1
|
Micai M, Fulceri F, Salvitti T, Romano G, Poustka L, Diehm R, Iskrov G, Stefanov R, Guillon Q, Rogé B, Staines A, Sweeney MR, Boilson AM, Leósdóttir T, Saemundsen E, Moilanen I, Ebeling H, Yliherva A, Gissler M, Parviainen T, Tani P, Kawa R, Pisula E, Vicente A, Rasga C, Budişteanu M, Dale I, Povey C, Flores N, Jenaro C, Monroy ML, Primo PG, Charman T, Cramer S, Warberg CK, Canal-Bedia R, Posada M, Schendel D, Scattoni ML. Autistic Adult Services Availability, Preferences, and User Experiences: Results From the Autism Spectrum Disorder in the European Union Survey. Front Psychiatry 2022; 13:919234. [PMID: 35757227 PMCID: PMC9226363 DOI: 10.3389/fpsyt.2022.919234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022] Open
Abstract
There is very little knowledge regarding autistic adult services, practices, and delivery. The study objective was to improve understanding of current services and practices for autistic adults and opportunities for improvement as part of the Autism Spectrum Disorder in the European Union (ASDEU) project. Separate survey versions were created for autistic adults, carers of autistic adults, and professionals in adult services. 2,009 persons responded to the survey and 1,085 (54%) of them completed at least one of the services sections: 469 autistic adults (65% female; 55% <35 years old), 441 carers of autistic adults (27% female; 6% <35 years old), 175 professionals in adult services (76% female; 67% in non-medical services). Top choices by autistic adults, carers or professionals for services best suiting their current needs were: residential services: "help in own home" (adults, carers of high independent adults, professionals), "fulltime residential facility" (carers of low independent adults); employment services: "job mentors" (adults, carers of high independent adults, professionals), "Sheltered employment" (carers of low independent adults); education services: "support in regular education setting" (all groups); financial services: financial support in lieu of employment ("Supplementary income for persons unable to have full employment" for adults, "full pension" for carers of low independent adults) or to supplement employment earnings for carers of high independent adults and professionals; social services: "behavior training" (adults) and "life skills training" (carers and professionals). Waiting times for specific services were generally < 1 month or 1-3 months, except for residential services which could be up to 6 months; most professionals were uninformed of waiting times (>50% responded "don't know"). Five of seven residential services features recommended for autistic adults were experienced by <50% of adults. The knowledge of good local services models that work well for autistic adults was generally low across all services areas. The variation in services experiences and perceptions reported by autistic adults, carers, or professionals underscore the need to query all groups for a complete picture of community services availability and needs. The results showed areas for potential improvement in autistic adult services delivery in the EU to achieve recommended standards.
Collapse
Affiliation(s)
- Martina Micai
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Francesca Fulceri
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Tommaso Salvitti
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Giovanna Romano
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Luise Poustka
- University Medical Center Göttingen, Department of Child and Adolescent Psychiatry and Psychotherapy, Göttingen, Germany
| | - Robert Diehm
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Georgi Iskrov
- Institute for Rare Diseases, Plovdiv, Bulgaria.,Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Institute for Rare Diseases, Plovdiv, Bulgaria.,Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Mary Rose Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Andrew Martin Boilson
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | | | | | - Irma Moilanen
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland.,Oulu University Hospital, Medical Faculty, Oulu, Finland
| | - Hanna Ebeling
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland.,Oulu University Hospital, Medical Faculty, Oulu, Finland
| | - Anneli Yliherva
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland.,Logopedic Child Language Research Center, University of Oulu, Oulu, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Molecular Medicine and Surgery and Region Stockholm, Academic Primary Health Care Centre, Karolinska Institute, Stockholm, Sweden
| | - Tarja Parviainen
- Finnish Association for Autism and Asperger's Syndrome, Helsinki, Finland
| | - Pekka Tani
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Rafal Kawa
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Eva Pisula
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Astrid Vicente
- Center for Biodiversity, Functional and Integrative Genomics, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Célia Rasga
- Center for Biodiversity, Functional and Integrative Genomics, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Magdalena Budişteanu
- "Victor Babeş" National Institute for Research and Development in Pathology and Biomedical Sciences, Bucharest, Romania
| | - Ian Dale
- National Autistic Society, The Centre for Autism, London, United Kingdom
| | - Carol Povey
- National Autistic Society, The Centre for Autism, London, United Kingdom
| | - Noelia Flores
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos Salamanca, Instituto Universitario de Integración en la Comunidad, University of Salamanca, Salamanca, Spain
| | - Cristina Jenaro
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos Salamanca, Instituto Universitario de Integración en la Comunidad, University of Salamanca, Salamanca, Spain
| | - Maria Luisa Monroy
- Departamento de Psicología Evolutiva y de la Educación, Instituto Universitario de Integración en la Comunidad, University of Salamanca, Salamanca, Spain
| | | | - Tony Charman
- King's College London, Institute of Psychiatry, London, United Kingdom
| | - Susanne Cramer
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ricardo Canal-Bedia
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos Salamanca, Instituto Universitario de Integración en la Comunidad, University of Salamanca, Salamanca, Spain
