Autistic Adult Services Availability, Preferences, and User Experiences: Results From the Autism Spectrum Disorder in the European Union Survey

There is very little knowledge regarding autistic adult services, practices, and delivery. The study objective was to improve understanding of current services and practices for autistic adults and opportunities for improvement as part of the Autism Spectrum Disorder in the European Union (ASDEU) project. Separate survey versions were created for autistic adults, carers of autistic adults, and professionals in adult services. 2,009 persons responded to the survey and 1,085 (54%) of them completed at least one of the services sections: 469 autistic adults (65% female; 55% <35 years old), 441 carers of autistic adults (27% female; 6% <35 years old), 175 professionals in adult services (76% female; 67% in non-medical services). Top choices by autistic adults, carers or professionals for services best suiting their current needs were: residential services: "help in own home" (adults, carers of high independent adults, professionals), "fulltime residential facility" (carers of low independent adults); employment services: "job mentors" (adults, carers of high independent adults, professionals), "Sheltered employment" (carers of low independent adults); education services: "support in regular education setting" (all groups); financial services: financial support in lieu of employment ("Supplementary income for persons unable to have full employment" for adults, "full pension" for carers of low independent adults) or to supplement employment earnings for carers of high independent adults and professionals; social services: "behavior training" (adults) and "life skills training" (carers and professionals). Waiting times for specific services were generally < 1 month or 1-3 months, except for residential services which could be up to 6 months; most professionals were uninformed of waiting times (>50% responded "don't know"). Five of seven residential services features recommended for autistic adults were experienced by <50% of adults. The knowledge of good local services models that work well for autistic adults was generally low across all services areas. The variation in services experiences and perceptions reported by autistic adults, carers, or professionals underscore the need to query all groups for a complete picture of community services availability and needs. The results showed areas for potential improvement in autistic adult services delivery in the EU to achieve recommended standards.

Autistic Adult Health and Professional Perceptions of It: Evidence From the ASDEU Project

The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults-especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups, <20% of responders knew an organization or clinician which has developed a way to monitor health, and prevent poor health, that works well for adults on the autism spectrum. The results point to means for better management of co-occurring conditions associated with autism in adulthood in order to reduce hospital admissions and potential areas of improvement in health and social services for autistic adults. Specifically, efforts should be focused on (1) professionals' education on risks for co-occurring conditions in autistic adults; (2) promoting preventive health behaviors; (3) making services user-friendly for autistic adults and their families; and (4) encouraging knowledge of good local services.

Intervention Services for Autistic Adults: An ASDEU Study of Autistic Adults, Carers, and Professionals' Experiences

The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated local services’ use experiences of autistic adults, carers and professionals with interventions for autistic adults. The majority of the 697 participants experienced recommended considerations prior to deciding on intervention and during the intervention plan and implementation. Psychosocial interventions were the most commonly experienced interventions, while pharmacological interventions NOT recommended for core autistic symptoms were reported by fairly large proportions of participants. Family interventions were experienced slightly more commonly by carers than adults or professionals. Less than the 26% of autistic adult responders who had experienced challenging behaviors reported receiving an intervention to change them. These results provide insights for improving gaps in service provision of interventions among autistic adults.

Real-World Experiences in Autistic Adult Diagnostic Services and Post-diagnostic Support and Alignment with Services Guidelines: Results from the ASDEU Study

Research providing an evidence-base for autistic adult services is sparse. The Autism Spectrum Disorders in the European Union (ASDEU) network implemented an on-line survey to determine gaps in autistic adult diagnostic evaluation and post-diagnostic support services. More than 55% in all groups experienced most of the recommended features for diagnostic evaluation for autistic adults. In contrast, < 2% of adults or carers, and < 21% of professionals experienced each of the recommended features for post-diagnostic support. In contrast to 61% of professionals, only about 30% of autistic adults and carers had knowledge of good local services models for autism diagnosis in adulthood. There are major differences between good practice guidelines for diagnostic and post-diagnostic care for autistic adults, and what is actually experienced by services users and professionals.

Diffusion capacity of the lung in young and old endurance athletes

Lung diffusion capacity (D LCO) declines with age. A significant proportion of older endurance athletes develop exercise-induced hypoxemia (SaO2<95%). We hypothesised that master endurance athletes have a lower D LCO than age-matched non-athletes. We recruited 33 control (16 young; 17 old) and 29 male endurance athletes (13 young; 16 old) during the World Masters Athletics Indoor Championships, 2012 (Jyväskylä, Finland). To measure D LCO the participant exhaled to residual volume and then quickly inhaled to ≥ 90% total lung capacity from a gas source with 0.3% carbon monoxide. The D LCO and transfer coefficient (K CO) were corrected for the actual haemoglobin concentration. Spirometric function was similar in athletes and age-matched controls. D LCO and K CO were 33% and 25% lower in old and young controls, respectively (P<0.001). Although predicted D LCO and K CO were 11%-points higher in athletes than age-matched controls (P<0.001), they were 23% and 16% lower in old athletes than young controls, respectively (P<0.001). D LCO did not correlate with age-graded performance or weekly training hours. The better lung diffusion capacity in male endurance athletes than age-matched controls might be an adaptation to training, self-selection and/or attrition bias. However, the diffusion capacity of the older athlete is lower than that of the young non-athlete.

