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High-quality evidence from prospective longitudinal studies in humans is essential to testing hypotheses related to the developmental origins of health and disease. In this paper, the authors draw upon their own experiences leading birth cohorts with longitudinal follow-up into adulthood to describe specific challenges and lessons learned. Challenges are substantial and grow over time. Long-term funding is essential for study operations and critical to retaining study staff, who develop relationships with participants and hold important institutional knowledge and technical skill sets. To maintain contact, we recommend that cohorts apply multiple strategies for tracking and obtain as much high-quality contact information as possible before the child’s 18th birthday. To maximize engagement, we suggest that cohorts offer flexibility in visit timing, length, location, frequency, and type. Data collection may entail multiple modalities, even at a single collection timepoint, including measures that are self-reported, research-measured, and administrative with a mix of remote and in-person collection. Many topics highly relevant for adolescent and young adult health and well-being are considered to be private in nature, and their assessment requires sensitivity. To motivate ongoing participation, cohorts must work to understand participant barriers and motivators, share scientific findings, and provide appropriate compensation for participation. It is essential for cohorts to strive for broad representation including individuals from higher risk populations, not only among the participants but also the staff. Successful longitudinal follow-up of a study population ultimately requires flexibility, adaptability, appropriate incentives, and opportunities for feedback from participants.
Mental disorders and ADHD in people with ID are higher than in the general population.Clinicians may be reluctant to diagnose ADHD in people with ID. They could be denied effective treatment.
The purpose of the study was to ascertain antipsychotic use in people with ID before and after the a diagnosis of ADHD.
A casenote review in an ID service for aduls with ADHD. Data collected on psychotropic use before and after the diagnosis.
Forty-eight aduls with ADHD-ID were identified. 38(79%) were male and 10(21%) were female. 19 to 58 years of age. Four (8%) had mild ID; 44 (92%) had moderate to severe ID. 27(56%) had anxiety, mood disorders or psychosis. 21(44%) had ADHD only. Challenging behaviour was reported in 24 (50%) of cases. Thirty-three (68%) used psychotropic medication prior to the diagnosis of ADHD and after the diagnosis. Post-diagnosis, 20(60%) continued to use antipsychotic medication indicating the elimiation of antipsychotic use in 13(40%) of people. The level of medication use remained the same in spite of the reduction of antipsychotic medication. The diagnoses of challenging behaviour was not affected by the reduction in antipsychotic medication and the increase in ADHD medication use.
The use of antipsychotic medication in people with intellectual disaibilities and ADHD is high. ADHD should be considered when people present wtih challenging behaviour. ADHD medication can be effective in treating ADHD-ID and can lead to a significant reduction in the use of antipsychotic medication.
Effective diagnostic and treatment pathways for ADHD are needed in prison settings due to the high prevalence of ADHD and comorbidities in the prison population.
In this presentation, we will describe two studies conducted in seperate London prisons in England. In the first study, the aim was to identify prisoners with ADHD with a focus on describing comorbidity. In the second study, using QI (quality improvement) methodology, the aim was to measure the practicability and effectiveness of a specialist ADHD diagnostic and treatment pathway for prisoners.
Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.
Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.
Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.
Magnetic resonance imaging scans of the internal acoustic meatus are commonly requested in the investigation of audio-vestibular symptoms for potential vestibular schwannoma. There have been multiple studies into protocols for requesting magnetic resonance imaging for vestibular schwannoma, but none have been reported based on UK National Institute for Health and Care Excellence guidelines for investigating audio-vestibular symptoms. This study intended to identify the local magnetic resonance imaging detection rates and patterns of vestibular schwannoma, and to audit the conformity of scan requests with the National Institute for Health and Care Excellence guidelines, with a review of relevant literature.
A retrospective analysis of 1300 magnetic resonance imaging scans of the internal acoustic meatus, compared against National Institute for Health and Care Excellence guidelines, was conducted over two years.
Results and conclusion
Sixteen scans were positive for vestibular schwannoma, with a detection rate of 1.23 per cent. All positive cases fit the guidelines; three of these could have been missed using other criteria. A total of 281 requests did not meet the guideline criteria but revealed no positive results, supporting the use of National Institute for Health and Care Excellence guidelines in planning magnetic resonance imaging scans for audio-vestibular symptoms.
The impacts of the COVID-19 pandemic affect all groups in society. People with intellectual disability (ID) are especially vulnerable to the physical, mental and social effects of the pandemic. Cognitive impairments can limit understanding of information to protect them relying on carers to be vigilant on their behalf during quarantine. Restrictions on usual activities are likely to induce mental stress especially among those who are autistic leading to an escalation in challenging behaviours, risk of placement breakdown and increased the use of psychotropic medication. People with ID are vulnerable to exploitation by others where the usual community supports no longer function to protect them. In future pandemics, it is important that lessons are learned from the impacts COVID-19 have on people with ID. Collecting the evidence through a rigorous approach should help to empower people with ID and their carers to face future outbreaks of infectious diseases.