| | - Manuel Posada
- Instituto de Salud Carlos III, Institute of Rare Diseases Research, Madrid, Spain
| | - Diana Schendel
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.,Department of Economics and Business, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Maria Luisa Scattoni
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| |
Collapse
|
2
|
Micai M, Ciaramella A, Salvitti T, Fulceri F, Fatta LM, Poustka L, Diehm R, Iskrov G, Stefanov R, Guillon Q, Rogé B, Staines A, Sweeney MR, Boilson AM, Leósdóttir T, Saemundsen E, Moilanen I, Ebeling H, Yliherva A, Gissler M, Parviainen T, Tani P, Kawa R, Vicente A, Rasga C, Budişteanu M, Dale I, Povey C, Flores N, Jenaro C, Monroy ML, Primo PG, Charman T, Cramer S, Warberg CK, Canal-Bedia R, Posada M, Scattoni ML, Schendel D. Autistic Adult Health and Professional Perceptions of It: Evidence From the ASDEU Project. Front Psychiatry 2021; 12:614102. [PMID: 34122158 PMCID: PMC8193054 DOI: 10.3389/fpsyt.2021.614102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/15/2021] [Indexed: 12/27/2022] Open
Abstract
The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults-especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups, <20% of responders knew an organization or clinician which has developed a way to monitor health, and prevent poor health, that works well for adults on the autism spectrum. The results point to means for better management of co-occurring conditions associated with autism in adulthood in order to reduce hospital admissions and potential areas of improvement in health and social services for autistic adults. Specifically, efforts should be focused on (1) professionals' education on risks for co-occurring conditions in autistic adults; (2) promoting preventive health behaviors; (3) making services user-friendly for autistic adults and their families; and (4) encouraging knowledge of good local services.
Collapse
Affiliation(s)
- Martina Micai
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Antonio Ciaramella
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Tommaso Salvitti
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Francesca Fulceri
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Laura Maria Fatta
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
| | - Robert Diehm
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria
| | - Georgi Iskrov
- Institute for Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Institute for Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Mary Rose Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Andrew Martin Boilson
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | | | | | - Irma Moilanen
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Medical Faculty, PEDEGO Research Unit, Oulu University, Oulu, Finland
| | - Hanna Ebeling
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Medical Faculty, PEDEGO Research Unit, Oulu University, Oulu, Finland
| | - Anneli Yliherva
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Faculty of Social Sciences, University of Tampere, Logopedics, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Stockholm, Karolinska Institute, Stockholm, Sweden
| | - Tarja Parviainen
- Finnish Association for Autism and Asperger's Syndrome, Helsinki, Finland
| | - Pekka Tani
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Rafal Kawa
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Astrid Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Center for Biodiversity, Functional and Integrative Genomics, Lisbon, Portugal
| | - Célia Rasga
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Center for Biodiversity, Functional and Integrative Genomics, Lisbon, Portugal
| | - Magdalena Budişteanu
- ‘Victor Babeş’ National Institute for Research and Development in Pathology and Biomedical Sciences, Timisoara, Romania
| | - Ian Dale
- National Autistic Society, The Center for Autism, London, United Kingdom
| | - Carol Povey
- National Autistic Society, The Center for Autism, London, United Kingdom
| | - Noelia Flores
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Cristina Jenaro
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Maria Luisa Monroy
- Departamento de Psicología Evolutiva y de la Educación, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Patricia García Primo
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Tony Charman
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Susanne Cramer
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ricardo Canal-Bedia
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Manuel Posada
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Maria Luisa Scattoni
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Diana Schendel
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Economics and Business, National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Micai M, Ciaramella A, Salvitti T, Fulceri F, Fatta LM, Poustka L, Diehm R, Iskrov G, Stefanov R, Guillon Q, Rogé B, Staines A, Sweeney MR, Boilson AM, Leósdóttir T, Saemundsen E, Moilanen I, Ebeling H, Yliherva A, Gissler M, Parviainen T, Tani P, Kawa R, Vicente A, Rasga C, Budişteanu M, Dale I, Povey C, Flores N, Jenaro C, Monroy ML, Primo PG, Charman T, Cramer S, Warberg CK, Canal-Bedia R, Posada M, Scattoni ML, Schendel D. Intervention Services for Autistic Adults: An ASDEU Study of Autistic Adults, Carers, and Professionals' Experiences. J Autism Dev Disord 2021; 52:1623-1639. [PMID: 33966137 PMCID: PMC8938388 DOI: 10.1007/s10803-021-05038-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated local services’ use experiences of autistic adults, carers and professionals with interventions for autistic adults. The majority of the 697 participants experienced recommended considerations prior to deciding on intervention and during the intervention plan and implementation. Psychosocial interventions were the most commonly experienced interventions, while pharmacological interventions NOT recommended for core autistic symptoms were reported by fairly large proportions of participants. Family interventions were experienced slightly more commonly by carers than adults or professionals. Less than the 26% of autistic adult responders who had experienced challenging behaviors reported receiving an intervention to change them. These results provide insights for improving gaps in service provision of interventions among autistic adults.
