Having Older Siblings Is Associated with Lower Rates of Depression, ADD/ADHD, Anxiety and Behavior Problems Among Children with ASD.

Objective Within the social determinants of mental health framework, this article investigated whether children with ASD who have older siblings are less likely to experience depression, anxiety, behavior problems or have ADD/ADHD after controlling for standard social determinants of mental health such as household income, parental education and adverse childhood experiences (ACEs). Methods Using the National Survey of Children's Health 2011-2012, children with ASD spectrum disorders (n = 1624) were categorized into three groups: only child, oldest child and has older siblings. Design corrected cross-tabulations, univariate and multivariate logistic regressions were estimated. Results The three groups of children with ASD were comparable in demographic characteristics (except age), ACEs, and parent-reported ASD severity. Children with ASD who had older siblings were significantly less likely to experience depression, anxiety or behavior problems. They were also less likely to have been diagnosed with ADD or ADHD. Adjusted odds ratios ranged from 0.12 to 0.53 indicating robust associations. Conclusions for Practice Children with ASD who have older siblings were less likely to have comorbid mental health disorders than other children with ASD. Conversely, oldest and only children with ASD were at increased risk for these disorders. Further research is needed to understand how this protection is conferred on children with ASD, and whether it can be adapted into interventions for only and oldest children with ASD.

Elevated burden for caregivers of children with persistent asthma and a developmental disability.

To evaluate how having a child with both persistent asthma and a developmental disability (DD) affects caregiver burden and quality of life (QOL). 3-10 year old children with persistent asthma in urban Rochester, NY. Cross-sectional baseline survey (2006-2009). Parent report of autism spectrum disorder or other behavioral disorder requiring medication. Caregiver burden and QOL as measured by scores on previously validated depression, parenting confidence, and asthma-related QOL scales as well as an assessment of competing demands on the caregiver. Bivariate and multivariate regression analyses controlling for caregiver age, education, marital status, race, ethnicity, and child asthma symptom severity. We enrolled 530 children as part of a larger study (response rate: 74; 63 % Black, 73 % Medicaid). Of this sample, 70 children (13 %) were defined as having a DD. There were no differences in asthma symptom severity between children with and without a DD diagnosis. However, even after adjusting for potential confounders, caregivers of children with a DD reported worse scores on the depression (p = .003), parenting confidence (p < .001), and competing demands (p = .013) scales and worse asthma-related QOL (p = .035) compared to caregivers of typically developing children with asthma. Despite having similar asthma symptom severity, caregivers of children with both persistent asthma and a DD diagnosis report more burden and lower QOL compared to that of caregivers of typically developing children and persistent asthma. Further attention to this subgroup is needed to promote optimal support for caregivers.

The school-based preventive asthma care trial: results of a pilot study.

OBJECTIVE: To test the feasibility and preliminary effectiveness of the School-Based Preventive Asthma Care Technology (SB-PACT) program, which includes directly observed therapy of preventive asthma medications in school facilitated by Web-based technology for systematic symptom screening, electronic report generation, and medication authorization from providers. STUDY DESIGN: We conducted a pilot randomized trial of SB-PACT versus usual care with 100 children (aged 3-10 years) from 19 inner-city schools in Rochester, New York. Outcomes were assessed longitudinally by blinded interviewers. Analyses included bivariate statistics and linear regression models, adjusting for baseline symptoms. RESULTS: There were data for 99 subjects for analysis. We screened all children using the Web-based system, and 44 of 49 treatment group children received directly observed therapy as authorized by their providers. Treatment group children received preventive medications 98% of the time they were in school. Over the school year, children in the treatment group experienced nearly 1 additional symptom-free day over 2 weeks versus the usual care group (11.33 vs 10.40, P = .13). Treatment children also experienced fewer nights with symptoms (1.68 vs 2.20, P = .02), days requiring rescue medications (1.66 vs 2.44, P = .01), and days absent from school due to asthma (0.37 vs 0.85, P = .03) compared with usual care. Further, treatment children had a greater decrease in exhaled nitric oxide (-9.62 vs -0.39, P = .03), suggesting reduction in airway inflammation. CONCLUSION: The SB-PACT intervention demonstrated feasibility and improved outcomes across multiple measures in this pilot study. Future work will focus on further integration of preventive care delivery across community and primary care systems.

