1
|
Hughes MM, Pas ET, Durkin MS, DaWalt LS, Bilder DA, Bakian AV, Amoakohene E, Shaw KA, Patrick ME, Salinas A, DiRienzo M, Lopez M, Williams S, McArthur D, Hudson A, Ladd-Acosta CM, Schwenk YD, Baroud TM, Robinson Williams A, Washington A, Maenner MJ. Health Conditions, Education Services, and Transition Planning for Adolescents With Autism. Pediatrics 2024; 153:e2023063672. [PMID: 38501189 DOI: 10.1542/peds.2023-063672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE Our objectives with this study were to describe the frequency of selected cooccurring health conditions and individualized education program (IEP) services and post-high school transition planning for adolescents with autism spectrum disorder and identify disparities by sex, intellectual ability, race or ethnicity, and geographic area. METHODS The study sample included 1787 adolescents born in 2004 who were identified as having autism through a health and education record review through age 16 years in 2020. These adolescents were part of a longitudinal population-based surveillance birth cohort from the Autism and Developmental Disabilities Monitoring Network from 2004 to 2020 in 5 US catchment areas. RESULTS Attention deficit hyperactivity disorder (47%) and anxiety (39%) were the most common cooccurring health conditions. Anxiety was less commonly identified for those with intellectual disability than those without. It was also less commonly identified among Black adolescents compared with White or Hispanic adolescents. There was wide variation across Autism and Developmental Disabilities Monitoring Network sites in the provision of school-based IEP services. Students with intellectual disability were less likely to receive school-based mental health services and more likely to have a goal for postsecondary independent living skills compared with those without intellectual disability. A total of 37% of students did not participate in standardized testing. CONCLUSIONS We identified disparities in the identification of cooccurring conditions and school-based IEP services, practices, and transition planning. Working with pediatric health and education providers, families, and adolescents with autism will be important to identify contributing factors and to focus efforts to reduce disparities in the supports and services adolescents with autism have access to and receive.
Collapse
Affiliation(s)
- Michelle M Hughes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elise T Pas
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Esther Amoakohene
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly A Shaw
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Patrick
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Monica DiRienzo
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maya Lopez
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Susan Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dedria McArthur
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Hudson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Yvette D Schwenk
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thaer M Baroud
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ashley Robinson Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anita Washington
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
2
|
Robinson Williams A, Amoakohene E, Maenner MJ, Zahorodny W, DiRienzo M, Grzybowski A, Hall-Lande J, Pas ET, Bakian AV, Lopez M, Patrick M, Shenouda J, Shaw KA. Community testing practices for autism within the autism and developmental disabilities monitoring network. Paediatr Perinat Epidemiol 2024. [PMID: 38531639 DOI: 10.1111/ppe.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND No data exist at the population level on what tests are used to aid in the diagnosis of autism spectrum disorder in community practice. OBJECTIVES To describe autism spectrum disorder testing practices to inform autism spectrum disorder identification efforts. METHODS Data are from the Autism and Developmental Disabilities Monitoring Network, a multi-site surveillance system reporting prevalence estimates and characteristics of 8-year-old children with autism spectrum disorder. Percentages of children with autism spectrum disorder who received any autism spectrum disorder test or a 'gold standard' test were calculated by site, sex, race, median household income, and intellectual ability status. Risk ratios were calculated to compare group differences. RESULTS Of 5058 8-year-old children with autism spectrum disorder across 11 sites, 3236 (64.0%) had a record of any autism spectrum disorder test and 2136 (42.2%) had a 'gold standard' ADOS or ADI-R test. Overall, 115 children (2.3%) had both the ADOS and ADI-R in their records. Differences persisted across race, median household income, and intellectual ability status. Asian/Pacific Islander children had the highest percent receiving any ASD test (71.8%; other groups range: 57.4-66.0%) and White children had the highest percent receiving 'gold standard' tests (46.4%; other groups range: 35.6-43.2%). Children in low-income neighbourhoods had a lower percent of any test (62.5%) and 'gold standard' tests (39.4%) compared to medium (70.2% and 47.5%, respectively) and high (69.6% and 46.8%, respectively) income neighbourhoods. Children with intellectual disability had a lower percent of any ASD test (81.7%) and 'gold standard' tests (52.6%) compared to children without intellectual disability (84.0% and 57.6%, respectively). CONCLUSIONS Autism spectrum disorder testing practices vary widely by site and differ by race and presence of co-occurring intellectual disability, suggesting opportunities to standardise and/or improve autism spectrum disorder identification practices.
Collapse
Affiliation(s)
- Ashley Robinson Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Research and Education, Oak Ridge, Tennessee, USA
| | - Esther Amoakohene
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew J Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Monica DiRienzo
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Elise T Pas
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amanda V Bakian
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maya Lopez
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Patrick
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Kelly A Shaw
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Hughes MM, Shaw KA, DiRienzo M, Durkin MS, Esler A, Hall-Lande J, Wiggins L, Zahorodny W, Singer A, Maenner MJ. The Prevalence and Characteristics of Children With Profound Autism, 15 Sites, United States, 2000-2016. Public Health Rep 2023; 138:971-980. [PMID: 37074176 PMCID: PMC10576490 DOI: 10.1177/00333549231163551] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVES Autism spectrum disorder (autism) is a heterogeneous condition that poses challenges in describing the needs of individuals with autism and making prognoses about future outcomes. We applied a newly proposed definition of profound autism to surveillance data to estimate the percentage of children with autism who have profound autism and describe their sociodemographic and clinical characteristics. METHODS We analyzed population-based surveillance data from the Autism and Developmental Disabilities Monitoring Network for 20 135 children aged 8 years with autism during 2000-2016. Children were classified as having profound autism if they were nonverbal, were minimally verbal, or had an intelligence quotient <50. RESULTS The percentage of 8-year-old children with profound autism among those with autism was 26.7%. Compared with children with non-profound autism, children with profound autism were more likely to be female, from racial and ethnic minority groups, of low socioeconomic status, born preterm or with low birth weight; have self-injurious behaviors; have seizure disorders; and have lower adaptive scores. In 2016, the prevalence of profound autism was 4.6 per 1000 8-year-olds. The prevalence ratio (PR) of profound autism was higher among non-Hispanic Asian/Native Hawaiian/Other Pacific Islander (PR = 1.55; 95 CI, 1.38-1.73), non-Hispanic Black (PR = 1.76; 95% CI, 1.67-1.86), and Hispanic (PR = 1.50; 95% CI, 0.88-1.26) children than among non-Hispanic White children. CONCLUSIONS As the population of children with autism continues to change, describing and quantifying the population with profound autism is important for planning. Policies and programs could consider the needs of people with profound autism across the life span to ensure their needs are met.
Collapse
Affiliation(s)
- Michelle M. Hughes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Commissioned Corps, US Public Health Service, Rockville, MD, USA
| | - Kelly A. Shaw
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Commissioned Corps, US Public Health Service, Rockville, MD, USA
| | - Monica DiRienzo
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maureen S. Durkin
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amy Esler
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer Hall-Lande
- College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| | - Lisa Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Walter Zahorodny
- Pediatrics Department, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Matthew J. Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
4
|
Hughes MM, Shaw KA, Patrick ME, DiRienzo M, Bakian AV, Bilder DA, Durkin MS, Hudson A, Spivey MH, DaWalt LS, Salinas A, Schwenk YD, Lopez M, Baroud TM, Maenner MJ. Adolescents With Autism Spectrum Disorder: Diagnostic Patterns, Co-occurring Conditions, and Transition Planning. J Adolesc Health 2023; 73:271-278. [PMID: 36849336 PMCID: PMC10450089 DOI: 10.1016/j.jadohealth.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/27/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 03/01/2023]
Abstract
PURPOSE The objectives of this study were to describe child characteristics associated with later autism spectrum disorder (ASD) identification and the health status and educational transition plans of adolescents with ASD. METHODS Longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network during 2002-2018 in five catchment areas in the United States. Participants included 3,148 children born in 2002 whose records were first reviewed for ASD surveillance in 2010. RESULTS Of the 1,846 children identified in the community as an ASD case, 11.6% were first identified after age 8 years. Children who were more likely to have ASD identified at older ages were Hispanic; were born with low birth weight; were verbal; had high intelligence quotient or adaptive scores; or had certain co-occurring neuropsychological conditions by age 8 years. By age 16 years, neuropsychological conditions were common with more than half of the adolescents with ASD having a diagnosis of attention-deficit/hyperactivity disorder or anxiety. Intellectual disability (ID) status was unchanged for the majority (>80%) of children from ages 8-16 years. A transition plan was completed for over 94% of adolescents, but disparities were observed in planning by ID status. DISCUSSION A high percentage of adolescents with ASD have co-occurring neuropsychological conditions, markedly higher than at age 8. While most adolescents had transition planning, this occurred less often for those with ID. Ensuring access to services for all people with ASD during adolescence and transition to adulthood may help to promote overall health and quality of life.
Collapse
Affiliation(s)
- Michelle M Hughes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Kelly A Shaw
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Patrick
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica DiRienzo
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Maureen S Durkin
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Allison Hudson
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Leann S DaWalt
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Angelica Salinas
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Yvette D Schwenk
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Maya Lopez
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thaer M Baroud
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Matthew J Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
5
|
Patrick ME, Hughes MM, Ali A, Shaw KA, Maenner MJ. Social vulnerability and prevalence of Autism Spectrum Disorder, Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). Ann Epidemiol 2023; 83:47-53.e1. [PMID: 37094622 PMCID: PMC10910514 DOI: 10.1016/j.annepidem.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The Metropolitan Atlanta Developmental Disabilities Surveillance Program tracks autism spectrum disorder (ASD) in selected counties within Georgia as part of the Autism and Developmental Disabilities Monitoring (ADDM) Network. ADDM Network analyses have historically found a higher prevalence of ASD in areas of higher socioeconomic status. METHODS We linked 2018 data from Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) to two Metropolitan Atlanta Developmental Disabilities Surveillance Program counties by census tract, grouped census tracts into tertiles representing low, medium, and high social vulnerability, and calculated ASD prevalence for each tertile, overall and by each of four SVI themes. RESULTS We found that overall prevalence was higher in areas of low compared to high vulnerability for the socioeconomic status and transportation themes, and in areas of medium compared to high vulnerability for all themes. This pattern was consistent among males but varied for females and by race or ethnicity. CONCLUSIONS Linking ASD prevalence to SVI metrics can improve the understanding of inequities among children with ASD in racial and ethnic minority groups or those living in low-resource settings. These methods can be applied to other ADDM Network surveillance sites and public health surveillance programs.