Collapse
Affiliation(s)
- Martina Micai
- Research Coordination and Support Service, Istituto Superiore Di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Antonio Ciaramella
- Research Coordination and Support Service, Istituto Superiore Di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Tommaso Salvitti
- Research Coordination and Support Service, Istituto Superiore Di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore Di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Laura Maria Fatta
- Research Coordination and Support Service, Istituto Superiore Di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
| | - Robert Diehm
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria
| | - Georgi Iskrov
- Institute for Rare Diseases, Plovdiv, Bulgaria.,Faculty of Public Health, Department of Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Institute for Rare Diseases, Plovdiv, Bulgaria.,Faculty of Public Health, Department of Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Quentin Guillon
- Université Toulouse Jean Jaurès, CERPPS, Toulouse, Occitanie, France
| | - Bernadette Rogé
- Université Toulouse Jean Jaurès, CERPPS, Toulouse, Occitanie, France
| | - Anthony Staines
- School of Nursing, Dublin City University, Psychotherapy & Community Health, Dublin, Ireland
| | - Mary Rose Sweeney
- School of Nursing, Dublin City University, Psychotherapy & Community Health, Dublin, Ireland
| | - Andrew Martin Boilson
- School of Nursing, Dublin City University, Psychotherapy & Community Health, Dublin, Ireland
| | - Thora Leósdóttir
- The State Diagnostic and Counselling Centre, 200, Kópavogur, Iceland
| | - Evald Saemundsen
- The State Diagnostic and Counselling Centre, 200, Kópavogur, Iceland
| | - Irma Moilanen
- Clinic of Child Psychiatry, University and University Hospital of Oulu, Oulu, Finland.,Medical Faculty, Oulu University Hospital, Oulu, Finland
| | - Hanna Ebeling
- Clinic of Child Psychiatry, University and University Hospital of Oulu, Oulu, Finland.,Medical Faculty, Oulu University Hospital, Oulu, Finland
| | - Anneli Yliherva
- Clinic of Child Psychiatry, University and University Hospital of Oulu, Oulu, Finland.,Logopedic Child Language Research Center, University of Oulu, Oulu, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tarja Parviainen
- Finnish Association for Autism and Asperger's Syndrome, Helsinki, Uusimaa, Finland
| | - Pekka Tani
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Rafal Kawa
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Astrid Vicente
- Center for Biodiversity, Functional and Integrative Genomics, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Célia Rasga
- Center for Biodiversity, Functional and Integrative Genomics, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Magdalena Budişteanu
- Development in Pathology and Biomedical Sciences, "Victor Babeş" National Institute for Research, Timisoara, Romania
| | - Ian Dale
- The Centre for Autism, National Autistic Society, London, UK
| | - Carol Povey
- The Centre for Autism, National Autistic Society, London, UK
| | - Noelia Flores
- Dpto. Personalidad, Evaluación Y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en La Comunidad University of Salamanca, Salamanca, Spain
| | - Cristina Jenaro
- Dpto. Personalidad, Evaluación Y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en La Comunidad University of Salamanca, Salamanca, Spain
| | - Maria Luisa Monroy
- Departamento de Psicología Evolutiva Y de La Educación, INICO - Instituto Universitario de Integración en La Comunidad University of Salamanca, Salamanca, Spain
| | | | - Tony Charman
- Institute of Psychiatry, Kings College London, London, UK
| | - Susanne Cramer
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ricardo Canal-Bedia
- Dpto. Personalidad, Evaluación Y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en La Comunidad University of Salamanca, Salamanca, Spain
| | - Manuel Posada
- Institute of Rare Diseases Research, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore Di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Diana Schendel
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Economics and Business, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
Scattoni ML, Micai M, Ciaramella A, Salvitti T, Fulceri F, Fatta LM, Poustka L, Diehm R, Iskrov G, Stefanov R, Guillon Q, Rogé B, Staines A, Sweeney MR, Boilson AM, Leósdóttir T, Saemundsen E, Moilanen I, Ebeling H, Yliherva A, Gissler M, Parviainen T, Tani P, Kawa R, Vicente A, Rasga C, Budişteanu M, Dale I, Povey C, Flores N, Jenaro C, Monroy ML, Primo PG, Charman T, Cramer S, Warberg CK, Canal-Bedia R, Posada M, Schendel D. Real-World Experiences in Autistic Adult Diagnostic Services and Post-diagnostic Support and Alignment with Services Guidelines: Results from the ASDEU Study. J Autism Dev Disord 2021; 51:4129-4146. [PMID: 33502713 PMCID: PMC8510906 DOI: 10.1007/s10803-021-04873-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