Working toward a sustainable system of asthma care: development of the School-Based Preventive Asthma Care Technology (SB-PACT) trial.

OBJECTIVE: We previously conducted the School-Based Asthma Therapy trial to improve adherence to national asthma guidelines for urban children through directly observed administration of preventive asthma medications in school. The trial successfully improved outcomes among these children; however, several factors limit its potential for dissemination. To enhance sustainability, we subsequently developed a new model of care using web-based guides for efficient communications and integration within school and community systems. This article describes the development of the School-Based Preventive Asthma Care Technology (SB-PACT) trial. METHOD: We developed the SB-PACT web-based system based on stakeholder feedback, and conducted a pilot randomized trial with 100 children to establish its feasibility in facilitating preventive asthma care for high-risk children. The SB-PACT system represents a new model of care using web-based guides for asthma symptom screening, follow-up control assessments, and electronic communications with providers. RESULT: We enrolled and successfully screened all children using the web-based system. Most providers used the electronic communication system without difficulty, and the majority of children in the intervention group received preventive medications through school as planned and dose adjustments as needed. Several challenges to implementation also were encountered. CONCLUSIONS: This program is designed to promote sustainability of school-based asthma care, reduce program costs, and ultimately succeed in a real-world setting. With further refinements, it has the potential to be implemented nationally in schools.

School readiness among children with behavior problems at entrance into kindergarten: results from a US national study.

The impact of behavior problems on kindergarten readiness is not known. Our objective was to estimate the association between behavior problems and kindergarten readiness on a US national sample. In the US educational system, kindergarten is a natural point of entry into formal schooling at age 5 because fewer than half of the children enter kindergarten with prior formal preschool education. Parents of 1,200 children who were scheduled to enter kindergarten for the first time and were members of the Harris Interactive online national panel were surveyed. We defined behavior problems as an affirmative response to the question, "Has your child ever had behavior problems?" We validated this against attention deficit hyperactivity disorder diagnosis, scores on a reliable socioemotional scale, and child's receipt of early intervention services. We used linear, tobit, and logistic regression analyses to estimate the association between having behavior problems and scores in reliable scales of motor, play, speech and language, and school skills and an overall kindergarten readiness indicator. The sample included 176 children with behavior problems for a national prevalence of 14% (confidence interval, 11.5-17.5). Children with behavior problems were more likely to be male and live in households with lower income and parental education. We found that children with behavior problems entered kindergarten with lower speech and language, motor, play, and school skills, even after controlling for demographics and region. Delays were 0.6-1 SD below scores of comparable children without behavior problems. Parents of children with behavior problems were 5.2 times more likely to report their child was not ready for kindergarten. Childhood behavior problems are associated with substantial delays in motor, language, play, school, and socioemotional skills before entrance into kindergarten. Early screening and intervention is recommended.

Riociguat in the Treatment of Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is a severe clinical condition that significantly affects patients' quality of life and survival. Since the emergence of prostanoids 45 years ago, different drugs acting on vasoconstriction/vasodilation mechanisms have been developed for the treatment of PAH. Current evidence shows that better results occur when combined therapy is initiated up-front with periodic and systematized evaluations for escalation and switching. Among these strategies, riociguat has a relevant role, supported by the results of several clinical studies. This document issues recommendations by a panel of experts who analysed and discussed the indications and limitations for riociguat in PAH in different institutions of the Mexican health system.

Parental Involvement of Parents of Children With ADHD: A First Population Study.

Objective: The purpose of the study was to create a national profile of parental involvement for parents of children with ADHD in the United States. Method: Using the 2016 Parent and Family Involvement in Education Survey, parents of children with ADHD (N = 1,600) were compared with other parents (N = 11,923) on 32 distinct measures of parental involvement in education. Results: Parents of children with ADHD were more likely to invest more time in communications regarding school and behavior problems, teaching their child time management skills, checking and helping with their homework, whereas they were less likely to engage in athletic sports, attend class or school events, or visit the library. Conclusion: A more systematic approach to encourage and support parental involvement in education for children with ADHD is needed.

