RESUMO
OBJECTIVE: The objective of this study was to compare the prevalence of home care practices in very to moderately preterm (VPT), late preterm (LPT) and term infants born in Massachusetts. STUDY DESIGN: Using 2007 to 2010 Massachusetts Pregnancy Risk Assessment Monitoring System data, births were categorized by gestational age (VPT: 23 to 33 weeks; LPT: 34 to 36 weeks; term: 37 to 42 weeks). Home care practices included breastfeeding initiation and continuation, and infant sleep practices (supine sleep position, sleeping in a crib, cosleeping in an adult bed). We developed multivariate models to examine the association of infant sleep practices and breastfeeding with preterm status, controlling for maternal sociodemographic characteristics. RESULTS: Supine sleep position was more prevalent among term infants compared with VPT and LPT infants (77.1%, 71.5%, 64.4%; P=0.02). In the adjusted model, LPT infants were less likely to be placed in supine sleep position compared with term infants (adjusted prevalence ratio=0.86; 95% confidence interval: 0.75 to 0.97). Breastfeeding initiation and continuation did not differ among preterm and term groups. Nearly 16% of VPT and 18% of LPT and term infants were not sleeping in cribs and 14% of LPT and term infants were cosleeping on an adult bed. CONCLUSION: Compared with term infants, LPT infants were less likely to be placed in supine sleep position after hospital discharge. A significant percent of preterm and term infants were cosleeping on an adult bed. Hospitals may consider improving their safe sleep education, particularly to mothers of LPT infants.
Assuntos
Serviços de Assistência Domiciliar/tendências , Mães/educação , Alta do Paciente , Adulto , Aleitamento Materno , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Massachusetts , Análise Multivariada , Gravidez , Estudos Retrospectivos , Sono , Decúbito Dorsal , Nascimento a TermoRESUMO
Recent evidence supports a role for genetics in autism, but other findings are difficult to reconcile with a purely genetic cause. Pathological changes in the cerebellum in autism are thought to correspond to an event before 30-32 weeks gestation. Our purpose was to determine whether there is an increased incidence of stressors in autism before this time period. Surveys regarding incidence and timing of prenatal stressors were distributed to specialized schools and clinics for autism and Down syndrome, and to mothers of children without neurodevelopmental diagnoses in walk-in clinics. Incidence of stressors during each 4-week block of pregnancy was recorded. Incidence of stressors in the blocks prior to and including the predicted time period (21-32 weeks gestation) in each group of surveys was compared to the other prenatal blocks. A higher incidence of prenatal stressors was found in autism at 21-32 weeks gestation, with a peak at 25-28 weeks. This does support the possibility of prenatal stressors as a potential contributor to autism, with the timing of stressors consistent with the embryological age suggested by neuroanatomical findings seen in the cerebellum in autism. Future prospective studies would be needed to confirm this finding.
Assuntos
Transtorno Autístico/epidemiologia , Acontecimentos que Mudam a Vida , Estresse Psicológico/psicologia , Transtorno Autístico/diagnóstico , Cerebelo/embriologia , Criança , Síndrome de Down/epidemiologia , Feminino , Doenças Fetais/epidemiologia , Doenças Fetais/fisiopatologia , Seguimentos , Idade Gestacional , Humanos , Incidência , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Inquéritos e QuestionáriosRESUMO
The initial description of Asperger syndrome commented on the poor handwriting and motor coordination difficulties of individuals with this condition. Early descriptions of autism do not remark upon such difficulties. Recent evidence, however, suggests that individuals with both conditions have a similar motor control impairment. Handwriting has not been formally assessed in this context. Our study compared handwriting size between individuals with autism spectrum disorder and age- and IQ-matched control subjects. Macrographia was observed among subjects with autism spectrum disorder which remained statistically significant when covaried with educational level. This finding may correlate with the anatomical abnormalities present in the cerebellum of individuals with autism spectrum disorder.
Assuntos
Síndrome de Asperger/diagnóstico , Escrita Manual , Inteligência , Adolescente , Adulto , Cerebelo/anormalidades , Feminino , Humanos , Masculino , Transtornos Psicomotores/diagnósticoRESUMO
OBJECTIVE: Several deficits have been proposed to account for cognitive impairment in autism including an inability to comprehend the perspectives of others ("theory of mind"), an inability to process emotional information, and difficulty drawing together diverse information in context ("central coherence"). Because context (central coherence) and emotion can influence memory, a study was designed to show if autism spectrum disorder was associated with impaired utilisation of context and emotion in recall; and if impairments in theory of mind processing would influence recall in autism spectrum disorder. METHODS: Ten high functioning subjects with autism spectrum disorder and 13 age and IQ matched controls were tested using recall tests. In the first coherence memory test, subjects listened to a series of word lists that were in varying degrees of syntactic and semantic (coherent) order and were asked to recall the words. In the second coherence memory test, subjects listened to stories consisting of sentences that were, or were not, in logical (coherent) order. In the emotional memory test, the subjects listened to sentences that were highly emotional or non-emotional. In the theory of mind test, the subjects listened to stories requiring varying levels of understanding of the perspectives of others. RESULTS: There were no significant differences between groups in recall of coherent versus incoherent word lists, nor was there a significant difference between groups in recall of coherent versus incoherent stories. However, the control subjects recalled more of the emotional than non-emotional sentences, whereas the autism spectrum disorder group did not show such a difference. No significant difference existed in recall of stories requiring varying levels of understanding of the perspectives of others among subjects with autism spectrum disorder, and subjects with autism spectrum disorder did not differ from control subjects in the influence of theory of mind content on story recall. CONCLUSION: The study shows that memory in high functioning adults with autism spectrum disorder is facilitated by emotional content to a lesser degree than it is facilitated by coherence. Therefore, impairments in emotional processing cannot be considered as simply an effect of the "weak central coherence" theory in autism spectrum disorder. Whereas the reasons for this emotional deficit are unknown, evidence of abnormalities of the limbic structures in autism spectrum disorder may provide an anatomical explanation.