Research providing an evidence-base for autistic adult services is sparse. The Autism Spectrum Disorders in the European Union (ASDEU) network implemented an on-line survey to determine gaps in autistic adult diagnostic evaluation and post-diagnostic support services. More than 55% in all groups experienced most of the recommended features for diagnostic evaluation for autistic adults. In contrast, < 2% of adults or carers, and < 21% of professionals experienced each of the recommended features for post-diagnostic support. In contrast to 61% of professionals, only about 30% of autistic adults and carers had knowledge of good local services models for autism diagnosis in adulthood. There are major differences between good practice guidelines for diagnostic and post-diagnostic care for autistic adults, and what is actually experienced by services users and professionals.
Collapse
Affiliation(s)
- Maria Luisa Scattoni
- Istituto Superiore Di Sanità, Research Coordination and Support Service, Regina Elena 299, 00161, Roma, Italy.
| | - Martina Micai
- Istituto Superiore Di Sanità, Research Coordination and Support Service, Regina Elena 299, 00161, Roma, Italy
| | - Antonio Ciaramella
- Istituto Superiore Di Sanità, Research Coordination and Support Service, Regina Elena 299, 00161, Roma, Italy
| | - Tommaso Salvitti
- Istituto Superiore Di Sanità, Research Coordination and Support Service, Regina Elena 299, 00161, Roma, Italy
| | - Francesca Fulceri
- Istituto Superiore Di Sanità, Research Coordination and Support Service, Regina Elena 299, 00161, Roma, Italy
| | - Laura Maria Fatta
- Istituto Superiore Di Sanità, Research Coordination and Support Service, Regina Elena 299, 00161, Roma, Italy
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
| | - Robert Diehm
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria
| | - Georgi Iskrov
- Institute for Rare Diseases, Plovdiv, Bulgaria.,Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv Town, Bulgaria
| | - Rumen Stefanov
- Institute for Rare Diseases, Plovdiv, Bulgaria.,Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv Town, Bulgaria
| | - Quentin Guillon
- Université Toulouse Jean Jaurès, CERPPS, Toulouse, Occitanie, France
| | - Bernadette Rogé
- Université Toulouse Jean Jaurès, CERPPS, Toulouse, Occitanie, France
| | - Anthony Staines
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Republic of Ireland
| | - Mary Rose Sweeney
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Republic of Ireland
| | - Andrew Martin Boilson
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Republic of Ireland
| | - Thora Leósdóttir
- The State Diagnostic and Counselling Centre, 200, Kópavogur, Iceland
| | - Evald Saemundsen
- The State Diagnostic and Counselling Centre, 200, Kópavogur, Iceland
| | - Irma Moilanen
- Clinic of Child Psychiatry, University and University Hospital of Oulu, Oulu, Finland.,Medical Faculty, Oulu University Hospital, Oulu, Finland
| | - Hanna Ebeling
- Clinic of Child Psychiatry, University and University Hospital of Oulu, Oulu, Finland.,Medical Faculty, Oulu University Hospital, Oulu, Finland
| | - Anneli Yliherva
- Clinic of Child Psychiatry, University and University Hospital of Oulu, Oulu, Finland.,University of Oulu, Logopedic Child Language Research Center, Oulu, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland.,University of Turku, Research Centre for Child Psychiatry, Turku, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tarja Parviainen
- Finnish Association for Autism and Asperger's Syndrome, Helsinki, Uusimaa, Finland
| | - Pekka Tani
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Rafal Kawa
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Astrid Vicente
- Center for Biodiversity, Functional and Integrative Genomics, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Célia Rasga
- Center for Biodiversity, Functional and Integrative Genomics, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Magdalena Budişteanu
- Victor Babeş" National Institute for Research and Development in Pathology and Biomedical Sciences, Timisoara, Romania
| | - Ian Dale
- National Autistic Society, The Centre for Autism, London, UK
| | - Carol Povey
- National Autistic Society, The Centre for Autism, London, UK
| | - Noelia Flores
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO-Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Cristina Jenaro
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO-Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Maria Luisa Monroy
- Departamento de Psicología Evolutiva y de la Educación, INICO-Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Patricia García Primo
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Tony Charman
- Institute of Psychiatry, Kings College London, London, UK
| | - Susanne Cramer
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ricardo Canal-Bedia
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO-Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Manuel Posada
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Diana Schendel
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Economics and Business, Aarhus University, National Centre for Register-Based Research, Aarhus, Denmark
| |
Collapse
|
5
|
