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Background. Type 2 diabetes mellitus is an illness with many individual and community level determinants that can predispose a person to developing this condition. Race, age, family history, and other pre-existing conditions can accelerate the development of this metabolic condition from an individual level, but community level factors like average income, education status, and food insecurity as well as access to healthcare, also play a role. Objectives. To quantify and analyze the associations between Community Health Index, a scale that combines PCP density, county-level public health preparedness, and social assets and the incidence and prevalence of type 2 diabetes in Maryland, Virginia, and the District of Columbia Methods. The CHI score was calculated from three different data sources: PCP supply rates came from the 2019 American Medical Association (AMA) Masterfile, a public health preparedness score was determined from the 2020 National Health Security Preparedness Index, and the inverse of the Social Deprivation Index, which came from the American Communities Survey Data from 2015 to 2019. Diabetes incidence and prevalence came from the 2018 and 2019, respectively, data from the Centers for Disease Control and Prevention (CDC)'s diabetes surveillance tool. Pearson's Correlation Coefficient was run to test the association between these two variables, and whether the association is statistically significant Results. Statistically significant mild (as defined by 0.1 Statistically significant strong correlations (0.5 Conclusions. CHI can be used as a predictor for type 2 diabetes risk at the state level. Given that the CHI is composed of three dynamic community level factors, stakeholders interested in mitigating diabetes risk at the local level can use this information as a guide in decision making and policy implementation., Presenters Raghav Ranga, MPH, Yalda Jabbarpour, [...]

: Introduction: Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). Methods: Using data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata. Results: Analyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. Conclusions: While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH, INTRODUCTION Persons living with HIV (PLWH), including those in low‐ and middle‐income countries, have experienced extended life expectancies due to the success of antiretroviral (ARV) therapies [1]. In 2014, the [...]

There is a need for measures to track symptom change in autism spectrum disorder (ASD). We conducted a validation study on a revised version of the Autism Behavior Inventory (ABI), and a short form (ABI-S). Caregivers of individuals (6-54 years) with confirmed diagnoses of ASD (N = 144) completed the ABI and other rating scales at 4 time points. Scale consistency for each domain, 3-5 day test-retest reliability, and construct validity, determined by comparison to pre-specified scales, were all good. Change in the ABI was congruent with changes in other instruments. Collectively, results suggest incipient suitability of the ABI as a measure of changes in core and associated symptoms of ASD. Trial Registration NCT02299700., Author(s): Abigail Bangerter [sup.1] , Seth Ness [sup.1] , David Lewin [sup.1] [sup.13] , Michael G. Aman [sup.2] , Anna J. Esbensen [sup.3] , Matthew S. Goodwin [sup.4] , Geraldine [...]

Despite average or above cognitive and verbal abilities, many children with autism spectrum disorder (ASD) experience difficulties in functional and social communication. Executive functioning (EF) may be the cognitive and regulatory mechanism that underlies these difficulties. Parents rated 92 children with ASD as demonstrating significantly more challenges than 94 typically developing children on measures of EF (Behavior Rating Inventory of Executive Function; BRIEF), functional communication (FC), and verbal conversation (VC) skills. For both groups, the BRIEF metacognition scale emerged as a strong predictor of FC, while the BRIEF behavior regulation and the inhibit scale were predictive of VC skills. These findings suggest that targeting EF domains specifically may improve FC and VC skills in children with ASD., Author(s): Sarah M. Hutchison [sup.1] [sup.2] [sup.3] , Ulrich Müller [sup.2] , Grace Iarocci [sup.1] Author Affiliations: (1) grid.61971.38, 0000 0004 1936 7494, Simon Fraser University, , Vancouver, BC, Canada [...]

Purpose A number of analyses have shown the immediate impact of COPD exacerbations on health status. However, none evaluated the long-term correlation between health status and the occurrence of exacerbations. Methods DACCORD is an observational study in patients with COPD recruited across Germany following initiation or change in COPD maintenance medication. Data collected include COPD Assessment Test (CAT) total score on entry and after 1 and 2 years, and the occurrence of exacerbations. We analysed the correlation between change from baseline in CAT total score and exacerbations, after excluding patients who exacerbated during the quarter immediately prior to the CAT assessment of interest. Results The initial correlation analysis was performed in 6075 patients, 28% with [greater than or equal to] 1 exacerbation over the 2-year follow-up, and 58% with a clinically relevant CAT improvement. There was a significant correlation between exacerbations over 2 years and CAT change from baseline at Year 2 (p = 0.0041). The Spearman's correlation coefficient was 0.03711, indicating very weak correlation-potentially driven by the high proportion of non-exacerbating patients. In a subsequent logistic regression, the probability of experiencing frequent ([greater than or equal to] 2 per year) or severe exacerbations was higher in patients with worsening in CAT total score (p < 0.001). However, the probability of a patient exacerbating in Year 1 or Year 2 did not correlate with CAT change. Conclusions In this population (initiating or changing maintenance COPD medication), patients with frequent or severe exacerbations had a long-term worsening in health status (beyond the acute effect of an exacerbation) compared with patients who do not exacerbate., Author(s): Peter Kardos [sup.1] , Claus F. Vogelmeier [sup.2] , Heinrich Worth [sup.3] , Roland Buhl [sup.4] , Victoria Obermoser [sup.5] , Carl-Peter Criée [sup.6] Author Affiliations: (1) Group Practice [...]

