Making a case for an autism-specific multimorbidity index: a comparative cohort study

Autistic people experience challenges in healthcare, including disparities in health outcomes and multimorbidity patterns distinct from the general population. This study investigated the efficacy of existing multimorbidity indices in predicting COVID-19 mortality among autistic adults and proposes a bespoke index, the ASD-MI, tailored to their specific health profile. Using data from the CVD-COVID-UK/COVID-IMPACT Consortium, encompassing England's entire population, we identified 1,027 autistic adults hospitalized for COVID-19, among whom 62 died due to the virus. Employing logistic regression with 5-fold cross-validation, we selected diabetes, coronary heart disease, and thyroid disorders as predictors for the ASD-MI, outperforming the Quan Index, a general population-based measure, with an AUC of 0.872 versus 0.828, respectively. Notably, the ASD-MI exhibited better model fit (pseudo-R2 0.25) compared to the Quan Index (pseudo-R2 0.20). These findings underscore the need for tailored indices in predicting mortality risks among autistic individuals. However, caution is warranted in interpreting results, given the limited understanding of morbidity burden in this population. Further research is needed to refine autism-specific indices and elucidate the complex interplay between long-term conditions and mortality risk, informing targeted interventions to address health disparities in autistic adults. This study highlights the importance of developing healthcare tools tailored to the unique needs of neurodivergent populations to improve health outcomes and reduce disparities

Examining GP online consultation in a primary care setting in east midlands, UK

open access articleBackground Increasing pressure threatens to overwhelm primary care services, affecting the quality of care and their role as gatekeepers to specialised care services. This study investigated healthcare users’ acceptability of – and the effectiveness of – an e-consultation system in primary care services. Methods Seven GP practices in East-Midlands, all of whom use online consultation system participated in the study, with a retrospective review being undertaken of 189 electronic patients’ records (age range of 18–76 years) over 5 months. The focus was on the electronic records of patients who accessed the service for five different conditions identified as presenting common conditions seen by the GPs practices. Statistical analysis was done using SPSS to perform an exploratory data analysis and descriptive statistics. Results The results showed a positive reception of the online consultation platform, with an average satisfaction score of 4.15 (most likely to recommend score = 5). Given the nature of the conditions, 47.6% of patients had experienced a previous episode of the health condition they were seeking consultation for, and a total of 72% had existing comorbidities. Follow-up activity occurred for 87.3% of patients, 66.1% of which included at least one follow-up visit for the same condition as the initial online consultation. Conclusion The results suggest that online consultation is convenient for patients, and it also has the potential to relieve pressure placed on primary care services. Although a number of challenges were identified, such as patient verification, this study gives insight into – and enhances our understanding of – the use of online GP consultations

A Case Study of a Pilot Smart Home Monitoring System with Older Adults Living Alone in East Midlands

open access articleThe aim of this project was to examine older adults and their next-of-kins’ experiences of using smart home technology. The technology unobtrusively monitors the older adult’s physical functional ability to undertake their daily activities at home. Using a case study approach, the participants comprised three family units: three older adults with a history of long-term co-morbidities and who lived alone, along with their next-of-kin (n=4). The older adults were all female aged between 72- 82 years of age, while the four next-of-kin were all females aged between 40 and 55 years of age. Participants experiences of using the smart home technology was evaluated at three- and eight-months post installation via in-depth one-to-one interviews with the older adults and their next-of-kin. The older adults described how the smart home sensors reduced their levels of anxiety because they were ‘not feeling alone’. Likewise, their next-of-kin described how the sensors gave them an insight to their older relatives’ activities of daily living, as well as the challenges they experienced. The findings highlighted the benefit of smart home technologies in terms of helping older adults and their next-of-kin monitor their daily activities, reduce social isolation, and adopt positive health and behavioural changes

Understanding covid-19 outcomes among people with intellectual disabilities in England

Background: Evidence from the UK from the early stages of the covid-19 pandemic showed that people with Intellectual Disabilities (ID) had higher rates of covid-19 mortality than people without ID. However, estimates of the magnitude of risk vary widely; different studies used different time periods; and only early stages of the pandemic have been analysed. Existing analyses of risk factors have also been limited. The objective of this study was to investigate covid-19 mortality rates, hospitalisation rates, and risk factors in people with ID in England up to the end of 2021. Methods: Retrospective cohort study of all people with a laboratory-confirmed SARS-CoV-2 infection or death involving covid-19. Datasets covering primary care, secondary care, covid-19 tests and vaccinations, prescriptions, and deaths were linked at individual level. Results: Covid-19 carries a disproportionately higher risk of death for people with ID, above their already higher risk of dying from other causes, in comparison to those without ID. Around 2,000 people with ID had a death involving covid-19 in England up to the end of 2021; approximately 1 in 180. The covid-19 standardized mortality ratio was 5.6 [95% CI 5.4, 5.9]. People with ID were also more likely to be hospitalised for covid-19 than people without ID. The main determinants of severe covid-19 outcomes (deaths and/or hospitalisations) in both populations were age, multimorbidity and vaccination status. The key factor responsible for the higher risk of severe covid-19 in the ID population was a much higher prevalence of multimorbidity in this population. AstraZeneca vaccine was slightly less effective in preventing severe covid-19 outcomes among people with ID than among people without ID. Conclusions: People with ID should be considered a priority group in future pandemics, such as shielding and vaccinations