Howes OD, Rogdaki M, Findon JL, Wichers RH, Charman T, King BH, Loth E, McAlonan GM, McCracken JT, Parr JR, Povey C, Santosh P, Wallace S, Simonoff E, Murphy DG. Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology. J Psychopharmacol 2018; 32:3-29. [PMID: 29237331 PMCID: PMC5805024 DOI: 10.1177/0269881117741766] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert review of the aetiology, assessment, and treatment of autism spectrum disorder, and recommendations for diagnosis, management and service provision was coordinated by the British Association for Psychopharmacology, and evidence graded. The aetiology of autism spectrum disorder involves genetic and environmental contributions, and implicates a number of brain systems, in particular the gamma-aminobutyric acid, serotonergic and glutamatergic systems. The presentation of autism spectrum disorder varies widely and co-occurring health problems (in particular epilepsy, sleep disorders, anxiety, depression, attention deficit/hyperactivity disorder and irritability) are common. We did not recommend the routine use of any pharmacological treatment for the core symptoms of autism spectrum disorder. In children, melatonin may be useful to treat sleep problems, dopamine blockers for irritability, and methylphenidate, atomoxetine and guanfacine for attention deficit/hyperactivity disorder. The evidence for use of medication in adults is limited and recommendations are largely based on extrapolations from studies in children and patients without autism spectrum disorder. We discuss the conditions for considering and evaluating a trial of medication treatment, when non-pharmacological interventions should be considered, and make recommendations on service delivery. Finally, we identify key gaps and limitations in the current evidence base and make recommendations for future research and the design of clinical trials.
Collapse
Affiliation(s)
- Oliver D Howes
- 1 MRC London Institute of Medical Sciences, London, UK
- 2 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Rogdaki
- 1 MRC London Institute of Medical Sciences, London, UK
| | - James L Findon
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Robert H Wichers
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Tony Charman
- 4 Department of Psychology, King's College London, London UK
| | - Bryan H King
- 5 Department of Psychiatry, University of California at San Francisco, San Francisco, USA
| | - Eva Loth
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Gráinne M McAlonan
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - James T McCracken
- 8 Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, USA
| | - Jeremy R Parr
- 9 Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carol Povey
- 10 The National Autistic Society, London, UK
| | - Paramala Santosh
- 11 Department of Child Psychiatry, King's College London, London, UK
| | | | - Emily Simonoff
- 13 Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Declan G Murphy
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
|
7
|
Schnier C, Wild S, Kurdi Z, Povey C, Goldberg DJ, Hutchinson SJ. Matched population-based study examining the risk of type 2 diabetes in people with and without diagnosed hepatitis C virus infection. J Viral Hepat 2016; 23:596-605. [PMID: 26910297 DOI: 10.1111/jvh.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 01/14/2016] [Indexed: 01/03/2023]
Abstract
Meta-analyses have found hepatitis C virus (HCV) infection to be associated with an increased risk of type 2 diabetes mellitus (T2DM). Here, we examine this association within a large population-based study, according to HCV RNA status. A data-linkage approach was used to examine the excess risk of diagnosed T2DM in people diagnosed with antibodies to HCV (anti-HCV) in Scotland (21 929 anti-HCV(+ves) ; involving 15 827 HCV RNA(+ves) , 3927 HCV RNA(-ves) and 2175 with unknown RNA-status) compared to that of a threefold larger general population sample matched for gender, age and postcode (65 074 anti-HCV(-ves) ). To investigate effects of ascertainment bias the following periods were studied: up to 1 year before (pre-HCV)/within 1 year of (peri-HCV)/more than 1 year post (post-HCV) the date of HCV-diagnosis. T2DM had been diagnosed in 2.9% of anti-HCV(+ves) (including 3.2% of HCV RNA(+ves) and 2.3% of HCV RNA(-ves) ) and 2.7% of anti-HCV(-ves) . A higher proportion of T2DM was diagnosed in the peri-HCV period (i.e. around the time of HCV-diagnosis) for the anti-HCV(+ves) (22%) compared to anti-HCV(-ves) (10%). In both the pre-HCV and post-HCV periods, only those anti-HCV(+ves) living in less deprived areas (13% of the cohort) were found to have a significant excess risk of T2DM compared to anti-HCV(-ves) (adjusted odds ratio in the pre-HCV period: 4.0 for females and 2.3 for males; adjusted hazard ratio in the post-HCV period: 1.5). These findings were similarly observed for both HCV RNA(+ves) (chronic) and HCV RNA(-ves) (resolved). In the largest study of T2DM among chronic HCV-infected individuals to date, there was no evidence to indicate that infection conveyed an appreciable excess risk of T2DM at the population level.