CALIPER is a computer-based quantitative algorithm to accurately characterize and quantify pulmonary fibrosis, and a revised version of composite physiologic index (CPI) has been developed against this new algorithm. The prognostic capabilities of the original and CALIPER-revised versions of CPI were compared in a cohort of 185 patients with IPF prospectively followed in 2 centers. CALIPER-revised CPI was a significant risk factor towards lung transplant (LTx)-free survival, with enhanced hazard ratio (5.68) compared to the original CPI (5.36). Accuracy of LTx-free survival was substantially improved with CALIPER-revised CPI (area under the curve [AUC] 0.75 vs. 0.66), with much better specificity (83% vs. 55%). Six-month changes of CALIPER-revised CPI predicted survival significantly (AUC 0.65). CALIPER-revised CPI is a better predictor of LTx-free survival in patients with IPF. Since CALIPER technology is not available to all centers, this simple and easy to obtain tool may be used to guide management decisions in IPF., Author(s): Karishma S. Hosein [sup.1] , Gianluigi Sergiacomi [sup.2] , Maurizio Zompatori [sup.3] , Marco Mura [sup.1] Author Affiliations: (1) grid.39381.30, 0000 0004 1936 8884, Division of Respirology, Department of [...]

Objectives The Edinburgh Postnatal Depression Scale (EPDS) identifies women with depressive symptoms in pregnancy. Our primary objective was to determine the prevalence of EPDS screen-positive women delivering on our no prenatal care (laborist) service and to compare these patients to private patients delivering with prenatal care. Methods Retrospective cohort analysis of EPDS scores during January 1, 2015 to June 18, 2015 was conducted. Scores [greater than or equal to] 10 were considered at-risk. Results were analyzed as an aggregate and then as no prenatal care versus prenatal care. Characteristics for patients with at-risk scores (EPDS [greater than or equal to] 10) versus low-risk scores (EPDS < 10) were quantified. Results Analysis occurred on 970 women. EPDS [greater than or equal to] 10 occurred in 12.4% (n = 120/970). Positive EPDS score was 21.1% without prenatal care versus 10.9% with adequate prenatal care (P = 0.003). Maternal demographics and delivery characteristics were clinically similar in patients with prenatal care compared to no prenatal care. Private insurance was more common in patients with prenatal care compared to no prenatal care (23.5 versus 8.1%, P = 0.0001). However, analysis of patients with EPDS > 10 showed non-significant distributions of ethnicity, private insurance, Medicaid, or no insurance compared to patients with EPDS < 10. Conclusion for Practice Patients without prenatal care who arrive solely for urgent 'drop-in' delivery have a measurable increased risk factor for postpartum depressive symptoms. Ethnicity and payor status were related to adequacy of prenatal care but were not significant variables when analyzing patients with EPDS > 10. Laborist services providing care to 'drop-in' patients should recognize this increased risk and develop policies for screening, referral and follow-up of at-risk patients., Author(s): Alexandra T. Magliarditi [sup.1] , Lannah L. Lua [sup.2] , Melissa A. Kelley [sup.1] , David N. Jackson [sup.2] Author Affiliations: (Aff1) 0000 0000 9961 7078, grid.476990.5, University of [...]

The relationship between brain development and clinical heterogeneity in autism (ASD) is unknown. This study examines the Social Responsiveness Scale (SRS) in relation to the longitudinal development of cortical thickness. Participants (N = 91 ASD, N = 56 TDC; 3-39 years at first scan) were scanned up to three times over a 7-year period. Mixed-effects models examined cortical thickness in relation to SRS score. ASD participants with higher SRS scores showed regionally increased age-related cortical thinning. Regional thickness differences and reduced age-related cortical thinning were found in predominantly right lateralized regions in ASD with decreasing SRS scores over time. Our findings emphasize the importance of examining clinical phenotypes in brain-based studies of ASD., Author(s): Molly B. D. Prigge [sup.1] [sup.2] [sup.3] [sup.11] , Erin D. Bigler [sup.4] , Brittany G. Travers [sup.3] [sup.5] , Alyson Froehlich [sup.6] , Tracy Abildskov [sup.4] , Jeffrey [...]

Aberrant interoceptive accuracy could contribute to the co-occurrence of anxiety and premonitory urge in chronic tic disorders (CTD). If it can be manipulated through intervention, it would offer a transdiagnostic treatment target for tics and anxiety. Interoceptive accuracy was first assessed consistent with previous protocols and then re-assessed following an instruction attempting to experimentally enhance awareness. The CTD group demonstrated lower interoceptive accuracy than controls but, importantly, this group difference was no longer significant following instruction. In the CTD group, better interoceptive accuracy was associated with higher anxiety and lower quality of life, but not with premonitory urge. Aberrant interoceptive accuracy may represent an underlying trait in CTD that can be manipulated, and relates to anxiety and quality of life., Author(s): Victoria Pile [sup.1] , Jennifer Y. F. Lau [sup.1] , Marta Topor [sup.2] , Tammy Hedderly [sup.2] , Sally Robinson [sup.2] [sup.3] Author Affiliations: (Aff1) 0000 0001 2322 6764, [...]