Collapse
Affiliation(s)
- Mary E Patrick
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA.
| | - Michelle M Hughes
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
| | - Akilah Ali
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Kelly A Shaw
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
| | - Matthew J Maenner
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
| |
Collapse
|
6
|
Hughes MM, Kirby AV, Davis J, Bilder DA, Patrick M, Lopez M, DaWalt LS, Pas ET, Bakian AV, Shaw KA, DiRienzo M, Hudson A, Schwenk YD, Baroud TM, Washington A, Maenner MJ. Individualized Education Programs and Transition Planning for Adolescents With Autism. Pediatrics 2023; 152:e2022060199. [PMID: 37345494 PMCID: PMC10911052 DOI: 10.1542/peds.2022-060199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES The study objectives were to examine the contents of individualized education programs (IEPs) of adolescents with autism spectrum disorder (ASD), including postsecondary transition goals, services, and changes in special education classification over time. METHODS This study involved a longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network from 2002 to 2018 in 3 catchment areas in the United States. The sample included 322 adolescents who were born in 2002, identified with ASD, and had an IEP available for review at ages 15-16 years. RESULTS We found that 297 (92%) adolescents with ASD had an IEP including a transition plan. Those without intellectual disability (ID) were more likely to have postsecondary education and employment goals and have those goals be to pursue higher education or competitive employment compared with those with ID. Forty-one percent of adolescents with ASD had a postsecondary living arrangement goal. Although 28% of adolescents with ASD received school-based mental health services, none of these adolescents were Black; additionally, 15% of those with ID received mental health services compared with 34% without ID. The percentage of adolescents with ASD served under an autism classification increased from 44% at age 8 years to 62% by age 16. CONCLUSIONS We identified gaps and disparities in school-based postsecondary transition planning. Working with education partners, families, and adolescents will be important to identify what challenges contribute to these findings and what supports are needed to improve the equity and quality of the transition planning process for adolescents with ASD so they are prepared for adulthood.
Collapse
Affiliation(s)
- Michelle M. Hughes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - John Davis
- University of Texas at San Antonio, San Antonio, Texas
| | | | - Mary Patrick
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maya Lopez
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Elise T. Pas
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Kelly A. Shaw
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica DiRienzo
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Hudson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Thaer M. Baroud
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Anita Washington
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J. Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
7
|
Shaw KA, Bilder DA, McArthur D, Williams AR, Amoakohene E, Bakian AV, Durkin MS, Fitzgerald RT, Furnier SM, Hughes MM, Pas ET, Salinas A, Warren Z, Williams S, Esler A, Grzybowski A, Ladd-Acosta CM, Patrick M, Zahorodny W, Green KK, Hall-Lande J, Lopez M, Mancilla KC, Nguyen RH, Pierce K, Schwenk YD, Shenouda J, Sidwell K, Vehorn A, DiRienzo M, Gutierrez J, Hallas L, Hudson A, Spivey MH, Pettygrove S, Washington A, Maenner MJ. Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ 2023; 72:1-15. [PMID: 36952289 PMCID: PMC10042615 DOI: 10.15585/mmwr.ss7201a1] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Problem/Condition Autism spectrum disorder (ASD). Period Covered 2020. Description of System The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2020, a total of 11 sites (located in Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) conducted surveillance of ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2020. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in an evaluation, 2) a special education classification of autism (eligibility), or 3) an ASD International Classification of Diseases (ICD) code (revisions 9 or 10). Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had a documented qualified professional's statement indicating a suspicion of ASD. This report focuses on children aged 4 years in 2020 compared with children aged 8 years in 2020. Results For 2020, ASD prevalence among children aged 4 years varied across sites, from 12.7 per 1,000 children in Utah to 46.4 in California. The overall prevalence was 21.5 and was higher among boys than girls at every site. Compared with non-Hispanic White children, ASD prevalence was 1.8 times as high among Hispanic, 1.6 times as high among non-Hispanic Black, 1.4 times as high among Asian or Pacific Islander, and 1.2 times as high among multiracial children. Among the 58.3% of children aged 4 years with ASD and information on intellectual ability, 48.5% had an IQ score of ≤70 on their most recent IQ test or an examiner's statement of intellectual disability. Among children with a documented developmental evaluation, 78.0% were evaluated by age 36 months. Children aged 4 years had a higher cumulative incidence of ASD diagnosis or eligibility by age 48 months compared with children aged 8 years at all sites; risk ratios ranged from 1.3 in New Jersey and Utah to 2.0 in Tennessee. In the 6 months before the March 2020 COVID-19 pandemic declaration by the World Health Organization, there were 1,593 more evaluations and 1.89 more ASD identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. After the COVID-19 pandemic declaration, this pattern reversed: in the 6 months after pandemic onset, there were 217 fewer evaluations and 0.26 fewer identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. Patterns of evaluation and identification varied among sites, but there was not recovery to pre-COVID-19 pandemic levels by the end of 2020 at most sites or overall. For 2020, prevalence of suspected ASD ranged from 0.5 (California) to 10.4 (Arkansas) per 1,000 children aged 4 years, with an increase from 2018 at five sites (Arizona, Arkansas, Maryland, New Jersey, and Utah). Demographic and cognitive characteristics of children aged 4 years with suspected ASD were similar to children aged 4 years with ASD. Interpretation A wide range of prevalence of ASD by age 4 years was observed, suggesting differences in early ASD identification practices among communities. At all sites, cumulative incidence of ASD by age 48 months among children aged 4 years was higher compared with children aged 8 years in 2020, indicating improvements in early identification of ASD. Higher numbers of evaluations and rates of identification were evident among children aged 4 years until the COVID-19 pandemic onset in 2020. Sustained lower levels of ASD evaluations and identification seen at a majority of sites after the pandemic onset could indicate disruptions in typical practices in evaluations and identification for health service providers and schools through the end of 2020. Sites with more recovery could indicate successful strategies to mitigate service interruption, such as pivoting to telehealth approaches for evaluation. Public Health Action From 2016 through February of 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing ASD evaluation and identification 4 years earlier (from 2012 until March 2016) among the cohort of children aged 8 years in 2020 . From 2016 to March 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing that among children aged 8 years in 2020 from 2012 until March 2016. The disruptions in evaluation that coincided with the start of the COVID-19 pandemic and the increase in prevalence of suspected ASD in 2020 could have led to delays in ASD identification and interventions. Communities could evaluate the impact of these disruptions as children in affected cohorts age and consider strategies to mitigate service disruptions caused by future public health emergencies.
Collapse
|
8
|
Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA, Durkin MS, Fitzgerald RT, Furnier SM, Hughes MM, Ladd-Acosta CM, McArthur D, Pas ET, Salinas A, Vehorn A, Williams S, Esler A, Grzybowski A, Hall-Lande J, Nguyen RH, Pierce K, Zahorodny W, Hudson A, Hallas L, Mancilla KC, Patrick M, Shenouda J, Sidwell K, DiRienzo M, Gutierrez J, Spivey MH, Lopez M, Pettygrove S, Schwenk YD, Washington A, Shaw KA. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ 2023; 72:1-14. [PMID: 36952288 PMCID: PMC10042614 DOI: 10.15585/mmwr.ss7202a1] [Citation(s) in RCA: 286] [Impact Index Per Article: 286.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Problem/Condition Autism spectrum disorder (ASD). Period Covered 2020. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. Results For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). Interpretation For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability. Public Health Action The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states.
Collapse
|
9
|
Shaw KA, Williams S, Hughes MM, Warren Z, Bakian AV, Durkin MS, Esler A, Hall-Lande J, Salinas A, Vehorn A, Andrews JG, Baroud T, Bilder DA, Dimian A, Galindo M, Hudson A, Hallas L, Lopez M, Pokoski O, Pettygrove S, Rossow K, Shenouda J, Schwenk YD, Zahorodny W, Washington A, Maenner MJ. Statewide county-level autism spectrum disorder prevalence estimates-seven U.S. states, 2018. Ann Epidemiol 2023; 79:39-43. [PMID: 36669598 DOI: 10.1016/j.annepidem.2023.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/29/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE Autism spectrum disorder (ASD) prevalence information is necessary for identifying community needs such as addressing disparities in identification and services. METHODS Seven Autism and Developmental Disabilities Monitoring (ADDM) Network sites participated in a pilot project to link statewide health and education data to generate statewide and county-level prevalence estimates for a broader age range for their states for the first time. RESULTS Statewide prevalence of ASD for ages 3-21 years in 2018 ranged from 1.5% in Tennessee and Wisconsin to 2.3% in Arizona. The median county-level prevalence of ASD was 1.4% of residents ages 3-21 years. More boys than girls had ASD at all sites, and prevalence was lower among non-Hispanic Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native residents compared to non-Hispanic White residents at most sites. ASD prevalence estimates for children aged 8 years were similar to 2018 ADDM Network estimates that used record review to provide more in-depth information, but showed greater variation for children aged 4 years. CONCLUSIONS Linkage of statewide data sets provides less detailed but actionable local information when more resource-intensive methods are not possible.
