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We previously showed that amyloid-β 1-42 (Aβ(42)) levels in cerebrospinal fluid (CSF) were markedly altered in response to a 4-week dietary intervention in normal aging and mild cognitive impairment (MCI). Here, we re-examined the data to assess whether diet-induced effects on CSF Aβ(42) were modulated by high intensity physical activity (hi-PA). Normal older adults (n = 18, mean age = 68.6 ± 7.4 y) and adults with amnestic MCI (n = 23, mean age = 68.0 ± 6.5 y) received a low saturated fat/low glycemic index (LOW) diet or a high saturated fat/high glycemic index (HIGH) diet, and CSF levels of Aβ(42), tau, and IL-8 were measured at baseline and week 4. Pre-study activity levels were assessed using a 7-d questionnaire, and weekly duration of hi-PA was quantified. At baseline, increased hi-PA in normals predicted lower CSF levels of tau (r = -0.54, p = 0.020) and IL-8 (r = -0.70, p = 0.025). Diet-induced effects on CSF Aβ(42) during the intervention study were modulated by hi-PA, and the nature of this effect differed for normals and MCI (ANOVA, p = 0.039). That is, for normal adults, increased hi-PA attenuated the effects of the HIGH diet on CSF Aβ(42) whereas in MCI, increased hi-PA potentiated the effects of the LOW diet. Our results suggest that normal adults who engage in hi-PA are less vulnerable to the pathological effects of an unhealthy diet, while in MCI, the benefit of a healthy diet on Aβ modulation is greatest when paired with hi-PA. Exercise may thus interact with diet to alter pathological processes that ultimately modify risk of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Digital technologies can be used at multiple levels to support the mental health care of children including (1) health system/health care provider level; (2) patient-provider interface; (3) patient-facing consumer applications; and (4) new technology, including artificial intelligence. At each of these levels, these novel technologies may lead to care improvements but also may have risks. This review provides an overview of each of innovations across the digital landscape., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: Atypical eye gaze is an early-emerging symptom of autism spectrum disorder (ASD) and holds promise for autism screening. Current eye-tracking methods are expensive and require special equipment and calibration. There is a need for scalable, feasible methods for measuring eye gaze., Objective: Using computational methods based on computer vision analysis, we evaluated whether an app deployed on an iPhone or iPad that displayed strategically designed brief movies could elicit and quantify differences in eye-gaze patterns of toddlers with ASD vs typical development., Design, Setting, and Participants: A prospective study in pediatric primary care clinics was conducted from December 2018 to March 2020, comparing toddlers with and without ASD. Caregivers of 1564 toddlers were invited to participate during a well-child visit. A total of 993 toddlers (63%) completed study measures. Enrollment criteria were aged 16 to 38 months, healthy, English- or Spanish-speaking caregiver, and toddler able to sit and view the app. Participants were screened with the Modified Checklist for Autism in Toddlers-Revised With Follow-up during routine care. Children were referred by their pediatrician for diagnostic evaluation based on results of the checklist or if the caregiver or pediatrician was concerned. Forty toddlers subsequently were diagnosed with ASD., Exposures: A mobile app displayed on a smartphone or tablet., Main Outcomes and Measures: Computer vision analysis quantified eye-gaze patterns elicited by the app, which were compared between toddlers with ASD vs typical development., Results: Mean age of the sample was 21.1 months (range, 17.1-36.9 months), and 50.6% were boys, 59.8% White individuals, 16.5% Black individuals, 23.7% other race, and 16.9% Hispanic/Latino individuals. Distinctive eye-gaze patterns were detected in toddlers with ASD, characterized by reduced gaze to social stimuli and to salient social moments during the movies, and previously unknown deficits in coordination of gaze with speech sounds. The area under the receiver operating characteristic curve discriminating ASD vs non-ASD using multiple gaze features was 0.90 (95% CI, 0.82-0.97)., Conclusions and Relevance: The app reliably measured both known and new gaze biomarkers that distinguished toddlers with ASD vs typical development. These novel results may have potential for developing scalable autism screening tools, exportable to natural settings, and enabling data sets amenable to machine learning.

