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Lopez-Espejo MA, Nuñez AC, Saez V, Ruz M, Moscoso OC, Vives A. The Influence of Social and Developmental Factors on the Timing of Autism Spectrum Disorder Diagnosis of Preschool-Aged Children: Evidence from a Specialized Chilean Center. J Autism Dev Disord 2024:10.1007/s10803-024-06376-5. [PMID: 38744740 DOI: 10.1007/s10803-024-06376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
We investigated the influence of developmental and social factors on the age of autism diagnosis (AoD) in a cohort of toddlers living in Chile. A cross-sectional study was conducted among 509 preschool children diagnosed with autism spectrum disorder [M = 40.2 months (SD = 8.6), girls: 32%] in the neurodevelopmental unit of a university clinic in Santiago, Chile (2015-2023). Structural changes in the annual trend of AoD were tested. Generalized linear models (gamma distribution) with and without interaction terms were used for the multivariate analysis, adjusting for gender, residential area, year of diagnosis, developmental variables (language regression, delayed walking, and use of expressive verbal language), and primary caregiver age and education level (CEL). 95% confidence intervals of the unstandardized regression coefficients (B) were calculated using 1000 bootstrap resampling to estimate associations. AoD increased between 2021-2022 and decreased in 2023. Female gender (B = 2.72 [1.21-4.23]), no history of language regression (B = 3.97 [1.66-6.28]), and the presence of expressive verbal language at diagnosis (B = 1.57 [0.05-3.08]) were associated with higher AoD. Children whose caregivers had tertiary education were diagnosed earlier than those with ≤ 12 years of formal education. Although the influence of CEL increased with caregiver age, differences between CEL groups were significant only for caregivers aged ≥ 30 years. Improved education and early screening for clinical features of autism among healthcare professionals and the community, with a focus on young children without highly apparent developmental concerns and those from vulnerable social groups, are warranted.
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Affiliation(s)
- Mauricio A Lopez-Espejo
- Section of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Neurodevelopmental Unit, UC CHRISTUS Clinical Hospital, Santiago, Chile.
| | - Alicia C Nuñez
- Section of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Neurodevelopmental Unit, UC CHRISTUS Clinical Hospital, Santiago, Chile
| | - Valentina Saez
- Neurodevelopmental Unit, UC CHRISTUS Clinical Hospital, Santiago, Chile
| | - Melanie Ruz
- Neurodevelopmental Unit, UC CHRISTUS Clinical Hospital, Santiago, Chile
| | - Odalie C Moscoso
- Neurodevelopmental Unit, UC CHRISTUS Clinical Hospital, Santiago, Chile
| | - Alejandra Vives
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Gunz S, Rozen-Knisbacher I, Blumenfeld A, Hendler K, Yahalom C. The prevalence of autism among children with albinism. Eur J Ophthalmol 2024; 34:666-671. [PMID: 37787167 PMCID: PMC11067420 DOI: 10.1177/11206721231206091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The association between Autism spectrum disorders (ASD) and visual impairment has been mentioned in the literature. The aim of our study was to investigate the prevalence of autism among children with albinism compared to the prevalence of ASD in children with visual impairment secondary to other causes. METHODS Retrospective study of children with albinism from January 2015 to December 2020. A control group was created with children with early onset visual impairment of similar visual range and age, secondary to diagnosis other than albinism. Patients with associated Autism were identified in both groups. RESULTS Seven hundred and eight children aged 1-18 years with visual impairment were included in the study. 401 children had a diagnosis of albinism, of whom 14 were also diagnosed with ASD. In the control group, composed of 307 patients, only 3 had ASD (p: 0·03). CONCLUSIONS The prevalence of ASD in patients with albinism was 1 in 28, while in children with visual impairment from other causes was 1 in 102. We aim to raise awareness of the higher prevalence of autism in children diagnosed with albinism in order to reach earlier diagnosis and support.