Collapse
Affiliation(s)
- Kelly A Shaw
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia.
| | - Susan Williams
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Michelle M Hughes
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Zachary Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda V Bakian
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Maureen S Durkin
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin; Waisman Center, University of Wisconsin, Madison, Wisconsin
| | - Amy Esler
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota
| | | | - Alison Vehorn
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Thaer Baroud
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Deborah A Bilder
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adele Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota
| | - Maureen Galindo
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Allison Hudson
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Libby Hallas
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota
| | - Maya Lopez
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Olivia Pokoski
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin; Waisman Center, University of Wisconsin, Madison, Wisconsin
| | - Sydney Pettygrove
- Department of Pediatrics, University of Arizona, Tucson, Arizona; College of Public Health, University of Arizona, Tucson, Arizona
| | - Katelyn Rossow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Josephine Shenouda
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yvette D Schwenk
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Walter Zahorodny
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anita Washington
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Matthew J Maenner
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| |
Collapse
|
10
|
Henkel A, Johnson SA, Cahill EP, Matthew RF, Blumenthal PD, Shaw KA. O05Cabergoline for lactation inhibition after second-trimester abortion or loss: A randomized controlled trial. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
11
|
Henkel A, Miller HE, Owens SN, Lyell DJ, Shaw KA. P048Risk of uterine rupture in second-trimester medication abortions using mifepristone and misoprostol after cesarean section birth: A systematic review and meta-analysis. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
12
|
Shaw KA, McArthur D, Hughes MM, Bakian AV, Lee LC, Pettygrove S, Maenner MJ. Progress and Disparities in Early Identification of Autism Spectrum Disorder: Autism and Developmental Disabilities Monitoring Network, 2002-2016. J Am Acad Child Adolesc Psychiatry 2022; 61:905-914. [PMID: 34838692 PMCID: PMC9353949 DOI: 10.1016/j.jaac.2021.11.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 04/21/2021] [Revised: 08/28/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Early identification can improve outcomes for children with autism spectrum disorder (ASD). We sought to assess changes in early ASD identification over time and by co-occurring intellectual disability (ID) and race/ethnicity. METHOD Using data for 2002-2016 from a biennial population-based ASD surveillance program among 8-year-old children in the United States, we defined identification as a child's earliest recorded ASD diagnosis or special education eligibility. Unidentified children had characteristics meeting the ASD surveillance case definition but no recorded identification by age 8 years. We calculated median age at identification among identified children, median age at identification including unidentified children, and cumulative incidence of identification by age 48 months. RESULTS ASD identification by age 48 months was 4 times (95% CI: 3.6-4.3) as likely in 2016 as in 2002, with the largest increases among children without ID. Median age at ASD identification among identified children decreased 3 months during this time. Children of every race/ethnicity were more likely to be identified over time. There were racial disparities stratified by ID: in 2016, Black and Hispanic children without ID were less likely to be identified with ASD than were White children (both groups risk ratio: 0.7; 95% CI: 0.5-0.8), but Black children were 1.5 times (95% CI: 1.3-1.9) as likely as White children to be identified with ASD and ID. CONCLUSION Substantial progress has been made to identify more children with ASD early, despite minimal decrease in median age at diagnosis. Considerable disparities remain in early ASD identification by race/ethnicity and co-occurring intellectual disability.
Collapse
Affiliation(s)
- Kelly A. Shaw
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dedria McArthur
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle M. Hughes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Matthew J. Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
13
|
Shaw KA, Maenner MJ, Bakian AV, Bilder DA, Durkin MS, Furnier SM, Hughes MM, Patrick M, Pierce K, Salinas A, Shenouda J, Vehorn A, Warren Z, Zahorodny W, Constantino JN, DiRienzo M, Esler A, Fitzgerald RT, Grzybowski A, Hudson A, Spivey MH, Ali A, Andrews JG, Baroud T, Gutierrez J, Hallas L, Hall-Lande J, Hewitt A, Lee LC, Lopez M, Mancilla KC, McArthur D, Pettygrove S, Poynter JN, Schwenk YD, Washington A, Williams S, Cogswell ME. Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ 2021. [PMID: 34855727 DOI: 10.15585/mmwr.ss7011a1.pmid:34855725;pmcid:pmc8639024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
PROBLEM/CONDITION Autism spectrum disorder (ASD). PERIOD COVERED 2018. DESCRIPTION OF SYSTEM The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD. RESULTS For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years). INTERPRETATION Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months. PUBLIC HEALTH ACTION Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.
Collapse
|
14
|
Maenner MJ, Shaw KA, Bakian AV, Bilder DA, Durkin MS, Esler A, Furnier SM, Hallas L, Hall-Lande J, Hudson A, Hughes MM, Patrick M, Pierce K, Poynter JN, Salinas A, Shenouda J, Vehorn A, Warren Z, Constantino JN, DiRienzo M, Fitzgerald RT, Grzybowski A, Spivey MH, Pettygrove S, Zahorodny W, Ali A, Andrews JG, Baroud T, Gutierrez J, Hewitt A, Lee LC, Lopez M, Mancilla KC, McArthur D, Schwenk YD, Washington A, Williams S, Cogswell ME. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ 2021; 70:1-16. [PMID: 34855725 PMCID: PMC8639024 DOI: 10.15585/mmwr.ss7011a1] [Citation(s) in RCA: 637] [Impact Index Per Article: 212.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Problem/Condition Autism spectrum disorder (ASD). Period Covered 2018. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts active surveillance of ASD. This report focuses on the prevalence and characteristics of ASD among children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. In 2018, children met the case definition if their records documented 1) an ASD diagnostic statement in an evaluation (diagnosis), 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Results For 2018, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 16.5 in Missouri to 38.9 in California. The overall ASD prevalence was 23.0 per 1,000 (one in 44) children aged 8 years, and ASD was 4.2 times as prevalent among boys as among girls. Overall ASD prevalence was similar across racial and ethnic groups, except American Indian/Alaska Native children had higher ASD prevalence than non-Hispanic White (White) children (29.0 versus 21.2 per 1,000 children aged 8 years). At multiple sites, Hispanic children had lower ASD prevalence than White children (Arizona, Arkansas, Georgia, and Utah), and non-Hispanic Black (Black) children (Georgia and Minnesota). The associations between ASD prevalence and neighborhood-level median household income varied by site. Among the 5,058 children who met the ASD case definition, 75.8% had a diagnostic statement of ASD in an evaluation, 18.8% had an ASD special education classification or eligibility and no ASD diagnostic statement, and 5.4% had an ASD ICD code only. ASD prevalence per 1,000 children aged 8 years that was based exclusively on documented ASD diagnostic statements was 17.4 overall (range: 11.2 in Maryland to 29.9 in California). The median age of earliest known ASD diagnosis ranged from 36 months in California to 63 months in Minnesota. Among the 3,007 children with ASD and data on cognitive ability, 35.2% were classified as having an intelligence quotient (IQ) score ≤70. The percentages of children with ASD with IQ scores ≤70 were 49.8%, 33.1%, and 29.7% among Black, Hispanic, and White children, respectively. Overall, children with ASD and IQ scores ≤70 had earlier median ages of ASD diagnosis than children with ASD and IQ scores >70 (44 versus 53 months). Interpretation In 2018, one in 44 children aged 8 years was estimated to have ASD, and prevalence and median age of identification varied widely across sites. Whereas overall ASD prevalence was similar by race and ethnicity, at certain sites Hispanic children were less likely to be identified as having ASD than White or Black children. The higher proportion of Black children compared with White and Hispanic children classified as having intellectual disability was consistent with previous findings. Public Health Action The variability in ASD prevalence and community ASD identification practices among children with different racial, ethnic, and geographical characteristics highlights the importance of research into the causes of that variability and strategies to provide equitable access to developmental evaluations and services. These findings also underscore the need for enhanced infrastructure for diagnostic, treatment, and support services to meet the needs of all children.
Collapse
|
15
|
Shaw KA, Maenner MJ, Bakian AV, Bilder DA, Durkin MS, Furnier SM, Hughes MM, Patrick M, Pierce K, Salinas A, Shenouda J, Vehorn A, Warren Z, Zahorodny W, Constantino JN, DiRienzo M, Esler A, Fitzgerald RT, Grzybowski A, Hudson A, Spivey MH, Ali A, Andrews JG, Baroud T, Gutierrez J, Hallas L, Hall-Lande J, Hewitt A, Lee LC, Lopez M, Mancilla KC, McArthur D, Pettygrove S, Poynter JN, Schwenk YD, Washington A, Williams S, Cogswell ME. Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ 2021; 70:1-14. [PMID: 34855727 PMCID: PMC8639027 DOI: 10.15585/mmwr.ss7010a1] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PROBLEM/CONDITION Autism spectrum disorder (ASD). PERIOD COVERED 2018. DESCRIPTION OF SYSTEM The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD. RESULTS For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years). INTERPRETATION Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months. PUBLIC HEALTH ACTION Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.
Collapse
|
16
|
McGovern OL, Kobayashi M, Shaw KA, Szablewski C, Gabel J, Holsinger C, Drenzek C, Brennan S, Milucky J, Farrar JL, Wolff BJ, Benitez AJ, Thurman KA, Diaz MH, Winchell JM, Schrag S. Use of Real-Time PCR for Chlamydia psittaci Detection in Human Specimens During an Outbreak of Psittacosis - Georgia and Virginia, 2018. MMWR Morb Mortal Wkly Rep 2021; 70:505-509. [PMID: 33830980 PMCID: PMC8030988 DOI: 10.15585/mmwr.mm7014a1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Psittacosis is typically a mild febrile respiratory illness caused by infection with the bacterium Chlamydia psittaci and usually transmitted to humans by infected birds (1). On average, 11 psittacosis cases per year were reported in the United States during 2000-2017. During August-October 2018, the largest U.S. psittacosis outbreak in 30 years (82 cases identified*) occurred in two poultry slaughter plants, one each in Virginia and Georgia, that shared source farms (2). CDC used C. psittaci real-time polymerase chain reaction (PCR) to test 54 human specimens from this outbreak. This was the largest number of human specimens from a single outbreak ever tested for C. psittaci using real-time PCR, which is faster and more sensitive than commercially available serologic tests. This represented a rare opportunity to assess the utility of multiple specimen types for real-time PCR detection of C. psittaci. C. psittaci was detected more frequently in lower respiratory specimens (59% [10 of 17]) and stool (four of five) than in upper respiratory specimens (7% [two of 28]). Among six patients with sputum and nasopharyngeal swabs tested, C. psittaci was detected only in sputum in five patients. Cycle threshold (Ct) values suggested bacterial load was higher in lower respiratory specimens than in nasopharyngeal swabs. These findings support prioritizing lower respiratory specimens for real-time PCR detection of C. psittaci. Stool specimens might also have utility for diagnosis of psittacosis.
