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BackgroundHeterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services.MethodsUsing a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups.ResultsClustering revealed four subgroups. One subgroup-broad symptom worsening only (20%)-included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup.LimitationsNotable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic.ConclusionsConcomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.

Given the heterogeneity of Attention-Deficit Hyperactivity Disorder (ADHD), there is a constant need for proper diagnosis, employing more accurate, efficient, patient-friendly, and clinician-friendly tools. We developed a Greek version of the National Institute for Children's Health Quality (NICHQ) Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) for follow-up assessment and examined its reliability and validity. A total of 100 schoolchildren (65 girls and 35 boys) between 7 and 12 years old with ADHD were included in the study. The internal consistency and test-retest reliability were examined via principal component analysis. Three-component structure in our study accounts for 74.63% of the tool's variance. The questions' loadings onto the factors and the internal reliability of the three factors were satisfactory. Finally, the reliability of all factors presented was found adequately high, confirming the high internal consistency of the items. Our results suggest that the Greek version of the VADPRS-follow-up may be used as an accurate psychometric instrument for the purposes of diagnosing ADHD. Furthermore, the combined use of the VADPRS-follow-up with other widely accepted tools, such as the ADHD Rating Scale-IV, may present clinical utility in collating parent information concerning the behavioural phenotype of their children.

Human granulocytic anaplasmosis (HGA) is a tick-borne disease caused by Anaplasma phagocytophilum that has the potential to spread in new geographical areas. The first fatal case of HGA in Greece is presented. Fever of unknown origin, renal and respiratory insufficiency and development of macrophage activation syndrome characterized the clinical presentation. Amplification and sequencing of a fragment of the groEL gene revealed the presence of A. phagocytophilum . The epidemiological and clinical features were collected during an epidemiological investigation. Public health measures were instituted by the Hellenic Centre for Disease Control and Prevention. The Public Health intervention required the collaboration of epidemiologists, veterinarians and microbiologists. Emphasis was given to communication activities and misconceptions concerning canines and their role in the disease. The emergence of human anaplasmosis in a new geographical area highlights the importance of disease awareness and of the need for continued support for tick and tick-borne disease surveillance networks. [ABSTRACT FROM AUTHOR]

Objective To examine maternal serum concentrations of placental growth factor (PlGF) at 11–14 gestational weeks in pregnancies that developed gestational diabetes mellitus (GDM) and to create first trimester prediction models for GDM. Methods Case control study including 40 GDM cases and 94 controls. PlGF, biophysical and biochemical markers and maternal–pregnancy characteristics were analyzed. Results Log 10 transformed PlGF (log 10 PlGF) was not related to maternal factors. Log 10 PlGF was increased (p = 0.008) in the GDM group compared to the control group. Log 10 PlGF was associated with fasting glucose levels (p = 0.04) in the oral glucose tolerance test. Log 10 PlGF had a strong relation with birth weight adjusted for gestational age in the control but not in the GDM group. Maternal weight and maternal age were the only predictors of GDM among the maternal factors [area under the curve (AUC) = 0.73, p < 0.001]. Log 10 PlGF alone was a significant predictor of GDM (AUC = 0.63, p < 0.001). Combination of maternal weight, maternal age and log 10 PlGF resulted in an improved prediction (DR = 71.4%, for 25% FPR, AUC = 0.78, Model R 2 = 0.17, p < 0.001). Conclusion At 11–14 weeks in pregnancies that develop GDM, the maternal serum levels of PlGF are increased. Measurement of serum PlGF at 11–14 weeks improves the performance of early screening for GDM provided by maternal factors alone. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Childhood obesity is associated with an increased risk for atherosclerosis mediated by the pathogenetic mechanisms that lead to the development of the Metabolic Syndrome (MetS). High-Sensitivity Troponin T (hs-TnT) is a specific marker of ischemic myocardial damage, whereas a minimal elevation of this biomarker has been found in adults with a high-risk for cardiovascular disease. We hypothesized that hs-TnT might be altered in obese children with and/or without the Mets. Materials and Methods: Fifty-seven (34 males) obese and 25 non-obese (6 males) children were assessed at the Childhood Obesity Clinic of our department. Obesity was defined using the IOTF criteria. Metabolic syndrome was defined with the IDF criteria. Hs-TnT was measured using an electrochemiluminescence-based assay. Results: The entire group of obese children had significantly higher hs-TnT concentrations [4.1 ± 3.4 ng/L] (p=0.029) than the non-obese ones [3.0 ± 0.2 ng/L), however, in both groups the levels of the cardiac biomarker were within the normal range. Comparison of the obese children with or without the MetS and the non-obese, revealed that those with the MetS had significantly higher hs-TnT (6.7±7.1 ng/L) than the obese without MetS (3.7 ± 2.1 ng/L) [p=0.044], and the non-obese [p=0.014]. Hs-TnT did not differ between the obese without MetS and the non-obese. Conclusions: Circulating concentrations of hs-TnT in obese children with the MetS are higher than those of the obese without the MetS and the non-obese, suggesting that it is obesity-related metabolic changes rather than obesity per se linked to increased hs-TnT in children. [Copyright &y& Elsevier]