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Affiliation(s)
- Stav Gunz
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | - Anat Blumenfeld
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Karen Hendler
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Claudia Yahalom
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
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3
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Lindroth H, Nalaie K, Raghu R, Ayala IN, Busch C, Bhattacharyya A, Moreno Franco P, Diedrich DA, Pickering BW, Herasevich V. Applied Artificial Intelligence in Healthcare: A Review of Computer Vision Technology Application in Hospital Settings. J Imaging 2024; 10:81. [PMID: 38667979 PMCID: PMC11050909 DOI: 10.3390/jimaging10040081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
Computer vision (CV), a type of artificial intelligence (AI) that uses digital videos or a sequence of images to recognize content, has been used extensively across industries in recent years. However, in the healthcare industry, its applications are limited by factors like privacy, safety, and ethical concerns. Despite this, CV has the potential to improve patient monitoring, and system efficiencies, while reducing workload. In contrast to previous reviews, we focus on the end-user applications of CV. First, we briefly review and categorize CV applications in other industries (job enhancement, surveillance and monitoring, automation, and augmented reality). We then review the developments of CV in the hospital setting, outpatient, and community settings. The recent advances in monitoring delirium, pain and sedation, patient deterioration, mechanical ventilation, mobility, patient safety, surgical applications, quantification of workload in the hospital, and monitoring for patient events outside the hospital are highlighted. To identify opportunities for future applications, we also completed journey mapping at different system levels. Lastly, we discuss the privacy, safety, and ethical considerations associated with CV and outline processes in algorithm development and testing that limit CV expansion in healthcare. This comprehensive review highlights CV applications and ideas for its expanded use in healthcare.
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Affiliation(s)
- Heidi Lindroth
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN 55905, USA; (K.N.); (R.R.); (I.N.A.); (C.B.)
- Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Keivan Nalaie
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN 55905, USA; (K.N.); (R.R.); (I.N.A.); (C.B.)
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA; (D.A.D.); (B.W.P.); (V.H.)
| | - Roshini Raghu
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN 55905, USA; (K.N.); (R.R.); (I.N.A.); (C.B.)
| | - Ivan N. Ayala
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN 55905, USA; (K.N.); (R.R.); (I.N.A.); (C.B.)
| | - Charles Busch
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN 55905, USA; (K.N.); (R.R.); (I.N.A.); (C.B.)
- College of Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA
| | | | - Pablo Moreno Franco
- Department of Transplantation Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Daniel A. Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA; (D.A.D.); (B.W.P.); (V.H.)
| | - Brian W. Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA; (D.A.D.); (B.W.P.); (V.H.)
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA; (D.A.D.); (B.W.P.); (V.H.)
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4
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Slobodin O, Hetzroni OE, Mandel M, Saad Nuttman S, Gawi Damashi Z, Machluf E, Davidovitch M. Infant screen media and child development: A prospective community study. INFANCY 2024; 29:155-174. [PMID: 38157284 DOI: 10.1111/infa.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
The current study examined longitudinal associations between early screen media exposure (assessed at 6, 12, and 24 months) and the child's motor and language/communication development at the ages of 24 and 36 months. We also aimed to study whether these associations varied by socioeconomic status (SES). Participants were 179 parent-infant dyads, recruited from well-baby clinic services during routine visits. Child development measures included standardized measures of developmental milestones as assessed by professionals and referral data to child developmental centers. Both measures were retrieved from the official health maintenance organization records by an expert in child development. Results indicated that screen exposure at 6 and 12 months was associated with a higher risk for language/communication deficits at 36 months in children with moderate or high SES but not in children with low SES. Our findings are consistent with existing literature demonstrating cross-sectional and longitudinal associations between early screen exposure and language development deficits. Given that media use practices and motivations vary among families from different backgrounds, further investigation of the interaction between SES and screen exposure is needed.