Collapse
Affiliation(s)
- C Schnier
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - S Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Z Kurdi
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - C Povey
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - D J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| |
Collapse
|
8
|
Fischbacher CM, Steiner M, Bhopal R, Chalmers J, Jamieson J, Knowles D, Povey C. Variations in all Cause and Cardiovascular Mortality by Country of Birth in Scotland, 1997-2003. Scott Med J 2016; 52:5-10. [PMID: 18092629 DOI: 10.1258/rsmsmj.52.4.5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background and Aims Country of birth provides a proxy for ethnic group for recent migrants. Major differences in mortality by country of birth have been demonstrated in England and Wales, but similar published data for Scotland are lacking. We aimed to examine variations in mortality by country of birth for Scottish residents. Methods We calculated standardised mortality ratios by country of birth for Scottish residents aged 25 years and over between January 1997 and March 2003. Results and Conclusion Comparisons with England and Wales showed high allcause, coronary heart disease (CHD) and stroke mortality among Scottish residents born in Scotland, Northern Ireland, the Republic of Ireland, India and Hong Kong. However, most country of birth groups had similar or lower mortality than the Scottish born. These are the first data on mortality by country of birth in Scotland and they demonstrate major variations. Comparisons within the Scottish population might be interpreted as reassuring, since they do not show the excesses in CHD mortality by country of birth reported in England and Wales. However, the use of England and Wales as a comparison group shows a substantial excess of CHD risk among South Asians in Scotland, comparable to that reported in England and Wales.
Collapse
Affiliation(s)
- CM Fischbacher
- Consultant in Public Health Medicine, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
- Honorary Senior Lecturer, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - M Steiner
- Senior Registrar, Department of Environmental and Occupational Medicine, Liberty Safe Work Research Centre, Forresterhill Road, Aberdeen, AB25 2ZP. (Formerly, Department of Public Health Sciences, University of Edinburgh, EH8 9AG)
| | - R Bhopal
- Professor of Public Health, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - J Chalmers
- Consultant in Public Health Medicine, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
- Honorary Senior Lecturer, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - J Jamieson
- Programme Manager, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
| | - D Knowles
- Head of Group, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
| | - C Povey
- Information Analyst, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
| |
Collapse
|
9
|
Kenny L, Hattersley C, Molins B, Buckley C, Povey C, Pellicano E. Which terms should be used to describe autism? Perspectives from the UK autism community. Autism 2015; 20:442-62. [DOI: 10.1177/1362361315588200] [Citation(s) in RCA: 779] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Recent public discussions suggest that there is much disagreement about the way autism is and should be described. This study sought to elicit the views and preferences of UK autism community members – autistic people, parents and their broader support network – about the terms they use to describe autism. In all, 3470 UK residents responded to an online survey on their preferred ways of describing autism and their rationale for such preferences. The results clearly show that people use many terms to describe autism. The most highly endorsed terms were ‘autism’ and ‘on the autism spectrum’, and to a lesser extent, ‘autism spectrum disorder’, for which there was consensus across community groups. The groups disagreed, however, on the use of several terms. The term ‘autistic’ was endorsed by a large percentage of autistic adults, family members/friends and parents but by considerably fewer professionals; ‘person with autism’ was endorsed by almost half of professionals but by fewer autistic adults and parents. Qualitative analysis of an open-ended question revealed the reasons underlying respondents’ preferences. These findings demonstrate that there is no single way of describing autism that is universally accepted and preferred by the UK’s autism community and that some disagreements appear deeply entrenched.
