Co-design of an NHS primary care health check for autistic adults.

LAY ABSTRACT: Autistic people are on average more likely to experience poor health than people who are not autistic. Health checks have been shown to improve access to effective healthcare. This study investigated people's views about a primary care health check for autistic adults. We held discussion groups and interviewed autistic adults, adults with intellectual disabilities, supporters and health professionals. People wanted the health check to look at a person's physical and mental health, and how they were doing socially. They thought people should be able to share information about their needs and the reasonable adjustments they would like before the health check. They wanted healthcare services to change the way they communicate with autistic people, such as being able to book appointments online rather than by telephone. They wanted a choice in how the health check was completed, with video call or email offered as well as face-to-face appointments. People thought further training of primary care staff on autism was needed, to increase awareness of the diversity of experiences of autistic people and ways in which difficulties, such as pain, may present differently to non-autistic people. Clinicians raised questions about whether mental health and social care services could meet the additional needs that might be identified through the health check. We used this information to design an NHS primary care health check for autistic people in collaboration with autistic people, supporters and health professionals.

Views about primary care health checks for autistic adults: UK survey findings.

BACKGROUND: Compared with the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to health care. A health check for autistic people may improve their health outcomes. AIM: To establish the views of autistic people towards a primary care health check for autistic people. DESIGN & SETTING: Cross-sectional questionnaire study in England and Wales. METHOD: A questionnaire was sent to autistic adults with physical health conditions in England and Wales. A total of 458 people (441 autistic adults and 17 proxy responders) completed the questionnaire. RESULTS: Most responders (73.4%, n = 336) thought a health check is needed for all autistic people. Around half of the participants thought a health check should be offered from childhood and the health check appointment should last between 15 and 30 minutes. Autistic people were positive about providing primary care staff with contextual information regarding their health and the reasonable adjustments they would like before their health check appointment. Training about autism and the health check was considered important, alongside adequate time for discussions in the health check appointment (all by over 70% of responders). The clinician's autism knowledge, seeing a familiar clinician, environmental adaptations, appropriate information, and accessible appointments were considered particularly important in making a health check accessible. CONCLUSION: Autistic people and relatives were supportive of a primary care health check for autistic people. Information gathered was used to support the design of a primary care health check for autistic adults.

Monitoring of nanoclay-protein adsorption isotherms via fluorescence techniques.

The investigation of nanoparticles and their interaction with bio-macromolecules have become an important issue; the widely discussed protein corona around nanoparticles and their biological fate in general have drawn particular attention. Here, we focus on nanoclay dispersions and the use of solvatochromic fluorescent dyes (Dansyl and Coumarin 153) for monitoring the interaction with two model proteins, bovine serum albumin and ß-lactoglobulin. On one hand, these dyes are poorly emissive in water, but experience a boost in their fluorescence when adsorbed into the hydrophobic domains of proteins. On the other hand, (nano)clays and clay minerals have previously been investigated in terms of their individual protein adsorption isotherms and their usefulness for the solubilization of water-insoluble dyes into an aqueous environment. In the following, we have combined all three individual parts (nanoclay, fluorophore and protein) in dispersions in a wide range of concentration ratios to systematically study the various adsorption processes via fluorescence techniques. In order to clarify the extent of dye diffusion and adsorption-desorption equilibria in the investigations, nanoclay hybrids with an adsorbed dye (Coumarin 153) and a covalently conjugated dye (Dansyl) were compared. The results suggest that the fluorescence progression of protein titration curves correlate with the amount of protein adsorbed, matching their reported adsorption isotherms on hectorite clays. Furthermore, experimental data on the protein monolayer formation around the nanoclays could be extracted due to only minor alterations of the dispersions' optical quality and transparency. In this manner, a fluorescence-based monitor for the formation of the globular protein layer around the nanoclay was realized.

A longitudinal population-based study of factors in adolescence predicting homelessness in young adulthood.

PURPOSE: Almost everything known about risk factors for homelessness is based on cross-sectional studies of non-random samples. Furthermore, most studies have focused on a small number of risk factors and have not evaluated their relative importance. Our aim was to examine which factors, in a population-based sample of adolescents, independently predict homelessness in young adults. METHODS: Participants (n = 10,433) in the US National Longitudinal Study of Adolescent Health (Add Health) were initially selected through systematic random sampling of US high schools. Interviews were conducted at home in 1994-1995 when the participants were 11-18 years of age and again in 2001 when participants were 18-28 years of age. We examined the relationships between a range of risk factors reported in adolescence (mood-related problems, substance involvement, delinquency, personality, quality of family relations, neighborhood quality, school adjustment, religious affiliation, perpetration of violence, and experiences of victimization) and experiences of homelessness reported in young adulthood, using regression analysis. RESULTS: Each risk factor predicted homelessness. However, only family relationship quality (odds ratio [OR] = .79, 95% confidence interval [CI] = .69-.90), school adjustment problems (OR = 1.57, 95% CI = 1.35-1.82), and experiences of victimization (OR = 1.27, 95% CI = 1.11-1.45) were found to independently predict homelessness. CONCLUSIONS: Among a range of well-established risk factors, a troubled family background, school adjustment problems and experiences of victimization were found to be the strongest predictors of homelessness in a general population of young people. Our findings suggest possibilities for the early identification of young persons at risk for homelessness through schools, agencies offering family-based support, and clinical services.