Examining the clinical utility of the modified Alarm Distress Baby Scale (m-ADBB) for the detection of early signs of Autism Spectrum Disorder

Background / Aim Signs of Autism Spectrum Disorder (ASD) can be observed in the first two years of life. However early detection of ASD remains challenging, partly because no reliable and easy to use routine screening instrument for infants and toddlers is currently available to clinicians. Some early ASD related deficits in social communication and interaction are also typical of sustained social withdrawal in infants and toddlers. The current study aims to test whether a brief observational screening instrument for social withdrawal in infants, the modified Alarm Distress Baby Scale (m-ADBB), may be clinically useful for detection of ASD in the first two years of life. It is hypothesised, that children with ASD will score higher on the m-ADBB than typically developing (TD) children, indicating more symptoms of social withdrawal. Method Home-video recordings of children with ASD and of TD children from approximately age 12 month and 24 month were analysed using the m-ADBB. Results Home-videos of 10 children with ASD and 10 TD children were available at each age. Children with a diagnosis of ASD scored statistically significantly higher on the m-ADBB than TD children at 12 month (Z=-2.54; p=0.023; r=-0.57) and at 24 month (Z=-2.40; p=0.023; r=-0.54). Five of ten children with ASD met the m-ADBB criterion for social withdrawal in their 12 month videos, and four out of ten in their 24 month videos. Using a lower cut-off score increased detection rates (7 at 12 month; 8 at 24 month). False positive rates were low at both ages and for both cut-off scores (range 1 to 3 out of 10). Conclusion Observing only five social withdrawal behaviours as operationalized by the m-ADBB appears to be useful in flagging possible presence of ASD during the first two years of life. The scale’s sensitivity and specificity for ASD detection needs to be established in a larger sample

Optimising access to best practice primary health care: a systematic review

Ensuring that Australians have access to health care is an integral component of Australian health care policy. Growing awareness of the importance of primary health care (PHC) in delivering equitable and cost-effective care is creating interest in better understanding and addressing access to best practice PHC. This review examines evidence from the published literature on potential interventions to enhance access to ‘best practice’.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Optimizing access to best practice primary health care: a systematic review

The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Engaging participants in a complex intervention trial in Australian General Practice

© 2008 Perkins et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

The impact of a team-based intervention on the lifestyle risk factor management practices of community nurses: outcomes of the community nursing SNAP trial

BackgroundLifestyle risk factors like smoking, nutrition, alcohol consumption, and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care is an appropriate setting to address these risk factors in individuals. Generalist community health nurses (GCHNs) are uniquely placed to provide lifestyle interventions as they see clients in their homes over a period of time. The aim of the paper is to examine the impact of a service-level intervention on the risk factor management practices of GCHNs.MethodsThe trial used a quasi-experimental design involving four generalist community nursing services in NSW, Australia. The services were randomly allocated to either an intervention group or control group. Nurses in the intervention group were provided with training and support in the provision of brief lifestyle assessments and interventions. The control group provided usual care. A sample of 129 GCHNs completed surveys at baseline, 6 and 12 months to examine changes in their practices and levels of confidence related to the management of SNAP risk factors. Six semi-structured interviews and four focus groups were conducted among the intervention group to explore the feasibility of incorporating the intervention into everyday practice.ResultsNurses in the intervention group became more confident in assessment and intervention over the three time points compared to their control group peers. Nurses in the intervention group reported assessing physical activity, weight and nutrition more frequently, as well as providing more brief interventions for physical activity, weight management and smoking cessation. There was little change in referral rates except for an improvement in weight management related referrals. Nurses’ perception of the importance of ‘client and system-related’ barriers to risk factor management diminished over time.ConclusionsThis study shows that the intervention was associated with positive changes in self-reported lifestyle risk factor management practices of GCHNs. Barriers to referral remained. The service model needs to be adapted to sustain these changes and enhance referral

Displaced Amacrine Cells Disappear from the Ganglion Cell Layer in the Central Retina of Adult Fish during Growth