Abstract: Stress, that is, the state of threatened or perceived as threatened homeostasis, is associated with activation of the stress system, mainly comprised by the hypothalamic-pituitary-adrenal axis and the arousal/sympathetic nervous systems. The stress system normally functions in a circadian manner and interacts with other systems to regulate a variety of behavioral, endocrine, metabolic, immune, and cardiovascular functions. However, the experience of acute intense physical or emotional stress, as well as of chronic stress, may lead to the development of or may exacerbate several psychologic and somatic conditions, including anxiety disorders, depression, obesity, and the metabolic syndrome. In chronically stressed individuals, both behavioral and neuroendocrine mechanisms promote obesity and metabolic abnormalities: unhealthy lifestyles in conjunction with dysregulation of the stress system and increased secretion of cortisol, catecholamines, and interleukin-6, with concurrently elevated insulin concentrations, lead to development of central obesity, insulin resistance, and the metabolic syndrome. Fetal life, childhood, and adolescence are particularly vulnerable periods of life to the effects of intense acute or chronic stress. Similarly, these life stages are crucial for the later development of behavioral, metabolic, and immune abnormalities. Developing brain structures and functions related to stress regulation, such as the amygdala, the hippocampus, and the mesocorticolimbic system, are more vulnerable to the effects of stress compared with mature structures in adults. Moreover, chronic alterations in cortisol secretion in children may affect the timing of puberty, final stature, and body composition, as well as cause early-onset obesity, metabolic syndrome, and type 2 diabetes mellitus. The understanding of stress mechanisms leading to metabolic abnormalities in early life may lead to more effective prevention and intervention strategies of obesity-related health problems. [Copyright &y& Elsevier]

Introduction: Raw seafood consumption has frequently been linked to gastroenteritis and Norovirus is a common cause. In February and March 2010, there was an increase cases of gastroenteritis on the remote island of Agios Efstratios in the Northern Aegean Sea, Greece. A massive increase in seafood consumption associated with a religious festival a few days prior to the outbreak suggested seafood as the vehicle of transmission. Methods: An outbreak investigation team visited the island in order to document the outbreak and find epidemiological evidence for its source. The whole island was used as a cohort in the retrospective cohort study that was conducted. Results: Sixty-four of the 181 participants reported having had symptoms of gastroenteritis, of which 34 were considered primary cases. People who consumed any raw seafood imported to the island were 21.5 times (95% CI: 8.95-51.8) more likely to develop symptoms of gastroenteritis in the 72 hours following exposure. Consumption of local seafood was not found to be a risk factor. Conclusion: Despite the lack of laboratory evidence, all four Kaplan's criteria were met and the outbreak was thought to have been caused by Norovirus. The outbreak investigation demonstrates epidemiological methods for use in a remote setting, where the means for laboratory and environmental investigation may be absent or limited. [ABSTRACT FROM AUTHOR]