US children with special health care needs and ethnic discrimination: results from multivariate modeling.

BACKGROUND: To determine the prevalence of parent-reported ethnic/racial discrimination, and to determine if children with special health care needs are more likely to experience ethnic discrimination than other children who have similar family income, age, sex, race, parental education and Hispanic ethnicity. METHODS: Using the National Survey of Children's Health 2011-2012 (n = 95,677), ethnic discrimination was measured by two questions that asked "was child ever treated or judged unfairly because of his/her race or ethnic group?" and if so, how often it occurred in the last 12 months prior to the survey. RESULTS: An estimated 3 million US children aged 0-17 years have experienced parent-reported ethnic discrimination (1.4% White, 9.1% Black, 9.9% other race, 4.7% Hispanic). The likelihood to experience ethnic discrimination is much higher for Black and other race children, compared to White children. Children with special health care needs were two times more likely to experience ethnic discrimination frequently in the 12 months prior to the survey than comparable children in terms of age, sex, race, family income, parental education, and social capital. Higher family income did not prevent the exposure to ethnic discrimination but was associated with fewer instances. CONCLUSIONS: Theoretical frameworks, such as social determinants of health, must account for the bidirectional nature of the relationship between health and ethnic discrimination. Pediatric care must assess if ethnic discrimination has occurred and whether trauma-informed approaches are needed.

The relationship between pharmacy students' beliefs about medications and their academic achievement in a pharmacy practice counseling course.

INTRODUCTION: Pharmacists' beliefs about medications have been identified as a potential factor in how patients are counseled. However, no studies have assessed this relationship. METHODS: Third year pharmacy students were surveyed using previously validated questionnaires about medication beliefs, including the BMQ-General (General-Overuse and General-Harm subscales), Benefit, and Perceived Sensitivity to Medications (Sensitive Soma) scales; each is rated on a five-point Likert scale (higher scores represent stronger feelings). Belief profiles were created using two-step cluster analysis. Students also reported demographics and prior work in a pharmacy. Grades from simulated counseling sessions were collected via school records. Student t-test and multivariate linear regression were used to compare beliefs with grades. RESULTS: Among the 66 responders (84.5% response rate), 54.5% were female, 80.3% white, and 77.3% non-Hispanic; 84.8% reported prior work in a pharmacy. Overall mean (SD) belief scores were General-Overuse 3.12 (0.76), General-Harm 1.83 (0.53), Benefit 3.99 (0.55), and Sensitive Soma 2.37 (0.82). Cluster analyses revealed two beliefs profiles: negative profile (more feelings of overuse, harm, and sensitivity to medications) and positive profile (less feelings of overuse, harm, and sensitivity to medications). Students with positive belief profiles were graded higher by faculty compared to students with negative belief profiles (90.0 vs. 87.2, p = 0.014). Findings remained in a multivariate regression controlling for gender and prior work in a pharmacy. CONCLUSIONS: Findings from this study demonstrate the need for greater understanding about the relationship between pharmacists' beliefs about medications and patient counseling.

The impact of health insurance gaps on access to care among children with asthma in the United States.

BACKGROUND: Health insurance coverage is important to help assure children appropriate access to medical care and preventive services. Insurance gaps could be particularly problematic for children with asthma, since appropriate preventive care for these children depends on frequent, consistent contacts with health care providers. OBJECTIVE: The aim of this study was to determine the association between insurance gaps and access to care among a nationally representative sample of children with asthma. METHODS: The National Survey of Children's Health provided parent-report data for 8097 children with asthma. We identified children with continuous public or continuous private insurance and defined 3 groups with gaps in insurance coverage: those currently insured who had a lapse in coverage during the prior 12 months (gained insurance), those currently uninsured who had been insured at some time during the prior 12 months (lost insurance), and those with no health insurance at all during the prior 12 months (full-year uninsured). RESULTS: Thirteen percent of children had coverage gaps (7% gained insurance, 4% lost insurance, and 2% were full-year uninsured). Many children with gaps in coverage had unmet needs for care (7.4%, 12.8%, and 15.1% among the gained insurance, lost insurance, and full-year uninsured groups, respectively). In multivariate models, we found significant associations between insurance gaps and every indicator of poor access to care among this population. CONCLUSIONS: Many children with asthma have unmet health care needs and poor access to consistent primary care, and lack of continuous health insurance coverage may play an important role. Efforts are needed to ensure uninterrupted coverage for these children.