Collapse
|
17
|
Patrick ME, Shaw KA, Dietz PM, Baio J, Yeargin-Allsopp M, Bilder DA, Kirby RS, Hall-Lande JA, Harrington RA, Lee LC, Lopez MLC, Daniels J, Maenner MJ. Prevalence of intellectual disability among eight-year-old children from selected communities in the United States, 2014. Disabil Health J 2021; 14:101023. [PMID: 33272883 PMCID: PMC10962268 DOI: 10.1016/j.dhjo.2020.101023] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/08/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Children with intellectual disability (ID), characterized by impairments in intellectual functioning and adaptive behavior, benefit from early identification and access to services. Previous U.S. estimates used administrative data or parent report with limited information for demographic subgroups. OBJECTIVE Using empiric measures we examined ID characteristics among 8-year-old children and estimated prevalence by sex, race/ethnicity, geographic area and socioeconomic status (SES) area indicators. METHODS We analyzed data for 8-year-old children in 9 geographic areas participating in the 2014 Autism and Developmental Disabilities Monitoring Network. Children with ID were identified through record review of IQ test data. Census and American Community Survey data were used to estimate the denominator. RESULTS Overall, 11.8 per 1,000 (1.2%) had ID (IQ ≤ 70), of whom 39% (n = 998) also had autism spectrum disorder. Among children with ID, 1,823 had adaptive behavior test scores for which 64% were characterized as impaired. ID prevalence per 1,000 was 15.8 (95% confidence interval [95% CI], 15.0-16.5) among males and 7.7 (95% CI, 7.2-8.2) among females. ID prevalence was 17.7 (95% CI, 16.6-18.9) among children who were non-Hispanic black; 12.0 (95% CI, 11.1-13.0), among Hispanic; 8.6 (95% CI, 7.1-10.4), among non-Hispanic Asian; and 8.0 (95% CI, 7.5-8.6), among non-Hispanic white. Prevalence varied across geographic areas and was inversely associated with SES. CONCLUSIONS ID prevalence varied substantively among racial, ethnic, geographic, and SES groups. Results can inform strategies to enhance identification and improve access to services particularly for children who are minorities or living in areas with lower SES.
Collapse
Affiliation(s)
- Mary E Patrick
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kelly A Shaw
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jon Baio
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | - Li-Ching Lee
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | |
Collapse
|
18
|
Shaw KA, Wright K, Privett K, Holloman K, Levine S, McCombs K, Turner L, Holsinger C, Woolard D. Salmonellosis Outbreak After a Large-Scale Food Event in Virginia, 2017. Public Health Rep 2020; 135:668-675. [PMID: 32791024 DOI: 10.1177/0033354920944861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The Virginia Department of Health (VDH) identified an outbreak of Salmonella serotype Javiana infections in Virginia after a chili and chowder cook-off with 11 competitors and about 2500 attendees on September 30, 2017. The objectives of this study were to assess the extent of the outbreak and identify the most likely source of exposure. METHODS To identify people with suspected Salmonella infection, VDH used press releases and social media posts to recruit event attendees to take an online survey about foods eaten at the cook-off and any gastrointestinal (GI) symptoms experienced. VDH defined a case as reported GI illness that occurred within 1 week after eating food from the cook-off. Confirmed cases required a clinical specimen culture positive for Salmonella. Probable cases reported diarrhea or related clinical symptoms. "Not ill" people did not report GI illness. Investigators calculated unadjusted relative risks of illness and performed stratified analysis to address potential confounding. Available food samples were tested for Salmonella. Environmental health specialists interviewed food handlers and inspected restaurants where 3 competitors had prepared food. RESULTS Of 438 survey responses, 171 (39%) met the case definition. Of all chilies and chowders consumed, Chowder A was associated with the highest relative risk of illness (8.9; 95% CI, 5.7-13.7). A Chowder A sample tested positive for Salmonella serotype Javiana. The environmental investigation did not identify an original contamination source but did find deficiencies in maintaining safe cooking temperatures. CONCLUSIONS Epidemiologic and laboratory findings indicated that Chowder A was the most likely cause of outbreak. Recommendations to prevent future outbreaks include preparation of all food on-site to ensure safe temperatures during food preparation and service.
Collapse
Affiliation(s)
- Kelly A Shaw
- 1242 Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
- 2396 Division of Surveillance and Investigation, Virginia Department of Health, Richmond, VA, USA
| | - Kimberly Wright
- 2396 Eastern Shore Health District, Virginia Department of Health, Accomac, VA, USA
| | - Keith Privett
- 2396 Eastern Shore Health District, Virginia Department of Health, Accomac, VA, USA
| | - Kelsey Holloman
- 2396 Division of Surveillance and Investigation, Virginia Department of Health, Richmond, VA, USA
| | - Seth Levine
- 2396 Division of Surveillance and Investigation, Virginia Department of Health, Richmond, VA, USA
| | - Katherine McCombs
- 2396 Division of Surveillance and Investigation, Virginia Department of Health, Richmond, VA, USA
| | - Lauren Turner
- 2396 Division of Consolidated Laboratory Services, Virginia Department of General Services, Richmond, VA, USA
| | - Caroline Holsinger
- 2396 Division of Surveillance and Investigation, Virginia Department of Health, Richmond, VA, USA
| | - Diane Woolard
- 2396 Division of Surveillance and Investigation, Virginia Department of Health, Richmond, VA, USA
| |
Collapse
|
19
|
Shaw KA, Szablewski CM, Kellner S, Kornegay L, Bair P, Brennan S, Kunkes A, Davis M, McGovern OL, Winchell J, Kobayashi M, Burton N, de Perio MA, Gabel J, Drenzek C, Murphy J, Holsinger C, Forlano L. Psittacosis Outbreak among Workers at Chicken Slaughter Plants, Virginia and Georgia, USA, 2018. Emerg Infect Dis 2020; 25:2143-2145. [PMID: 31625859 PMCID: PMC6810211 DOI: 10.3201/eid2511.190703] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
During August–October, 2018, an outbreak of severe respiratory illness was reported among poultry slaughter plant workers in Virginia and Georgia, USA. A multiorganizational team investigated the cause and extent of illness, determined that the illness was psittacosis, and evaluated and recommended controls for health hazards in the workplace to prevent additional cases.
Collapse
|
20
|
Shaw KA, Maenner MJ, Baio J, Washington A, Christensen DL, Wiggins LD, Pettygrove S, Andrews JG, White T, Rosenberg CR, Constantino JN, Fitzgerald RT, Zahorodny W, Shenouda J, Daniels JL, Salinas A, Durkin MS, Dietz PM. Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Early Autism and Developmental Disabilities Monitoring Network, Six Sites, United States, 2016. MMWR Surveill Summ 2020; 69:1-11. [PMID: 32214075 PMCID: PMC7119643 DOI: 10.15585/mmwr.ss6903a1] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION Autism spectrum disorder (ASD). PERIOD COVERED 2016. DESCRIPTION OF SYSTEM The Early Autism and Developmental Disabilities Monitoring (Early ADDM) Network, a subset of the overall ADDM Network, is an active surveillance program that estimates ASD prevalence and monitors early identification of ASD among children aged 4 years. Children included in surveillance year 2016 were born in 2012 and had a parent or guardian who lived in the surveillance area in Arizona, Colorado, Missouri, New Jersey, North Carolina, or Wisconsin, at any time during 2016. Children were identified from records of community sources including general pediatric health clinics, special education programs, and early intervention programs. Data from comprehensive evaluations performed by community professionals were abstracted and reviewed by trained clinicians using a standardized ASD surveillance case definition with criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). RESULTS In 2016, the overall ASD prevalence was 15.6 per 1,000 (one in 64) children aged 4 years for Early ADDM Network sites. Prevalence varied from 8.8 per 1,000 in Missouri to 25.3 per 1,000 in New Jersey. At every site, prevalence was higher among boys than among girls, with an overall male-to-female prevalence ratio of 3.5 (95% confidence interval [CI] = 3.1-4.1). Prevalence of ASD between non-Hispanic white (white) and non-Hispanic black (black) children was similar at each site (overall prevalence ratio: 0.9; 95% CI = 0.8-1.1). The prevalence of ASD using DSM-5 criteria was lower than the prevalence using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria at one of four sites that used criteria from both editions. Among sites where ≥60% of children aged 4 years had information about intellectual disability (intelligence quotient ≤70 or examiner's statement of intellectual disability documented in an evaluation), 53% of children with ASD had co-occurring intellectual disability. Of all children aged 4 years with ASD, 84% had a first evaluation at age ≤36 months and 71% of children who met the surveillance case definition had a previous ASD diagnosis from a community provider. Median age at first evaluation and diagnosis for this age group was 26 months and 33 months, respectively. Cumulative incidence of autism diagnoses received by age 48 months was higher for children aged 4 years than for those aged 8 years identified in Early ADDM Network surveillance areas in 2016. INTERPRETATION In 2016, the overall prevalence of ASD in the Early ADDM Network using DSM-5 criteria (15.6 per 1,000 children aged 4 years) was higher than the 2014 estimate using DSM-5 criteria (14.1 per 1,000). Children born in 2012 had a higher cumulative incidence of ASD diagnoses by age 48 months compared with children born in 2008, which indicates more early identification of ASD in the younger group. The disparity in ASD prevalence has decreased between white and black children. Prevalence of co-occurring intellectual disability was higher than in 2014, suggesting children with intellectual disability continue to be identified at younger ages. More children received evaluations by age 36 months in 2016 than in 2014, which is consistent with Healthy People 2020 goals. Median age at earliest ASD diagnosis has not changed considerably since 2014. PUBLIC HEALTH ACTION More children aged 4 years with ASD are being evaluated by age 36 months and diagnosed by age 48 months, but there is still room for improvement in early identification. Timely evaluation of children by community providers as soon as developmental concerns have been identified might result in earlier ASD diagnoses, earlier receipt of evidence-based interventions, and improved developmental outcomes.