Prevalence of ADHD among people with intellectual disability (ID) is higher than people without intellectual disability (Reilly & Holland 2010), however it appears to be underdiagnosed (Rose et al 2009).
Describe the prevalence of ADHD in ID psychiatric clinics and patient characteristics in Surrey, UK.
Patients' records in ID psychiatric clinics were audited.
14 patients attending ID clinics had a diagnosis of ADHD. Age range was 18 to 32. 85% were male. Prescribed ADHD medications were Concerta XL, Medikinet XL, methylphenidate, atomoxetine and clonidine. 21% were on combination of two ADHD medications. 43% of the patients were also on other psychotropic medications. 36% of patients with ADHD also had a diagnosis Autism. 42% had another comorbid mental disorder.
Given the prevalence rate for ID (1.03%) and ADHD (6.8%), nearly 400 individuals with ID should have a diagnosis of ADHD in this catchment area. Presence of only 14 individual with ADHD shows that ADHD is extremely under diagnosed and under treated within ID population. This raises the issue whether patients are treated with psychotropic medications and psychological methods for behavioural and mental health issues due to under diagnosis of ADHD. Diagnosis of ADHD and complexities of such diagnostic processes among people with ID may be some of the reasons for under diagnosis (White et al 1995, Reiss et al 1982). Screening tools and increasing awareness may be needed to detect ADHD symptoms in this group of people when psychiatric diagnoses are often challenging.
Prevalence of intellectual disability (ID) ranges from 0.05 to 1.55%. A total of10–15% of the people with ID present with challenging behavior (CB). This causes a significant strain on mental health services. People with ID; end up staying in psychiatric inpatient units for longer periods. Most people with ID move out of their family home to various care settings due to severity of their behavior difficulties. Few European countries have specialist services for people with ID whereas most countries manage people with ID and CB using adult mental health services. There is ongoing debate whether patients with ID and CB need to be managed by specialist services. There are significant financial implications looking after people with ID and CB. This has often led to over prescribing of psychotropic medications to people with ID without a mental disorder to manage their behaviors. There are significant strains on mental health services to manage people with ID and CB. This presentation discusses. Describe people with CB and ID and their characteristics including mental disorder, use of psychotropic medications, socio demographic factors and financial costs to look after them. Social and health care approach to look after people with CB in the UK, Challenges to develop services for people with CB in ID in Germany and Poland. Do we need specialist services for people with ID and CB? Pros and cons.
Disclosure of interest
COI: Bhathika Perera, I have received travel grants from pharmaceutical companies to attend ADHD conferences and I have been a speaker at pharmaceutical company sponsored events on ADHD.
Pregabalin is a well-established anti-epileptic drug in the treatment of epilepsy. It is also indicated for the treatment of generalised anxiety disorder and neuropathic pain. In addition, it has mood modulating properties. In people with intellectual disabilities it is used to treat epilepsy. There is little evidence of the use of pregabalin in managing mental health difficulties in people with intellectual disabilities.
To describe the use of pregabalin in adults with intellectual disabilities.
A descriptive case series of adults with intellectual disabilities living in the community, under the care of a community psychiatrist, who are prescribed Pregabalin. Outcomes of treatment were measured using the health of the nation outcome scale for people with intellectual disabilities (HoNOS-LD).
Fourteen cases were identified in the community service of adults with Intellectual Disabilities. Twelve were men and two were women. The average age of the sample was 29 years. The range in duration of using pregabalin was from 3 to 72 months. Thirteen adults had a diagnosis of Autism of which three also had ADHD. The indications for using pregabalin and numbers were : anxiety (12); liability of mood (2); generalised anxiety disorder (1); epilepsy (1). The daily dose range was from 150 mg to 300 mg The mean change in HoNOS-LD scores was 32%.
Pregabalin is a useful treatment in people with intellectual disabilities who experience anxiety. It is especially effective among adults with ID and autism to modulate mood and anxiety symptoms.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Prevalence of intellectual disability (ID) ranges from 0.05 to 1.55%. A total of 10–15% of the people with ID present with challenging behaviour (CB). This causes a significant strain on mental health services. People with ID often end up staying in psychiatric inpatient units for longer periods. Most people with ID move out of their family home to various care settings due to severity of their behavioural difficulties. This descriptive study shows characteristic features of people with ID and CB and financial costs to look after them in the community. This study highlights the importance to improve services to manage challenging behaviour, which may lead to better quality of life to the person with CB and reduction in financial pressures.
Disclosure of interest
COI: Bhathika Perera has received grants to attend conferences and speak at ADHD conferences by pharmaceutical companies.