Organ doses and effective doses in pediatric radiography: patient-dose survey in Finland

BACKGROUND

Use of the effective dose in diagnostic radiology permits the radiation exposure of diverse diagnostic procedures to be quantified. Fundamental knowledge of patient doses enhances the implementation of the "as low as reasonably achievable" (ALARA) principle.

PURPOSE

To provide comparative information on pediatric examination protocols and patient doses in skull, sinus, chest, abdominal, and pelvic radiography examinations.

MATERIAL AND METHODS

24 Finnish hospitals were asked to register pediatric examination data, including patient information and examination parameters and specifications. The total number of examinations in the study was 1916 (1426 chest, 228 sinus, 96 abdominal, 94 skull, and 72 pelvic examinations). Entrance surface dose (ESD) and dose-area products (DAP) were calculated retrospectively or DAP meters were used. Organ doses and effective doses were determined using a Monte Carlo program (PCXMC).

RESULTS

There was considerable variation in examination protocols between different hospitals, indicating large variations in patient doses. Mean effective doses of different age groups ranged from 5 microSv to 14 microSv in skull and sinus examinations, from 25 microSv to 483 microSv in abdominal examinations, and from 6 microSv to 48 microSv in chest examinations.

CONCLUSION

In chest and sinus examinations, the amount of data was extensive, allowing national pediatric diagnostic reference levels to be defined. Parameter selection in pediatric examination protocols should be harmonized in order to reduce patient doses and improve optimization.

De novo seropositive rheumatoid arthritis during immunosuppressive treatment after kidney transplantation

We detected de novo seropositive erosive rheumatoid arthritis (RA) in a patient seven years after successful cadaveric kidney transplantation (RTx). RA developed in spite of treatment with cyclosporine A (CyA), methylprednisolon (MP) and azathioprine (Aza), compounds often also used for treatment of active RA. Renal failure was due to diabetes mellitus (DM) nephropathy. Besides a slight increase in C-reactive protein (CRP) concentration two years after RTx, the clinical symptoms of RA were observed seven years after RTx. RA was confirmed by X-ray examination, isotopic skeletal scan and positive serum RA factor. After switching Aza to methotrexate (Mtx) treatment, his symptoms disappeared and CRP concentration returned to normal. Our patient had HLA DRB1 *0101, *0401 alleles and DQB1 *0501, *0302 alleles which have strong genetic association with both DM and RA. To our best knowledge, this is the first case in which de novo seropositive erosive RA developed while on treatment with triple immunosuppression after RTx. The immunosuppressive treatment probably masked the inflammation and symptoms of RA.

Correlation of patient and staff doses in interventional cardiology

The purpose of this study was to measure staff radiation doses in representative institutions of five European countries performing coronary angiographies (CA) and percutaneous transluminal coronary angioplasties (PTCA), as well as to investigate any correlation with patient doses. Patient doses were recorded in terms of dose-area product (DAP). Staff doses were measured by thermoluminescence dosemeters placed on the operator's left shoulder and left foot. Radiation protection measures were also recorded. Third quartile shoulder and foot doses were 90 and 66 microSv in CA, and 157 and 173 microSv in PTCA, respectively. Shoulder dose was poorly correlated with DAP in CA (R2 = 0.29) and only moderately correlated in PTCA (R2 = 0.69). DAP and foot dose correlation was poor both in CA (R2 = 0.16) and in PTCA (R2 = 0.02). Protective measures taken by staff varied between countries, which may explain the poor correlation of patient and staff radiation doses.

Albumin clearance from human skeletal muscle during prolonged steady-state running

This study was designed to find out if the lymph flow, indicated as albumin clearance, from active skeletal muscle is maintained constant during a prolonged steady-state exercise. 99mTc-labelled albumin was injected bilaterally into the vastus lateralis muscles of eight endurance-trained men. The radioactivity at the injection site was monitored by a gamma-camera before, frequently during, and after a 2 h run at a controlled steady intensity of 69 +/- 4% of the maximal heart rate. The fractional clearance rate of albumin was calculated for each monitoring interval, and was expressed as percentage clearance per minute (% min(-1)). During the first 15 min of exercise the clearance rate was five times higher than at rest before the exercise (0.29 +/- 0.12 vs. 0.06 +/- 0.05% min(-1), P = 0.001). During the next 25 min of running the clearance rate fell to 0.19 +/- 0.08% min(-1) (P = 0.02), from which level it was further attenuated, being 0.12 +/- 0.04% min(-1) at the end of the exercise. After the exercise the clearance rate fell rapidly to the level of 0.04 +/- 0.03% min(-1). The results showed that the albumin clearance from working muscles is not constant during steady-state exercise, suggesting that lymph flow from exercising skeletal muscle may not be constant despite lymphatic pumping being assumed to be unchanged during the course of exercise (i.e. constant exercise intensity and running speed).