FRAGESTELLUNG. Fische wachsen ihr Leben lang; auch Auge und Netzhaut nehmen stetig an Größe zu. Dem Wachstum der Netzhaut liegen Anpassungsmechanismen wie Zellproliferation und dendritisches Wachstum zugrunde. Um weitere Mechanismen zu entdecken, mit welchen bei Fischen die Anpassung an die zunehmende Augengröße erfolgt, wurde die Verteilung von displatzierten Amakrinzellen (DACs) und Ganglienzellen (GCs) in der Retina unterschiedlich großer Tiere des südamerikanischen Cichliden, Aequidens pulcher, untersucht. METHODEN. DACs wurden mit Hilfe von Antikörpern gegen das Calcium bindende Protein Parvalbumin angefärbt. Diese zeigten außerdem eine schwach positive Reaktion auf die Färbung mit Antikörpern gegen Cholineacetyl Transferase (ChaT). GCs wurden retrograd mit Rhodamin Dextran markiert. Die Dichte von DACs und GCs fiel in den Netzhäuten großer Fische geringer aus. Um größenabhängige Veränderungen von spezifischen Anpassungsvorgängen unterscheiden zu können, wurde das Verhältnis von DACs zu GCs sowie die absolute Zelldichte in verschiedenen Regionen der Netzhaut an Schnitten und Netzhautpräparationen von Fischen unterschiedlicher Größe untersucht. ERGEBNISSE. Die vergleichende Untersuchung kleiner und großer Fische zeigt, dass in der Peripherie der Netzhaut, wo im Bereich der Wachstumszone neues retinales Gewebe entsteht, DACs und GCs jeweils zu ähnlichen Anteilen (Verhältnis von DACs zu GCs, 0.62) gebildet werden. In der zentralen Netzhaut großer Fische ändert sich jedoch dieses Verhältnis zu Gunsten der GCs (Verhältnis von DACs zu GCs nur 0,25). SCHLUSSFOLGERUNG. Während des Wachstums des Auges nimmt der Anteil der DACs in der Ganglienzellschicht ab, was darauf hinweist, dass diese Zellen durch einen bislang unbekannten Mechanismus aus der Ganglienzellschicht eliminiert werden.PURPOSE. Fish grow throughout life, including enlargement of eye and retina. Retinal growth involves several mechanisms of adjustment, such as cell addition and dendritic growth. To discover possible other means with which the animals adjust to changing eye size, the distribution of displaced amacrine cells (DACs) and ganglion cells (GCs) was analyzed in the retina of three sizes of a South American cichlid, the blue arcara Aequidens pulcher. METHODS. DACs were identified by staining with antibodies specific for the calcium-binding protein parvalbumin. They were also weakly positive for staining against choline acetyl transferase (ChaT). GCs were labeled retrogradely with rhodamine dextran. Densities for both DACs and GCs were lower in the retinas of large fish. To distinguish changes due to eye size from specific adjustments, the proportions of DACs to GCs were examined, rather than the absolute cell densities, in various retinal regions in cryostat sections and wholemount preparations from fish of the three sizes. RESULTS. The analyses suggest that, in small and large fish, DACs and GCs were produced in similar proportions (ratio of DACs to GCs, 0.62) in the retinal periphery where new retinal tissue was added by the germinal zone. However, in the central retina of large fish, this proportion was shifted toward GCs (DAC-GC ratio as low as 0.25). CONCLUSIONS. During growth of the eye, the proportion of DACs in the ganglion cell layer decreases, indicating that these cells are eliminated from the ganglion cell layer by some unknown mechanism

Die Versorgungspraxis der Substitutionstherapie Opiatabhängiger (COBRA)