Fasciola jacksoni is a significant contributor to the health and mortality of Asian elephants, particularly those in Sri Lanka. Despite the impact of fascioliasis on elephant populations, it is a neglected veterinary disease with limited taxonomic understanding. Molecular characterization and phylogenetic analysis of F. jacksoni were carried out to evaluate its suggested basal position in the Fasciolidae. Adult worms were collected during post-mortem of elephants, and eggs were collected from living elephants in National parks across Sri Lanka. Using the mitochondrial genes nicotinamide dehydrogenase subunit 1 (nad1) and cytochrome oxidase subunit 1 (cox1), and a partial 28S ribosomal DNA (28S rDNA), DNA sequences were generated from the F. jacksoni adult and egg material. Maximum likelihood (ML) phylogenetic analyses did not resolve F. jacksoni to be basal to the Fasciolidae. Furthermore, the ML analyses showed that the genus Fasciola was not monophyletic and that F. jacksoni was a sister species to the deer liver fluke Fascioloides magna. A clear framework is required to determine the taxonomic status of F. jacksoni and this current study provides the first detailed application of molecular techniques from multiple hosts across Sri Lanka with the production of reference DNA sequences for this important parasite.
Micronutrient supplementation is recommended in Ebola Virus Disease (EVD). However, there is limited data on its therapeutic impacts. This study evaluated the association between vitamin A supplementation and mortality outcomes in EVD patients.
This retrospective cohort study accrued patients with EVD admitted to five International Medical Corps run Ebola Treatment Units (ETU) in two countries from 2014-2015. Protocolized treatments with antimicrobials and micronutrients were used at all ETUs. However, due to resource limitations and care variations, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola virus RT-PCR cycle threshold (CT) values were collected. The outcome of interest was mortality compared between cases treated with 200,000 International Units of vitamin A on care days one and two and those not. Propensity scores (PS) based on the first 48-hours of care were derived using the covariates of age, duration of ETU function, malaria status, CT values, symptoms of confusion, hemorrhage, diarrhea, dysphagia, and dyspnea. Treated and non-treated cases were matched 1:1 based on nearest neighbors with replacement. Covariate balance met predefined thresholds. Mortality proportions between cases treated and untreated with vitamin A were compared using generalized estimating equations to calculate relative risks (RR) with associated 95% confidence intervals (CI).
There were 424 cases analyzed, with 330 (77.8%) being vitamin A-treated cases. The mean age was 30.5 years and 57.0% were female. The most common symptoms were diarrhea (86%), anorexia (81%), and vomiting (77%). Mortality proportions among cases untreated and treated with vitamin A were 71.9% and 55.0%, respectively. In a propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77 95%; CI:0.59-0.99; p = 0.041).
Early vitamin A supplementation was associated with reduced mortality in EVD patients and should be provided routinely during future epidemics.
PSR B1820–30A is located in the globular cluster NGC 6624 and has the smallest projected distance to the centre of any globular cluster in the sky plane. We observe this millisecond pulsar over more than 25 years and obtain higher-order rotational frequency time derivative measurements through high-precision timing. Modelling these higher-order derivatives as being due to orbital motion, we find that the pulsar is in either a low-eccentricity smaller orbit with a low mass companion or a high-eccentricity larger orbit with a massive companion. The cluster mass properties and the observed properties of other nearby sources indicate that the high-eccentricity solution is more probably. This reveals that the pulsar is orbiting around an intermediate-mass black hole (IMBH) of mass >7500 M⊙ located at the cluster centre. This contribution is based on previous work published in MNRAS 471, 1258 (2017).
Dengue vector control programmes are mainly focused on insecticide fogging/space spraying to control adult Aedes mosquito vector populations. Due to the diurnal habit of the vectors, spraying is routinely conducted during the day when many other insect species are also active. This study reports the simultaneous effect of fogging on non-target insects by direct counting of knockdown in the insect population. Eight fogging treatments were conducted in two sites in Kurunegala District of Sri Lanka. Pesguard insecticide was sprayed in each treatment for 8 minutes according to the standard methodology and the ‘knockdown insects’ were collected on randomly spread polyethythene sheets (10 m2). A total of 3884 insects (24.3 insects per treatment per m2) belonging to 12 orders were collected and 12.44% of them recovered during a 24-hr recovery period. Diptera was the most affected insect order (36%) followed by Collembola (30%) and Thysanoptera (17%). Out of the 31 mosquitoes (<1%) collected, only two (<0.1%) belonged to the genus Aedes. Body length of 93% of the affected insects ranged from 0.35 mm to 1.8 mm. Positive controls using the WHO standard cage bioassays with the mosquito Ae. albopictus (n = 417) and the stingless bee Trigona iridipennis (n = 122) showed 100% initial knockdown, and 83.5% mosquito and 93.5% bee mortalities after the recovery period. The study shows that insecticide fogging does have a severe effect on non-target insects such as pollinators; therefore, fogging operations should be done in a controlled manner and indiscriminate fogging should be avoided.