Collapse
Affiliation(s)
- Lorcan Kenny
- Centre for Research in Autism and Education, UCL Institute of Education, University College London, UK
| | | | | | | | | | - Elizabeth Pellicano
- Centre for Research in Autism and Education, UCL Institute of Education, University College London, UK
- School of Psychology, University of Western Australia, Australia
| |
Collapse
|
10
|
Hashemi R, Povey C, Derksen M, Naseri H, Garber J, Predoi-Cross A. Doppler broadening thermometry of acetylene and accurate measurement of the Boltzmann constant. J Chem Phys 2014; 141:214201. [PMID: 25481135 DOI: 10.1063/1.4902076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this paper, we present accurate measurements of the fundamental Boltzmann constant based on a line-shape analysis of acetylene spectra in the ν1 + ν3 band recorded using a tunable diode laser. Experimental spectra recorded at low pressures (0.25 - 9 Torr), have been analyzed using a Speed Dependent Voigt model that takes into account the molecular speed dependence effects. This line-shape model reproduces the experimental data with good accuracy and allows us to determine precise line-shape parameters for the P(25) transition of the ν1 + ν3 band. From the recorded spectra we obtained the Doppler-width and then determined the Boltzmann constant, k(B).
Collapse
Affiliation(s)
- R Hashemi
- Alberta Terrestrial Imaging Centre, Department of Physics and Astronomy, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K3M4, Canada
| | - C Povey
- Alberta Terrestrial Imaging Centre, Department of Physics and Astronomy, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K3M4, Canada
| | - M Derksen
- Alberta Terrestrial Imaging Centre, Department of Physics and Astronomy, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K3M4, Canada
| | - H Naseri
- Alberta Terrestrial Imaging Centre, Department of Physics and Astronomy, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K3M4, Canada
| | - J Garber
- Alberta Terrestrial Imaging Centre, Department of Physics and Astronomy, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K3M4, Canada
| | - A Predoi-Cross
- Alberta Terrestrial Imaging Centre, Department of Physics and Astronomy, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K3M4, Canada
| |
Collapse
|
11
|
Mukaetova-Ladinska EB, Perry E, Baron M, Povey C. Ageing in people with autistic spectrum disorder. Int J Geriatr Psychiatry 2012; 27:109-18. [PMID: 21538534 DOI: 10.1002/gps.2711] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/28/2011] [Accepted: 02/08/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although autism in children and in adults attracts attention with respect to clinical and research needs, autism in the older individuals has not been considered to any degree. We review the evidence for urgently addressing the question of ageing in people with autistic spectrum disorder (ASD), focusing on those with disability. METHODS Perspectives are reviewed in relation to demographics, experiences of relatives or carers, anticipated residential care needs, requirement for specifically designed cognitive assessment tools and importance of initiating new brain ageing research initiatives in this area. RESULTS With escalating numbers of ASD individuals with disability reaching old age, provision of care is the paramount issue that is only beginning to be addressed in a few European communities and in the USA. How ageing affects cognition in such individuals as they reach an age no longer consistent with parental care is unknown, lacking any published evidence, and there is a clear need to design cognitive and behavioural assessment tools appropriate to ageing in ASD individuals with disability, as was the case with respect to dementia as a whole. Although there is a growing body of evidence on pathological, imaging, neuropharmacological and other key brain abnormalities in ASD, these are, to date, confined to children and young (only rarely to middle aged) adults. CONCLUSIONS The need for new initiatives in research into ageing in ASD is urgent. Apart from a growing care crisis, the prospect of understanding brain ageing in this population may bring potential rewards beyond immediate clinical need given the precedent of Down syndrome.
Collapse
Affiliation(s)
- E B Mukaetova-Ladinska
- Campus for Ageing and Vitality, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.
| | | | | | | | | |
Collapse
|
12
|
Bansal N, Bhopal R, Fischbacher C, Povey C, Chalmers J, Brewster D, Mueller G, Steiner M, Brown H. O3-2.1 Linkage of data in the study of ethnic inequalities and inequities in health outcomes in Scotland: the Scottish Health and Ethnicity Linkage Study (SHELS). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976a.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
13
|
Kendrick S, Frame S, Povey C. Beds occupied by emergency patients: long-term trends in patterns of short-term fluctuation in Scotland. Health Bull (Edinb) 1997; 55:167-75. [PMID: 9364105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Kendrick
- Information and Statistics Division, Scottish Health Service, Edinburgh
| | | | | |
Collapse
|
14
|
Abstract
BACKGROUND AND PURPOSE Clinical trials routinely use stroke scales to compare baseline characteristics of treatment groups. It is unclear which stroke scale provides the most prognostic information. This often leads to collection of multiple scales in clinical trials. We aimed to determine which of several commonly used scales best predicted outcome. METHODS A single observer scored consecutive admissions to an acute stroke unit on the National Institutes of Health Stroke Scale (NIHSS), the Canadian Neurological Scale, and the Middle Cerebral Artery Neurological Score. Guy's prognostic score was determined from clinical data. Outcome at 2, 3, 6, and 12 months was categorized as good (alive at home) or poor (alive in care or dead). Predictive accuracy of the variables was compared by receiver operating characteristic curves and stepwise logistic regression. RESULTS Of the 408 patients studied, 373 had confirmed acute stroke and completed follow-up. The three stroke rating scales each predicted 3-month outcome with an accuracy of .79 or greater. The NIHSS provided the most prognostic information: sensitivity to poor outcome, .71 (95% confidence interval [CI], .64 to .79); specificity, .90 (95% CI, .86 to .94); and overall accuracy, .83 (95% CI, .79 to .87). Logistic regression showed that the NIHSS added significantly to the predictive value of all other scores. No score added useful information to the NIHSS. A cut point of 13 on the NIHSS best predicted 3-month outcome. CONCLUSIONS Baseline NIHSS best predicts 3-month outcome. The Canadian Neurological Scale and Middle Cerebral Artery Neurological Score also perform well. Baseline assessments in clinical trials only need to include a single stroke rating scale.
