scholarly journals Behavioural and Physiological Response to Frustration in Autistic Youth: Associations with Irritability

2020 ◽  
Author(s):  
Virginia Carter Leno ◽  
Georgia Forth ◽  
Susie Chandler ◽  
Philippa White ◽  
Isabel Yorke ◽  
...  
Keyword(s):  
Physiological Response ◽  
Rate Ratio ◽  
Objective Measure ◽  
Parent Report ◽  
Behavioural Response ◽  
Reactivity Index ◽  
Physiological Data ◽  
Experimental Task ◽  
Incident Rate Ratio ◽  
Incident Rate

Abstract Background: Irritability is a common and impairing occurrence in autistic youth, yet the underlying mechanisms are not well known. In typically developing populations, differences in frustration response have been suggested as important driver of the behavioural symptoms of irritability. Research exploring the role of frustration response as a risk factor for irritability in autistic populations is limited and often uses on parent report or observer ratings; objective measures of frustration response appropriate for use in autistic populations are required to advance the field. Methods: In the current study, fifty-two autistic adolescents aged 13-17 years from a population-based longitudinal study completed an experimental task designed to induce frustration through exposure to periods of unexpected delay. Behavioural (number of button presses) and physiological (heart rate; HR) metrics were collected during delay periods. Irritability was measured using the parent-rated Affective Reactivity Index (ARI). Analyses used mixed-level models to test whether irritability was associated with different slopes of behavioural and physiological response in response to experimentally induced frustration. Age and baseline HR (for the physiological data only) were included as covariates. Results: Analyses showed a marginal association between irritability and the slope of behavioural response (incident rate ratio=.98, p=.06), and a significant association with the slope of physiological response (b=-.10, p=.04); higher levels of irritability were associated with a dampened behavioural and physiological response, as indicated by flatter slopes of change over the course of the task. This pattern of results remained when adjusting for IQ, autism symptom severity and medication use (association between irritability and slope of behavioural response: incident rate ratio=.98, p=.02; slope of HR response; b=-.10, p=.04). Conclusions: Results suggest that the current experimental task may be a useful objective measure of frustration response for use with autistic populations, and that a non-adaptive response to frustration may be one biological mechanism underpinning irritability in autistic youth. This may represent an important target for future intervention studies.

scholarly journals Behavioural and physiological response to frustration in autistic youth: associations with irritability

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Virginia Carter Leno ◽  
Georgia Forth ◽  
Susie Chandler ◽  
Philippa White ◽  
Isabel Yorke ◽  
...  
Keyword(s):  
Physiological Response ◽  
Objective Measure ◽  
Parent Report ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Reactivity Index ◽  
Physiological Data ◽  
Experimental Task ◽  
Incident Rate ◽  
Underlying Mechanisms

Abstract Background Irritability is a common and impairing occurrence in autistic youth, yet the underlying mechanisms are not well-known. In typically developing populations, differences in frustration response have been suggested as important driver of the behavioural symptoms of irritability. Research exploring the role of frustration response as a risk factor for irritability in autistic populations is limited and often uses parent report or observer ratings; objective measures of frustration response appropriate for use in autistic populations are required to advance the field. Methods In the current study, fifty-two autistic adolescents aged 13–17 years from a population-based longitudinal study completed an experimental task designed to induce frustration through exposure to periods of unexpected delay. Behavioural (number of button presses) and physiological (heart rate; HR) metrics were collected during delay periods. Irritability was measured using the parent-rated Affective Reactivity Index (ARI). Analyses used mixed-level models to test whether irritability was associated with different slopes of behavioural and physiological response to experimentally induced frustration during the task. Age and baseline HR (for the physiological data only) were included as covariates. Results Analyses showed a marginal association between irritability and the slope of behavioural response (incident rate ratio (IRR) =.98, p=.06), and a significant association with the slope of physiological response (b=−.10, p=.04); higher levels of irritability were associated with a dampened behavioural and physiological response, as indicated by flatter slopes of change over the course of the task. The pattern of results largely remained in sensitivity analyses, although the association with physiological response became non-significant when adjusting for IQ, autism symptom severity, and medication use (b=−.10, p=.10). Conclusions Results suggest that the current experimental task may be a useful objective measure of frustration response for use with autistic populations, and that a non-adaptive response to frustration may be one biological mechanism underpinning irritability in autistic youth. This may represent an important target for future intervention studies.

scholarly journals 1381. Rotavirus Gastroenteritis among older adults: discussion based on a systematic literature review

