Experiences before and after nasogastric and gastrostomy tube insertion with emphasis on mealtimes: a case study of an adolescent with cerebral palsy

Purpose: Adolescents with cerebral palsy may need a feeding tube due to feeding challenges, since nutritional intake and mealtimes may be negatively affected. The purpose of the study was to describe and better understand how one adolescent with cerebral palsy and her parents experienced mealtimes before and after a nasogastric and gastrostomy tube insertion and how the use of these feeding tubes was experienced in daily life. Methods: Individual interviews were performed with one adolescent and each of her parents. In total, six interviews were conducted on two separate occasions. The qualitative approach known as Interpretive Description was used during the analysis. Results: Four thematic patterns were identified within the data: (i) struggling with nutritional intake, (ii) the paradox of using an aid, (iii) being different, and (iv) challenges of public mealtimes. Conclusions: The results showed that four themes influenced daily mealtimes in adolescents with cerebral palsy and a gastrostomy tube. Nutritional intake and mealtimes may be difficult, which is why using a gastrostomy tube can be a relief. However, the gastrostomy tube can also pose a challenge and a paradox. Time of change and acceptance seems necessary in order to meet these challenges

Boys with Asperger Syndrome grown up. A longitudinal follow-up study of 100 cases more than 5 years after original diagnosis

Introduction and aims: In 1981, the diagnostic label of Asperger Syndrome (AS), was coined after the Austrian paediatrician Hans Asperger, by the English psychiatrist Lorna Wing, who reintroduced his 1944 work about “die autistischen Psychopathen im Kindesalter”, so as to have a concept for relatively high functioning individuals with problems in the “autism spectrum”. Little is known about the risk factors and outcome of AS and whether or not they are different from those of autism. The present study were to examine (1) a large number of background and associated factors in AS; (2) how aims of the different kinds of background factors influence IQ, neuropsychological skills, and psychomotor development in males with AS; (3) the outcome of AS in males, and compare it to that of a similarly aged group of males with autism; and (4) to what extent males with AS acknowledge problems related to their diagnosis, and agree with their parents on these matters. Subjects and methods: Medical records of 100 clinical cases of males with AS diagnosed at least five years prior to the present study were searched for information concerning background and associated factors. Sub-grouping in accordance with operationalised “pathogenetic” factors was attempted, and the influence of subgroup on psychomotor development, IQ, and degree of autism spectrum problems was investigated. These 100 males (and their parents) were approached for inclusion in a follow-up study. Seventy-six of the families participated in this in-depth study. The individuals with AS were evaluated at neuropsychiatric examinations, neuropsychological testing, and by interview schedules and questionnaires, some of which were used with their parents as well. Those 70 males with AS whose parents/carers had been given the Diagnostic Interview for Social and Communication disorders were compared with 70 males with autism of similar age. Specific outcome criteria were used taking into consideration, employment, education/vocational training, independent living, and peer relations. Results and Discussion: Mean age at original diagnosis was 11.3 years. In 28 cases there was a strong suspicion of autism spectrum problems in close relatives, 12 of whom had been formally diagnosed with autism or AS. Some pre- and perinatal risk factors were much more common than in the general population. No definite clue as to “pathogenesis” could be established in 13%. Intellectual ability was average, and more than half the group had a verbal over performance IQ difference of 15 points or more at original diagnosis, consistent with so called Non-Verbal Learning Disability (NVLD). However, at follow-up fewer than 20% had indications of NVLD. For the AS cases followed up diagnosis and overall IQ were stable over time. However, 12% no longer met criteria for an autism spectrum disorder. Overall outcome was good in 27% of cases, but 26% had a very restricted life, with no occupation/activity and no friends. Outcome in the autism group was significantly worse, possibly due to the much lower IQ in this group. The males with AS had a good understanding of their own problems in some areas, but disagreed with their parents regarding some core AS symptoms. In spite of the much better outcome than in the autism group, prognosis in clinical cases of AS appears to be restricted as compared with individuals at the same IQ-level in the general population. However, given the lack of a general population comparator group, no generalized conclusions can be drawn in this respect

Pre-schoolchildren with autism spectrum disorders are rarely macrocephalic: a population study

Numerous clinical studies over the past decades have concluded that there is an association between autism spectrum disorders (ASD) and large head size. Lately, some studies have reported conflicting results. The present study was conducted with a view to assess the presence of macrocephaly in a community-representative group of pre-school children with ASD. The prevalence of ASD in this general population was 0.8%. Thirty-three children (5 girls, 28 boys) recruited after general population screening for ASD, and diagnosed with ASD (two-thirds not globally delayed) were assessed as regards growth parameters; height, weight, and head circumference (HC), at birth and at comprehensive medical-psychiatric diagnostic examinations at a mean age of 3 years. Macrocephaly in the present study was defined as HC above the 97th percentile, and ≥2 SD above recorded length/height. Only one of the 33 children (3%) had macrocephaly which is similar to the general population prevalence. Another 9% had a big but proportional head. None of the children were microcephalic. In this community-based study we found no evidence to support a strong link between a large head size and ASD. Conclusions must be guarded because of the relatively small number of ASD cases included