Post-traumatic Stress Disorder (PTSD) is an anxiety syndrome that develops after exposure to traumatic life events. Symptoms include re-experience of the initial trauma, avoidance of stimuli associated with the trauma and symptoms of excessive arousal. Neuroendocrine studies in adults with PTSD have demonstrated that basal cerebrospinal fluid (CSF) CRH levels are elevated and urinary cortisol levels are variable - low in the majority of cases - whereas other studies demonstrate no differences in urinary and plasma cortisol concentrations. Urinary catecholamine excretion is higher in PTSD patients than those of control subjects and other psychiatric disorders. Children may differ from adults in their psychologic and physiologic responses to severe stressors. Also, exposure to stress during critical periods of development may have irreversible effects on behavioral maturation and may affect specific vulnerable brain areas, altering CNS development. Similar to findings in adult studies, PTSD in children is characterized by increased sympathetic nervous system (SNS) activity, as indicated by elevated norepinephrine levels in the periphery. High cortisol levels in urine or saliva have been reported in most studies of childhood PTSD, while prospective longitudinal studies concerning the natural history of neuroendocrine changes in pediatric PTSD after an acute stressor are limited. The identification of neurobiologic changes in response to early adverse experiences is of major importance for the prognosis, prevention, management, and treatment of children and adolescents at risk for or suffering from PTSD. [ABSTRACT FROM AUTHOR]

PURPOSE OF REVIEW: The metabolic syndrome, a clustering of abnormalities such as hyperglycemia, insulin resistance, hypertension, dyslipidemia, and central obesity, is a principal risk factor for cardiovascular disease, the leading cause of morbidity and mortality in the Western world. There are several definitions of the metabolic syndrome, all aiming at including as many persons at risk as possible. The assessment and, hence, the identification of such persons in a clinical setting is of utmost importance. RECENT FINDINGS: Clinicians should document the presence of central obesity, assessed by waist circumference measurement or determination of body composition using dual X-ray absorptiometry or measurement of visceral fat using computed tomography or magnetic resonance imaging. The presence of dyslipidemia, insulin resistance, and arterial hypertension constitutes the full profile of the metabolic syndrome. Nevertheless, elevated uric acid levels or presence of nonalcoholic fatty liver, or the diagnosis of the polycystic ovary syndrome in women of reproductive age, all are reflected in high risk of later occurrence of the full metabolic syndrome and atherosclerotic cardiovascular disease. SUMMARY: Although no unified definition for the metabolic syndrome exists, it is important to identify persons at risk, in order to reduce the resultant high morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

PURPOSE OF REVIEW: The metabolic syndrome, a clustering of abnormalities such as hyperglycemia, insulin resistance, hypertension, dyslipidemia, and central obesity, is a principal risk factor for cardiovascular disease, the leading cause of morbidity and mortality in the Western world. There are several definitions of the metabolic syndrome, all aiming at including as many persons at risk as possible. The assessment and, hence, the identification of such persons in a clinical setting is of utmost importance.RECENT FINDINGS: Clinicians should document the presence of central obesity, assessed by waist circumference measurement or determination of body composition using dual X-ray absorptiometry or measurement of visceral fat using computed tomography or magnetic resonance imaging. The presence of dyslipidemia, insulin resistance, and arterial hypertension constitutes the full profile of the metabolic syndrome. Nevertheless, elevated uric acid levels or presence of nonalcoholic fatty liver, or the diagnosis of the polycystic ovary syndrome in women of reproductive age, all are reflected in high risk of later occurrence of the full metabolic syndrome and atherosclerotic cardiovascular disease.SUMMARY: Although no unified definition for the metabolic syndrome exists, it is important to identify persons at risk, in order to reduce the resultant high morbidity and mortality rates. [ABSTRACT FROM AUTHOR]