Collapse
Affiliation(s)
- K W Muir
- University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK
| | | | | | | | | |
Collapse
|
15
|
Carman S, Povey C. The failure of an inactivated mink enteritis virus vaccine in four preparations to provide protection to dogs against challenge with canine parvovirus-2. Can J Comp Med 1982; 46:47-50. [PMID: 6280820 PMCID: PMC1320194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Four experimental vaccine preparations comprising a strain of mink enteritis virus inactivated by either formalin or beta-propiolactone, and either adjuvanted or nonadjuvanted, failed to stimulate a consistent serum antibody response in 20 vaccinated dogs and failed to protect all but one of these dogs against oral challenge with canine parvovirus-2.
Collapse
|
16
|
Povey C. Development of a vaccine incorporating killed virus of canine origin for the prevention of canine parvovirus infection. Can Vet J 1982; 23:15-21. [PMID: 7039811 PMCID: PMC1790074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A parvovirus of canine origin, cultured in a feline kidney cell line, was inactivated with formalin. Three pilot serials were produced and three forms of finished vaccine (nonadjuvanted, single adjuvanted and double adjuvanted) were tested in vaccination and challenge trials. A comparison was also made with two inactivated feline panleukopenia virus vaccines, one of which has official approval for use in dogs. The inactivated canine vaccine in nonadjuvanted, adjuvanted or double adjuvanted form was immunogenic in 20 of 20 vaccinated dogs. The double adjuvanted vaccine is selected as the one of choice on the basis of best and most persistent seriological response.
Collapse
|
17
|
Carman S, Povey C. Successful experimental challenge of dogs with canine parvovirus-2. Can J Comp Med 1982; 46:33-8. [PMID: 6280819 PMCID: PMC1320191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Withholding food from dogs for 24 hours prior to, and for 48 hours following oral challenge with a gut mucosal homogenate of canine parvovirus-2, was a successful means of reproducing gastroenteric signs of canine parvovirus-2 infection. Twenty-one of 24 dogs, which had previously received various vaccine preparations of mink enteritis virus or were unvaccinated, and which were starved at challenge, developed soft or liquid feces with large or without large clots of mucus. Altered feces were most frequent on postexposure day 11. Seven dogs passed frank blood in their stools on one or more occasions and seven dogs vomited sporadically. Pyrexia was noted in 71.6% of the dogs on postexposure day 6 and lymphopenia was detected on postexposure day 5 or 6 in 50% of the dogs monitored. In contrast, four dogs not starved at the time of challenge remained free of gastrointestinal signs apart from one dog which passed a soft stool with scant mucus on one day, postexposure day 6. Also four dogs vaccinated with a killed canine parvovirus-2 vaccine preparation and subsequently starved at the time of challenge, remained clinically healthy. Apart from these last mentioned four dogs, all others shed canine parvovirus-2 in their feces following challenge.
Collapse
|
18
|
|
19
|
Abstract
Each of five groups of specific-pathogen-free and conventionally reared cats was infected with a different strain of feline calicivirus. Two of the strains were pathogenic, producing characteristically fever, depression, loss of appetite, buccal ulceration, and occasionally increased ocular and nasal secretion. Two of the other strains were midly pathogenic and associated with fever or buccal ulceration or both; the fifth strain was nonpathogenic. The two pathogenic strains plus three others shown also to be pathogenic were used 3 months after the initial infection to challenge the cats in rearranged groupings. Of the 28 conventional cats challenged six (21.4%) showed at least a febrile response, although none of the 30 specific-pathogen-free cats showed any clinical signs. After challenge, virus was recovered from throat swabs of 37 or the 58 cats (63.8%) including the six which showed symptoms, but the duration of the excretion of virus was significantly less than that seen with the initial infection. The homologous and heterotypic antibody responses correlated well with the clinical protection, or lack of it, seen on challenge. The results provide further evidence for significant cross-relationships between feline caliciviruses.
Collapse
|