Child, parent, and family mental health and functioning in Australia during COVID-19: comparison to pre-pandemic data.

The COVID-19 pandemic presents significant risks to population mental health. Despite evidence of detrimental effects for adults, there has been limited examination of the impact of COVID-19 on parents and children specifically. We aim to examine patterns of parent and child (0-18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19, compared to pre-pandemic data, and to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0-18 years (N = 2365). Parents completed an online self-report survey during 'stage three' COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent depression, anxiety, and stress (Cohen's d = 0.26-0.81, all p < 0.001), higher parenting irritability (d = 0.17-0.46, all p < 0.001), lower family positive expressiveness (d = - 0.18, p < 0.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p < 0.001). In multivariable analyses, we consistently found that younger parent age, increased financial deprivation, pre-existing parent and child physical and mental health conditions, COVID-19 psychological and environmental stressors, and housing dissatisfaction were associated with worse parent and child functioning and more strained family relationships. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.

A comparison of children and adolescent's self-report and parental report of the PedsQL among those with and without autism spectrum disorder.

PURPOSE: Children and adolescents with autism spectrum disorders (ASD) are understood to experience a reduced quality of life compared to typically developing (TD) peers. The evidence to support this has largely been derived from proxy reports, in turn which have been evaluated by Cronbach's alpha and interrater reliability, neither of which demonstrate unidimensionality of scales, or that raters use the instruments consistently. To redress this, we undertook an evaluation of the Pediatric Quality of Life Inventory™ (PedsQL), a widely used measure of children's quality of life. Three questions were explored: (1). do TD children or adolescents and their parents use the PedsQL differently; (2). do children or adolescents with ASD and their parents use the PedsQL differently, and (3). do children or adolescents with ASD and TD children or adolescents use the PedsQL differently? By using the scales differently, we mean whether respondents endorse items differently contingent by group. METHODS: We recruited 229 children and adolescents with ASD who had an IQ greater than 70, and one of their parents, as well as 74 TD children or adolescents and one of their parents. Children and adolescents with ASD (aged 6-20 years) were recruited from special primary and secondary schools in the Amsterdam region. Children and adolescents were included based on an independent clinical diagnosis established prior to recruitment according to DSM-IV-TR criteria by psychiatrists and/or psychologists, qualified to make the diagnosis. Children or adolescents and parents completed their respective version of the PedsQL. RESULTS: Data were analysed for unidimensionality and for differential item functioning (DIF) across respondent for TD children and adolescents and their parents, for children and adolescents with ASD and their parents, and then last, children and adolescents with ASD were compared to TD children and adolescents for DIF. Following recoding the data, the unidimensional model was found to fit all groups. We found that parents of and TD children and adolescents do not use the PedsQL differently ([Formula: see text] = 64.86, p = ns), consistent with the literature that children and adolescents with ASD and TD children and adolescents use the PedsQL similarly ([Formula: see text] = 92.22, p = ns), though their score levels may differ. However, children and adolescents with ASD and their parents respond to the PedsQL differently ([Formula: see text] = 190.22, p < 0.001) and contingently upon features of the child or adolescent. CONCLUSIONS: We suggest this is due to children or adolescents with ASD being less forthcoming with their parents about their lives. This, however, will require additional research to confirm. Consequently, we conclude that parents of high-functioning children with ASD are unable to act as reliable proxies for their children with ASD.

Sexual Orientation in Autism Spectrum Disorder.

Clinical impressions suggest a different sexual profile between individuals with and without Autism Spectrum Disorder (ASD). Little is presently known about the demographics of sexual orientation in ASD. Sexual Orientation was surveyed using the Sell Scale of Sexual Orientation in an international online sample of individuals with ASD (N = 309, M = 90, F= 219), aged (M = 32.30 years, SD = 11.93) and this was compared to sexual orientation of typically-developing individuals (N = 310, M = 84, F= 226), aged (M = 29.82 years, SD = 11.85). Findings suggested that sexual orientation was contingent on diagnosis (N = 570, χ2(9) =104.05, P < 0.001, φ = 0.43). In the group with ASD, 69.7% of the sample reported being non-heterosexual, while in the TD group, 30.3% reported being non-heterosexual. The group with ASD reported higher rates of homosexuality, bisexuality and asexuality, but lower rates of heterosexuality. The results support the impression that non-heterosexuality is more prevalent in the autistic population. Increased non-heterosexuality in ASD has important clinical implications to target unique concerns of this population, and suggests a need for specialized sex education programs for autistic populations for increased support and awareness. Autism Res 2018, 11: 133-141. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Research suggests that individuals with Autism Spectrum Disorder (ASD) report increased homosexuality, bisexuality, and asexuality, but decreased heterosexuality. It is important to increase awareness about increased non-heterosexuality in ASD among autistic populations, medical professionals and care-takers, so as to provide specialized care, if needed and increase support and inclusion for non-heterosexual autistic individuals.