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Affiliation(s)
- Ortal Slobodin
- School of Education, Ben-Gurion University, Beer-Sheva, Israel
| | - Orit E Hetzroni
- Faculty of Education, Department of Special Education, Haifa University, Haifa, Israel
| | - Moran Mandel
- Department of Psychology, Ben-Gurion University, Beer-Sheva, Israel
| | | | - Zainab Gawi Damashi
- Faculty of Education, Department of Special Education, Haifa University, Haifa, Israel
| | - Eden Machluf
- Faculty of Education, Department of Special Education, Haifa University, Haifa, Israel
| | - Michael Davidovitch
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
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Dinstein I, Solomon S, Zats M, Shusel R, Lottner R, Gershon BB, Meiri G, Menashe I, Shmueli D. Large increase in ASD prevalence in Israel between 2017 and 2021. Autism Res 2024; 17:410-418. [PMID: 38193609 DOI: 10.1002/aur.3085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
Accurate estimation of annual changes in autism spectrum disorders (ASD) prevalence is critical for planning the expansion of diagnostic, education, and intervention services at an adequate rate. Previous studies from Israel have reported that ASD prevalence among 8-year-old children has increased from estimates of 0.3% in 2008 to 0.65% in 2015 and 1.3% in 2018. Here, we analyzed data acquired from the National Insurance Institute of Israeli (NII), a governmental organization that approves and monitors all ASD children who receive welfare services in Israel, and Clalit Health Services (CHS), the largest Health Maintenance Organization in Israel that provides health services to ~52% of the population. Data from both sources included annual data files from 2017 to 2021 containing the number of ASD cases per year of birth for 1-17-year-old children. This allowed us to estimate annual ASD prevalence among 3.5 million children born between 2000 and 2020 in Israel. Both data sources revealed a nearly two-fold increase in ASD prevalence among 1-17-year-old children from 2017 to 2021. Estimated prevalence rates differed across age groups with 2-3-year-old (day-care) children increasing from 0.27% to 1.19% (>4 fold change), 4-6-year-old (pre-school) children increasing from 0.8% to 1.83%, and 8-year-old children increasing from 0.82% to 1.56% in NII data. These results demonstrate that autism prevalence continues to increase in Israel with a shift towards diagnosis at earlier ages. These findings highlight the challenge facing health and education service providers in meeting the needs of a rapidly growing autism population.
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Affiliation(s)
- Ilan Dinstein
- Psychology Department, Ben Gurion University of the Negev, Beer Sheva, Israel
- Cognitive and Brain Sciences Department, Ben Gurion University of the Negev, Beer Sheva, Israel
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shirley Solomon
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Zats
- ALUT, The National Society for Children and Adults with Autism, Tel Aviv, Israel
| | - Ronit Shusel
- ALUT, The National Society for Children and Adults with Autism, Tel Aviv, Israel
| | | | | | - Gal Meiri
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben Gurion University of the Negev, Beer Sheva, Israel
- Child and Adolescent Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Idan Menashe
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben Gurion University of the Negev, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Dorit Shmueli
- Child Development Services, Clalit Healthcare, Tel Aviv, Israel
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Alhozyel E, Elbedour L, Balaum R, Meiri G, Michaelovski A, Dinstein I, Davidovitch N, Kerub O, Menashe I. Association Between Early Developmental Milestones and Autism Spectrum Disorder. Res Child Adolesc Psychopathol 2023; 51:1511-1520. [PMID: 37231233 DOI: 10.1007/s10802-023-01085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Early diagnosis and treatment of autism spectrum disorder (ASD) has been shown to lead to better prognosis. Here, we examined the association of commonly measured early developmental milestones (DMs) with later diagnosis of ASD. We conducted a case-control study of 280 children with ASD (cases) and 560 typically developed children (controls) matched to cases by date of birth, sex, and ethnicity in a control/case ratio of 2:1. Both cases and controls were ascertained from all children whose development was monitored at mother-child health clinics (MCHCs) in southern Israel. DM failure rates during the first 18 months of life in three developmental categories (motor, social, and verbal) were compared between cases and controls. Conditional logistic regression models were used to assess the independent association of specific DMs with the risk of ASD, while adjusting for demographic and birth characteristics.Significant case-control differences in DM failure rates were observed as early as 3 months of age (p < 0.001), and these differences increased with age. Specifically, cases were 2.4 times more likely to fail ≥ 1 DM at 3 months (aOR = 2.39; 95%CI = 1.41-4.06), and 15.3 times more likely to fail ≥ 3 DMs at 18 months (aOR = 15.32; 95%CI = 7.75-30.28). The most notable DM-ASD association was observed for social DM failure at 9-12 months (aOR = 4.59; 95%CI = 2.59-8.13). Importantly, the sex or ethnicity of the participants did not affect these DM-ASD associations. Our findings highlight the potential role of DMs as early signs of ASD that could facilitate earlier referral and diagnosis of ASD.
