underwent thermal testing and were asked to report pain threshold, pain tolerance, VAS ratings of pain intensity and unpleasantness, and a computerized visual analogue scales (VAS) rating of pain intensity during the procedure. Subjects completed the GREP questionnaire to assess sex-related stereotypic attributions of pain sensitivity, pain endurance, and willingness to report pain. Consistent with previous research, significant sex differences emerged for measures of pain threshold, pain tolerance, and pain unpleasantness. After statistically controlling for age, GREP scores were significant predictors of threshold, tolerance, and pain unpleasantness, accounting for an additional 7, 11, and 21% of the variance, respectively. Sex remained a significant predictor of pain tolerance in hierarchical regression analyses after controlling for GREP scores. Results provide support for two competing but not mutually exclusive hypotheses related to the sex differences in experimental pain. Both psychosocial factors and first-order, biological sex differences remain as viable explanations for differences in experimental pain report between the sexes. It appears that GREP do play a part in determining an individual's pain report and may be contributing to the sex differences in the laboratory setting.     

Parallel amygdala and inferotemporal activation reflect emotional intensity and fear relevance

Much research demonstrates that emotional stimuli prompt increased amygdala and visual cortical activation. Here we measure functional activity in the visual cortex and amygdala with fMRI while selected fearful and control participants view a range of neutral, emotionally arousing, and fear-relevant pictures. BOLD signal in the amygdala and inferotemporal visual cortex closely covaried during emotional picture viewing, increasing systematically with rated picture arousal. Furthermore, fearful individuals reacting to specific fear cues show parallel, heightened activation in these two structures compared with non-fearful controls. The findings suggest an individually-sensitive, positive linear relationship between the arousing quality of visual stimuli and activation in amygdala and ventral visual cortex, supporting the hypothesized functional connectivity described in the animal model.     

针刺治疗脑卒中合并睡眠呼吸暂停低通气综合征随访分析

目的观察分析针刺廉泉对脑卒中合并睡眠呼吸暂停低通气综合征的近、远期临床疗效。方法符合诊断的30例患者采用针刺廉泉穴治疗,治疗前和治疗4星期后进行睡眠监测、ESS嗜睡量表、NIHSS卒中量表评价,治疗2年后进行ESS嗜睡量表评价以及相关临床症状随访,观察临床疗效。结果完成观察21例,9例脱落。21例脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的患者,针刺加电针治疗后呼吸暂停指数明显下降（P〈0.05）,睡眠时最低血氧饱和度值明显上升（P〈0.05）,ESS嗜睡量表评价分数明显下降（P〈0.05）。NIHSS卒中量表评价分数无明显改善（P〉0.05）。2年后随访21例,完成16例,脱落5例,16例脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的患者,2年后ESS嗜睡量表评价分数较之治疗前无明显改善（P〉0.05）,较之治疗后4星期也无明显改善（P〉0.05）。结论针刺廉泉治疗脑卒中合并阻塞性睡眠呼吸暂停低通气综合征,可降低患者呼吸暂停AHI指数,提高睡眠时最低血氧饱和度,改善临床症状。2年后随访,远期疗效不明显。