Intensive intervention for adolescents with autism spectrum disorder: comparison of three rehabilitation treatments.

INTRODUCTION: Autism spectrum disorder (ASD) is a set of heterogeneous neurodevelopmental conditions, characterised by difficulties in social communication and restricted, repetitive behaviours and interests. There are several rehabilitative interventions for individuals with ASD but the evidence of their effectiveness is low or moderate overall. The transition phase of ASD individuals from adolescence to adulthood represents an important challenge. Adults with ASD struggle to access employment or independent living. METHODS: In our study, we evaluated the effect of three different high-intensity interventions, namely Applied Behaviour Analysis (ABA), Treatment and Education of Autistic and Communication-Handicapped Children (TEACCH) and Behavioural Educational Intervention (BEI), in 93 ASD (levels 2 and 3) adolescents (age range 12-18 years). RESULTS: Our results showed that all adolescents with ASD reported an improvement of core symptoms, regardless of the type of treatment. CONCLUSIONS: A high intensity intervention ameliorates the core symptoms of ASD, enriching evidence of effectiveness regarding adolescents with ASD.KEY POINTSIndividuals with ASD need lifespan support and they struggle to access employment, independent living and community inclusion.There are several rehabilitative interventions for individuals with ASD but the evidence of their effectiveness in adolescents is insufficient.The main purpose of this study was to evaluate the possible enhancement produced by three intensive interventions (ABA, TEACCH, BEI) of symptom severity and adaptive functions.Results show that independently of the treatment, individuals with ASD decrease in ASD severity.Individuals who were treated with the BEI and TEACCH programmes reported improvements in the adaptive domains.

Effect of temperature on the release of carvacrol and cinnamaldehyde incorporated into polymeric systems to control growth and biofilms of Escherichia coli and Staphylococcus aureus.

This study assessed the effect of temperature on the release of essential oil components incorporated by melt compounding into polymeric films. Specifically, polyethylene-co-vinylacetate (EVA) films containing carvacrol (CAR) and cinnamaldehyde (ALD), alone and in combination, were prepared and their surface and mechanical properties and antibacterial and anti-biofilm activity against Escherichia coli and Staphylococcus aureus were evaluated. The addition of ALD and CAR did not provoke variation in the surface morphology of EVA and allowed their delivery. At 37°C, films containing CAR, ALD or their combination (25+75%) were found to have the strongest bactericidal effect, whereas at lower temperatures a lower killing rate was observed. There was no clear evidence of the influence of temperature on the anti-biofilm activity of the essential oil component-based polymeric films. The biomass formed on EVA containing ALD, CAR or their combination (25+75) was significantly lower (60-80% reduction) than that formed on the EVA control at both 37° and 22°C.

Development and characterization of essential oil component-based polymer films: a potential approach to reduce bacterial biofilm.

The development of new polymeric materials aimed to control the bacterial biofilm appears to be an important practical approach. The goal of the present study was to prepare and characterize poly(ethylene-co-vinyl acetate) copolymer (EVA) films containing citronellol, eugenol, and linalool and evaluate their efficiency on growth and biofilm formation of Listeria monocytogenes, Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa in monospecies and dual species. The results showed that the addition of oil components influenced the elastic modulus (15 % decrease), the tensile stress (30 % decrease), the elongation at break (10 % increase), and the contact angle values (10-20° decrease) while leaving the homogeneity of the surface unaltered. Among the polymeric films, EVA + citronellol and EVA + eugenol at 7 wt% had the best inhibitory effect. After 24-48 h of incubation, EVA + citronellol was more effective against the growth (30-60 % reduction) than EVA + eugenol (15-30 % inhibition). However, this inhibition decreased after 240 h of incubation. On the contrary, the biofilm evaluation revealed a strong inhibition trend also after prolonged incubation time: the amount of biomass per square centimeter formed on copolymer with oil components was significantly less (40-70 % decrease) than that on pure copolymer control for L. monocytogenes, S. aureus, and E. coli. When polymeric materials were simultaneously inoculated with combinations of S. aureus and E. coli, the biomass accumulated was higher for EVA + citronellol and lower for EVA + eugenol than that in monoculture biofilm. The findings were similar to the results obtained by 2,3-bis[2-methyloxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide assay that measures the metabolic activity of viable cells.