Hintergrund: Die Datenlage zur Substitutionstherapie Opiatabhängiger ist defizitär. Vor diesem markant defizitären Erkenntnishintergrund erscheint es sinnvoll und notwendig, eine versorgungsepidemiologische Studie zur aktuellen Versorgungslage opiatabhängiger Substitutionspatienten durchzuführen, um offene Fragen zu klären. Hierfür haben wir ein mehrstufiges Forschungsprojekt unter dem Akronym COBRA initiiert. COBRA steht für "Cost-Benefit and Risk Appraisal of Substitution Treatments" und signalisiert, dass wir uns in umfassender Weise um eine Evaluation der Risiken, Vor- und Nachteile verschiedener Interventionsstrategien und Modalitäten in der Substitutions- und Versorgungspraxis Opiatabhängiger in Deutschland bemühen. Zielsetzungen des COBRA-Projekts sind: • Die Charakterisierung von bestehenden Einrichtungsformen und -modellen; • Die Charakterisierung von: – Merkmalen opiatabhängiger Patienten in diesen Einrichtungen (Schwere, Dauer/ Stadium, Komorbidität, Delinquenz, Desintegration etc.), – der Diagnostik sowie den Indikations- und Allokationsentscheidungen in der Versorgungsrealität sowie – den eingesetzten Interventionsmethoden (Substitutionsmittel, Therapie komorbider Störungen, psychotherapeutische und soziale Interventionen) • Die Ermittlung von Problemen der Substitutionstherapie bei verschiedenen Risikogruppen (z.B. Hepatitis-C- und HIVPatienten) • Die Beschreibung des Kurzzeitverlaufs und Outcomes hinsichtlich verschiedener klinischer und sozialer Kriterien Methodik: Die Studie teilt sich in einen deskriptiv-klinisch-epidemiologischen und einen analytisch-evaluativen Teil. Der deskriptive Teil soll zunächst darüber Auskunft geben, wie viele und welche Arten von Substitutionseinrichtungen in Deutschland wie viele Opiatabhängige erreichen und behandeln. Auf dieser Grundlage soll dann im evaluativen Teil an möglichst repräsentativen Einrichtungen und Patienten beurteilt werden, wie und mit welchen Methoden welche Arten von Patienten und Problemlagen versorgt werden. Durch Abgleich mit den wissenschaftlichen Bewertungsmaßstäben können daraus Defizite, Probleme und mögliche verbesserte Allokationsstrategien abgeleitet werden. Ergebnisse: Es werden erste Vorstudienbefunde und Ihre Design- Konsequenzen vorgestellt und diskutiert.In the present paper, we will describe aims, methods, and design along with selected pre-study findings of an epidemiological study in a nationally representative sample of substitution doctors (N = 381) and their patients (n = 2500) in Germany. The project has three major components: (a) Pre-study: We sent mailed questionnaires to a sample of over 1000 substitution doctors to describe qualification and setting characteristics, treatment profiles and attitudes of substitution doctors in Germany. (b) Cross-sectional study: With a two-step epidemiological design (target day assessment of the patients, clinical appraisals by the doctors), our main aims were (1) to determine the number of opiate addicts treated by methadone or buprenorphine or other substitution drugs; (2) to find predictors and correlates for treatment, taking into account doctors, patients, and system variables; and (3) to evaluate cross-sectional differences between groups with regard to clinical presentation (comorbidity), clinical course, acceptance/compliance, critical incidences, and social integration. (c) Furthermore, the study includes a prospective-longitudinal cohort study of a total of 1000 patients sampled from this data base. The cohort will be followed-up over a period of three months to investigate whether buprenorphine patients have a more favorable course and outcome in terms of clinical, psychosocial, pharmaco-economic, and related measures. Selected pre-study findings are summarized, highlightening that current registers include a considerable proportion of doctors and a considerable heterogeneity of setting characteristics in terms of the number of patients, choice of substitution drugs and involvement in hepatitis- C treatment

Die Versorgungspraxis der Substitutionstherapie Opiatabhängiger (COBRA)