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Affiliation(s)
- Einav Alhozyel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leena Elbedour
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rewaa Balaum
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Meiri
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Analya Michaelovski
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Ilan Dinstein
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Psychology and Brain and Cognition Departments, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orly Kerub
- The Mother and Child Department, Ministry of Health, Beer-Sheva, Israel
| | - Idan Menashe
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Lavi R, Stokes MA. Reliability and validity of the Autism Screen for Kids and Youth. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1968-1982. [PMID: 36688323 DOI: 10.1177/13623613221149542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
LAY ABSTRACT It is important that autistic children be diagnosed as early as possible so their needs can be met and their families can gain important insights into their behavior and interact with them appropriately. However, very few autism screening instruments are appropriate for children who have outgrown early childhood. The Autism Screen for Kids and Youth (ASKY) presents parents of children aged 4-18 years with 30 items that relate to autistic behaviors as defined by the current clinical diagnostic criteria for autism spectrum disorder (DSM-5 ASD). We evaluated the Hebrew instrument's performance on 167 autistic and non-autistic children and adolescents. We found that the ASKY algorithm correctly identified 92% of the autistic individuals as "probable ASD" and correctly identified 72% of the non-autistic individuals as "probable non-ASD," with these classifications showing excellent stability over time. Using total questionnaire score instead of the algorithm improved the ASKY's ability to correctly identify autistic individuals as "probable ASD" and non-autistic individuals as "probable non-ASD" to 93% and 78%, respectively. Overall, the ASKY is a promising instrument for ASD screening of older children.
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Davidovitch M, Gazit S, Patalon T, Leitner Y, Rotem RS. Late diagnosis of autism spectrum disorder-Journey, parents' concerns, and sex influences. Autism Res 2023; 16:294-301. [PMID: 36495248 DOI: 10.1002/aur.2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
Despite increasing awareness for diagnosing autism spectrum disorder (ASD) and initiating treatments early in life, many children and adolescents continue to be diagnosed at a relatively older age. Focusing on children who first received an ASD diagnosis at age six or older, this study aimed to describe the symptoms that parents reported when ASD was diagnosed, follow the patients' clinical trajectory prior to receiving the diagnosis, and describe differences in symptoms and prior diagnoses between males and females cases. We included 258 children (205 males and 53 females) who were first diagnosed with autism at age 6-18 in 2017-2018. We retrieved demographic information, neurologic and developmental symptoms, diagnoses, and medications dispensing history from the children's electronic medical charts. The data indicated that prior diagnoses of language delays and attention deficit hyperactivity disorder were common among children with a late ASD diagnosis. Two thirds of the children were prescribed one or more medications to treat psychosocial and behavioral conditions before receiving a late ASD diagnosis. Difficulties in social relationships with peers were the leading reported symptoms by parents at the time of ASD diagnosis. Across these different domains, some differences were found between males and females, including a somewhat higher cognitive level in males, who were also more likely to present aggressive behavior.
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Affiliation(s)
- Michael Davidovitch
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yael Leitner
- Child Development Center & Pediatric ADHD Clinic, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ran S Rotem
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
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Camodeca A. Diagnostic Utility of the Gilliam Autism Rating Scales-3rd Edition Parent Report in Clinically Referred Children. J Autism Dev Disord 2022; 53:2112-2126. [PMID: 35244837 DOI: 10.1007/s10803-022-05483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
There is limited research regarding the Gilliam Autism Rating Scales-3rd Edition (GARS-3) despite its extensive use. A comprehensive diagnostic evaluation, including the Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2) was provided to 186 clinically referred children suspected of autism ([Formula: see text] age = 8.98; Autism [AUT] n = 87; Not Autism [NOT] n = 99). Mean difference analyses, Logistic Regressions, and ROC analyses were non-significant for both Autism Index scores. The author-suggested cutoff score of 70 correctly classified approximately 47% of participants, with false positive rates = 82.83-87.88%. ADOS-2 correlations were significantly lower vis-à-vis the standardization sample. The Social Interaction subscale demonstrated weak, marginal results, and sensitivity/specificity could not be optimized. In its current form, the GARS-3 does not demonstrate adequate criterion validity for use in assessment of complex community samples.
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Affiliation(s)
- Amy Camodeca
- Psychology Department, The Pennsylvania State University, 100 University Drive, Monaca, PA, 15061, USA. .,University of Windsor, Windsor, ON, Canada. .,The Pennsylvania State University, Beaver Campus, 100 University Drive, Monaca, PA, 15108, USA.