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S700-S701
Author(s):  
Cristina Carias ◽  
Susanne Hartwig ◽  
M Nabi Kanibir ◽  
Ya-Ting Chen
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Acute Gastroenteritis ◽  
Rate Ratio ◽  
Rotavirus Gastroenteritis ◽  
Incident Rate Ratio ◽  
The Us ◽  
Incident Rate ◽  
The Uk ◽  
Retrospective Database

Abstract Background While the burden of Rotavirus Gastroenteritis (RGE) is well recognized in young children, it is less so in older adults. However, older adults are also at high-risk of Acute Gastroenteritis (AGE) severe outcomes. In this review, we thus aimed to comprehensively assess RGE burden and vaccination impact in older individuals. Methods We performed a systematic literature review with PubMed and Scopus, from 2000 to 2019, using MESH and free-range terms. We included only studies that reported the incidence, and/or RV vaccination impact, in adults aged 60 and above and using regional specific data-sources. Results We analyzed 11 manuscripts for individuals aged 60 and above (Figure 1). Studies spanned Australia, Sweden, Netherlands, Canada (2), Germany (2), UK (2), and the US (2). Yearly inpatient RV incidence varied between 1.6 per 100,000 in Australia for those 65+ (retrospective database analyses, pre-vaccine); and 26 per 100,000 for those 85+ in Canada (modeling estimates for 2006-10, pre-vaccine). The incidence rate ratio for inpatient RGE between the post and pre-vaccine periods for those 65+ was 0.57 [95% CI: 0.10 – 3.15] in Canada, but 2.24 [95%CI: 1.78-2.83] in Australia, which may be due to increased testing for RV in the elderly post-vaccine. Reductions in the post-vaccination burden of RV and AGE among 60+ were reported in the UK (2 studies), and the US (2 studies) via retrospective database analyses In the UK, post-vaccine reductions in AGE health care-utilization were reported in the Emergency Department (21%), and outpatient centers (walk-in centers: 47%; general practice consultations: 36%). Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period. Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period. Conclusion While the burden of RGE mainly falls on young children, it also affects older adults. Retrospective database analyses reveal that, likely due to indirect vaccination benefits, increases in RV vaccination coverage have had an impact on lowering RGE, and AGE cases and healthcare utilization in older adults, a group at high-risk of severe outcomes for AGE. Disclosures Cristina Carias, PhD, Merck (Employee, Shareholder) Susanne Hartwig, n/a, MSD Vaccins (Employee) M.Nabi Kanibir, MD, Merck/MSD (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder)

scholarly journals Hospitalization Rates in Older Adults With Albuminuria: The Cardiovascular Health Study

2020 ◽  
Vol 75 (12) ◽  
pp. 2426-2433 ◽  
Author(s):  
Joshua I Barzilay ◽  
Petra Buzkova ◽  
Michael G Shlipak ◽  
Nisha Bansal ◽  
Pranav Garimella ◽  
...  
Keyword(s):  
Older Adults ◽  
Rate Ratio ◽  
Regression Models ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Hospitalization Rates ◽  
Incident Rate Ratio ◽  
Increased Risk ◽  
Incident Rate

Abstract Background Albuminuria is highly prevalent among older adults, especially those with diabetes. It is associated with several chronic diseases, but its overall impact on the health of older adults, as measured by hospitalization, has not been quantified. Method We followed up 3,110 adults, mean age 78 years, for a median 9.75 years, of whom 654 (21%) had albuminuria (≥30 mg albumin/gram creatinine) at baseline. Poisson regression models, adjusted for cardiovascular, renal, and demographic factors, were used to evaluate the association of albuminuria with all-cause and cause-specific hospitalizations, as defined by ICD, version 9, categories. Results The rates of hospitalization per 100 patient-years were 65.85 for participants with albuminuria and 37.55 for participants without albuminuria. After adjustment for covariates, participants with albuminuria were more likely to be hospitalized for any cause than participants without albuminuria (incident rate ratio, 1.39 [95% confidence intervals, 1.27. 1.53]) and to experience more days in hospital (incident rate ratio 1.56 [1.37, 1.76]). The association of albuminuria with hospitalization was similar among participants with and without diabetes (adjusted incident rate ratio for albuminuria versus no albuminuria: diabetes 1.37 [1.11, 1.70], no diabetes 1.40 [1.26, 1.55]; p interaction nonsignificant). Albuminuria was significantly associated with hospitalization for circulatory, endocrine, genitourinary, respiratory, and injury categories. Conclusions Albuminuria in older adults is associated with an increased risk of hospitalization for a broad range of illnesses. Albuminuria in the presence or absence of diabetes appears to mark a generalized vulnerability to diseases of aging among older adults.