The DSM-5 features level of support ratings for social communication (SC) and restrictive and repetitive behaviors (RRB) for individuals with autism spectrum disorder (ASD). We contrasted cognitive, adaptive, and autism severity scores across SC and RRB groups for 158 individuals with ASD diagnosed in a developmental disabilities clinic. Roughly 46% of individuals were identified by licensed psychologists' clinical judgement as needing Level 2 SC support and 49% were identified as needing Level 2 RRB support. No individuals were rated as needing a combination of Level 1/Level 3 supports across domains. MANOVA and direct discriminant analysis revealed that both SC and RRB groups showed a graded pattern of higher adaptation/lower autism severity to lower adaptation/higher autism severity from Level 1 to Level 3., Author(s): Lauren M. Gardner [sup.1] , Jonathan M. Campbell [sup.2] , Bruce Keisling [sup.3] , Laura Murphy [sup.3] Author Affiliations: (Aff1) 0000 0004 0467 2330, grid.413611.0, Autism Center, Johns Hopkins [...]

Increasing attention is being paid to how adults on the autism spectrum perceive and interpret the interoceptive sense. This 20-item Interoception Sensory Questionnaire represents a single factor scale that can be interpreted as representing confusion about interoceptive bodily states unless these states are extreme (Alexisomia), and has been designed to discriminate across populations (total sample 511 participants). Findings showed that 74% of adults with autism reported interoceptive confusion. Another finding of the study was that as autistic traits increased, interoceptive confusion increased, with adults with diagnosed autism scoring highest on the construct. Implications for physiological self-regulation as well as physical health outcomes are discussed, as well as recommendations for future research., Author(s): L. Fiene [sup.1] , M. J. Ireland [sup.1] , C. Brownlow [sup.1] Author Affiliations: (Aff1) 0000 0004 0473 0844, grid.1048.d, School of Psychology and Counselling, University of Southern Queensland, [...]

Group social skills interventions (GSSIs) are a commonly offered treatment for children with high functioning ASD. We critically evaluated GSSI randomised controlled trials for those aged 6-25 years. Our meta-analysis of outcomes emphasised internal validity, thus was restricted to trials that used the parent-report social responsiveness scale (SRS) or the social skills rating system (SSRS). Large positive effect sizes were found for the SRS total score, plus the social communication and restricted interests and repetitive behaviours subscales. The SSRS social skills subscale improved with moderate effect size. Moderator analysis of the SRS showed that GSSIs that include parent-groups, and are of greater duration or intensity, obtained larger effect sizes. We recommend future trials distinguish gains in children's social knowledge from social performance., Author(s): J. Wolstencroft [sup.1] , L. Robinson [sup.2] , R. Srinivasan [sup.1] , E. Kerry [sup.1] , W. Mandy [sup.3] , D. Skuse [sup.1] Author Affiliations: (Aff1) 0000000121901201, grid.83440.3b, The [...]

In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of autism spectrum disorder (ASD) and predictive value of an observational (ADOS)-and questionnaire-based screening instrument were assessed. Complete data was available for 128 children. The prevalence rate for clinical ASD was 10.9%, which is clearly higher than in the general population. This prevalence rate is presumably more accurate than in previous studies that examined children with NF1 with an ASD presumption or solely based on screening instruments. The combined observational- and screening based classifications demonstrated the highest positive predictive value for DSM-IV diagnosis, highlighting the importance of using both instruments in children with NF1., Author(s): S. Eijk [sup.1] [sup.2] , S. E. Mous [sup.1] [sup.2] , G. C. Dieleman [sup.1] [sup.2] , B. Dierckx [sup.1] [sup.2] , A. B. Rietman [sup.1] [sup.2] , P. [...]

We integrated multiple behavioural and developmental measures from multiple time-points using machine learning to improve early prediction of individual Autism Spectrum Disorder (ASD) outcome. We examined Mullen Scales of Early Learning, Vineland Adaptive Behavior Scales, and early ASD symptoms between 8 and 36 months in high-risk siblings (HR; n = 161) and low-risk controls (LR; n = 71). Longitudinally, LR and HR-Typical showed higher developmental level and functioning, and fewer ASD symptoms than HR-Atypical and HR-ASD. At 8 months, machine learning classified HR-ASD at chance level, and broader atypical development with 69.2% Area Under the Curve (AUC). At 14 months, ASD and broader atypical development were classified with approximately 71% AUC. Thus, prediction of ASD was only possible with moderate accuracy at 14 months., Author(s): G. Bussu [sup.1] , E. J. H. Jones [sup.2] , T. Charman [sup.3] , M. H. Johnson [sup.2] , J. K. Buitelaar [sup.1] Author Affiliations: (Aff1) 0000 0004 0444 [...]

Research on sex-related differences in Autism Spectrum Disorder (ASD) has been impeded by small samples. We pooled 28 datasets from 18 sites across nine European countries to examine sex differences in the ASD phenotype on the ADI-R (376 females, 1763 males) and ADOS (233 females, 1187 males). On the ADI-R, early childhood restricted and repetitive behaviours were lower in females than males, alongside comparable levels of social interaction and communication difficulties in females and males. Current ADI-R and ADOS scores showed no sex differences for ASD severity. There were lower socio-communicative symptoms in older compared to younger individuals. This large European ASD sample adds to the literature on sex and age variations of ASD symptomatology., Author(s): J. Tillmann [sup.1] , K. Ashwood [sup.2] , M. Absoud [sup.3] [sup.26] , S. Bölte [sup.4] [sup.5] , F. Bonnet-Brilhault [sup.6] , J. K. Buitelaar [sup.7] , S. Calderoni [...]

The goal of this paper is to examine the psychometric properties of a live-coded behavioral measure of joint attention, the Attention-Following and Initiating Joint Attention Protocol (JA Protocol), in order to assist researchers and clinicians in identifying when this measure may meet their joint attention assessment needs. Data from 260 children with autism spectrum disorder, developmental delay, or typical development between the ages of 2 and 12 years were used to evaluate this measure using quality standards for measurement. Overall, the JA Protocol demonstrated good psychometric properties. Recommendations and limitations for use of this measure based on psychometric analysis results are reported., Author(s): Sallie W. Nowell [sup.1] [sup.3] , Linda R. Watson [sup.1] , Richard A. Faldowski [sup.1] , Grace T. Baranek [sup.2] Author Affiliations: (Aff1) 0000000122483208, grid.10698.36, Department of Allied Health [...]

Hantaviruses (family Bunyaviridae, genus Hantavirus) are enveloped viruses with negative, trisegmented, single-stranded RNA genomes that can induce hemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (1). The viruses [...]

Objective To examine the empirical basis for including the diagnostic category of 'a single episode of harmful substance use' in the 11th revision of the International statistical classification of diseases and related health problems (ICD-11). Methods We used data on patients admitted to emergency departments in 21 countries with alcohol-related injuries (i.e. with drinking within the preceding six hours) who had no sign of alcohol intoxication or withdrawal, no alcohol in blood and no sign of alcohol dependence or harmful drinking as described in the ICD-10. We obtained data on alcohol-related injuries, the patient's causal attribution of injury to drinking, the alcohol amount consumed, blood alcohol concentration and usual drinking pattern. Patients with and without alcohol dependence or harmful drinking were compared. Findings We included a representative sample of 18 369 patients. After adjustment for unequal sampling, 18.8% reported drinking in the six hours before injury and 47.1 % of these attributed their injury to drinking; 16.3% of those reporting drinking and 10.3% of those attributing their injury to drinking were not alcohol dependent or harmful drinkers. The majority of these last two groups reported never having had five or more drinks on one occasion during the last year and had a blood alcohol concentration less than 0.05%. Conclusion Some individuals attending emergency departments had alcohol-attributable injuries due to a single episode of drinking but had no history of harmful use or dependence. These findings highlight the public health relevance of including the new diagnostic category in the ICD-11. Objectif Examiner les conditions empiriques de l'inclusion de la categorie de diagnostic <> dans la 11e revision de la Classification internationale des maladies et des problemes de sante connexes (CIM-11). Methodes Nous avons utilise des donnees relatives a des patients admis dans des services d'urgence dans 21 pays pour des traumatismes lies a l'alcool (consommation au cours des six dernleres heures) qui ne presentaient aucun signe d'intoxication a l'alcool ou de sevrage alcoolique, aucune trace d'alcool dans le sang et aucun signe de dependance a l'alcool ou de consommation nocive, comme decrit dans la CIM-10. Nous avons recueilli des donnees sur les traumatismes lies a l'alcool, i'attribution causale du traumatisme a la consommation d'alcool par le patient, la quantite d'alcool consommee, la concentration d'alcool dans le sang et les habitudes de consommation. Nous avons compare des patients qui presentaient une dependance a l'alcool ou une consommation nocive a d'autres pour qui ce n'etait pas le cas. Resultats Nous avons inclus un echantillon representatif de 18 369 patients. Apres ajustement pour echantillonnage inegal, 18,8% des patients ont indique avoir consomme de l'alcool au cours des six heures ayant precede le traumatisme, 47,1 % d'entre eux attribuant leur traumatisme a la consommation d'alcool; 16,3% des patients ayant indique avoir consomme de l'alcool et '10,3% de ceux attribuant leur traumatisme a la consommation d'alcool n'etaient ni dependants a l'alcool, ni des consommateurs excessifs. La majorite des membres de ces deux derniers groupes ont signale n'avoir jamais consomme cinq verres ou plus lors d'une meme occasion au cours de l'annee ecoulee et presentalent une concentration d'alcool dans le sang inferieure a 0,05%. Conclusion Certains patients pris en charge par des services d'urgence avaient des traumatismes attribuables a l'alcool en raison d'un episode isole de consommation, mais ne presentaient pas d'antecedents de consommation nocive ou de dependance. Ces conclusions soulignent l'interet pour la sante publique d'inclure une nouvelle categorie de diagnostic danslaCIM-11. Objetivo Examinar las bases empiricas para incluir la categoria diagnostica de 'episodio unico de consumo de sustancia nociva' en la undecima revision de la Clasificacion internacional de enfermedades y problemas relacionados con la salud (CIE-11). Metodos Utilizamos datos de pacientes admitidos en salas de emergencia en 21 paises con danos asociados al alcohol (es decir, consumo de alcohol en las seis horas previas) que no presentaron signos de intoxicacion por alcohol o abstinencia, sin rastros de alcohol en sangre y sin signos de dependencia del alcohol o consumo nocivo segun se describe en la CIE-10. Obtuvimos datos sobre danos relacionados con el alcohol, la atribucion causal del dano a la bebida realizada por el paciente, la cantidad de alcohol consumido, la concentracion de alcohol en sangre y el patron habitual de consumo. Se compararon pacientes con dependencia al alcohol y sin dependencia o consumo nocivo. Resultados Incluimos una muestra representativa de 18369 pacientes. Despues del ajuste por muestreo desigual, el 18,8% informaron haber bebido en las seis horas previas al dano y el 47,1 % atribuyo el dano a la bebida; el 16,3% de los que Indicaron haber bebido y el 10,3% de los que atribuyeron el dano a la bebida no eran dependientes al alcohol o consumidores nocivos. La mayoria en estos ultimos dos grupos dijo'no haber bebido cinco o mas tragos en una ocasion durante el ultimo ano y su concentracion de alcohol en sangre fue inferior al 0,05%. Conclusion Algunos individuos recibidos en salas de emergencia presentaron danos atribuibles al alcohol debido aun unico episodio de consumo de alcohol, pero no tenian antecedentes de consumo nocivo o dependencia. Estos resultados destacan la Importancia para la salud publica de la Inclusion de la nueva categoria diagnostica en la CIE-11., [phrase omitted] Introduction Alcohol use is among the top 10 risk factors for ill health globally and is one of the five leading risk factors among men, such use accounts [...]

Engaging in recommended levels of physical activity during pregnancy can provide a host of physical and mental health benefits for the expecting mother and her child. However, methodological issues related to physical activity measurement have plagued many studies examining the effects of physical activity during this important life stage. Burgeoning support exists for the more widespread use of objective methods, and accelerometers specifically, for an accurate appraisal of maternal physical activity. In this commentary, we highlight discrepancies between activity estimates obtained via self-report and objective measures and describe the implications of erroneous measurement when making clinical recommendations and in conducting future physical activity and pregnancy research. Most importantly, we aim to foster academic discussion and propose a call to action requiring a paradigm shift where we acknowledge the shortcomings of self-report and move toward an empirically driven approach for physical activity measurement. Results from more high-quality research studies will help support public health messaging and facilitate trust among health care providers, clinical researchers, and expecting mothers regarding the health benefits of physical activity recommendations., Author(s): Eva Guérin [sup.1] , Zachary M. Ferraro [sup.2] [sup.3] , Kristi B. Adamo [sup.3] [sup.4] , Denis Prud'homme [sup.1] [sup.4] Author Affiliations: (Aff1) Institut du Savoir Montfort (ISM), , [...]

Introduction Numerous studies have shown that the constructs of the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB) and Breastfeeding Self-Efficacy (BSE) Framework can effectively identify relationships between maternal psychosocial factors and breastfeeding initiation. However, the ability of these theories to predict breastfeeding duration has not been adequately analyzed. The aim of the review was to examine the utility of the constructs of TRA/TPB and BSE to predict breastfeeding duration. Methods We conducted a literature search using Pubmed (1980-May 2015), Medline (1966-May 2015), CINAHL (1980-May 2015), EMBASE (1980-May 2015) and PsycINFO (1980-May 2015). We selected studies that were observational studies without randomization or blinding, using TRA, TPB or BSE as the framework for analysis. Only studies reporting on breastfeeding duration were included. Results Thirty studies were selected, which include four using TRA, 10 using TPB, 15 using BSE and one using a combination of TPB and BSE. Maternal intention and breastfeeding self-efficacy were found to be important predictors of breastfeeding duration. Inconsistent findings were found in assessing the relationship between maternal attitudes, subjective norms, perceived behavior control and breastfeeding duration. Discussion The inadequacy of these constructs in explaining breastfeeding duration indicates a need to further explore the role of maternal self-determination in breastfeeding behavior., Author(s): Christine Y. K. Lau [sup.1] , Kris Y. W. Lok [sup.1] , Marie Tarrant [sup.2] Author Affiliations: (Aff1) 0000000121742757, grid.194645.b, School of Nursing, Li Ka Shing Faculty of Medicine, [...]

Positive emotion is associated with lower cardiovascular disease (CVD) risk, yet some mechanisms remain unclear. One potential pathway is via emotional competencies/skills. The present study tests whether the ability to facially express positive emotion is associated with CVD risk scores, while controlling for potential confounds and testing for sex moderation. Eighty-two men and women underwent blood draws before completing self-report assessments and a performance test of expressive skill. Positive expressions were scored for degree of 'happiness' using expression coding software. CVD risk scores were calculated using established algorithms based on biological, demographic, and behavioral risk factors. Linear regressions revealed a main effect for skill, with skill in expressing positive emotion associated with lower CVD risk scores. Analyses also revealed a sex-by-skill interaction whereby links between expressive skill and CVD risk scores were stronger among men. Objective tests of expressive skill have methodological advantages, appear to have links to physical health, and offer a novel avenue for research and intervention., Author(s): Natalie L. Tuck [sup.1] , Kathryn S. Adams [sup.2] , Sarah D. Pressman [sup.3] , Nathan S. Consedine [sup.1] Author Affiliations: (1) Department of Psychological Medicine, University of Auckland, [...]

Purpose This article offers constructive commentary on The Life Course Health and Development Model (LCHD) as an organizing framework for MCH research. Description The LCHD has recently been proposed as an organizing framework for MCH research. This model integrates biomedical, biopsychosocial, and life course frameworks, to explain how 'individual health trajectories' develop over time. In this article, we propose that the LCHD can improve its relevance to MCH policy and practice by: (1) placing individual health trajectories within the context of family health trajectories, which unfold within communities and societies, over historical and generational time; and (2) placing greater weight on the social determinants that shape health development trajectories of individuals and families to produce greater or lesser health equity. Assessment We argue that emphasizing these nested, historically specific social contexts in life course models will enrich study design and data analysis for future developmental science research, will make the LCHD model more relevant in shaping MCH policy and interventions, and will guard against its application as a deterministic framework. Specific ways to measure these and examples of how they can be integrated into the LCHD model are articulated. Conclusion Research applying the LCHD should incorporate the specific family and socio-historical contexts in which development occurs to serve as a useful basis for policy and interventions. Future longitudinal studies of maternal and child health should include collection of time-dependent data related to family environment and other social determinants of health, and analyze the impact of historical events and trends on specific cohorts., Author(s): Marian Moser Jones [sup.1] , Kevin Roy [sup.2] Author Affiliations: (1) Department of Family Science, University of Maryland School of Public Health, 0000 0001 0941 7177, grid.164295.d, , 1142W [...]

This study examined the reliability and criterion-related validity of parent ratings on the Adapted Skillstreaming Checklist (ASC) for a sample of 275 high-functioning children, ages 6-12 years, with ASD. Internal consistency for the total sample was 0.92. For two subsamples, test-retest reliability was very good at the 6-week and good at the 9-month intervals. Child age, IQ, and language abilities were unrelated to the ASC score. The ASC total score was inversely and strongly related to parent ratings of ASD symptom severity. Significant positive correlations (moderate-to-high) were found between the ASC and prosocial skills scales and significant negative correlations (low-to-moderate) with problem behavior scales on a broad measure of child functioning. Implications and suggestions for future study are discussed., Author(s): Christopher Lopata [sup.1] , Jonathan D. Rodgers [sup.1] , James P. Donnelly [sup.1] , Marcus L. Thomeer [sup.1] , Christin A. McDonald [sup.1] , Martin A. Volker [sup.2] Author [...]

Author(s): Vanessa H. Bal [sup.1] , Cristan Farmer [sup.2] , Audrey Thurm [sup.2] Author Affiliations: (1) Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 0000 0001 [...]

The transition from DSM-IV to DSM-5 criteria for autism spectrum disorder (ASD) sparked considerable concern about the potential implications of these changes. This study was designed to address limitations of prior studies by prospectively examining the concordance of DSM-IV and final DSM-5 criteria on a consecutive sample of 439 children referred for autism diagnostic evaluations. Concordance and discordance were assessed using a consistent diagnostic battery. DSM-5 criteria demonstrated excellent overall specificity and good sensitivity relative to DSM-IV criteria. Sensitivity and specificity were strongest for children meeting DSM-IV criteria for autistic disorder, but poor for those meeting criteria for Asperger's disorder and pervasive developmental disorder. Higher IQ, older age, female sex, and less pronounced ASD symptoms were associated with greater discordance., Author(s): Micah O. Mazurek [sup.1] [sup.2] , Frances Lu [sup.3] , Heather Symecko [sup.3] [sup.4] , Eric Butter [sup.5] , Nicole M. Bing [sup.6] , Rachel J. Hundley [sup.7] , [...]

Autism spectrum disorders (ASD) are difficult to detect in old age. This study examined if ASD symptoms in older adults (age > 60) can be detected with the Dutch informant personality questionnaire, (Hetero-Anamnestische Persoonlijkheidsvragenlijst, HAP) in a mental health setting. Patients with ASD (N = 40) were compared to patients with a different psychiatric diagnosis (N = 43; personality disorders excluded). The ASD group had significant higher scores on the scales 'Socially avoidant behavior', 'Rigid behavior' and 'Unpredictable and impulsive behavior'. These scales were able to discriminate between individuals with or without ASD. The HAP can thus be used as a screening instrument for ASD symptoms in elderly patients. Further research is needed to clarify what items have the best predictive validity for ASD symptoms., Author(s): S. M. J. Heijnen-Kohl [sup.1] , R. M. Kok [sup.2] , R. M. H. J. Wilting [sup.3] , G. Rossi [sup.4] , S. P. J. van Alphen [sup.1] [sup.4] [...]

An intervention has social validity to the extent that it is socially acceptable to participants and stakeholders. This pilot convergent mixed methods study evaluated parents' perceptions of the social validity of the Early Start Denver Model (ESDM), a naturalistic behavioral intervention for children with autism. It focused on whether the parents viewed (a) the ESDM goals as appropriate for their children, (b) the intervention procedures as acceptable and appropriate, and (c) whether changes in their children's behavior was practically significant. Parents of four children who participated in the ESDM completed the TARF-R questionnaire and participated in a semi-structured interview. Both data sets indicated that parents rated their experiences with the ESDM positively and rated it as socially-valid. The findings indicated that what was implemented in the intervention is complemented by how it was implemented and by whom., Author(s): Emily Ogilvie [sup.1] , Matthew T. McCrudden [sup.1] Author Affiliations: (1) Faculty of Education, Victoria University of Wellington, 0000 0001 2292 3111, grid.267827.e, , P. O. Box 600, 6140, [...]

The Autism-Spectrum Quotient (AQ) is among the most widely used scales assessing autistic traits in the general population. However, some aspects of the AQ are questionable. To test its scale properties, the AQ was translated into Swedish, and data were collected from 349 adults, 130 with autism spectrum disorder (ASD) and 219 without ASD, and analysed with Rasch. Several scale properties of the AQ were satisfactory but it did not meet the criterion of a unidimensional measure of autistic traits. The Rasch analysis showed that the 50-item AQ could be reduced to a 12-item subset with little loss of explanatory power, with the potential to efficiently measure the degree to which adults with and without ASD show autistic traits., Author(s): Lars-Olov Lundqvist [sup.1] , Helen Lindner [sup.2] Author Affiliations: (1) 0000 0001 0738 8966grid.15895.30University Health Care Research Center, Faculty of Medicine and Health, Örebro University, P.O. Box 1613, 701 [...]