Study on carvacrol and cinnamaldehyde polymeric films: mechanical properties, release kinetics and antibacterial and antibiofilm activities.

Polyethylene-co-vinylacetate (EVA) films with different concentrations (3.5 wt% and 7 wt%) of essential oil constituents, carvacrol or cinnamaldehyde, were prepared and characterized by mechanical, antibacterial and antibiofilm properties. The incorporation of the compounds into copolymer films affected their elastic modulus, tensile stress and elongation at break. Carvacrol and cinnamaldehyde act as plasticizers which reduce the intermolecular forces of polymer chains, thus improving the flexibility and extensibility of the film. The analysis of the surface characteristics demonstrated that essential oil constituents lowered the contact angle values without causing any remarkable variation of the surface roughness. The films allowed progressive diffusion of the bioactive molecules and the kinetic of release was correlated with the damaging effect on bacterial growth. The kill curves proved that the film with essential oil constituents (7 wt%) had a significant bactericidal effect (reduction of 4 and 2 log CFU) against Staphylococcus aureus and Escherichia coli and a bacteriostatic effect against Staphylococcus epidermidis and Listeria monocytogenes (reduction of about 1 log CFU). With regard to biofilm formation the biomass formed on polymeric films surface was significantly reduced if compared with the pure copolymer control. The results were confirmed by fluorescence microscopy images by Live/dead staining. The reduction in the surface tension coupled to an inherent bactericidal property of carvacrol and cinnamaldehyde could in turn affect the initial attachment phase of bacteria and compromise the normal biofilm development.

Norfloxacin and ursolic acid: in vitro association and postantibiotic effect against Staphylococcus aureus.

AIMS: We investigated the effectiveness in vitro of the association between norfloxacin (NOR) and ursolic acid (UA) against Staphylococcus aureus. METHODS AND RESULTS: The minimal inhibitory concentrations (MICs), the minimal bactericidal concentrations, the bacterial killing and the postantibiotic effect (PAE) of NOR and UA were determined both singly and in combination. A synergistic interaction was observed against Staph. aureus ATCC 29213: the mean PAEs were 3 h for NOR, -1.2 h for UA (1 × MIC) and 2.0 h for UA (2 × MIC). Synergism was observed with longer PAEs and postantibiotic sub-MIC effects after NOR/UA exposure. UA was also active against clinical isolates and methicillin-resistant Staph. aureus. CONCLUSIONS: The application of antimicrobial combinations may address the rising resistance to established classes of both systemic and topical agents. SIGNIFICANCE AND IMPACT OF THE STUDY: In vitro interactions between NOR and UA may contribute to the development of novel topical agents for the treatment of skin infections as well as for topical formulations.

[Organizational appropriateness evaluation of hospital discharges related to DRGs at high risk of inappropriateness in a pediatric observation ward from 2000 to 2004]. / Valutazione della appropriatezza organizzativa dei ricoveri ordinari attribuiti ai DRG ad alto rischio di inappropriatezza effettuati in un Reparto di Osservazione Pediatrica nel periodo 2000-2004.

The aim of the study is to measure and to describe organizational appropriateness of a Paediatric Temporary Observation Ward in the Emergency Department. We selected hospital discharges related to 43 DRGs at high risk of inappropriateness (DPCM 29/11/2001); we studied the relationship between appropriateness and patient's or discharge characteristics. We also investigated the inappropriateness to find tools for improving ward's efficiency. Assessment of selected paediatric clinical records was performed using PRUO protocol and showed that 41.5% of hospital discharges are completely appropriated and only 13.8% are completely not appropriated and, consequently, could be provided in a different organizational setting. Inappropriateness in our study is lower than the expected one; this finding shows that the ward under investigation is able to provide health assistance with good level of appropriateness. The used tool to evaluate appropriateness is a modified PRUO version, specific for pediatric hospital stays. Pediatric PRUO protocol is easy to be applied even if reasonable and shared evaluation criteria do not seem able to recognise some peculiar characteristics of Pediatric Temporary Observation Ward in the Emergency Department.

[Evaluation of the appropriateness of hospital admissions with the Italian version of the AEP in a university hospital]. / Analisi dell'appropriatezza organizzativa dei ricoveri ospedalieri mediante PRUO in un ospedale del Molise.