Collapse
|
21
|
Maenner MJ, Shaw KA, Baio J, Washington A, Patrick M, DiRienzo M, Christensen DL, Wiggins LD, Pettygrove S, Andrews JG, Lopez M, Hudson A, Baroud T, Schwenk Y, White T, Rosenberg CR, Lee LC, Harrington RA, Huston M, Hewitt A, Esler A, Hall-Lande J, Poynter JN, Hallas-Muchow L, Constantino JN, Fitzgerald RT, Zahorodny W, Shenouda J, Daniels JL, Warren Z, Vehorn A, Salinas A, Durkin MS, Dietz PM. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016. MMWR Surveill Summ 2020. [PMID: 32214087 DOI: 10.15585/mmwr.ss6904a1externalicon] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PROBLEM/CONDITION Autism spectrum disorder (ASD). PERIOD COVERED 2016. DESCRIPTION OF SYSTEM The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years whose parents or guardians live in 11 ADDM Network sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by medical and educational service providers in the community. In the second phase, experienced clinicians who systematically review all abstracted information determine ASD case status. The case definition is based on ASD criteria described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS For 2016, across all 11 sites, ASD prevalence was 18.5 per 1,000 (one in 54) children aged 8 years, and ASD was 4.3 times as prevalent among boys as among girls. ASD prevalence varied by site, ranging from 13.1 (Colorado) to 31.4 (New Jersey). Prevalence estimates were approximately identical for non-Hispanic white (white), non-Hispanic black (black), and Asian/Pacific Islander children (18.5, 18.3, and 17.9, respectively) but lower for Hispanic children (15.4). Among children with ASD for whom data on intellectual or cognitive functioning were available, 33% were classified as having intellectual disability (intelligence quotient [IQ] ≤70); this percentage was higher among girls than boys (39% versus 32%) and among black and Hispanic than white children (47%, 36%, and 27%, respectively) [corrected]. Black children with ASD were less likely to have a first evaluation by age 36 months than were white children with ASD (40% versus 45%). The overall median age at earliest known ASD diagnosis (51 months) was similar by sex and racial and ethnic groups; however, black children with IQ ≤70 had a later median age at ASD diagnosis than white children with IQ ≤70 (48 months versus 42 months). INTERPRETATION The prevalence of ASD varied considerably across sites and was higher than previous estimates since 2014. Although no overall difference in ASD prevalence between black and white children aged 8 years was observed, the disparities for black children persisted in early evaluation and diagnosis of ASD. Hispanic children also continue to be identified as having ASD less frequently than white or black children. PUBLIC HEALTH ACTION These findings highlight the variability in the evaluation and detection of ASD across communities and between sociodemographic groups. Continued efforts are needed for early and equitable identification of ASD and timely enrollment in services.
Collapse
|
22
|
Maenner MJ, Shaw KA, Baio J, Washington A, Patrick M, DiRienzo M, Christensen DL, Wiggins LD, Pettygrove S, Andrews JG, Lopez M, Hudson A, Baroud T, Schwenk Y, White T, Rosenberg CR, Lee LC, Harrington RA, Huston M, Hewitt A, Esler A, Hall-Lande J, Poynter JN, Hallas-Muchow L, Constantino JN, Fitzgerald RT, Zahorodny W, Shenouda J, Daniels JL, Warren Z, Vehorn A, Salinas A, Durkin MS, Dietz PM. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016. MMWR Surveill Summ 2020; 69:1-12. [PMID: 32214087 PMCID: PMC7119644 DOI: 10.15585/mmwr.ss6904a1] [Citation(s) in RCA: 1409] [Impact Index Per Article: 352.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION Autism spectrum disorder (ASD). PERIOD COVERED 2016. DESCRIPTION OF SYSTEM The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years whose parents or guardians live in 11 ADDM Network sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by medical and educational service providers in the community. In the second phase, experienced clinicians who systematically review all abstracted information determine ASD case status. The case definition is based on ASD criteria described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS For 2016, across all 11 sites, ASD prevalence was 18.5 per 1,000 (one in 54) children aged 8 years, and ASD was 4.3 times as prevalent among boys as among girls. ASD prevalence varied by site, ranging from 13.1 (Colorado) to 31.4 (New Jersey). Prevalence estimates were approximately identical for non-Hispanic white (white), non-Hispanic black (black), and Asian/Pacific Islander children (18.5, 18.3, and 17.9, respectively) but lower for Hispanic children (15.4). Among children with ASD for whom data on intellectual or cognitive functioning were available, 33% were classified as having intellectual disability (intelligence quotient [IQ] ≤70); this percentage was higher among girls than boys (39% versus 32%) and among black and Hispanic than white children (47%, 36%, and 27%, respectively) [corrected]. Black children with ASD were less likely to have a first evaluation by age 36 months than were white children with ASD (40% versus 45%). The overall median age at earliest known ASD diagnosis (51 months) was similar by sex and racial and ethnic groups; however, black children with IQ ≤70 had a later median age at ASD diagnosis than white children with IQ ≤70 (48 months versus 42 months). INTERPRETATION The prevalence of ASD varied considerably across sites and was higher than previous estimates since 2014. Although no overall difference in ASD prevalence between black and white children aged 8 years was observed, the disparities for black children persisted in early evaluation and diagnosis of ASD. Hispanic children also continue to be identified as having ASD less frequently than white or black children. PUBLIC HEALTH ACTION These findings highlight the variability in the evaluation and detection of ASD across communities and between sociodemographic groups. Continued efforts are needed for early and equitable identification of ASD and timely enrollment in services.
Collapse
|
23
|
Denson LA, Jurickova I, Karns R, Shaw KA, Cutler DJ, Okou D, Valencia CA, Dodd A, Mondal K, Aronow BJ, Haberman Y, Linn A, Price A, Bezold R, Lake K, Jackson K, Walters TD, Griffiths A, Baldassano RN, Noe JD, Hyams JS, Crandall WV, Kirschner BS, Heyman MB, Snapper S, Guthery SL, Dubinsky MC, Leleiko NS, Otley AR, Xavier RJ, Stevens C, Daly MJ, Zwick ME, Kugathasan S. Genetic and Transcriptomic Variation Linked to Neutrophil Granulocyte-Macrophage Colony-Stimulating Factor Signaling in Pediatric Crohn's Disease. Inflamm Bowel Dis 2019; 25:547-560. [PMID: 30124884 PMCID: PMC6391846 DOI: 10.1093/ibd/izy265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Granulocyte-macrophage colony-stimulating factor auto-antibodies (GMAbs) suppress neutrophil-extrinsic GM-CSF signaling and increase risk for stricturing behavior in Crohn's disease (CD). We aimed to define clinical, genomic, and functional associations with neutrophil-intrinsic GM-CSF signaling. METHODS Missense mutations in CSF2RA, CSF2RB, JAK2, STAT5A, and STAT5B were identified using whole-exome sequencing in 543 pediatric inflammatory bowel disease (IBD) patients. Neutrophil-intrinsic GM-CSF signaling was defined using the GM-CSF-induced STAT5 stimulation index (GMSI) in 180 pediatric IBD patients and 26 non-IBD controls. Reduced GM-CSF signaling (GMSI-Lo) was defined as the 20th percentile within the control group. Variation in neutrophil phospho-protein abundance, bacterial killing, and the global pattern of gene expression with the GMSI was determined. RESULTS We validated 18 potentially damaging missense mutations in CSF2RA and CSF2RB. CSF2RA A17G carriage increased from 10% in those with intact neutrophil GMSI to 32% in those with low GMSI (P = 0.02). The frequency of reduced Staphylococcus aureus killing increased from 17% in those with intact neutrophil GMSI to 35% in GMSI-Lo neutrophils (P = 0.043). Crohn's disease neutrophils with low GMSI exhibited specific alterations in phospho-protein networks and genes regulating cytokine production, wound healing, and cell survival and proliferation. Stricturing behavior increased from 7% in patients with both low GMAb and intact GMSI to 64% in patients with both elevated GMAb and low GMSI (P < 0.0001). CONCLUSIONS Low/normal neutrophil-intrinsic GM-CSF signaling is associated with CSF2RA missense mutations, alterations in gene expression networks, and higher rates of disease complications in pediatric CD.