Augmented video consultations in care homes during the covid-19 pandemic

open access journalBackground: The COVID-19 pandemic necessitated an unprecedented implementation of remote consultations in UK primary care services. Specifically, older adults in care homes had a high need for infection prevention due to their existing health conditions. GP practices in the East Midlands incorporated augmented video consultations with the potential to support remote healthcare assessments for older adults at care homes. Aim: To explore GPs and care home staff experiences of the use of augmented video consultation as a mechanism to perform remote examinations of older adults in care homes. Design and setting: Qualitative interviews were conducted with GPs and care home staff during May-August 2020. Method: A convenience sample of GPs (n=5), nurses (n=12) and senior health care assistants (n=3) were recruited using a purposive approach. Data was collected through semi-structured telephone interviews and was analysed using framework analysis. Results: Findings from participants indicated that augmented video consultation enables real-time patient examinations to aid diagnosis; and promotes person-centred care in meeting the needs of older adults. The participants also discussed the challenges of video consultations for patients with cognitive impairment and those under end-of-life care. Conclusion: Augmented video consultations show great potential in terms of GPs providing primary care services for care homes. However, healthcare staff must be involved in the development of the technology, and consideration should be given to the needs of older adults with cognitive impairment and those under end-of-life care. It is also vital that training is available to encourage confidence and competency in implementing the technology

A functional magnetic resonance imaging examination of audiovisual observation of a point-light string quartet using intersubject correlation and physical feature analysis.

Peer reviewed: TrueAcknowledgements: We acknowledge the musicians from the Quartetto di Cremona. We thank the reviewers and the editor for their advice and encouragement to improve the manuscript. Scanning resources were provided by the Centre for Cognitive Neuroimaging, University of Glasgow.We use functional Magnetic Resonance Imaging (fMRI) to explore synchronized neural responses between observers of audiovisual presentation of a string quartet performance during free viewing. Audio presentation was accompanied by visual presentation of the string quartet as stick figures observed from a static viewpoint. Brain data from 18 musical novices were obtained during audiovisual presentation of a 116 s performance of the allegro of String Quartet, No. 14 in D minor by Schubert played by the 'Quartetto di Cremona.' These data were analyzed using intersubject correlation (ISC). Results showed extensive ISC in auditory and visual areas as well as parietal cortex, frontal cortex and subcortical areas including the medial geniculate and basal ganglia (putamen). These results from a single fixed viewpoint of multiple musicians are greater than previous reports of ISC from unstructured group activity but are broadly consistent with related research that used ISC to explore listening to music or watching solo dance. A feature analysis examining the relationship between brain activity and physical features of the auditory and visual signals yielded findings of a large proportion of activity related to auditory and visual processing, particularly in the superior temporal gyrus (STG) as well as midbrain areas. Motor areas were also involved, potentially as a result of watching motion from the stick figure display of musicians in the string quartet. These results reveal involvement of areas such as the putamen in processing complex musical performance and highlight the potential of using brief naturalistic stimuli to localize distinct brain areas and elucidate potential mechanisms underlying multisensory integration

A population-based cross-sectional investigation of COVID-19 hospitalizations and mortality among autistic people

Background: Current evidence suggests the possibility that autistic people may be at more risk of COVID-19 infection, hospitalisation, and mortality than the general population. Previous studies, however, are either limited in scale or do not investigate potential risk factors. Whilst many risk factors have been speculated to be responsible for severe COVID-19, this research has focused on general population samples. Methods: Using data-linkage and a whole-country population, this study modelled associations between autism and COVID-19 hospitalisation and mortality risk in adults, investigating a multitude of clinical and demographic risk factors. Results: Autistic adults had higher rates of hospitalisation, Standardised Incident Ratio 1.6 in 2020 and 1.3 in 2021, and mortality, Standardised Mortality Ratio 1.52 in 2020 and 1.34 in 2021, due to COVID-19 than the general population. In both populations, age, complex multimorbidity and vaccination status were the most significant predictors of COVID-19 hospitalisation and mortality. Effects of psychotropic medication varied by class. Conclusions: Although similar factors exhibited a positive association with heightened risk of severe COVID-19 in both the autistic and general populations, with comparable effect sizes, mortality rates were elevated among the autistic population as compared to the general population. Specifically, the presence of complex multimorbidity and classification of prescribed medications may emerge as particularly significant predictors of severe COVID-19 among individuals within the autistic population due to higher prevalence of complex multimorbidity in the autistic population and variability in the association between medication classes and severe COVID-19 between both populations, though further research is needed