It has been carried out a survey to evaluate the appropriateness of hospital stay in a university hospital. The aims of the study were: to determine the amount of inappropriate hospital admissions and inappropriate days of stay in relation to either wards and characteristics of admission; to analyse the reasons for inappropriate patient stay. A randomised sample stratified by ward of discharge of 224 medical records were analysed using the Italian version of the Appropriateness Evaluation Protocol. 37.9% of the hospital admissions and 18.9% of hospitalisation days were judged to be inappropriate. The main reasons for categorising an admission or a day of stay as inappropriate were a) delay in performing elective surgery procedures; b) that the patient's problem could be treated on an outpatient basis; c) delay in performing diagnostic examinations. The univariate statistical analysis showed an association between appropriateness of hospital stay and gender age, ward of discharge, length of hospital stay and DRG type (medical/surgical). The study highlights a lower level of inappropriateness compared to the results of other investigations. Hints were also identified for achieving an improved efficiency at hospital level.

[Evaluating hospital appropriateness with different tools: administrative data versus analytic review]. / La valutazione dell'appropriatezza organizzativa con differenti metodi: APPRO e PRUO.

PRUO, a modified version of AEP, is a widely used clinical-based tool to evaluate hospital appropriateness in Italy. We developed the APPRO method for assessing organizational appropriateness using administrative data. APPRO estimates the amount of inappropriate hospitalisation, giving consideration to severity of illness through APR-DRG classification system. The aims of the study were to: measure the agreement between evaluators using PRUO; investigate the relation between APR-DRG severity subgroups and PRUO assessment; asses the validity of APPRO method comparing its performance to PRUO results. We selected 361 hospital episodes assigned to DRG 39 ("lens procedures with or without vitrectomy") and 242 hospital episodes assigned to DRG 183 ("miscellaneous of digestive disorders, age > 17") from three hospitals in 2000. Clinical records were independently evaluated by two pairs of physicians using PRUO. Proportions of inappropriate episodes by hospital and DRG were also estimated through APPRO using data from Lazio regional hospital information system. The agreement between the two pairs of evaluators was high (k=0.93; p<0.0001). We observed no statistically significant association between APR-DRG severity subgroups and inappropriate hospitalisation found by PRUO. APPRO underestimates rates of inappropriate hospitalisation compared to PRUO. It depends on the different characteristics of the tools and particularly on the caution of APPRO in performing the evaluation using routine data.

Italian National Survey of Digestive Endoscopy Disinfection Procedures.

BACKGROUND AND STUDY AIMS: Inadequate disinfection of endoscopes and associated instrumentation can result in transmission of bacterial infections to patients. The aim of this study was to investigate the disinfection procedures carried out in the Italian centers of digestive endoscopy. MATERIALS AND METHODS: An anonymous postal questionnaire on the methods of cleaning and disinfecting endoscopy equipment in Italy was sent to 781 digestive endoscopy centers; 386 units (49.4 %) replied. RESULTS: Automatic washers were available in 47.6% of units. Nearly all the respondets (99.2%) cleaned the instruments before disinfection, using detergent, germicidal or enzymatic cleaner, but only 69.7% carried out brushing. Most centers (89.2 %) used a glutaraldehyde-based disinfectant (51 % used 2 % glutaraldehyde; 26.9% used 0.4% glutaraldehyde with 1.41% phenol and 0.26% sodium phenate; 5.9% used either; 5.4% did not specify glutaraldehyde formulation). The contact time of the disinfectant was < 10 minutes (1.8%), between 10 and 19 minutes (47.4%), between 20 and 29 minutes (31.9 %) and > or = 30 minutes (16.6%). The use-life of the disinfectant was > or = 14 days in 27.3 % of the centers with automatic washers and 30.8% in all centers. Only 25.4% of the centers carried out some form of sterilization for biopsy forceps. The majority (83.4 %) modified their disinfection procedures in the case of infectious disease patients. Quality control tests on the efficacy of the endoscopy disinfection procedures were carried out in 44.6 % of units. Only 43 % of the centers were based in hospitals with an infection control (surveillance) program. CONCLUSIONS: The data collected in the study showed that, in general, there is compliance with the Società Italiana di Endoscopia Digestiva (SIED) and Società Italiana di Gastroenterologia (SIGE) guidelines, although with some important exceptions.