An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To compare the effects of a 4-week high-saturated fat/high-glycemic index (HIGH) diet with a low-saturated fat/low-glycemic index (LOW) diet on insulin and lipid metabolism, cerebrospinal fluid (CSF) markers of Alzheimer disease, and cognition for healthy adults and adults with amnestic mild cognitive impairment (aMCI)., Design: Randomized controlled trial., Setting: Veterans Affairs Medical Center clinical research unit., Participants: Forty-nine older adults (20 healthy adults with a mean [SD] age of 69.3 [7.4] years and 29 adults with aMCI with a mean [SD] age of 67.6 [6.8] years)., Intervention: Participants received the HIGH diet (fat, 45% [saturated fat, > 25%]; carbohydrates, 35%-40% [glycemic index, > 70]; and protein, 15%-20%) or the LOW diet (fat, 25%; [saturated fat, < 7%]; carbohydrates, 55%-60% [glycemic index, < 55]; and protein, 15%-20%) for 4 weeks. Cognitive tests, an oral glucose tolerance test, and lumbar puncture were conducted at baseline and during the fourth week of the diet., Main Outcome Measures: The CSF concentrations of β-amyloid (Aβ42 and Aβ40), tau protein, insulin, F2-isoprostanes, and apolipoprotein E, plasma lipids and insulin, and measures of cognition., Results: For the aMCI group, the LOW diet increased CSF Aβ42 concentrations, contrary to the pathologic pattern of lowered CSF Aβ42 typically observed in Alzheimer disease. The LOW diet had the opposite effect for healthy adults, ie, decreasing CSF Aβ42, whereas the HIGH diet increased CSF Aβ42. The CSF apolipoprotein E concentration was increased by the LOW diet and decreased by the HIGH diet for both groups. For the aMCI group, the CSF insulin concentration increased with the LOW diet, but the HIGH diet lowered the CSF insulin concentration for healthy adults. The HIGH diet increased and the LOW diet decreased plasma lipids, insulin, and CSF F2-isoprostane concentrations. Delayed visual memory improved for both groups after completion of 4 weeks of the LOW diet., Conclusion: Our results suggest that diet may be a powerful environmental factor that modulates Alzheimer disease risk through its effects on central nervous system concentrations of Aβ42, lipoproteins, oxidative stress, and insulin.

Objective: To examine the test-retest reliability of a new interviewer-based psychiatric diagnostic measure (the Preschool Age Psychiatric Assessment) for use with parents of preschoolers aged 2 to 5 years., Method: A total of 1,073 parents of children attending a large pediatric clinic completed the Child Behavior Checklist 1 1/2-5. For 18 months, 193 parents of high scorers and 114 parents of low scorers were interviewed on two occasions an average of 11 days apart., Results: Estimates of diagnostic reliability were very similar to those obtained from interviews with parents of older children and adults, with kappas ranging from 0.36 to 0.79. Test-retest intraclass correlations for DSM-IV syndrome scale scores ranged from 0.56 to 0.89. There were no significant differences in reliability by age, sex, or race (African American versus non-African American)., Conclusions: The Preschool Age Psychiatric Assessment provides a reasonably reliable standardized measure of DSM-IV psychiatric symptoms and disorders in preschoolers for use in both research and clinical service evaluations of preschoolers as young as 2 years old.

Pregnant guinea pigs were injected with approximately 1 microgram/kg of CH3 203HgCl at 22,40,47,59,and 66 days of gestation, and fetal tissues were obtained 24 hours later. Autologous fetal erythrocytes were labeled with 51Cr and used to label the fetal blood pool at each gestational age except 22 days so that tissue-bound Hg could be calculated. In general, Hg absorbed by the whole fetus increased during gestation, in parallel with increasing tissue mass, while Hg found in whole placentas remained the same. Hg concentrations in the whole fetus and placenta were closely correlated, as were Hg concentrations in brain, liver, and kidney. Liver, kidney, blood, and brain contained the highest Hg concentration early in gestation. While it is difficult to interpret the potential effects of the increased Hg concentrations, particular attention should be paid to the brain, since it is considered a target tissue in MeHg toxicity.

Tissue samples were obtained from 115 swine fetuses from 10 litters and analyzed for tissue-bound Hg 24 h after mothers were exposed to low levels of methylmercury by iv injection. Absorption of Hg by the fetus and placenta increased throughout gestation in concert with increasing fetal weight, as did fetal hepatic Hg. Fetal renal Hg increased throughout gestation, but the increase appeared to be much greater than would be expected on the basis of weight increase alone. Blood Hg concentrations did not change significantly. Fetal brain Hg content and concentration increased dramatically toward the end of pregnancy, the gestational period during which the rate of brain growth is greatest in swine. The finding that a period of increased Hg concentration in brain corresponded with the period of maximal brain growth velocity is particularly interesting because of the hypothesis that the brain is especially sensitive to nutritional and, presumably, toxicological perturbation while it is growing most rapidly.