Lymph flow dynamics in exercising human skeletal muscle as detected by scintography

1. The effects of dynamic and isometric muscle contractions on the lymph flow dynamics in human skeletal muscle were studied with a scintographic method. 2. Radioactively labelled human serum albumin (99mTc-HSA) was injected bilaterally into the vastus lateralis muscles of eight men (n = 16), four of whom had had an endurance training background. The subjects performed 100 submaximal contractions in 10 min as (i) dynamic knee extensions (CONS), (ii) isometric contractions with the knees at full extension (IMExt), or (iii) isometric contractions with knees fixed at 90 deg angle flexion (IMFlex). The exercises were separated by 65 min periods in supine rest. The level of radioactivity at the injection site was monitored by a gamma-camera, and the clearance rate of radioactivity (CR) was calculated as the fractional decrease during the periods of interest (CR unit = % min-1). 3. The clearance rate was low during the rest periods (0.04 +/- 0.05% min-1), though higher in the trained than in the sedentary subjects (0.06 +/- 0.05 vs. 0.03 +/- 0.03% min-1; P = 0.008). Exercise increased the clearance rate three- to sixfold, to 0.16 +/- 0.16% min-1 during CONS, 0.20 +/- 0.15% min-1 during IMExt and 0.09 +/- 0.11% min-1 during IMFlex. There were no differences between the subject subgroups. 4. The higher clearance rate during IMExt than during IMFlex (P = 0.02) demonstrates the importance of muscle deformations on lymph propulsion and experimentally confirms the current concepts of lymph formation and propulsion in voluntarily active skeletal muscle. It is suggested that lymph propulsion by working muscle is most efficient when the muscle is able to shorten close to its minimum length.

Effects of granisetron with doxorubicin or epirubicin on ECG intervals

Commercially available serotonin-type 3 (5-HT3) receptor antagonists (ondansetron, granisetron, and tropisetron) have shown no clinically significant adverse effects on the cardiovascular system. In the dose-ranging evaluation of dolasetron, computer-generated ECGs revealed clinically asymptomatic prolongations of ECG intervals. We performed a clinical trial in which the possible changes in ECG intervals following a single 3-mg i.v. injection of granisetron and an injection of either doxorubicin or epirubicin were registered using computerized ECG analysis in cancer patients. A total of 30 patients who were designated to receive 3 mg granisetron i.v. for the prophylaxis of emesis induced by doxorubicin or epirubicin were entered into the study. Computer-generated ECG tracings were obtained before treatment, following the injection of 3mg granisetron, and immediately after doxorubicin or epirubicin injection. The mean PR interval duration increased from 160 to 166 ms after granisetron infusion (P=0.02). Doxorubicin and epirubicin did not potentiate this change. There was no statistically significant change in cardiac rhythm, QRS duration, or QTc intervals. The observed minor changes in the PR time following i.v. injection of granisetron do not seem to be of clinical relevance.

Interference of oral hygiene products with an adhesion-based assay of salivary mutans streptococci

The effect of several oral hygiene products on an adhesion-based assay for salivary mutans streptococci (Dentocult-SM Strip Mutans) was studied in three women. The mutans streptococci levels were recorded for up to 24 h after a 1-min rinse with the product. The chlorhexidine (0.05%) and stanno-amine fluoride solutions (corresponding 0.025% F) interfered selectively with the adhesion-based assay. No such effect was observed for a polyvidoneiodine solution (10 micrograms/ml) or two toothpastes containing either sodium lauryl sulfate or amine fluorides. The results indicate that antimicrobial agents showing retention in the oral cavity may interfere for several hours after their use with adhesion-based assays of salivary mutans streptococci.

The effect of different storage conditions on the chemical stability, laxative effect and acute toxicity of sennoside solutions

This paper investigates the effect of different storage conditions on the chemical stability, laxative effect and acute toxicity of sennoside solutions. The variables in storage conditions were pH, time and temperature (room temperature or 100 degrees). The chemical stability of sennosides in aqueous solutions was found to be pH-dependent, with the best stability at pH 6.5 (t90. = 8.4 months) and the poorest at pH 8.0 (t90. = 2.5 months). Two years of storage at room temperature did not reduce the laxative potency in mice, regardless of the pH. After 4.25 years of storage the potency declined in alkaline solutions only. The degradation products with laxative potencies are chemically unknown. The acute toxicity of sennoside solutions increased with time during storage, the acid solution being more toxic than either the neutral or alkaline ones.

Laxative potency and acute toxicity of some anthraquinone derivatives, senna extracts and fractions of senna extracts

This paper investigates the laxative effect and acute toxicity of certain fractions of senna extracts in mice. The same tests were also carried out with several pure anthraquinone derivatives common in senna pods. The results show that the laxative and toxic components of senna pods and senna extracts can be separated. The most potent laxative components, sennosides A + B and Fraction V (relative potencies 1 and 0.9 respectively), have the lowest toxicity (relative intravenous toxicities 1 and less than 1). Fractions with very low laxative activity (rhein-8-glucoside and Fraction IV, relative potencies 0.56 and 0.05) have the highest acute toxicity (relative toxicities 10 and 32 respectively).