Collapse
Affiliation(s)
- Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Address correspondence to: Lee A. Denson, MD, MLC 2010, 3333 Burnet Avenue, Cincinnati, OH ()
| | - Ingrid Jurickova
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rebekah Karns
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kelly A Shaw
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - David J Cutler
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - David Okou
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - C Alexander Valencia
- Program and Division of Human Genetics, Molecular Genetics Laboratory, Cincinnati, Ohio
| | - Anne Dodd
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Kajari Mondal
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Bruce J Aronow
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Yael Haberman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Aaron Linn
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Adam Price
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ramona Bezold
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kathleen Lake
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kimberly Jackson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Thomas D Walters
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Anne Griffiths
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Robert N Baldassano
- Department of Pediatrics, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua D Noe
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, Connecticut
| | - Wallace V Crandall
- Department of Pediatric Gastroenterology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Melvin B Heyman
- Department of Pediatrics, University of California at San Francisco, San Francisco, California
| | - Scott Snapper
- Department of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Marla C Dubinsky
- Department of Pediatrics, Mount Sinai Hospital, New York, New York
| | - Neal S Leleiko
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, Rhode Island
| | - Anthony R Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ramnik J Xavier
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Mark J Daly
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Michael E Zwick
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | | |
Collapse
|
24
|
Denson LA, Jurickova I, Karns R, Shaw KA, Cutler DJ, Okou D, Dodd A, Quinn K, Mondal K, Aronow BJ, Haberman Y, Linn A, Price A, Bezold R, Lake K, Jackson K, Walters TD, Griffiths A, Baldassano RN, Noe JD, Hyams JS, Crandall WV, Kirschner BS, Heyman MB, Snapper S, Guthery SL, Dubinsky MC, Leleiko NS, Otley AR, Xavier RJ, Stevens C, Daly MJ, Zwick ME, Kugathasan S. Clinical and Genomic Correlates of Neutrophil Reactive Oxygen Species Production in Pediatric Patients With Crohn's Disease. Gastroenterology 2018; 154:2097-2110. [PMID: 29454792 PMCID: PMC5985211 DOI: 10.1053/j.gastro.2018.02.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 10/11/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Individuals with monogenic disorders of phagocyte function develop chronic colitis that resembles Crohn's disease (CD). We tested for associations between mutations in genes encoding reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidases, neutrophil function, and phenotypes of CD in pediatric patients. METHODS We performed whole-exome sequence analysis to identify mutations in genes encoding NADPH oxidases (such as CYBA, CYBB, NCF1, NCF2, NCF4, RAC1, and RAC2) using DNA from 543 pediatric patients with inflammatory bowel diseases. Blood samples were collected from an additional 129 pediatric patients with CD and 26 children without IBD (controls); we performed assays for neutrophil activation, reactive oxygen species (ROS) production, and bacteria uptake and killing. Whole-exome sequence analysis was performed using DNA from 46 of the children with CD to examine associations with NADPH gene mutations; RNA sequence analyses were performed using blood cells from 46 children with CD to test for variations in neutrophil gene expression associated with ROS production. RESULTS We identified 26 missense mutations in CYBA, CYBB, NCF1, NCF2, and NCF4. Patients with CD who carried mutations in these genes were 3-fold more likely to have perianal disease (P = .0008) and stricturing complications (P = .002) than children with CD without these mutations. Among patients with CD with none of these mutations, 9% had undergone abdominal surgery; among patients with mutations in these NADPH oxidase genes, 31% had undergone abdominal surgery (P = .0004). A higher proportion of neutrophils from children with CD had low ROS production (47%) than from controls (15%) among the 129 patients tested for ROS (P = .002). Minor alleles of the NADPH genes were detected in 7% of children with CD whose neutrophils produced normal levels of ROS vs 38% of children whose neutrophils produced low levels of ROS (P = .009). Neutrophils that produced low levels of ROS had specific alterations in genes that regulate glucose metabolism and antimicrobial responses. CONCLUSIONS We identified missense mutations in genes that encode NADPH oxidases in children with CD; these were associated with a more aggressive disease course and reduced ROS production by neutrophils from the patients.
Collapse
Affiliation(s)
- Lee A. Denson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,to whom correspondence should be addressed: MLC 2010, 3333 Burnet Avenue, Cincinnati, OH 45229, Tel: 513-636-7575, Fax: 513-636-5581,
| | - Ingrid Jurickova
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rebekah Karns
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kelly A. Shaw
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - David J. Cutler
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - David Okou
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Anne Dodd
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Kathryn Quinn
- Cancer and Blood Disease Institute, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kajari Mondal
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Bruce J. Aronow
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yael Haberman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aaron Linn
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Price
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ramona Bezold
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen Lake
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly Jackson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas D. Walters
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Anne Griffiths
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Robert N. Baldassano
- Department of Pediatrics, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joshua D. Noe
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey S. Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Wallace V. Crandall
- Department of Pediatric Gastroenterology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Melvin B. Heyman
- Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA
| | - Scott Snapper
- Department of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | | | | | - Neal S. Leleiko
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
| | - Anthony R. Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Mark J. Daly
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Michael E. Zwick
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
25
|
Schivone GB, Lerma K, Montgomery C, Wright P, Conti JA, Blumenthal PD, Shaw KA. Self-administered lidocaine gel for pain control prior to osmotic dilator insertion: A randomized controlled trial. Contraception 2018. [DOI: 10.1016/j.contraception.2018.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
26
|
Shaw KA, Cutler DJ, Okou D, Dodd A, Aronow BJ, Haberman Y, Stevens C, Walters TD, Griffiths A, Baldassano RN, Noe JD, Hyams JS, Crandall WV, Kirschner BS, Heyman MB, Snapper S, Guthery S, Dubinsky MC, Shapiro JM, Otley AR, Daly M, Denson LA, Kugathasan S, Zwick ME. Genetic variants and pathways implicated in a pediatric inflammatory bowel disease cohort. Genes Immun 2018; 20:131-142. [PMID: 29593342 PMCID: PMC6162182 DOI: 10.1038/s41435-018-0015-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022]
Abstract
In the United States, approximately 5% of individuals with inflammatory bowel disease (IBD) are younger than 20 years old. Studies of pediatric cohorts can provide unique insights into genetic architecture of IBD, which includes Crohn's disease (CD) and ulcerative colitis (UC). Large genome-wide association studies have found more than 200 IBD-associated loci but explain a minority of disease variance for CD and UC. We sought to characterize the contribution of rare variants to disease development, comparing exome sequencing of 368 pediatric IBD patients to publicly available exome sequencing (dbGaP) and aggregate frequency data (ExAC). Using dbGaP data, we performed logistic regression for common variants and optimal unified association tests (SKAT-O) for rare, likely-deleterious variants. We further compared rare variants to ExAC counts with Fisher's exact tests. We did pathway enrichment analysis on the most significant genes from each comparison. Many variants overlapped with known IBD-associated genes (e.g. NOD2). Rare variants were enriched in CD-associated loci (p = 0.009) and showed suggestive enrichment in neutrophil function genes (p = 0.05). Pathway enrichment implicated immune-related pathways, especially cell killing and apoptosis. Variants in extracellular matrix genes also emerged as an important theme in our analysis.
Collapse
Affiliation(s)
- Kelly A Shaw
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - David J Cutler
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - David Okou
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Anne Dodd
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Bruce J Aronow
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yael Haberman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Thomas D Walters
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anne Griffiths
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Robert N Baldassano
- Department of Pediatrics, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joshua D Noe
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Wallace V Crandall
- Department of Pediatric Gastroenterology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Barbara S Kirschner
- Department of Pediatrics, The University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Melvin B Heyman
- Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA
| | - Scott Snapper
- Department of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Stephen Guthery
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Marla C Dubinsky
- Department of Pediatrics, Mount Sinai Hospital, New York, NY, USA
| | - Jason M Shapiro
- Department of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
| | - Anthony R Otley
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Mark Daly
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Michael E Zwick
- Department of Human Genetics, Emory University, Atlanta, GA, USA.
| |
Collapse
|
27
|
Shaw KA, Lerma K, Shaw JG, Scrivner KJ, Hugin M, Hopkins FW, Blumenthal PD. Preoperative effects of mifepristone for dilation and evacuation after 19 weeks of gestation: a randomised controlled trial. BJOG 2017; 124:1973-1981. [DOI: 10.1111/1471-0528.14900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- KA Shaw
- Division of Family Planning Services and Research; Department of Obstetrics & Gynecology; Stanford University School of Medicine; Stanford CA USA
| | - K Lerma
- Division of Family Planning Services and Research; Department of Obstetrics & Gynecology; Stanford University School of Medicine; Stanford CA USA
| | - JG Shaw
- Division of Primary Care and Population Health; Department of Medicine; Stanford University School of Medicine; Stanford CA USA
| | - KJ Scrivner
- Division of Family Planning Services and Research; Department of Obstetrics & Gynecology; Stanford University School of Medicine; Stanford CA USA
| | - M Hugin
- Department of Obstetrics & Gynecology; Santa Clara Valley Medical Center; San Jose CA USA
| | - FW Hopkins
- Division of Family Planning Services and Research; Department of Obstetrics & Gynecology; Stanford University School of Medicine; Stanford CA USA
- Department of Obstetrics & Gynecology; Santa Clara Valley Medical Center; San Jose CA USA
| | - PD Blumenthal
- Division of Family Planning Services and Research; Department of Obstetrics & Gynecology; Stanford University School of Medicine; Stanford CA USA
| |
Collapse
|
28
|
Shaw KA, Lerma K, Hugin M, Scrivner K, Hopkins FW, Blumenthal PD. Preoperative effects of mifepristone on dilation and evacuation: mifepristone versus placebo in conjunction with osmotic dilators after 19 weeks' gestation. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
Kharsa Z, Shaw KA. Postpartum interest in and uptake of long-acting reversible contraception at a large university-based medical center in California. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
Shaw KA, Lerma K, Hugin M, Scrivner K, Hopkins FW, Blumenthal PD. Preoperative effects of mifepristone on dilation and evacuation: mifepristone versus osmotic dilators after 19 weeks' gestation. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
31
|
Shaw KA, Bertha M, Hofmekler T, Chopra P, Vatanen T, Srivatsa A, Prince J, Kumar A, Sauer C, Zwick ME, Satten GA, Kostic AD, Mulle JG, Xavier RJ, Kugathasan S. Dysbiosis, inflammation, and response to treatment: a longitudinal study of pediatric subjects with newly diagnosed inflammatory bowel disease. Genome Med 2016; 8:75. [PMID: 27412252 PMCID: PMC4944441 DOI: 10.1186/s13073-016-0331-y] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/01/2016] [Indexed: 12/13/2022] Open
Abstract
Background Gut microbiome dysbiosis has been demonstrated in subjects with newly diagnosed and chronic inflammatory bowel disease (IBD). In this study we sought to explore longitudinal changes in dysbiosis and ascertain associations between dysbiosis and markers of disease activity and treatment outcome. Methods We performed a prospective cohort study of 19 treatment-naïve pediatric IBD subjects and 10 healthy controls, measuring fecal calprotectin and assessing the gut microbiome via repeated stool samples. Associations between clinical characteristics and the microbiome were tested using generalized estimating equations. Random forest classification was used to predict ultimate treatment response (presence of mucosal healing at follow-up colonoscopy) or non-response using patients’ pretreatment samples. Results Patients with Crohn’s disease had increased markers of inflammation and dysbiosis compared to controls. Patients with ulcerative colitis had even higher inflammation and dysbiosis compared to those with Crohn’s disease. For all cases, the gut microbial dysbiosis index associated significantly with clinical and biological measures of disease severity, but did not associate with treatment response. We found differences in specific gut microbiome genera between cases/controls and responders/non-responders including Akkermansia, Coprococcus, Fusobacterium, Veillonella, Faecalibacterium, and Adlercreutzia. Using pretreatment microbiome data in a weighted random forest classifier, we were able to obtain 76.5 % accuracy for prediction of responder status. Conclusions Patient dysbiosis improved over time but persisted even among those who responded to treatment and achieved mucosal healing. Although dysbiosis index was not significantly different between responders and non-responders, we found specific genus-level differences. We found that pretreatment microbiome signatures are a promising avenue for prediction of remission and response to treatment. Electronic supplementary material The online version of this article (doi:10.1186/s13073-016-0331-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kelly A Shaw
- Graduate Program in Genetics and Molecular Biology, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, 30322, USA
| | - Madeline Bertha
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA
| | - Tatyana Hofmekler
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA
| | - Pankaj Chopra
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA
| | - Tommi Vatanen
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.,Department of Computer Science, Aalto University School of Science, 02150, Espoo, Finland
| | - Abhiram Srivatsa
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA
| | - Jarod Prince
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA
| | - Archana Kumar
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA
| | - Cary Sauer
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA
| | - Michael E Zwick
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Glen A Satten
- Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Aleksandar D Kostic
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.,Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Jennifer G Mulle
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Ramnik J Xavier
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.,Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Subra Kugathasan
- Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, 2015 Uppergate Drive, room 248, Atlanta, GA, 30322, USA. .,Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA.