This study assessed the utility of a brief assessment (the Peabody Picture Vocabulary Test-4th Edition; PPVT4) as a proxy for verbal IQ (VIQ) in large-scale studies of autism spectrum disorder (ASD). In a sample of 2,420 proband with ASD, PPVT4:IQ correlations were strong. PPVT4 scores were, on average, 5.46 points higher than VIQ; 79% of children had PPVT4 scores within one standard deviation (+/-15) of their VIQ and 90% were similarly classified as having abilities above or below 70 on both measures. Distributions of PPVT4 and VIQ by de novo mutation status were highly similar. These results strongly support the utility of PPVT4 as a proxy for VIQ in large-scale ASD studies, particularly for genetic investigations., Author(s): Kate E. Krasileva [sup.1] , Stephan J. Sanders [sup.1] , Vanessa Hus Bal [sup.1] [sup.2] Author Affiliations: (1) 0000 0001 2297 6811grid.266102.1University of California San Francisco Department of Psychiatry, [...]

Introduction: Despite improved efficacy of, and access to, combination antiretroviral therapy (cART), HIV-associated cognitive impairments remain prevalent in both children and adults. Neuropsychological tests that detect such impairment can help clinicians formulate effective treatment plans. The Kaufman Assessment Battery for Children (KABC), although developed and standardized in the United States, is used frequently in many different countries and cultural contexts to assess paediatric performance across various cognitive domains. This systematic review investigated the cross-cultural utility of the original KABC, and its 2nd edition (KABC-II), in detecting HIV-associated cognitive impairment in children and adolescents. Methods: We entered relevant keywords and MeSH terms into the PubMed, PsycInfo, EBSCOHost, ProQuest, and Scopus databases, with search limits set from 1983-2017. Two independent reviewers evaluated the retrieved abstracts and manuscripts. Studies eligible for inclusion in the review were those that (a) used the KABC/KABC-II to assess cognitive function in children/adolescents aged 2-18 years, (b) featured a definition of cognitive impairment (e.g. >2 SD below the mean) or compared the performance of HIV-infected and uninfected control groups, and (c) used a sample excluded from population on which the instruments were normed. Results and discussion: We identified nine studies (eight conducted in African countries, and one in the United Kingdom) to comprise the review's sample. All studies detected cognitive impairment in HIV-infected children, including those who were cART-naive or who were cART treated and clinically stable. KABC/KABC-II subtests assessing simultaneous processing appeared most sensitive. Evaluation of the methodological quality of the selected studies by two independent reviews suggested that shortcomings included reporting and selection biases. Conclusions: This systematic review provides evidence for the cross-cultural utility of the KABC/KABC-II, particularly the simultaneous processing subtests, in detecting cognitive impairment in HIV-infected children (including those who are clinically stable). Although the current results suggest there is justification for using the KABC/KABC-II primarily in East Africa, further investigation is required to explore the instrument's utility in other HIV-prevalent regions of the globe. Keywords: cognitive impairment; cross-cultural; HIV; Kaufman assessment battery for children; paediatric; systematic review, Introduction Recent global estimates suggest that 3.2 million children under 15 years of age are living with HIV. Ninety-one per cent (more than 2.9 million) of those children reside in [...]

: Introduction: Heterogeneity of sociodemographics and risk behaviours across the HIV treatment cascade could influence the public health impact of universal ART in sub‐Saharan Africa if those not virologically suppressed are more likely to be part of a risk group contributing to onward infections. Sociodemographic and risk heterogeneity across the treatment cascade has not yet been comprehensively described or quantified and we seek to systematically review and synthesize research on this topic among adults in Africa. Methods: We conducted a systematic review of peer‐reviewed literature in Embase and MEDLINE databases as well as grey literature sources published in English between 2014 and 2018. We included studies that included people living with HIV (PLHIV) aged ≥15 years, and reported a 90‐90‐90 outcome: awareness of HIV‐positive status, ART use among those diagnosed or viral suppression among those on ART. We summarized measures of association between sociodemographics, within each outcome, and as a composite measure of population‐wide viral suppression. Results and discussion: From 3533 screened titles, we extracted data from 92 studies (50 peer‐reviewed, 42 grey sources). Of included studies, 32 reported on awareness, 53 on ART use, 32 on viral suppression and 23 on population‐wide viral suppression. The majority of studies were conducted in South Africa, Uganda, and Malawi and reported data for age and gender. When stratified, PLHIV ages 15 to 24 years had lower median achievement of the treatment cascade (60‐49‐81), as compared to PLHIV ≥25 years (70‐63‐91). Men also had lower median achievement of the treatment cascade (66‐72‐85), compared to women (79‐76‐89). For population‐wide viral suppression, women aged ≥45 years had achieved the 73% target, while the lowest medians were among 15‐ to 24‐year‐old men (37%) and women (49%). Conclusions: Considerable heterogeneity exists by age and gender for achieving the HIV 90‐90‐90 treatment goals. These results may inform delivery of HIV testing and treatment in sub‐Saharan Africa, as targeting youth and men could be a strategic way to maximize the population‐level impact of ART., Introduction In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) introduced the 90‐90‐90 goals as targets for achieving viral load suppression among people living with HIV (PLHIV) by 2020 [...]

