Child Characteristics and Parent Factors in Children with ASD and/or ADHD: Disruptive Behaviors, Internalizing Symptoms, Parental Distress, and Parenting Practices

The current study examined disruptive behaviors, internalizing symptoms, parental distress, and parenting practices in children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), ASD+ADHD, and typically-developing (TD) children. Specifically, the current study examined how those factors differed according to diagnostic group as well as how child characteristics (i.e., disruptive behaviors and internalizing symptoms) were related to parental factors above and beyond specific symptoms of ASD and ADHD (examined dimensionally). To examine those questions, parents of 14 children with ASD, 16 children with ADHD, 13 children with ASD+ADHD, and 15 TD children participated in the current study (total N = 58). They completed various online measures regarding their child’s diagnostic symptoms and functioning as well as self-report measures assessing their own distress levels and use of various specific parenting practices. Analyses of variance (ANOVAs) and analyses of covariance (ANCOVAs) were conducted to examine group differences, and regression analyses were conducted to examine unique variance in parental factors accounted for by child characteristics. Although many of the hypotheses were not supported, some of the relevant findings of this study include the following: Children with an ADHD diagnosis—with or without comorbid ASD—exhibited higher levels of disruptive behaviors than other children; children with an ADHD diagnosis generally exhibited higher levels of internalizing symptoms than other children; parents of children with dual diagnoses (ASD+ADHD) generally demonstrated the highest levels of parental distress, although not significantly more than parents of children with ADHD (and group effects were nonsignificant when accounting for control variables); and inconsistent discipline was related to ADHD diagnoses and child disruptive behaviors. Limitations of the study and suggestions for further research are discusse

Age and IQ as Potential Moderators in the Relation Among Endopheonotypes and Expressed Behaviors in Children With Autism Spectrum Disorder

The current study examined how certain endophenotypes (i.e., local processing ability, mental flexibility, planning, and disinhibition /inhibition) are related to specific expressed behaviors (i.e., acting out behaviors, social insight deficits, social contact problems, anxious/rigid behaviors, and stereotypical behaviors) that are commonly found in children with ASD. In addition, this study examined whether these associations are modified by age or IQ. Participants consisted of 29 children (ages 7 to 16 years) with ASD and their parents. Parents completed the Children’s Social Behavior Questionnaire (CSBQ) to assess their child’s variety of expressed behaviors. The children were given the Kaufman Brief Intelligence Test—Second Edition to assess IQ, an Embedded Figures Test to assess local processing ability, the Wisconsin Card Sorting Task to assess mental flexibility, the Tower of London task to assess planning ability, and a Go/No Go task to assess disinhibition/inhibition. It was expected that local processing ability would be positively related with social contact problems, social insight problems, anxious/rigid behaviors, and stereotypical behaviors. Mental flexibility was expected to be negatively related with social contact problems, social insight problems, anxious/rigid behaviors, and stereotypical behaviors. Planning abilities were expected to be negatively related with acting out behaviors and social insight problems. Disinhibition was expected to be positively related with acting out behaviors, and inhibition was expected to be positively related with anxious/rigid behaviors. Also, it was expected that age and IQ would moderate the relations between endophenotypes and expressed behaviors such that older age and higher IQ will attenuate the relations. However, these predictions were unsupported, potentially largely due to a small sample size leading to low power. Limitations of the study and suggestions for further research to better understand underlying factors that relate to these expressed behaviors are discussed

‘The core’: the centre as a concept in twentieth-century British planning and architecture. Part one: the emergence of the idea

This is the first of a pair of articles in which we argue that what we term the ‘centre-idea’ was fundamental to British modernist architecture and planning thought from the mid-1940s onwards. We locate this idea’s roots in the pre-1939 British voluntary sector, specifically the activities of the Peckham Experiment and the Pioneer Health Centre which housed it. We evidence its long-term influence on post-1945 architecture and planning in the invitation to the Experiment’s co-creator George Scott Williamson to speak at CIAM’s eighth Congress in 1951. The paper begins with a discussion of the Experiment, an architectural and urban setting which was understood to effect new forms of human relationships and subjectivity suited to a democratic, post-imperial modernity. We then consider other environments to show how this ‘centre-idea’ was widespread in progressive circles by the late 1930s. The paper concludes by discussing the community centre as an emerging building type increasingly supported by the state. This coming together of the British state, modernist architecture and progressive voluntarist thinking by the outbreak of war in 1939, would mean that the ‘centre-idea’ had a significant impact on reconstruction debates and post-war planning; the subject of our forthcoming companion article

Home-based tuberculosis contact investigation in Uganda: a household randomised trial.