Burns in the Third World: an unmet need.

Burns continue to present a significant public health problem, resulting in scores of preventable deaths and disability everyyear. The burden of burns disproportionately falls to the world's poor residing in low and middle-income countries (LMICs). Those who are burnt require timely access to acute burns management, including definitive surgical care. The current lack of access to safe and affordable surgical care with anaesthesia worldwide means that some 5 billion people do not have access to acute burns management, including definitive surgical care for burns, when needed most. Major limitations to access to burn care at healthcare facilities in LMICs include a lack of appropriately trained staff (including surgeons), appropriate equipment and resources. Burn prevention measures have been successful in reducing the incidence of burns and deaths in many developed countries, however there is currently a paucity of robust understanding of what works in LMICs to prevent burns. A combined effort to implement proven burn prevention strategies and address the unmet need for access to safe and affordable surgical care with anaesthesia is required to reduce the global burden of burns that still exists.

Les brûlures demeurent un problème de santé publique, en raison du nombre de décès et de handicaps préventibles survenant annuellement. Le risque de brûlure est particulièrement élevé parmi la population pauvre des pays en développement (PED). Les brûlés doivent recevoir des soins adaptés, y compris chirurgicaux, en temps et heure. Le manque actuel de structures chirurgicales (et anesthésiques) sécurisées et financièrement abordables place les 5 milliards d'humains les plus à risque en dehors des structures de prise en charge des brûlés. Les limitations à l'accès aux soins pour brûlés dans les PED comprennent l'absence de soignants entraînés (chirurgiens inclus), d'équipement, de moyens. Si les mesures de prévention ont permis de réduire l'incidence des brûlures et de leur mortalité dans nombre pays développés, on ne sait actuellement clairement ce qui serait efficace dans les PED. Des actions préventives combinées au développement de structures capables de prendre en charge correctement (à un coût raisonnable pour les patients) les brûlés sont nécessaire pour réduire le risque et les conséquences des brûlures, toujours très élevés dans les PED.

The effect of multiple pulses of light on the circadian phase response of the rat.

Multiple pulses of light administered to humans have been reported to result in type 0 phase responses. These results suggest the underlying pacemaker to be nonsimple. At present, results with this type of protocol have only been reported for humans. Therefore, multiple pulses of light were administered to rats. Rats were exposed to one, two, three, or four pulses of light for 5 h (1000 lux) at successive 24-h intervals. Results did not suggest a type 0 phase response. Nonetheless, results with a second, third, or fourth light exposure were not fully predictable from a phase response curve derived from a single light pulse.

Cardiorespiratory effects of laparoscopy with and without gas insufflation.

BACKGROUND: Patients who are undergoing laparoscopic procedures can present with a number of ventilatory and circulatory problems. The use of a gasless technique for performing a laparoscopy by using a mechanical lifting device may potentially avoid such problems. OBJECTIVE: To compare the cardiorespiratory effects of laparoscopy with and without gas insufflation. METHODS: Twelve adult pigs were randomized to undergo a laparoscopy by using either carbon dioxide insufflation or mechanical elevation. Full invasive monitoring was performed preoperatively and at 10-minute intervals throughout the operative period. Parameters that were measured included blood gas determinations, mean arterial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output, stroke volume, and total peripheral resistance. RESULTS: Carbon dioxide insufflation unlike mechanical elevation led to a fall in PO2 and absorption of a significant quantity of CO2, resulting in hypercapnia, acidosis, and a consequent hyperdynamic circulation. CONCLUSION: These findings have significant implications for the use of CO2 insufflation for laparoscopy in patients with a compromised respiratory or cardiac status.

Mortality in patients on home parenteral nutrition.

Fifty out of 228 patients recorded on the U.K. Home Parenteral Nutrition Register have died. The earliest to die was at 10 days following the commencement of home parenteral nutrition (HPN), and the longest to die was after 5 1/2 years. Half of the patients who died, did so within 6 months of commencing HPN. Sixty % died of their underlying disease. Most patients with scleroderma or an underlying malignancy are dead within a year of commencing HPN. In contrast, patients with Crohn's disease or the short bowel syndrome due to volvulus do well. In only 14 patients was death attributable to the administration of HPN. In this group the main causes were septicemia, SVC thrombosis, and hepatic failure. Our study suggests that HPN should be used in patients with malignancy and scleroderma only in exceptional circumstances and that further work is necessary for the prevention of SVC thrombosis.

A single, accurate measurement of resting metabolic expenditure.