| |
Collapse
|
32
|
Shaw KA, Mulle JG, Epstein MP, Fridovich-Keil JL. Gastrointestinal Health in Classic Galactosemia. JIMD Rep 2016; 33:27-32. [PMID: 27363831 DOI: 10.1007/8904_2016_575] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/18/2016] [Accepted: 05/23/2016] [Indexed: 01/23/2023] Open
Abstract
Classic galactosemia (CG) is an autosomal recessive disorder of galactose metabolism that affects approximately 1/50,000 live births in the USA. Following exposure to milk, which contains large quantities of galactose, affected infants may become seriously ill. Early identification by newborn screening with immediate dietary galactose restriction minimizes or prevents the potentially lethal acute symptoms of CG. However, more than half of individuals with CG still experience long-term complications including cognitive disability, behavioral problems, and speech impairment. Anecdotal reports have also suggested frequent gastrointestinal (GI) problems, but this outcome has not been systematically addressed. In this study we explored the prevalence of GI symptoms among 183 children and adults with CG (cases) and 190 controls. Cases reported 4.5 times more frequent constipation (95% CI 1.8-11.5) and 4.2 times more frequent nausea (95% CI 1.2-15.5) than controls. Cases with genotypes predicting residual GALT activity reported less frequent constipation than cases without predicted GALT activity but this difference was not statistically significant. Because the rigor of dietary galactose restriction varies among individuals with galactosemia, we further tested whether GI symptoms associated with diet in infancy. Though constipation was almost four times as common among cases reporting a more restrictive diet in infancy, this difference was not statistically significant. These data confirm that certain GI symptoms are more common in classic galactosemia compared to controls and suggest that future studies should investigate associations with residual GALT activity and dietary galactose restriction in early life.
Collapse
Affiliation(s)
- Kelly A Shaw
- Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
| | - Jennifer G Mulle
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA, USA
| | - Michael P Epstein
- Department of Human Genetics, Emory University School of Medicine, Room 325.2 Whitehead Building, 615 Michael Street, Atlanta, GA, 30322, USA
| | - Judith L Fridovich-Keil
- Department of Human Genetics, Emory University School of Medicine, Room 325.2 Whitehead Building, 615 Michael Street, Atlanta, GA, 30322, USA.
| |
Collapse
|
33
|
Stephens N, Coleman D, Shaw KA, O'Sullivan M, Venn A. Improving public health surveillance of chlamydia: analysis of population-level positivity trends. Sex Health 2015; 12:369-71. [PMID: 26053737 DOI: 10.1071/sh14201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/29/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Chlamydia remains Australia's most frequently notified communicable disease; however, interpretation of notification data is difficult without knowledge of testing practices. This study examined the value of reporting positivity trends. METHODS Tasmanian population-level chlamydia laboratory tests and notification data from 2001 to 2010 were compared. RESULTS Notifications, tests and positivity increased, most significantly in males and females aged 15-29 years. CONCLUSIONS Analysis of chlamydia positivity trends can inform the development, monitoring and evaluation of prevention and control activities and improves the interpretation of notification trends. After allowing for testing effort, an increase in chlamydia infections in young people was found.
Collapse
Affiliation(s)
- Nicola Stephens
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
| | - David Coleman
- Communicable Diseases Prevention Unit, Department of Health and Human Services, 25 Argyle Street, Hobart, Tas. 7000, Australia
| | - Kelly A Shaw
- Population Health, Department of Health and Human Services, 25 Argyle Street, Hobart, Tas. 7000, Australia
| | - Maree O'Sullivan
- Gold Coast Health and Hospital Services, Queensland Health, 2019 Gold Coast Highway, Miami, Qld 4220, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tas. 7000, Australia
| |
Collapse
|
34
|
Pyhtila BM, Shaw KA, Neumann SE, Fridovich-Keil JL. Erratum to: Newborn Screening for Galactosemia in the United States: Looking Back, Looking Around, and Looking Ahead. JIMD Rep 2014; 15:133. [PMID: 25381176 DOI: 10.1007/8904_2014_369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/05/2014] [Accepted: 02/14/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Brook M Pyhtila
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | | | | |
Collapse
|
35
|
Pyhtila BM, Shaw KA, Neumann SE, Fridovich-Keil JL. A brief overview of galactosemia newborn screening in the United States. J Inherit Metab Dis 2014; 37:649-50. [PMID: 24658844 DOI: 10.1007/s10545-014-9694-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
|
36
|
Abstract
Since the last update of this review multiple changes like new methods and other standards make it necessary to withdraw this review and register a new title on the same topic. The editorial group responsible for this previously published document have withdrawn it from publication.
Collapse
Affiliation(s)
- Leah Brennan
- Monash UniversityCentre for Obesity Research and EducationLevel 6, The Alfred Centre, 99 Commercial RoadMelbourneVICAustralia3004
| | - Kylie D Murphy
- Monash UniversityCentre for Obesity Research and EducationLevel 6, The Alfred Centre, 99 Commercial RoadMelbourneVICAustralia3004
| | - Kelly A Shaw
- Tasmanian GovernmentDepartment of Health and Human Services3/25 Argyle StreetHobartTasmaniaAustralia7000
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineThe Alfred Centre99 Commercial RoadMelbourneVictoriaAustralia3004
| | | |
Collapse
|
37
|
Pyhtila BM, Shaw KA, Neumann SE, Fridovich-Keil JL. Newborn screening for galactosemia in the United States: looking back, looking around, and looking ahead. JIMD Rep 2014; 15:79-93. [PMID: 24718839 DOI: 10.1007/8904_2014_302] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 01/07/2014] [Revised: 02/05/2014] [Accepted: 02/14/2014] [Indexed: 12/17/2022] Open
Abstract
It has been 50 years since the first newborn screening (NBS) test for galactosemia was conducted in Oregon, and almost 10 years since the last US state added galactosemia to their NBS panel. During that time an estimated >2,500 babies with classic galactosemia have been identified by NBS. Most of these infants were spared the trauma of acute disease by early diagnosis and intervention, and many are alive today because of NBS. Newborn screening for galactosemia is a success story, but not yet a story with a completely happy ending. NBS, follow-up testing, and intervention for galactosemia continue to present challenges that highlight gaps in our knowledge. Here we compare galactosemia screening and follow-up data from 39 NBS programs gathered from the states directly or from public sources. On some matters the programs agreed: for example, those providing relevant data all identify classic galactosemia in close to 1/50,000 newborns and recommend immediate and lifelong dietary restriction of galactose for those infants. On other matters the programs disagree. For example, Duarte galactosemia (DG) detection rates vary dramatically among states, largely reflecting differences in screening approach. For infants diagnosed with DG, >80% of the programs surveyed recommend complete or partial dietary galactose restriction for the first year of life, or give mixed recommendations; <20% recommend no intervention. This disparity presents an ongoing dilemma for families and healthcare providers that could and should be resolved.
Collapse
Affiliation(s)
- Brook M Pyhtila
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | | | | |
Collapse
|
38
|
Winzenberg TM, Shaw KA, van der Mei IAF, Jones G. Vitamin D supplementation in infancy for improving bone density. Cochrane Database of Systematic Reviews 2013. [DOI: 10.1002/14651858.cd010658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tania M Winzenberg
- University of Tasmania; Menzies Research Institute Tasmania; Private Bag 23 Hobart TAS Australia 7000
| | - Kelly A Shaw
- Tasmanian Government; Department of Health and Human Services; 3/25 Argyle Street Hobart Tasmania Australia 7000
| | - Ingrid AF van der Mei
- University of Tasmania; Menzies Research Institute Tasmania; Private Bag 23 Hobart TAS Australia 7000
| | - Graeme Jones
- University of Tasmania; Menzies Research Institute Tasmania; Private Bag 23 Hobart TAS Australia 7000
| |
Collapse
|
39
|
Winzenberg TM, Powell S, Shaw KA, Jones G. Cochrane Review: Vitamin D supplementation for improving bone mineral density in children. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/ebch.1822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
40
|
Winzenberg T, Shaw KA. Screening for physical inactivity in general practice - a test of diagnostic accuracy. Aust Fam Physician 2011; 40:57-61. [PMID: 21301698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND It is unclear what is the best method of accurately identifying physically inactive patients in general practice. This study aimed to compare the performance of different methods of assessing patient physical activity levels in general practice. OBJECTIVE Thirteen general practitioners were randomly allocated to perform either their usual assessment, or this with a Lifescripts tool, on consecutive patients. The authors measured patients' physical activity by accelerometer over 1 week, including steps per day, then calculated agreement, kappa specificity, sensitivity, positive and negative predictive value (PV) and ROC characteristics for each assessment method (GPs' usual assessment, Lifescripts tool and steps per day) against the reference standard of accelerometer classification. RESULTS Data from 29 patients was included. Agreement between subjective assessments was highest for GPs' usual assessment (agreement 73%; kappa 0.47; p=0.03), which also gave the highest area under the ROC curve (0.75, 95% CI: 0.52-0.98). However, this still had low specificity (67%) and positive PV (63%). Using a cut-off of 7500 steps/day maximised the area under the ROC curve at 0.91 (95% CI: 0.82-1.00), 19.2% greater than GPs' usual assessment. CONCLUSION Measuring steps per day may be a feasible and more effective way to screen for physically inactive patients than self report. A large scale study to confirm these results is necessary.