: Introduction: Lifelong antiretroviral therapy (ART) improves health outcomes for HIV‐positive individuals, but is jeopardized by irregular clinic attendance and hence poor adherence. Loss to follow‐up (LTFU) is typically defined retrospectively but this may lead to biased inferences. We assessed incidence of and factors associated with LTFU, prospectively and accounting for recurrent LTFU episodes, in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) of HIV‐positive persons in rural Tanzania. Methods: We included adults (≥15 years) enrolled in 2005 to 2016, regardless of ART status, with follow‐up through April 2017. LTFU was defined as >60 days late for a scheduled appointment. Participants could experience multiple LTFU episodes. We performed analyses based on the first (prospective) and last (retrospective) events observed during follow‐up, and accounting for recurrent LTFU episodes. Time to LTFU was estimated using cumulative incidence functions. We assessed factors associated with LTFU using cause‐specific proportional hazards, marginal means/rates, and Prentice, Williams and Peterson models. Results: Among 8087 participants (65% female, 60% aged ≥35 years, 42% WHO stage 3/4, and 47% CD4 count Conclusions: LTFU episodes were common and prompt tracing efforts are urgently needed. We identified socio‐demographic and clinical characteristics associated with LTFU that can be used to target tracing efforts and to help inform the design of appropriate interventions. Incidence of and risk factors for LTFU differed based on the LTFU definition applied, highlighting the importance of appropriately accounting for recurrent LTFU episodes. We recommend using a prospective definition of LTFU combined with recurrent event analyses in cohorts where repeated interruptions in care are common., Introduction Lifelong antiretroviral therapy (ART) is crucial to optimize health outcomes for people living with HIV. Retention in care is a critical component to reaching the second and third UNAIDS [...]

Background Studies have shown that airway obstruction and increased bronchial reactivity are present in early life in children developing asthma, which challenges the dogma that airway inflammation leads to low lung function. Further studies are needed to explore whether low lung function and bronchial hyperreactivity are inherent traits increasing the risk of developing airway inflammation and asthmatic symptoms in order to establish timely primary preventive initiatives. Methods and findings We investigated 367 (89%) of the 411 children from the at-risk Copenhagen Prospective Studies on Asthma in Childhood 2000 (COPSAC.sub.2000) birth cohort born to mothers with asthma, who were assessed by spirometry and bronchial reactivity to methacholine from age 1 month, plethysmography and bronchial reversibility from age 3 years, cold dry air hyperventilation from age 4 years, and exercise challenge at age 7 years. The COPSAC pediatricians diagnosed and treated asthma based on symptom load, response to inhaled corticosteroid, and relapse after treatment withdrawal according to a standardized algorithm. Repeated measures mixed models were applied to analyze lung function trajectories in children with asthma ever or never at age 1 month to 13 years. The number of children ever versus never developing asthma in their first 13 years of life was 97 (27%) versus 270 (73%), respectively. Median age at diagnosis was 2.0 years (IQR 1.2-5.7), and median remission age was 6.2 years (IQR 4.2-7.8). Children with versus without asthma had reduced lung function (z-score difference, forced expiratory volume, -0.31 [95% CI -0.47; -0.15], p < 0.001), increased airway resistance (z-score difference, specific airway resistance, +0.40 [95% CI +0.24; +0.56], p < 0.001), increased bronchial reversibility (difference in change in forced expiratory volume in the first second [[DELTA]FEV.sub.1 ], +3% [95% CI +2%; +4%], p < 0.001), increased reactivity to methacholine (z-score difference for provocative dose, -0.40 [95% CI -0.58; -0.22], p < 0.001), decreased forced expiratory volume at cold dry air challenge ([DELTA]FEV.sub.1, -4% [95% CI -7%; -1%], p < 0.01), and decreased forced expiratory volume after exercise ([DELTA]FEV.sub.1, -4% [95% CI -7%; -1%], p = 0.02). Both airway obstruction and bronchial hyperreactivity were present before symptom debut, independent of disease duration, and did not improve with symptom remission. The generalizability of these findings may be limited by the high-risk nature of the cohort (all mothers had a diagnosis of asthma), the modest study size, and limited ethnic variation. Conclusions Children with asthma at some point at age 1 month to 13 years had airway obstruction and bronchial hyperreactivity before symptom debut, which did not worsen with increased asthma symptom duration or attenuate with remission. This suggests that airway obstruction and bronchial hyperreactivity are stable traits of childhood asthma since neonatal life, implying that symptomatic disease may in part be a consequence of these traits but not their cause., Author(s): Henrik Wegener Hallas, Bo Lund Chawes, Morten Arendt Rasmussen, Lambang Arianto, Jakob Stokholm, Klaus Bønnelykke, Hans Bisgaard * Introduction The current paradigm of asthma pathophysiology suggests that an inflammatory [...]

Byline: Jayanthi. Sivaswamy, Alphin. Thottupattu, Raghav. Mehta, R. Sheelakumari, Chandrasekharan. Kesavadas Context: A brain magnetic resonanace imaging (MRI) atlas plays an important role in many neuroimage analysis tasks as it [...]

Byline: Vijay. Chenna, Subhash. Kaul, Swetha. Tandra, Sireesha. Yareeda, Neeharika. Mathukumalli, Abhijeet. Kohat, Rukmini. Kandadai, Suryaprabha. Turaga, Jabeen. Sheik, A. Meena, Rupam. Borgohain Background: Symptomatic Intracerebral hemorrhage (sICH) is a [...]