Indirect calorimetry is widely used in estimating nutritional requirements for severely ill patients. However, because the accuracy of a single measurement is dependent on many factors, the authors have sought to find the optimal single measurement. It is shown here that a more accurate resting metabolic expenditure (RME) can be obtained by studying a fasted, rested patient in relaxing surroundings after acclimatizing him or her to the calorimetric hood. Using this altered protocol, a significantly lower RME (by a mean of 125 kcal/d, p less than 0.0001) is achieved. This RME compares well with most of the various predictive equations. A predictive equation, based on the normal patients in this study and relating the RME to TBK (a measure of the body cell mass), allows calculation of a predicted RME, and subsequently a Stress Index as a measure of metabolic stress, ie, Predicted RME = TBK X 0.34 + 4.94. Stress Index = Measured RME/Predicted RME.

Total energy expenditure in patients with Crohn's disease: measurement by the combined body scan technique.

A combined body scan technique for measuring total energy expenditure (TEE) from energy intake and changes in energy stores is presented. The TEE of 13 patients with Crohn's disease who required nutrition support over a 14-day period was measured. They had a mean TEE of 33 kcal/kg per day. The components of the TEE in these 13 patients were also measured. Seventy percent of the TEE was made up by resting metabolic expenditure, 10% by diet-induced thermogenesis, and the remaining 20% by activity energy expenditure. These patients had a mean activity energy expenditure of 369 kcal/day. The diet-induced thermogenesis was a mean 12.6% increase on the resting metabolic expenditure. Each percent increase was caused by a mean of 210 kcal of energy in either the intravenous nutrition or the enteral nutrition. There was no difference in diet-induced thermogenesis between those having enteral nutrition and those receiving intravenous nutrition. Decreased activity was significantly correlated with increased activity of the disease (r = .7, p < .01). This confirms the belief that patients with Crohn's disease require no more energy (ie, 33 kcal/kg per day) than other patients. If the resting metabolic expenditure is increased through illness, then the activity energy expenditure decreases. The combined in vivo neutron activation-dual energy x-ray absorptiometry technique has allowed for the first time measurements in ward patients with Crohn's disease. The measurements confirm that TEE is not raised and that 30 to 35 kcal/kg per day is sufficient to achieve energy balance in such patients.

Peripheral parenteral nutrition: a preliminary report on its efficacy and safety.

In this preliminary study of peripheral parenteral nutrition, we compared our first nine patients fed by this method with 21 patients fed by total parenteral nutrition during the same period. We found that peripheral parenteral nutrition was as effective as total parenteral nutrition in improving physiologic function (both skeletal and respiratory muscle function). We also found that by using the protocol described here thrombophlebitis was not a significant problem. Additional study is required to ascertain the exact incidence of this and other complications. We would advocate the greater use of peripheral parenteral nutrition in suitable patients and the use of this protocol for its administration.

The effect of repeated pulses of light at the same time on period responses of the rat circadian pacemaker.

A consequence of simple velocity-based models is that, in response to light pulses, the circadian period should adjust inversely to phase. In addition, because of the interaction of circadian period and phase response, earlier circadian period changes should modify later circadian period changes. The literature contains few mentions of response curves of circadian period responses following light pulses. Rats were exposed to four pulses of light (60 minutes, 1000 lux) at the same circadian time, a minimum of 26 days apart; we assessed period responses and possible bias in the period-response curve. Modulation of circadian period following light-induced phase responses was examined by assessing the period of running wheel activity onset. Phase and circadian period were not consistently found to share an inverse relationship. Moreover, biases in initial period tended to be increased by the experimental protocol regardless of circadian time of pulse. Rats with a short initial (high-velocity) period had a lengthened period, while rats with a long initial period (low velocity) tended to have a reduce period. However, rats with a long initial period were phase delay biased, not phase advance biased. These results do not support a simple velocity model of the pacemaker.

Anesthesia for stereotactic radiosurgery in children.