Hintergrund: Die Datenlage zur Substitutionstherapie Opiatabhängiger ist defizitär. Vor diesem markant defizitären Erkenntnishintergrund erscheint es sinnvoll und notwendig, eine versorgungsepidemiologische Studie zur aktuellen Versorgungslage opiatabhängiger Substitutionspatienten durchzuführen, um offene Fragen zu klären. Hierfür haben wir ein mehrstufiges Forschungsprojekt unter dem Akronym COBRA initiiert. COBRA steht für "Cost-Benefit and Risk Appraisal of Substitution Treatments" und signalisiert, dass wir uns in umfassender Weise um eine Evaluation der Risiken, Vor- und Nachteile verschiedener Interventionsstrategien und Modalitäten in der Substitutions- und Versorgungspraxis Opiatabhängiger in Deutschland bemühen. Zielsetzungen des COBRA-Projekts sind: • Die Charakterisierung von bestehenden Einrichtungsformen und -modellen; • Die Charakterisierung von: – Merkmalen opiatabhängiger Patienten in diesen Einrichtungen (Schwere, Dauer/ Stadium, Komorbidität, Delinquenz, Desintegration etc.), – der Diagnostik sowie den Indikations- und Allokationsentscheidungen in der Versorgungsrealität sowie – den eingesetzten Interventionsmethoden (Substitutionsmittel, Therapie komorbider Störungen, psychotherapeutische und soziale Interventionen) • Die Ermittlung von Problemen der Substitutionstherapie bei verschiedenen Risikogruppen (z.B. Hepatitis-C- und HIVPatienten) • Die Beschreibung des Kurzzeitverlaufs und Outcomes hinsichtlich verschiedener klinischer und sozialer Kriterien Methodik: Die Studie teilt sich in einen deskriptiv-klinisch-epidemiologischen und einen analytisch-evaluativen Teil. Der deskriptive Teil soll zunächst darüber Auskunft geben, wie viele und welche Arten von Substitutionseinrichtungen in Deutschland wie viele Opiatabhängige erreichen und behandeln. Auf dieser Grundlage soll dann im evaluativen Teil an möglichst repräsentativen Einrichtungen und Patienten beurteilt werden, wie und mit welchen Methoden welche Arten von Patienten und Problemlagen versorgt werden. Durch Abgleich mit den wissenschaftlichen Bewertungsmaßstäben können daraus Defizite, Probleme und mögliche verbesserte Allokationsstrategien abgeleitet werden. Ergebnisse: Es werden erste Vorstudienbefunde und Ihre Design- Konsequenzen vorgestellt und diskutiert.In the present paper, we will describe aims, methods, and design along with selected pre-study findings of an epidemiological study in a nationally representative sample of substitution doctors (N = 381) and their patients (n = 2500) in Germany. The project has three major components: (a) Pre-study: We sent mailed questionnaires to a sample of over 1000 substitution doctors to describe qualification and setting characteristics, treatment profiles and attitudes of substitution doctors in Germany. (b) Cross-sectional study: With a two-step epidemiological design (target day assessment of the patients, clinical appraisals by the doctors), our main aims were (1) to determine the number of opiate addicts treated by methadone or buprenorphine or other substitution drugs; (2) to find predictors and correlates for treatment, taking into account doctors, patients, and system variables; and (3) to evaluate cross-sectional differences between groups with regard to clinical presentation (comorbidity), clinical course, acceptance/compliance, critical incidences, and social integration. (c) Furthermore, the study includes a prospective-longitudinal cohort study of a total of 1000 patients sampled from this data base. The cohort will be followed-up over a period of three months to investigate whether buprenorphine patients have a more favorable course and outcome in terms of clinical, psychosocial, pharmaco-economic, and related measures. Selected pre-study findings are summarized, highlightening that current registers include a considerable proportion of doctors and a considerable heterogeneity of setting characteristics in terms of the number of patients, choice of substitution drugs and involvement in hepatitis- C treatment

Moderating effects of maternal emotional availability on language and cognitive development in toddlers of mothers exposed to a natural disaster in pregnancy: The QF2011 Queensland Flood Study

Background Prenatal maternal stress exposure has been linked to sub-optimal developmental outcomes in toddlers, while maternal emotional availability is associated with better cognitive and language abilities. It is less clear whether early care-giving relationships can moderate the impact of prenatal stress on child development. The current study investigates the impact of stress during pregnancy resulting from the Queensland Floods in 2011 on toddlers’ cognitive and language development, and examines how maternal emotional availability is associated with these outcomes. Methods Data were available from 131 families. Measures of prenatal stress (objective hardship, cognitive appraisal, and three measures of maternal subjective stress) were collected within one year of the 2011 Queensland floods. Maternal emotional availability was rated from video-taped mother-child play sessions at 16 months: sensitivity (e.g., affective connection, responsiveness to signals) and structuring (e.g., scaffolding, guidance, limit-setting). The toddlers’ cognitive and language development was assessed at 30 months. Interactions were tested to determine whether maternal emotional availability moderated the relationship between prenatal maternal stress and toddler cognitive and language functioning. Results Prenatal stress was not correlated with toddlers’ cognitive and language development at 30 months. Overall, the higher the maternal structuring and sensitivity, the better the toddlers’ cognitive outcomes. However, significant interactions showed that the effects of maternal structuring on toddler language abilities depended on the degree of prenatal maternal subjective stress: when maternal subjective stress was above fairly low levels, the greater the maternal structuring, the higher the child vocabulary level. Conclusion The current study highlights the importance of maternal emotional availability, especially structuring, for cognitive and language development in young children. Findings suggest that toddlers exposed to higher levels of prenatal maternal stress in utero may benefit from high maternal structuring for their language development