IntroductionThe World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries, but most contacts do not complete a full clinical and laboratory evaluation.MethodsWe performed a randomised trial of home-based, SMS-facilitated, household TB contact investigation in Kampala, Uganda. Community health workers (CHWs) visited homes of index patients with pulmonary TB to screen household contacts for TB. Entire households were randomly allocated to clinic (standard-of-care) or home (intervention) evaluation. In the intervention arm, CHWs offered HIV testing to adults; collected sputum from symptomatic contacts and persons living with HIV (PLWHs) if ≥5 years; and transported sputum for microbiologic testing. CHWs referred PLWHs, children <5 years, and anyone unable to complete sputum testing to clinic. Sputum testing results and/or follow-up instructions were returned by automated SMS texts. The primary outcome was completion of a full TB evaluation within 14 days; secondary outcomes were TB and HIV diagnoses and treatments among screened contacts.ResultsThere were 471 contacts of 190 index patients allocated to the intervention and 448 contacts of 182 index patients allocated to the standard-of-care. CHWs identified 190/471 (40%) intervention and 213/448 (48%) standard-of-care contacts requiring TB evaluation. In the intervention arm, CHWs obtained sputum from 35/91 (39%) of sputum-eligible contacts and SMSs were sent to 95/190 (50%). Completion of TB evaluation in the intervention and standard-of-care arms at 14 days (14% versus 15%; difference -1%, 95% CI -9% to 7%, p=0.81) and yields of confirmed TB (1.5% versus 1.1%, p=0.62) and new HIV (2.0% versus 1.8%, p=0.90) diagnoses were similar.ConclusionsHome-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation, likely due to challenges delivering the intervention components

At risk of being risky: The relationship between "brain age" under emotional states and risk preference.

Developmental differences regarding decision making are often reported in the absence of emotional stimuli and without context, failing to explain why some individuals are more likely to have a greater inclination toward risk. The current study (N=212; 10-25y) examined the influence of emotional context on underlying functional brain connectivity over development and its impact on risk preference. Using functional imaging data in a neutral brain-state we first identify the "brain age" of a given individual then validate it with an independent measure of cortical thickness. We then show, on average, that "brain age" across the group during the teen years has the propensity to look younger in emotional contexts. Further, we show this phenotype (i.e. a younger brain age in emotional contexts) relates to a group mean difference in risk perception - a pattern exemplified greatest in young-adults (ages 18-21). The results are suggestive of a specified functional brain phenotype that relates to being at "risk to be risky.

How feasible or useful are timeliness metrics as a tool to optimise One Health outbreak responses?

INTRODUCTION: As timeliness metrics gain traction to assess and optimise outbreak detection and response performance, implementation and scale-up require insight into the perspectives of stakeholders adopting these tools. This study sought to characterise the feasibility and utility of tracking One Health outbreak milestones across relevant human, animal, plant, and environmental sectors to systematically quantify timeliness metrics in Uganda, a country prone to outbreaks of WHO priority diseases. METHODS: A database of outbreak events occurring in Uganda between 2018 and 2022 was compiled. Outbreak reports meeting our inclusion criteria were reviewed to quantify the frequency of milestone reporting. Key informant interviews were conducted with expert stakeholders to explore the feasibility and utility of tracking metrics using a framework analysis. Quantitative and qualitative data were collected and analysed concurrently. RESULTS: Of the 282 public health emergencies occurring between 2018 and 2022, 129 events met our inclusion criteria, and complete data were available for 82 outbreaks. For our qualitative portion, 10 informants were interviewed from 7 institutions, representing the human, animal and environmental sectors. Informants agreed most One Health milestones are feasible to track, which was supported by the frequency of milestone reporting; however, there was a demonstrated need for increased reporting of after-action reviews, as well as outbreak start and end dates. Predictive alerts signalling potential outbreaks and preventive responses to alerts are seen as challenging to routinely capture, reflecting the lack of public health action for these domains. CONCLUSION: Despite consensus among stakeholders that timeliness metrics are a beneficial tool to assess outbreak performance, not all One Health metrics are being tracked consistently, thereby missing opportunities to optimise epidemic intelligence, preparedness and prevention. The feasibility of tracking these metrics depends on the integration of reporting channels, enhanced documentation of milestones and development of guidance for early adopters, recognising country-specific on-the-ground realities and challenges to national scaling efforts

Drones and digital adherence monitoring for community-based tuberculosis control in remote Madagascar: a cost-effectiveness analysis

Continuing tuberculosis control with current approaches is unlikely to reach the World Health Organization's objective to eliminate TB by 2035. Innovative interventions such as unmanned aerial vehicles (or drones) and digital adherence monitoring technologies have the potential to enhance patient-centric quality tuberculosis care and help challenged National Tuberculosis Programs leapfrog over the impediments of conventional Directly Observed Therapy (DOTS) implementation. A bundle of innovative interventions referred to for its delivery technology as the Drone Observed Therapy System (DrOTS) was implemented in remote Madagascar. Given the potentially increased cost these interventions represent for health systems, a cost-effectiveness analysis was indicated.; A decision analysis model was created to calculate the incremental cost-effectiveness of the DrOTS strategy compared to DOTS, the standard of care, in a study population of 200,000 inhabitants in rural Madagascar with tuberculosis disease prevalence of 250/100,000. A mixed top-down and bottom-up costing approach was used to identify costs associated with both models, and net costs were calculated accounting for resulting TB treatment costs. Net cost per disability-adjusted life years averted was calculated. Sensitivity analyses were performed for key input variables to identify main drivers of health and cost outcomes, and cost-effectiveness.; Net cost per TB patient identified within DOTS and DrOTS were, respectively, $282 and$1,172. The incremental cost per additional TB patient diagnosed in DrOTS was $2,631 and the incremental cost-effectiveness ratio of DrOTS compared to DOTS was$177 per DALY averted. Analyses suggest that integrating drones with interventions ensuring highly sensitive laboratory testing and high treatment adherence optimizes cost-effectiveness.; Innovative technology packages including drones, digital adherence monitoring technologies, and molecular diagnostics for TB case finding and retention within the cascade of care can be cost effective. Their integration with other interventions within health systems may further lower costs and support access to universal health coverage