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McGee G, Haneuse S, Coull BA, Weisskopf MG, Rotem RS. On the Nature of Informative Presence Bias in Analyses of Electronic Health Records. Epidemiology 2022; 33:105-113. [PMID: 34711733 PMCID: PMC8633193 DOI: 10.1097/ede.0000000000001432] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Electronic health records (EHRs) offer unprecedented opportunities to answer epidemiologic questions. However, unlike in ordinary cohort studies or randomized trials, EHR data are collected somewhat idiosyncratically. In particular, patients who have more contact with the medical system have more opportunities to receive diagnoses, which are then recorded in their EHRs. The goal of this article is to shed light on the nature and scope of this phenomenon, known as informative presence, which can bias estimates of associations. We show how this can be characterized as an instance of misclassification bias. As a consequence, we show that informative presence bias can occur in a broader range of settings than previously thought, and that simple adjustment for the number of visits as a confounder may not fully correct for bias. Additionally, where previous work has considered only underdiagnosis, investigators are often concerned about overdiagnosis; we show how this changes the settings in which bias manifests. We report on a comprehensive series of simulations to shed light on when to expect informative presence bias, how it can be mitigated in some cases, and cases in which new methods need to be developed.
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Affiliation(s)
- Glen McGee
- Department of Statistics and Actuarial Science, University
of Waterloo, Waterloo, ON, Canada
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of
Public Health, Boston, MA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of
Public Health, Boston, MA
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T.H. Chan
School of Public Health, Boston, MA
| | - Ran S. Rotem
- Department of Environmental Health, Harvard T.H. Chan
School of Public Health, Boston, MA
- Kahn-Sagol-Maccabi Research and Innovation Institute,
Maccabi Healthcare Services, Tel Aviv, Israel
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Tasew S, Mekonnen H, Goshu AT. Knowledge of childhood autism among nurses working in governmental hospitals of Addis Ababa, Ethiopia. SAGE Open Med 2021; 9:20503121211049121. [PMID: 34691470 PMCID: PMC8532247 DOI: 10.1177/20503121211049121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Autism is a neurodevelopmental disorder that occurs in the early childhood period and is characterized by altered social interaction, communication problems, repetitive, and stereotyped behavior. Genetic, environmental, or physical risk factors are associated with prenatal, natal, or postnatal complications, leading to the development of autism spectrum disorders. Prompt diagnosis and management should be an integral component of the care provision in countries like Ethiopia. OBJECTIVE This study aimed to assess knowledge of childhood autism among nurses working in governmental hospitals in Addis Ababa, Ethiopia. METHODS Institutional based cross-sectional study design was used. The sample size was calculated using the single population proportion formula, and the final sample size was 360. Final study subjects were selected by using the simple random sampling method. Data were collected using structured self-administered questionnaires and were then coded and entered into Epi-data version 3.1 and exported to SPSS version 21 for analysis. Descriptive statistics were utilized to show frequencies and percentages, and analysis of variance was carried out to compute the association between the dependent and independent variables. Independent t-test was also done to see the association between dependent variables and independent variables with two means. A p-value of less than 0.05 was considered statistically significant. RESULTS The mean score for knowledge-related items was 8.79 ± 0.4. In this study, out of 331 nurses, 180 (54.35%) had good knowledge. Significant mean score difference was observed among age distribution (F-Ratio = 2.8, p-value = 0.04), level of education (F-ratio = 13.97, p < 0.001) and work experience (F-Ratio = 3.07 p-value = 0.017). CONCLUSION A significant gap was observed in the overall knowledge of childhood autism among nurses employed in the governmental hospitals of Addis Ababa. The respondents' knowledge level was significantly different among age group distributions, education levels, and work experience.
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Affiliation(s)
- Salem Tasew
- Department of Nursing, College of Health and Medical Sciences, Dilla University, Dilla, Ethiopia
| | - Hussen Mekonnen
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abel Tibebu Goshu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Volkova A, Ruggles K, Schulfer A, Gao Z, Ginsberg SD, Blaser MJ. Effects of early-life penicillin exposure on the gut microbiome and frontal cortex and amygdala gene expression. iScience 2021; 24:102797. [PMID: 34355145 PMCID: PMC8324854 DOI: 10.1016/j.isci.2021.102797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
We have established experimental systems to assess the effects of early-life exposures to antibiotics on the intestinal microbiota and gene expression in the brain. This model system is highly relevant to human exposure and may be developed into a preclinical model of neurodevelopmental disorders in which the gut–brain axis is perturbed, leading to organizational effects that permanently alter the structure and function of the brain. Exposing newborn mice to low-dose penicillin led to substantial changes in intestinal microbiota population structure and composition. Transcriptomic alterations implicate pathways perturbed in neurodevelopmental and neuropsychiatric disorders. There also were substantial effects on frontal cortex and amygdala gene expression by bioinformatic interrogation, affecting multiple pathways underlying neurodevelopment. Informatic analyses established linkages between specific intestinal microbial populations and the early-life expression of particular affected genes. These studies provide translational models to explore intestinal microbiome roles in the normal and abnormal maturation of the vulnerable central nervous system. Low-dose antibiotic exposure perturbs the infant gut mouse microbiome to PND10 Frontal cortex and amygdala gene expression were substantially affected Multiple pathways underlying neurodevelopment were affected Specific gut microbial populations were linked with expression of particular genes
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Affiliation(s)
- Angelina Volkova
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kelly Ruggles
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY 10016, USA.,Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Anjelique Schulfer
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Zhan Gao
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA.,Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ 08854, USA
| | - Stephen D Ginsberg
- Center for Dementia Research. Nathan Kline Institute, Orangeburg, NY 10962, USA.,Departments of Psychiatry, Neuroscience & Physiology, and NYU Neuroscience Institute, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Martin J Blaser
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA.,Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ 08854, USA
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Davidovitch M, Shmueli D, Rotem RS, Bloch AM. Diagnosis despite clinical ambiguity: physicians' perspectives on the rise in Autism Spectrum disorder incidence. BMC Psychiatry 2021; 21:150. [PMID: 33711966 PMCID: PMC7953811 DOI: 10.1186/s12888-021-03151-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To provide insight on physicians' perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders. METHOD A questionnaire was sent to 191 specialists in child neurology and child development, and 200 child psychiatrists in Israel. Information was collected on professional background, as well as on physicians' opinions concerning the accuracy and rate of ASD diagnosis compared to that of cerebral palsy (CP), mental illness, and Attention Deficit Hyperactivity Disorder (ADHD). For each closed-ended question, a global chi-square test for categorical variables was performed. RESULTS 115 (60.2%) of specialists in child neurology and development, and 59 (29.5%) of child psychiatrists responded. Most physicians (67.2%) indicated that there was a moderate/significant increase in the incidence of ASD, which was higher than similar responses provided for CP (2.9%, p < 0.01) and mental illnesses (14.4%, p < 0.01), and similar to responses provided for ADHD (70.1%, p = 0.56). 52.8% of physicians believed that in more than 10% of clinical assessments, an ASD diagnosis was given despite an inconclusive evaluation (CP: 8.6%, p < 0.01; mental illnesses: 25.8%, p = 0.03; ADHD: 68.4%, p = 0.03). CONCLUSION The clinicians perceive both ASD and ADHD as over-diagnosed disorders. The shared symptomology between ASD and other disorders, coupled with heightened awareness and public de-stigmatization of ASD and with the availability of ASD-specific services that are not accessible to children diagnosed with other conditions, might lead clinicians to over-diagnose ASD. It is advisable to adopt an approach in which eligibility for treatments is conditional on function, rather than solely on a diagnosis. The medical community should strive for accurate diagnoses and a continuous review of diagnostic criteria.
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Affiliation(s)
- Michael Davidovitch
- Child Development, Medical Division and Research Institute, Maccabi Healthcare Services, 27 Hamered St., 6812509, Tel Aviv, Israel. .,Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, 4 Koifmann St., 6801296, Tel Aviv, Israel.
| | - Dorit Shmueli
- Clalit Child Development Center, Clalit Healthcare Services, 75 Betlehem Rd., 9362410 Jerusalem, Israel
| | - Ran Shmuel Rotem
- grid.425380.8Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, 4 Koifmann St., 6801296 Tel Aviv, Israel ,grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts USA
| | - Aviva Mimouni Bloch
- grid.416027.60000 0004 0631 6399Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Hospital, 278 Ahuza St., 4310000 Raanana, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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