Bullying among children with autism and the influence of comorbidity with ADHD: a population-based study.

OBJECTIVE: Bullying is a significant problem among school-age children. The prevalence and predictors of bullying among children with autism are not known. The objectives of this population-based study were to: (1) estimate the prevalence of bullying among children with autism in the United States, (2) determine whether the presence of attention-deficit/hyperactivity disorder/attention-deficit disorder (ADHD/ADD) increases prevalence of bullying among children with autism, and (3) determine risk factors of bullying behavior among children with autism. METHODS: The National Survey of Children's Health, 2003 (NSCH), provided nationally representative data for children ages 4 to 17. We used multivariate logistic regression and Wald tests to determine whether children with autism were more likely to bully in the presence of ADHD/ADD. Taylor approximations were used to account for the complex sampling design. RESULTS: Children with autism had a high prevalence of bullying (44%, 95% confidence interval, 34-55). Parent report of ADHD/ADD appears to moderate the relationship between bullying and autism. Children with autism who did not have ADHD/ADD were not at greater risk for bullying compared with the general population. Children with autism and ADHD/ADD had increased odds of bullying (odds ratio 4.6, 95% confidence interval 2.4-8.6), even after controlling for household income, age, and gender. In addition to ADHD/ADD, living in a low-income household and younger age were risk factors for bullying among children with autism. Being female, however, did not decrease the risk of bullying in the autistic subpopulation. CONCLUSIONS: Children with autism and ADHD/ADD appear to be at increased risk for bullying behaviors.

Health-related quality of life in patients undergoing lumbar total disc replacement: A comparison with the general population.

OBJECTIVES: In up to half of the cases, low back pain (LBP) is thought to be related to a degeneration of the lumbar disc. Lumbar total disc replacement (LTDR) emerged as an alternative to fusion, but its use and indications are still subject to debate. The purpose of this paper was to compare Health-related Quality of life (HRQOL) in patients undergoing LTDR for one or two-level degenerative disc disease (DDD) with the paired age and gender general population values and to assess functional disability and residual pain at one year after the surgical procedure. MATERIAL AND METHODS: A series of 51 patients operated on for a one or two level DDD, were evaluated at one year after the surgical procedure. HRQOL was compared to that of paired age and gender general population using the EQ-5D-5L questionnaire. Disability, back (BP) and leg pain (LP) were compared to the preoperative values. RESULTS: ODI showed a mean improvement of 31.78 (p<0.001, 95% CI 27.39-36.17), BP-VAS of 5.29/10 (95% CI 4.56-6.02), LP-VAS of 4.03/10 (95% CI 3.15-4.92) at one year compared to the preoperative assessment. HRQOL had similar values to the general population in 32 patients and inferior in 19 patients. "Pain" was the HRQOL dimension in which most of the patients had inferior results compared to data from the general population. Patients with previous spinal surgery had lower improvements in HRQOL index, disability, and pain than those without previous surgery. CONCLUSIONS: We found that the majority of patients improved their HQOL to values similar to those of the general population. Disability and pain are significantly reduced compared to preoperative evaluations. Larger scale studies are needed to identify the best candidates for LTDR.

Maternal depressive symptoms are adversely associated with prevention practices and parenting behaviors for preschool children.