scholarly journals 106 Neighbourhood socioeconomic deprivation and assault injuries in urban youth

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e44-e44
Author(s):  
Tanjot Singh ◽  
Mayesha Khan ◽  
Gavin Tansley ◽  
Herbert Chan ◽  
Jeffrey Brubacher ◽  
...  
Keyword(s):  
Medical Care ◽  
Urban Youth ◽  
Rate Ratio ◽  
Negative Binomial ◽  
Social Deprivation ◽  
Health Concern ◽  
Emergency Medical Care ◽  
Incident Rate Ratio ◽  
Emergency Medical ◽  
Incident Rate

Abstract Introduction/Background Youth violence is a major global public health concern. Assault injuries are a major cause of trauma among youth, yet the causes for and medical consequences of assault victimization in this group remain uncertain. Objectives Using data from the third-largest urban area in Canada, we sought to describe the demographic, temporal and geographic influences on the incidence of youth assault injuries. Design/Methods We performed a population-based cross sectional study of Canadian youth aged 10 to 24 years seeking emergency medical care between April 2012 and March 2018 at any of the 16 hospitals in a major Canadian metropolitan area. Injury characteristics were described using graphical and statistical techniques. Neighbourhood material and social deprivation indices were examined as independent predictors of the population incidence of youth assault injury using negative binomial regression and geospatial methods. Results A total of 2,784 assaulted youth sought emergency medical care during the 6-year study interval, corresponding to an incidence rate of 101 youth assault injuries per 100,000 person-years. Assaulted youth were most commonly males between 20 and 24 years of age. Prior diagnoses of substance use and mental health disorders were common. Examination of temporal variation in the incidence of assault injury revealed a 103-fold difference between the riskiest and safest hours of the week (incident rate ratio, 103). The risk of youth assault injury in the most materially deprived quintile of neighbourhoods was more than four-fold greater than that in the wealthiest quintile (incident rate ratio per quintile increase, 1.42; 95%CI [1.27, 1.59]; p <0.001), and the risk of youth assault injury in the most socially deprived quintile of neighbourhoods was more than twelve-fold greater than that in the least deprived quintile (incident rate ratio per quintile increase, 1.88; 95%CI [1.69, 2.11]; p <0.001). Conclusion Assault injuries among youth vary substantially across time and space. Targeted violence prevention interventions might focus on weekend evenings and on socioeconomically deprived neighbourhoods.

scholarly journals An assessment of the UK inpatient care for heart failure patients with diabetes

2018 ◽  
Vol 17 (8) ◽  
pp. 690-697
Author(s):  
Lihua Wu ◽  
Jackie Cleator ◽  
Mamas Mamas ◽  
Christi Deaton
Keyword(s):  
Heart Failure ◽  
Medical Records ◽  
Inpatient Care ◽  
Rate Ratio ◽  
Care Management ◽  
Hospital Readmissions ◽  
Incident Rate Ratio ◽  
Co Morbidity ◽  
Patients With Heart Failure ◽  
Incident Rate

Background: Diabetes is a common co-morbidity for patients with heart failure. Diabetes as a co-morbidity means that inpatient care should focus on both conditions to maximize the treatment regimen. However, this pressing issue is not widely researched and so it is unclear whether the acute care management needs of these patients are being met. Aims: (1) To assess the differences in the number of hospital readmissions between patients with heart failure and patients with heart failure–diabetes; (2) to assess the use of integrated care approach for patients with heart failure–diabetes during the index heart failure-related admission; (3) to explore patient experiences of admissions. Methods: A mixed methods design was used: we identified heart failure-related admissions between 1 April 2011 and 31 March 2012 in two hospitals, then reviewed medical records and interviewed 14 patients. Results: Over a 12 month period patients with heart failure–diabetes ( n=172) had more heart failure-related Accident and Emergency attendance episodes (incident rate ratio 1.24, p<0.01) and hospital readmissions (incident rate ratio 1.23, p=0.01) than patients with heart failure ( n=370). We reviewed 72 medical records which met inclusion criteria (adults with heart failure–diabetes, ejection fraction <45%): during admission most of them were reviewed by heart failure specialists but less than one-third were reviewed by diabetes specialists. The interview respondents addressed the need for better integration and co-ordination of care. Conclusions: This is one of the first UK studies to assess the integration of inpatient care for those with heart failure and multi-morbidities. The findings suggest that maximal care management during admission should be explored as a way of reducing the frequent readmissions and improving patient outcomes.