The development of stereotactic radiosurgery has been a major advance in the treatment of intracranial lesions. By using a stereotactic head frame attached to the skull, large doses of radiation can be delivered precisely to the lesion while sparing surrounding tissues. Although adults can usually undergo this procedure with local anesthesia or conscious sedation alone, children frequently require general anesthesia. This report describes our experience with the anesthetic management of all children who have received this therapy at our institution since the inception of our stereotactic radiosurgery program in 1986 through June 1993. Sixty-eight radiosurgery procedures were performed in 65 patients. Anesthesia time averaged 9.2 h (range, 7-15). Twenty-two patients (ages 11-17; mean 14.3) received local anesthesia alone, two patients (ages 11 and 15) received local anesthesia plus i.v. sedation, and 44 patients (ages 2-14; mean, 7.3) received general anesthesia. Four potentially serious anesthesia-related events occurred; in one child (age 7) receiving general anesthesia, an endotracheal tube obstruction developed during radiosurgery requiring rapid reintubation while the child was still in the head frame; another (age 7) who was undergoing chemotherapy and had neutropenia and rhinitis had a lobar collapse while intubated, requiring mechanical ventilation and endotracheal tube suctioning for lung expansion. Another (age 5) with a recent upper respiratory tract infection had copious endotracheal secretions and sinusitis (ethmoid and maxillary) noted on initial computed tomography scanning and was given antibiotics and decongestants (following nasotracheal extubation), and another (age 15) receiving sedation without endotracheal intubation vomited an undigested meal midway through the procedure while her head was partially immobilized in the head frame.(ABSTRACT TRUNCATED AT 250 WORDS)

Home parenteral nutrition at Auckland Hospital.

This paper reports the results of home parenteral nutrition (HPN) from Auckland Hospital. In the last two and a half years, six patients have gone home from hospital on HPN. Four are still on it, after periods of from one to 30 months. There has been one death and one patient who developed catheter sepsis. Quality of life on HPN has in general been very good. Body composition studies performed on these patients have shown that a normal body composition can be maintained while on HPN.

Dietary management of the patient with massive enterectomy.

We present two cases who required massive enterectomy and who represent different points in the spectrum of this disease. We discuss their management from a nutritional stand-point and show details of energy uptake and expenditure for one of our patients. This describes our approach to this problem, and we hope it will be of use to others when dealing with patients following massive enterectomy.

A season of football injuries.

All rugby and soccer players presenting to the Accident & Emergency department during the football season 1992-1993 (a total of 871) were prospectively studied to compare the injuries sustained in the two sports. The nature and site of injury, treatment required, age, fitness, experience and position of the player, situation giving rise to injury, and medical attention at the grounds were all analysed. The results show that rugby and soccer players had the same number of injuries, and while there were some differences in the nature of the injuries, there was no difference in overall severity. Rugby flankers and soccer goalkeepers are particularly at risk. Competitive matches produce more injuries than training sessions. Experience or fitness did not appear to be a factor and 45% of rugby injuries and 15% of soccer injuries were from school matches. Law changes (e.g. the rugby scrum and the use of gum-shields) have reduced some injuries, but other areas (e.g. jumping for the ball in soccer, rucks and mauls in rugby) also warrant consideration. There was one death, but no spinal cord injuries. Medical attention at the grounds was limited. Rugby injuries, therefore, do not appear to be more numerous or severe than soccer injuries. Law changes have been of benefit but they need to be enforced and perhaps more should be considered. Medical attention at sports grounds could be improved and Registers of injuries kept by the sporting bodies would be of benefit.

Surgery for Crohn's disease.

In the last 12 years, 72 operations have been performed on 41 patients for Crohn's disease in this hospital. The patients were predominantly young (mean age 32 yrs) and there were more females than males. 28 had ileocolic disease, three small intestinal, two pan-enteric and eight colonic. Pain (in 76%), diarrhoea (56%) and weight loss (66%) were the main presenting symptoms. Diarrhoea occurred in all those with colonic disease, but in only 43% of those with ileocolic disease. A right hemicolectomy (28 patients), colonic resection (12) and small intestinal resection (9) were the commonest operations. There were no deaths. 22 patients had a total of 26 complications after surgery, eight necessitating further surgery. The mean post-operative stay was 15 days, being lowest in those with ileocolic disease. 19 patients have required only one operation, with a mean follow-up of 5.3 years. These patients also had significantly less complications (p < 0.05). Half of the patients requiring surgery for Crohn's disease have done very well. The other half require many operations and have a substantial morbidity.

Validation of autism spectrum quotient adult version in an Australian sample.

The Autism Spectrum Quotient is used to assess autistic spectrum traits in intellectually competent adults in both the general population and the autism spectrum community. While the autism spectrum Quotient has been validated in several different cultures, to date no study has assessed the psychometrics of the Autism Spectrum Quotient on an Australian population. The purpose of this study was to assess the psychometrics of the autism spectrum Quotient in an Australian sample of both typically developing individuals (n = 128) and individuals with autism spectrum disorder (n = 104). The results revealed that the internal consistency and the test-retest reliability were satisfactory; individuals with autism spectrum disorder scored higher on total Autism Spectrum Quotient score and its subscales than typically developing individuals; however, gender differences were not apparent on total score. Possible cultural differences may explain some of the psychometric variations found. The results of this analysis revealed that the Autism Spectrum Quotient was a reliable instrument for investigating variation in autistic symptomology in both typically developing and Autism Spectrum Disorders populations within an Australian population.