OBJECTIVE: To determine the relationship between maternal depressive symptoms and select prevention practices and parenting behaviors for older preschool children. METHODS: A telephone survey of mothers and female guardians of children entering kindergarten in Monroe County, New York, was administered to 400 eligible parents in 2001. The Mental Health Inventory-5 was used to determine maternal depressive symptoms. We examined the impact of maternal depression on well-child care, immunizations, routine dental care, tooth brushing, frequent reading, safe motor vehicle seating location, car seat or booster seat use, discipline consistency, and parenting confidence. RESULTS: A total of 17.7% of mothers had depressive symptoms, with increased rates among women who were poor, less educated, and single parents. Children of mothers with depressive symptoms were more likely to have not received routine dental care in the past year (21.1% vs 8.2%, P = .001), brush their teeth less than twice a day (37.1% vs 25.2%, P = .041), or be read to less than 3 times per week (31.0% vs 13.7%, P < .001) compared with children of mothers without depressive symptoms. In addition, mothers with depressive symptoms were more likely to describe inconsistent discipline practices (36.6% vs 20.1%, P = .005) and less confidence in their parenting (39.4% vs 18.5%, P < .001). All associations remained significant in multivariate analyses controlling for maternal race, ethnicity, education, income, age, and household structure. CONCLUSIONS: Maternal depressive symptoms are associated with diminished positive parenting behaviors including dental care, reading, and discipline consistency for older preschoolers. These findings have implications for clinical pediatrics as well as preventive public health efforts.

Characteristics of school-age children with autism.

The objectives of this study were to provide a national profile of children with autism, to describe the impact of autism on school functioning, and to describe the utilization of services among children with autism. We performed a cross-sectional descriptive analysis of 9583 children (grades K-8) from the 2001 National Household Education Survey Before and After School Survey. We used parent-reported information to determine the prevalence of autism, and children with autism were compared to children without autism on sociodemographic measures and several measures of school functioning and utilization of services. The prevalence of autism in this sample was 66 per 10,000. Children with autism were proportionately represented in all communities and all regions of the country. While children with autism were equally likely to attend public schools compared to children without autism, they were significantly more likely to have learning difficulties and to carry multiple diagnoses, including attention deficit disorder and learning disability. Most of these children received services for their disability through the school district. In conclusion, data from this survey yielded a prevalence estimate of autism similar to other recent studies. Children with autism have performance and behavior problems that persist despite the availability of services to the majority of children. The important needs of these children warrant further attention.

Children With Autism Spectrum Disorder and Screen Time: Results From a Large, Nationally Representative US Study.

OBJECTIVE: To test the hypotheses that children with autism spectrum disorder (ASD) have higher screen time than other children on a US nationally representative sample and that children with ASD are overrepresented among children who exceed the American Academy of Pediatrics (AAP) screen time recommendation (2 hours or less a day). METHODS: The National Survey of Children's Health 2011-2012, a nationally representative survey, asked parents to report their child's (aged 6-17 years) average daily media usage. The ASD subpopulation (n = 1393) was compared to children without ASD (non-ASD, n = 64,163). Differences were compared by design-corrected F tests. Regression models were estimated for both groups separately. Adjusted Wald tests were used to rigorously test the hypotheses. RESULTS: More than half of US children exceed the AAP screen time recommendation. Compared to non-ASD, children with ASD had similar amounts of total screen time (3.21 hours per day vs 3.46 hours per day; P > .05), media (TV/video) time, and computer/mobile device leisure time. Children with ASD have a milder age gradient than the general population on computer/mobile device usage. Children with ASD were proportionally represented among high users (more than 2 hours per day). Data did not support hypotheses. CONCLUSIONS: In a large, nationally representative US sample, there was no evidence that children with ASD differ in their screen time habits from other children. Both groups have high screen time use. Caution should be exercised before assuming that children with ASD are at higher risk of exceeding AAP screen time recommendations. Efforts to promote adherence to the recommendation are needed, but they should neither target nor exclude children with ASD.

Endoluminal occlusion devices: technology update.