scholarly journals Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013–2018

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049811
Author(s):  
Charlie Moss ◽  
Matt Sutton ◽  
Sudeh Cheraghi-Sohi ◽  
Caroline Sanders ◽  
Thomas Allen
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Primary Diagnosis ◽  
Secondary Outcome ◽  
Emergency Admissions ◽  
Incident Rate Ratio ◽  
Chronic Angina ◽  
Access To Primary Care ◽  
Incident Rate ◽  
Preventable Admissions

ObjectivesPeople experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics.DesignRetrospective matched cohort study.SettingHospitals in England.Participants16 161 homeless patients and 74 780 housed patients aged 16–75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis.Primary and secondary outcome measuresAnnual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015–2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients.ResultsMean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina.ConclusionsHomeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.

scholarly journals Increased incidence of adult pneumococcal pneumonia during school holiday periods

2017 ◽  
Vol 3 (1) ◽  
pp. 00100-2016 ◽  
Author(s):  
Priya Daniel ◽  
Chamira Rodrigo ◽  
Thomas Bewick ◽  
Carmen Sheppard ◽  
Sonia Greenwood ◽  
...  
Keyword(s):  
Pneumococcal Disease ◽  
Pneumococcal Pneumonia ◽  
Social Dynamics ◽  
Disease Incidence ◽  
Community Acquired Pneumonia ◽  
Intervention Strategies ◽  
Detection Methods ◽  
Incident Rate Ratio ◽  
Incident Rate ◽  
Adjusted Incidence

Child contact is a recognised risk factor for adult pneumococcal disease. Peaks in invasive pneumococcal disease incidence observed during winter holidays may be related to changes in social dynamics. This analysis was conducted to examine adult pneumococcal community-acquired pneumonia (CAP) incidence during school holiday periods.Between September 2008 and 2013, consecutive adults admitted to hospitals covering the Greater Nottingham area with a diagnosis of CAP were studied. Pneumococcal pneumonia was detected using culture and antigen detection methods.Of 2221 adults studied, 575 (25.9%) were admitted during school holidays and 643 (29.0%) had pneumococcal CAP. CAP of pneumococcal aetiology was significantly more likely in adults admitted during school holidays compared to term time (35.3% versus 26.7%; adjusted OR 1.38, 95% CI 1.11–1.72, p=0.004). Over the 5-year period, the age-adjusted incidence of hospitalised pneumococcal CAP was higher during school holidays compared to term time (incident rate ratio 1.35, 95% CI 1.14–1.60, p<0.001); there was no difference in rates of all-cause CAP or non-pneumococcal CAP. Reported child contact was higher in individuals with pneumococcal CAP admitted during school holidays compared to term time (42.0% versus 33.7%, OR 1.43, 95% CI 1.00–2.03, p=0.046).Further study of transmission dynamics in relation to these findings and to identify appropriate intervention strategies is warranted.

A Multimethod Assessment of Anxiety and Problem Behavior in Children With Autism Spectrum Disorders and Intellectual Disability

2013 ◽  
Vol 118 (6) ◽  
pp. 419-434 ◽  
Author(s):  
Lauren J. Moskowitz ◽  
Emile Mulder ◽  
Caitlin E. Walsh ◽  
Darlene Magito McLaughlin ◽  
Jennifer R. Zarcone ◽  
...  
Keyword(s):  
Autism Spectrum Disorders ◽  
Intellectual Disability ◽  
Problem Behavior ◽  
Children With Autism ◽  
Parent Report ◽  
Autism Spectrum ◽  
Physiological Data ◽  
Sinus Arrhythmia ◽  
Increased Risk ◽  
Spectrum Disorders

Abstract Despite the increased risk for anxiety disorders in children with autism spectrum disorders (ASD), there is a lack of research on the assessment and treatment of anxiety in this population, particularly for those with an intellectual disability (ID). The present study evaluated a multimethod strategy for the assessment of anxiety and problem behavior in three children with ASD and ID. Anxiety was operationally defined using: (1) behavioral data from anxious behaviors, (2) affective/contextual data from parent-report and observer ratings of overall anxiety, and (3) physiological data (heart rate [HR] and respiratory sinus arrhythmia [RSA]). A functional assessment of problem behavior during high- and low-anxiety conditions was conducted. Higher levels of problem behavior and HR and lower RSA were found in the high-anxiety than in the low-anxiety conditions.

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