Open-Label Trial of Atomoxetine Hydrochloride in Adults With ADHD

Background: While atomoxetine is an established treatment for attention-deficit/hyperactivity disorder in children, few studies have examined its efficacy for adults. Methods: Open-label trial of atomoxetine in 20 individuals with ADHD, aged 19-47 years, for 10 weeks, and a total of one year for responders. Results: Ten patients met primary efficacy criteria at 10 weeks. Only one patient completed the whole study. Six patients discontinued before 10 weeks and thirteen at 10 weeks or later, mainly because of side-effects (aggression, depressed mood, raised liver enzymes, thyroid hormones, diastolic blood pressure), decreasing efficacy or non-compliance. Conclusion: Fifty percent responded to treatment, but only one patient (5%) felt sufficient improvement to continue for one year. Dosage may have been too low, and baseline impairment too high, for atomoxetine to have sufficient effect on ADHD symptoms in our group of adults. The majority had few side-effects, but several terminated treatment because of adverse effects

Aspects of sexuality in adolescents and adults diagnosed with autism spectrum disorders in childhood

The literature concerning sexuality in autism spectrum disorders (ASDs) is limited regarding inappropriate sexual behaviours and paraphilias and its relation to age, verbal ability, symptom severity, intellectual ability, or adaptive functioning. A cohort of 184 adolescents and young adults (ages 15–39 years) with ASD diagnosed in childhood, including both low and high functioning individuals, was examined. The large majority were found to have a sexual interest and showed interest towards the opposite sex. Inappropriate sexual behaviours and paraphilias were reported for about a fourth of the individuals. No relationships were found between inappropriate sexual behaviours and any of the background variables listed above. However, associations were found between paraphilias and ASD symptom severity, intellectual ability, and adaptive functioning

High Exposure to Perfluoroalkyl Substances and Antibody Responses to SARS-CoV-2 mRNA Vaccine-an Observational Study in Adults from Ronneby, Sweden

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are widely used, environmentally ubiquitous, and stable chemicals that have been associated with lower vaccine-induced antibody responses in children; however, data on adults are limited. The drinking water from one of the two waterworks in Ronneby, Sweden, was heavily contaminated for decades with PFAS from firefighting foams, primarily perfluorohexane sulfonic acid and perfluorooctanesulfonic acid (PFOS). Vaccination against SARS-CoV-2 offered a unique opportunity to investigate antibody responses to primary vaccination in adults who had been exposed to PFAS.OBJECTIVES: Our objective was to evaluate associations between PFAS, across a wide range of exposure levels, and antibody responses in adults 5 wk and 6 months after a two-dose vaccination regime against SARS-CoV-2.METHODS: Adults age 20-60 y from Ronneby (n=309, median PFOS serum level 47 ng/mL, fifth to 95th percentile 4-213 ng/mL) and a group with background exposure (n=47, median PFOS serum level 4 ng/mL) received two doses of the Spikevax (Moderna) mRNA vaccine. The levels of seven PFAS were measured in serum before vaccination. Serum immunoglobulin G antibodies against the SARS-CoV-2 spike antigen (S-Abs) were measured before vaccination and at 5 wk (n=350) and 6 months (n=329) after the second vaccine dose. Linear regression analyses were fitted against current, historical, and prenatal exposure to PFAS, adjusting for sex, age, and smoking, excluding individuals with previous SARS-CoV-2-infection.RESULTS: PFAS exposure, regardless of how it was estimated, was not negatively associated with antibody levels 5 wk [current PFOS: -0.5% S-Abs/PFOS interquartile range (IQR); 95% confidence interval (CI): -8, 7] or 6 months (current PFOS: 3% S-Abs/PFOS IQR; 95% CI: -6, 12) after COVID-19 vaccination.DISCUSSION: Following a strict study protocol, rigorous study design, and few dropouts, we found no indication that PFAS exposure negatively affected antibody responses to COVID-19 mRNA vaccination for up to 6 months after vaccination. https://doi.org/10.1289/EHP11847

Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries : A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study

Background: It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. Design: The design of this study was as a cross-sectional analysis from a population-based study cohort. Methods: From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50–64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013–December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. Results: Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score >0 ranged from 40.7–65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50–54 and 60–65 years, respectively. In women, the corresponding difference was from 17.1–38.9% and from 41.0–58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score >0 (odds ratio: 2.18 (95% confidence interval 2.07–2.30)) and to have >1 carotid plaques (1.67 (1.61–1.74)). Conclusion: Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis