Weighted blankets for sleep problems - prescription, use and cost analysis

BACKGROUND

Weighted blankets (WBs) have been suggested as a treatment option for insomnia and are commonly prescribed despite lack of evidence of efficacy.

AIM

To investigate prescription pattern, return rate and cost of WBs.

MATERIAL AND METHODS

This observational cohort register-based study in western Sweden included every individual who, in a 2.5-year period, was prescribed and received at least one WB (n = 4092). A cost evaluation was made by mapping prescription processes for WBs and sleep medication.

RESULTS

Individuals diagnosed with dementia, anxiety, autism or intellectual disability (ID) retained the WB longer than others. Individuals younger than six and older than 65 years had shorter use time. The cost evaluation showed that the prescription process for WBs was longer and resulted in a higher cost than for sleep medication.

CONCLUSIONS

Some individuals had longer use time, indicating a possible benefit from using a WB. Due to low risk of harm but high economic cost, a revision of the WBs prescription process could be recommended to identify those who might benefit from WB.

SIGNIFICANCE

Our result points towards a need for revision of the prescription process, to implement standardized sleep assessments, and create a more efficient prescription process to lower the cost.

Weighted blanket and sleep medication use among adults with psychiatric diagnosis - a population-based register study

OBJECTIVE

To measure rate of subscription of common sleep medication and diagnoses of substance use disorder (SUD) before and after receiving a prescribed weighted blanket (WB) among patients with psychiatric diagnoses.

MATERIALS AND METHODS

Using register-based data of health-related factors in a Swedish region, a total of 1785 adult individuals with a psychiatric diagnosis, received a WB and resided in the region during the study period were identified. Using each individual as their own control, the rate of one-year prior prescription of WB or diagnosed SUD was compared to rate after a half year wash-out after prescription of WB for a full year.

RESULTS

The number of patients without prescription of sleep medication increased by 3.3% (95% confidence interval (95%CI): 0.2-6.4, p=.04). Furthermore, the proportion without a prescription of benzodiazepine receptor agonist/antihistamines sleep medication increased by 5.5% (95%CI: 2.2-8.8, p=.001). Melatonin prescription increased after WB by 3.6% (95%CI: 1.1-6.2, p=.006). Younger age and unipolar-, anxiety-, attention-deficit/hyperactivity-, and post-traumatic stress disorder was associated with decreased use while psychotic-/bipolar- and personality disorder was not associated with a decrease in the use of sleep medication. The number of alcohol SUD diagnoses did not increase while sedative SUD rate increased statistically significantly by 0.7% (odds ratio = 1.63, p=.02). In a multivariate model, only younger age predicted discontinuation of sleep medication while psychotic-/bipolar- and personality disorder had statistically less decrease.

CONCLUSION

This observational register study found a statistically significant association between WB use and decreased use of common sleep medication except melatonin that increased slightly.

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.

Parent Questionnaires in the Evaluation of Pre-School Children Referred for Neuropsychiatric Assessment

One-hundred twenty-four pre-school children referred for assessment to a neuropsychiatric team were included in this study of the Autism Behavior Checklist (ABC), ESSENCE-Q, and Conners Abbreviated Parent-Teacher Rating Scale (CAPRS). All three questionnaires showed a good correlation towards severity of symptoms in ASD. The ABC questionnaire was, as has been shown in earlier research less accurate in identifying individuals with ASD having an IQ within the normal range. However the ESSENCE-Q, and the CAPRS proved to identify children with difficulties needing further assessment regardless of intellectual ability. The CAPRS showed a good correlation to severity in ASD indicating difficulties in the regulation of activity and behavior likely to be connected to ASD in pre-school children.

Autism Mental Status Examination (AMSE): A Valid Instrument in the Evaluation of Pre-school Children with Suspected Autism Spectrum Disorders?

In this study the Autism Mental Status Exam (AMSE) was validated towards ICD-10 Autism Spectrum Diagnoses (ASD) based on an interview with the Diagnostic Interview for Social and Communication Disorders (DISCO-11) with parent(s)/caregiver(s) in a group of 124 children referred for assessment to a clinical assessment unit for pre-school children. The results from the study indicates a Fair relation across the AMSE score and ICD-10 Autism Spectrum Disorder (ASD). AMSE mean score for children not fulfilling criteria for an ASD at the assessment was significantly lower compared to the AMSE mean score for children who acquired an ASD diagnosis in the study. In addition, Vineland-II Parent/caregiver rating questionnaire GAF standard scores showed a reversed correlation to the AMSE mean scores (i.e. higher AMSE mean scores were related to lower Vineland-II GAF standard scores and vice versa).

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.

Perfusion of human placenta with hemoglobin introduces preeclampsia-like injuries that are prevented by α1-microglobulin

BACKGROUND

Preeclamptic women have increased plasma levels of free fetal hemoglobin (HbF), increased gene expression of placental HbF and accumulation of free HbF in the placental vascular lumen. Free hemoglobin (Hb) is pro-inflammatory, and causes oxidative stress and tissue damage.

METHODOLOGY

To show the impact of free Hb in PE, we used the dual ex vivo placental perfusion model. Placentas were perfused with Hb and investigated for physical parameters, Hb leakage, gene expression and morphology. The protective effects of α(1)-microglobulin (A1M), a heme- and radical-scavenger and antioxidant, was investigated.

RESULTS

Hb-addition into the fetal circulation led to a significant increase of the perfusion pressure and the feto-maternal leakage of free Hb. Morphological damages similar to the PE placentas were observed. Gene array showed up-regulation of genes related to immune response, apoptosis, and oxidative stress. Simultaneous addition of A1M to the maternal circulation inhibited the Hb leakage, morphological damage and gene up-regulation. Furthermore, perfusion with Hb and A1M induced a significant up-regulation of extracellular matrix genes.

SIGNIFICANCE

The ex vivo Hb-perfusion of human placenta resulted in physiological and morphological changes and a gene expression profile similar to what is observed in PE placentas. These results underline the potentially important role of free Hb in PE etiology. The damaging effects were counteracted by A1M, suggesting a role of this protein as a new potential PE therapeutic agent.

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.

Asperger syndrome in adolescent and young adult males. Interview, self- and parent assessment of social, emotional, and cognitive problems

Descriptive and comparative follow-up studies of young adult males with Asperger syndrome (AS) diagnosed in childhood, using both interview, self- and parent assessment instruments for the study of aspects of emotional well-being, social functioning, and cognitive-practical skills have not been performed in the past. One-hundred males with AS diagnosed in childhood were approached for the assessment using the Asperger Syndrome Diagnostic Interview (ASDI), (personal and parent interview), the Leiter-R-Questionnaires, the Beck Depression Inventory (BDI), and the Dysexecutive Questionnaire (DEX). About 75% of the targeted group participated. The ASDI results came out significantly different at personal vs parent interviews in several key domains. In contrast, the Leiter-R-Questionnaires, showed no significant differences across the individuals with AS and their parents in the scoring of cognitive/social and emotional/adaptive skills. The BDI proved to be an adequate screening instrument for depression in that it correctly identified the vast majority of cases with clinical depression in the AS group. The DEX results suggested an executive function deficit problem profile in males with AS as severe as that reported in groups of individuals with traumatic brain injury and schizophrenia. Interviews (personal and collateral), and self-rating and parent-rating questionnaires all have a role in the comprehensive diagnostic process in AS and other autism spectrum disorders, and could be used as adjuncts when evaluating whether or not individuals meeting diagnostic symptom criteria for the condition have sufficient problems in daily life to warrant a clinical diagnosis of AS.

Asperger Syndrome and Autism: A Comparative Longitudinal Follow-Up Study More than 5 Years after Original Diagnosis

Prospective follow-up study of 70 males with Asperger syndrome (AS), and 70 males with autism more than 5 years after original diagnosis. Instruments used at follow-up included overall clinical assessment, the Diagnostic Interview for Social and Communication Disorders, Wechsler Intelligence Scales, Vineland Adaptive Behavior Scales, and Global Assessment of Functioning Scale. Specific outcome criteria were used. Outcome in AS was good in 27% of cases. However, 26% had a very restricted life, with no occupation/activity and no friends. Outcome in the autism group was significantly worse. Males with AS had worse outcomes than expected given normal to high IQ. However, outcome was considerably better than for the comparison group of individuals with autism.

Brief report: "the autism epidemic". The registered prevalence of autism in a Swedish urban area

The objective of this study was to establish rates of diagnosed autism spectrum disorders (ASDs) in a circumscribed geographical region. The total population born in 1977-1994, living in Göteborg Sweden in 2001, was screened for ASD in registers of the Child Neuropsychiatry Clinic. The minimum registered rate of autistic disorder was 20.5 in 10,000. Other ASDs were 32.9 in 10,000, including 9.2 in 10,000 with Asperger syndrome. Males predominated. In the youngest group (7-12 years), 1.23% had a registered diagnosis of ASD. There was an increase in the rate of diagnosed registered ASD over time; the cause was not determined. The increase tended to level off in the younger age cohort, perhaps due to Asperger syndrome cases missed in screening.

Asperger syndrome: familial and pre- and perinatal factors

OBJECTIVE

Study familial and pre- and perinatal factors in Asperger Syndrome (AS).

METHODS

One hundred boys with AS had their records reviewed. "Pathogenetic subgroups" were defined according to presence of medical syndromes/chromosomal abnormalities, indices of familiality, and pre- and perinatal risk factors predisposing to brain damage.

RESULTS

No major index of pathogenetic factors was found in 13%, a syndrome/chromosomal abnormality in 8%, pre- or perinatal risk 13%, combined pre- or perinatal risk and family history in 11%, and family history only in 55%.

COMMENT

About 50% of all boys with AS have a paternal family history of autism spectrum disorder. Pre- and perinatal risks appear to be important in about 25% of cases.

One hundred males with Asperger syndrome: a clinical study of background and associated factors

The objective of this study was to investigate the background and associated factors in a representative group of young males with Asperger syndrome (AS) presenting at a specialized autism clinic. One hundred males aged 5 years 6 months to 24 years 6 months, with a mean age of 11 years 4 months (SD 3y 10mo), who had a clinical diagnosis of AS were included in the study. An in-depth review of their medical records and neuropsychological test data was performed. There was a high rate (51%) of non-verbal learning disability (defined as Verbal IQ more than 15 points higher than Performance IQ), but otherwise there was little or no support for the notion of right-hemisphere brain dysfunction being at the core of the syndrome. There was a very high rate of close relatives with autism spectrum problems, but also high rates of prenatal and perinatal problems, including prematurity and postmaturity. In comparison with general population data, those with AS very often had a combination of genetic and prenatal and perinatal risk factors. Non-verbal learning disability test results applied in about half the group. There was a subgroup of individuals with AS who had macrocephalus. However, there was no support for an association of AS with low body mass index.