Collapse
|
41
|
Abstract
BACKGROUND Results of randomised controlled trials (RCTs) of vitamin D supplementation to improve bone density in children are inconsistent. OBJECTIVES To determine the effectiveness of vitamin D supplementation for improving bone mineral density in children, whether any effect varies by sex, age or pubertal stage, the type or dose of vitamin D given or baseline vitamin D status, and if effects persist after cessation of supplementation. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 3, 2009), MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), AMED (1985 to present) and ISI Web of Science (1945 to present) on 9 August 2009, and we handsearched key journal conference abstracts. SELECTION CRITERIA Placebo-controlled RCTs of vitamin D supplementation for at least three months in healthy children and adolescents (aged from one month to < 20 years) with bone density outcomes. DATA COLLECTION AND ANALYSIS Two authors screened references for inclusion, assessed risk of bias, and extracted data. We conducted meta-analyses and calculated standardised mean differences (SMD) of the percent change from baseline in outcomes in treatment and control groups. We performed subgroup analyses by sex, pubertal stage, dose of vitamin D and baseline serum vitamin D and considered these as well as compliance and allocation concealment as possible sources of heterogeneity. MAIN RESULTS We included six RCTs (343 participants receiving placebo and 541 receiving vitamin D) for meta-analyses. Vitamin D supplementation had no statistically significant effects on total body bone mineral content (BMC), hip bone mineral density (BMD) or forearm BMD. There was a trend to a small effect on lumbar spine BMD (SMD 0.15, 95% CI -0.01 to 0.31, P = 0.07). There were no differences in effects between high and low serum vitamin D studies at any site though there was a trend towards a larger effect with low vitamin D for total body BMC (P = 0.09 for difference). In low serum vitamin D studies, significant effects on total body BMC and lumbar spine BMD were approximately equivalent to a 2.6% and 1.7 % percentage point greater change from baseline in the supplemented group. AUTHORS' CONCLUSIONS These results do not support vitamin D supplementation to improve bone density in healthy children with normal vitamin D levels, but suggest that supplementation of deficient children may be clinically useful. Further RCTs in deficient children are needed to confirm this.
Collapse
Affiliation(s)
- Tania M Winzenberg
- Menzies Research Institute, University of Tasmania, Private Bag 23, Hobart, TAS, Australia, 7001
| | | | | | | |
Collapse
|
42
|
Bocquet J, Winzenberg T, Shaw KA. Epicentre of influenza - the primary care experience in Melbourne, Victoria. Aust Fam Physician 2010; 39:313-316. [PMID: 20485719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND General practice in Australia is expected to play a major role in responding to an influenza pandemic. This study investigated the experience of frontline general practice during the H1N1 influenza pandemic of 2009. METHODS Semi-structured interviews were conducted with general practices in the northern suburbs of Melbourne (Victoria) in August and September 2009. Purposive sampling chose practices with high volumes of patient presentations early in the pandemic. Interviews were content transcribed at the time of interview. Major themes were identified through discussion with general practice division personnel and academic general practitioners in the field. RESULTS There was significant variability in the pandemic experiences of the 10 participating practices. DISCUSSION Addressing issues identified in this study could increase the capacity of general practice to support the community and public health measures during a pandemic. Future planning for the role of general practice in pandemics should include pre-pandemic assessment of practice capacity, review of public health communication strategies and workforce protection, and improved integration of general practice and public health responses.
Collapse
|
43
|
Pancratov C, Kurzer JM, Shaw KA, Trawick ML. Why Computer Architecture Matters: Thinking through Trade-offs in Your Code. Comput Sci Eng 2008. [DOI: 10.1109/mcse.2008.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
44
|
|
45
|
|
46
|
Winzenberg TM, Powell S, Shaw KA, Jones G. Vitamin D supplementation for improving bone mineral density in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd006944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
47
|
Shaw KA, Srikanth VK, Fryer JL, Blizzard L, Dwyer T, Venn AJ. Dual energy X-ray absorptiometry body composition and aging in a population-based older cohort. Int J Obes (Lond) 2006; 31:279-84. [PMID: 16788568 DOI: 10.1038/sj.ijo.0803417] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this cross-sectional study were (1) to examine the effect of age on body composition in older adults using dual-energy X-ray absorptiometry (DXA) and (2) to evaluate the agreement of DXA with standard indirect anthropometric measures (body mass index (BMI), waist circumference and waist-to-hip ratio (WHR)). RESEARCH METHODS AND PROCEDURES A population-based sample of 731 adults aged between 50 and 79 years underwent measurement of BMI, waist circumference, WHR, DXA total body fat mass, DXA % total body fat, DXA % trunk fat and DXA lean body mass. Linear regression was used to test for trend in measures of body composition between age categories in men and women. Partial correlations and Bland-Altman analysis were used to examine the agreement of DXA measures with indirect measures. RESULTS DXA lean body mass decreased significantly with increasing age in both sexes (P<0.05). In males, BMI (P=0.01) and body weight (P<0.01) decreased with age, and in females, WHR (P=0.05), DXA % total fat (P=0.02) and DXA % trunk fat (P=0.05) increased with age. There was good agreement between DXA measures of fatness and indirect anthropometric measures, except for WHR, which showed greater variability in its comparisons with DXA. CONCLUSION Using the highly sensitive and direct DXA method of measuring body composition, a decline in lean body mass and an increase in adiposity was observed with aging. Except for WHR, indirect anthropometric measures generally showed high levels of agreement with DXA fat measures in this older cohort.
Collapse
Affiliation(s)
- K A Shaw
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
BACKGROUND Current pandemic influenza plans to place GPs at the front line of a pandemic influenza response. However, little is known about GPs' perceptions of their role and preparedness in the event of a pandemic occurring. OBJECTIVE Our aim was to assess general practice preparedness to respond to pandemic influenza and to identify issues that need to be addressed to enhance preparedness for the next pandemic. METHODS We conducted a series of semi-structured interviews to explore GPs' views regarding their role in responding to pandemic influenza, practice preparedness and planning issues, and the expectations and requirements of GPs for provision of professional services during a pandemic. The subjects were 60 Australian GPs, purposively selected to maximize diversity within the sample. RESULTS GPs in this study expressed a willingness to provide professional services in a pandemic. The motivation for this was largely altruistic and was in the context of high personal risk of becoming infected. Participants did not have stockpiles of antivirals or personal protective equipment within their practices and felt that government had a duty of care to stockpile on behalf of the general practice workforce. Participants were enthusiastic about receiving further information and training in pandemic preparedness. The most appropriate setting for this was within practices. CONCLUSIONS GPs were willing to provide clinical services in a pandemic. However, appropriate education, training and supply of equipment were necessary to support them in this role. This information will inform further planning for the public health response to pandemic influenza.
Collapse
Affiliation(s)
- Kelly A Shaw
- Southern Tasmanian Division of General Practice, University of Tasmania, Hobart 7000, Australia.
| | | | | | | |
Collapse
|
49
|
Turner KS, Shaw KA, Coleman DJ, Misrachi A. Augmentation of influenza surveillance with rapid antigen detection at the point-of-care: results of a pilot study in Tasmania, 2004. Commun Dis Intell Q Rep 2006; 30:201-4. [PMID: 16841501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Tasmania contributes very few laboratory confirmed cases to Australia's national influenza surveillance statistics. In 2004, a study was conducted to pilot test sentinel syndromic surveillance for influenza-like illness supplemented by point-of-care testing using the Binax Now Flu A Test Kit and by viral culture, to assess the feasibility and acceptability of this method of surveillance. Overall, the goal of such a system would be to increase laboratory surveillance activity within Tasmania and increase the number of specimens sent for viral culture. Five sites participated in the study, including three public hospital emergency departments and two general practices. Despite being conducted during a period of low influenza activity, the pilot study demonstrated that augmentation of syndromic surveillance with point-of-care testing is both feasible and acceptable but is best conducted in the general practice setting.
Collapse
Affiliation(s)
- Kate S Turner
- Communicable Diseases Surveillance, Department of Health and Human Services, Hobart, Tasmania.
| | | | | | | |
Collapse
|
50
|
Shaw KA, McGregor AR, Taylor RE, Williamson J, Misrachi A, Coleman DJ, Andrewartha L. Meningococcal vaccine failure in conjunction with an unusual meningococcal cluster in southern Tasmania. Commun Dis Intell Q Rep 2005; 29:160-4. [PMID: 16119764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The following is a report of an unusual family cluster of group C invasive meningococcal disease in Tasmania. This unusual case cluster raises several important issues of public health significance regarding vaccine failure and nucleic acid amplification testing use in the setting of invasive meningococcal disease.
Collapse
Affiliation(s)
- Kelly A Shaw
- Public Health Registrar, Department of Health and Human Services, Hobart, Tasmania.
| | | | | | | | | | | | | |
Collapse
|