Most influenza virus infections are associated with mild disease. One approach to estimate the occurrence of influenza virus infections in individuals is via repeated measurement of humoral antibody titres. We used baseline and convalescent antibody titres measured by haemagglutination inhibition (HI) and viral neutralization (VN) assays against influenza A(H1N1), A(H3N2) and B viruses to investigate the characteristics of antibody rises following virologically confirmed influenza virus infections in participants in a community-based study. Multivariate models were fitted in a Bayesian framework to characterize the distribution of changes in antibody titres following influenza A virus infections. In 122 participants with PCR-confirmed influenza A virus infection, homologous antibody titres rose by geometric means of 1·2- to 10·2-fold after infection with A(H1N1), A(H3N2) and A(H1N1)pdm09. Significant cross-reactions were observed between A(H1N1)pdm09 and seasonal A(H1N1). Antibody titre rises for some subtypes and assays varied by age, receipt of oseltamivir treatment, and recent receipt of influenza vaccination. In conclusion, we provided a quantitative description of the mean and variation in rises in influenza virus antibody titres following influenza virus infection. The multivariate patterns in boosting of antibody titres following influenza virus infection could be taken into account to improve estimates of cumulative incidence of infection in seroepidemiological studies.
We examined factors affecting the immunogenicity of trivalent inactivated influenza vaccination (TIV) in children using the antibody titres of children participating in a Hong Kong community-based study. Antibody titres of strains included in the 2009–2010 northern hemisphere TIV [seasonal A(H1N1), seasonal A(H3N2) and B (Victoria lineage)] and those not included in the TIV [2009 pandemic A(H1N1) and B (Yamagata lineage)] were measured by haemagglutination inhibition immediately before and 1 month after vaccination. Multivariate regression models were fitted in a Bayesian framework to characterize the distribution of changes in antibody titres following vaccination. Statistically significant rises in geometric mean antibody titres were observed against all strains, with a wide variety of standard deviations and correlations in rises observed, with the influenza type B antibodies showing more variability than the type A antibodies. The dynamics of antibody titres after vaccination can be used in more complex models of antibody dynamics in populations.
Dengue has become the fastest-growing mosquito-borne disease in Sri Lanka and the control of the vectors, Aedes aegypti Linnaeus and Ae. albopictus Skuse, is the most effective way of controlling the disease. A detailed study on vector prevalence has not been recorded from Sri Lanka. Therefore, the present study was undertaken to study the prevalence of both vectors in four semi-urban study sites in two of the most affected districts, namely Kandy (wet zone) and Kurunegala (intermediate zone), by conducting egg surveys (using ovitraps) and larval surveys from June 2007 to May 2008. A total of 82,524 eggs and 2658 larvae of Ae. aegypti and Ae. albopictus were collected. A total of 3699 potential breeding habitats were examined. Ovitrap and larval indices (house, container and Breteau) showed that all four areas are at epidemic risk, especially due to a high abundance of Ae. albopictus. The highest numbers for both the species were from the Kandy sites where dense vegetation, high rainfall and low temperature prevailed. The results showed a high mortality rate during the egg-to-larva transition, suggesting that conducting an egg survey alone would overestimate the vector abundance and the disease risk. For Ae. albopictus, the monthly mean number of eggs showed positive relationships with relative humidity in both districts and with rainfall in the Kandy District. The number of dengue cases in the area had no positive relationships with the abundance of eggs or larval density indices. Discarded receptacles were the most preferred breeding habitat for these dengue vectors. Since the attractiveness (inferred by the calculated risk factors) of most of the breeding habitats was very high, elimination of these breeding sites is essential for the success of dengue control programmes.
We report the results of the New Zealand Acute Gastrointestinal Illness (AGI) Community Study, a representative cross-sectional community telephone survey of 3655 participants conducted over a 12-month period. Respondents were asked questions about vomiting and diarrhoea in the previous 4 weeks. At least one episode of diarrhoea and/or vomiting was reported by 8·6% of respondents, an incidence of 1·11 episodes/person per year. Prevalence was highest in children aged <5 years and lowest in those aged >64 years. The mean duration of illness was 2·5 days and most common symptoms were diarrhoea (82·5%), stomach cramps (75·7%), nausea (56·9%) and vomiting (49·0%). Extrapolation of the adjusted estimates indicates there are about 4·66 million episodes of AGI per year in New Zealand, nearly 1 million visits to the general medical practitioner, in excess of 300 000 courses of antibiotics being dispensed and more than 4·5 million days of paid work lost due to AGI. This represents a significant burden of disease.