Endoluminal occlusion has been performed since the early beginning of interventional radiology. Over recent decades, major technological advances have improved the techniques used and different devices have been developed for changing conditions. Most of these occlusion devices have been implemented in the vascular territory. Early embolization materials included glass particles, hot contrast, paraffin, fibrin, and tissue fragments such as muscle fibers and blood clots; today, occlusion materials include metallic devices, particles, and liquid materials, which can be indicated for proximal or distal occlusion, high-flow and low-flow situations, and in large-caliber and small-caliber vessels, based on need. Technological progress has led to a decreased size of delivery catheters, and an increase in safety due to release systems that permit the withdrawing and replacement of embolization material. Furthermore, bioactive embolization materials have been developed to increase the efficacy of embolization or the biological effect of medication. Finally, materials have been modified for changing indications. Intravascular stents were initially developed to keep an artery open; however, by adding a covering membrane, these stents can be used to occlude the wall of a vessel or other endoluminal structures. This article gives an overview of the devices most utilized for occlusion of endoluminal structures, as well as their major purpose in the endovascular territory.

Human herpesvirus 1 meningoencephalitis after trigeminal neuralgia surgery.

We report a case of human herpesvirus 1 (HHV-1) meningoencephalitis in a patient who underwent trigeminal neuralgia surgery. Although this surgery has been reported to increase the risk of mucocutaneous HHV-1 recurrence, to our knowledge, an association between trigeminal surgery and HHV-1 encephalitis has not been previously described.

Difference between early clinical features of swine origin A H1N1 influenza confirmed and not confirmed infection in Mexico.

INTRODUCTION: The Swine Origin A H1N1 Influenza Virus (SOIV) pandemic emerged in April 2009 affecting people and health-care systems worldwide. This study examined the differences among the early clinical features presented in confirmed SOIV cases, those who tested negative for SOIV infection, fatalities, and hospitalized cases. METHODOLOGY: We reviewed 1,024 initial medical records of patients presenting with acute respiratory symptoms who attended the respiratory emergency room of a general hospital in Mexico and had a confirmatory test for influenza AH1N1 by RT-PCR from April to December 2009. RESULTS: Out of 1,024 cases, 457 (44%) were men with a mean age of 31±17 years; however, of these, SOIV confirmed cases were younger (26±8, p=0.000). SOIV infection was confirmed in 36% of the patients. Most (%?) cases presented mild infection, 20% of the patients required hospitalization, and 0.09% patients died. Asthma was more frequent in confirmed cases (p=0.028). Presence of COPD, systemic arterial hypertension, and diabetes mellitus was significant in confirmed hospitalized cases. Pulmonary rales, wheezing, and sudden symptom onset were more frequent and statistically significant in confirmed patients. Influenza-like illness was more frequent in confirmed cases (p=0.049).  CONCLUSIONS: This study presents one of the largest series of the new SOIV infection confirmed by RT-PCR reported. This infection is frequently mild and affects mainly young adults. Sudden symptoms onset, pulmonary rales, and wheezing are early features of this infection. Asthma, COPD, systemic arterial hypertension, and diabetes mellitus should be identified to identify potentially severe and fatal cases. ILI helps distinguish SOIV infection.

White-black disparities in family-centered care among children with autism in the United States: evidence from the NS-CSHCN 2005-2006.

OBJECTIVES: The aim of this study was to compare the reported receipt of family-centered care between parents of white and black children with autism spectrum disorders (ASD) in the United States, and to disentangle the associations of race and ASD on different aspects of family-centered care. METHODS: Parents of 35,386 children, aged 0 to 17 years, were surveyed by the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2005-2006. Autism was defined by the question, "To the best of your knowledge, does [child] currently have autism or autism spectrum disorder, that is, ASD?" Family-centered care was measured with 5 key indicators on a 4-point Likert scale. Univariate and multivariate analyses were used, with adjustment for the complex sampling design. RESULTS: The prevalence of autism in this sample was 5.4% (n = 1869). We found that, among children with SHCN but no ASD, more white parents than black parents reported receiving family-centered care. Further, fewer parents of both white children and black children with ASD reported receiving family-centered care compared with those with a child who had special needs other than ASD. Lastly, among parents with a child with ASD, being black was associated with lower reporting of family-centered care for 3 of 5 items. In multivariate analyses, black parents with a child with ASD had 2 to 5 times greater odds of not reporting family-centered care on each item compared with white parents without a child with ASD. CONCLUSION: Targeted efforts are needed to improve family-centered care for parents with a child with ASD, and particularly for black families.