One in 57 children are diagnosed with autism in the UK, and the estimated cost for supporting these children in education is substantial. Social Stories™ is a promising and widely used intervention for supporting children with autism in schools and families. It is believed that Social Stories™ can provide meaningful social information to children that can improve social understanding and may reduce anxiety. However, no economic evaluation of Social Stories has been conducted.

To assess the cost-effectiveness of Social Stories through Autism Spectrum Social Stories in Schools Trial 2, a multi-site, pragmatic, cluster-randomised controlled trial.

Children with autism who were aged 4–11 years were recruited and randomised (N = 249). Costs measured from the societal perspective and quality-adjusted life-years (QALYs) measured by the EQ-5D-Y-3L proxy were collected at baseline and at 6-month follow-up for primary analysis. The incremental cost-effectiveness ratio was calculated, and the uncertainty around incremental cost-effectiveness ratios was captured by non-parametric bootstrapping. Sensitivity analyses were performed to evaluate the robustness of the primary findings.

Social Stories is likely to result in a small cost savings (–£191 per child, 95% CI −767.7 to 337.7) and maintain similar QALY improvements compared with usual care. The probability of Social Stories being a preferred option is 75% if society is willing to pay £20 000 per QALY gained. The sensitivity analysis results aligned with the main study outcomes.

Compared with usual care, Social Stories did not lead to an increase in costs and maintained similar QALY improvements for primary-aged children with autism.

Older age is associated with an increase in altruistic behaviors such as charitable giving. However, few studies have investigated the cognitive correlates of financial altruism in older adults. This study investigated the cognitive correlates of financial altruism measured using an altruistic choice paradigm in a community-based sample of older adults.

In the present study, a sample of older adults (N = 67; M age = 69.21, SD = 11.23; M education years = 15.97, SD = 2.51; 58.2% female; 71.6% Non-Hispanic White) completed a comprehensive neuropsychological assessment and an altruistic choice paradigm in which they made decisions about allocating money between themselves and an anonymous person.

In multiple linear regression analyses that controlled for age, education, and sex, financial altruism was negatively associated with performance on cognitive measures typically sensitive to early Alzheimer’s Disease. These included CVLT-II Short Delay Free Recall (Beta=-0.26, p=0.03); CVLT-II Long Delay Cued Recall (Beta=-0.32, p=0.04), Craft Story 21 Delayed Recall (Beta=-0.32, p=0.01), and Animal Fluency (Beta=-0.27, p=0.02). Findings held when responses were grouped according to how much was given (Gave Equally, Gave More, Gave Less) for word list memory and story memory measures.

Findings of this study point to a negative relationship between financial altruism and cognitive functioning in older adults on measures known to be sensitive to Alzheimer’s Disease (AD). Findings also point to a potential link between financial exploitation risk and AD in older age.

In recent years, rates of alcohol consumption and alcohol use disorder have steadily increased among adults age 60 and older. Large studies have demonstrated that moderate-to-heavy alcohol consumption (>7 drinks per week) is a risk factor for developing various types of dementias. The effects of alcohol-related problems on cognition are less clear, and are particularly understudied in older adults. Similarly, while there is an established link between worse cognition and financial exploitation vulnerability in older adults, no studies have examined relationships between alcohol-related problems and financial exploitation in this population. The current study therefore explores whether alcohol-related problems are associated with neuropsychological performance and financial exploitation vulnerability in a sample of older adults.

Participants were a community sample of cognitively unimpaired adults over the age of 50 (N = 55, Age M(SD) = 69.1(6.2), 74.5% female, Years of education M(SD) = 16.8(2.3)). Interested individuals were excluded if they reported current or past substance use disorders. Participants completed a laboratory visit that included a neuropsychological assessment. Measures included the NIH Cognition toolbox, CVLT-II, Digit Span, Trails A/B, Benson Complex Figure Recall, and Verbal Fluency: Phonemic and Semantic, from the Alzheimer’s Disease Centers’ Uniform Data Set (UDS) version 3. Participants completed the CAGE Alcohol Abuse Screening Tool and the Short Michigan Alcohol Screener Test - Geriatric Version (SMAST) to assess alcohol-related problems. Both measures are used as clinical screening tools to measure likelihood of a substance use disorder and produce a summary score (0-4 for CAGE, 010 for SMAST) tabulating symptoms of alcohol-related problems. Participants also completed the Perceived Financial Vulnerability Scale (PFVS) to assess financial exploitation vulnerability. As a significant number of participants reported no drinking and therefore no alcohol-related problems, negative binomial regressions were used to test associations between neuropsychological measures, financial exploitation vulnerability, and alcohol-related problems.

After covarying for age and sex, SMAST was negatively associated with NIH toolbox total cognition (B(SE) = -.14(.07), p<.05) and marginally negatively associated with fluid cognition (B(SE) = -.07(.04), p=.06). Neither SMAST nor CAGE scores were significantly associated with performance on any other neuropsychological test (ps = .13-.99). SMAST was positively associated with financial exploitation vulnerability (B(SE) = .31(.16), p = .05); this effect remained significant after covarying for NIH total composite score in a secondary analysis.

In a community sample of cognitively unimpaired, low-drinking adults over the age of 50, more alcohol-related problems were associated with worse NIH toolbox cognition scores. Similarly, more alcohol-related problems were associated with greater financial exploitation vulnerability, and this relationship was not driven by worse cognition. These results suggest that even low amounts of drinking and alcohol-related problems may be associated with cognition and financial exploitation vulnerability in cognitively unimpaired older adults. This study also corroborates the use of the SMAST over the CAGE in older adult populations that may be more sensitive to cognitive changes.

Prior work suggests financial exploitation vulnerability may be an early behavioral manifestation of Alzheimer’s disease (AD). Brain morphometric measures of the parahippocampal gyrus and entorhinal cortex have been shown to be sensitive to early AD progression. We hypothesized that perceived financial exploitation vulnerability may be associated with morphometric measures of the parahippocampal gyrus and entorhinal cortex in cognitively unimpaired older adults. We secondarily investigated the association of morphometric measures with neuropsychological measures.

The sample consisted of 39 cognitively unimpaired older adults (mean age = 68.74 ± 6.43, mean education = 16.87 ± 2.35, 77% female). Cognitive impairment was screened using the telephone version of the Montreal Cognitive Assessment (MoCA) and the cut-off was 21 for study participation. Perceived financial exploitation vulnerability was characterized using a 6-item self-report measure derived from the contextual items of the Lichtenberg Financial Rating Scale. Neuropsychological measures included the CVLT-II Long Delay Free Recall (verbal memory), Benson Complex Figure Recall (visual memory), and Verbal Fluency: Phonemic Test from the Alzheimer’s Disease Centers’ Uniform Data Set (UDS) version 3. Brain images were collected on a 7 Tesla Siemens Magnetom with the following parameters: TE=2.95ms, TR=2200ms, 240 sagittal slices, acquired voxel size (avs)=0.7mm x 0.7mm x 0.7mm. Structural brain images were processed using FreeSurfer version 7.2.0. Cortical thickness and volume measures were generated using the Killiany/Desikian parcellation atlas. Regions were averaged across hemispheres to obtain a single value for each region. Volume measures were adjusted for intracranial volume. Bivariate analyses were conducted to assess relationships between each outcome variable and potential confounders (age, sex, and education). Linear regression models were adjusted for any covariates significantly associated with the outcome variable (none for perceived financial exploitation vulnerability; sex and age for verbal memory; education for visual memory; sex for verbal fluency).

Smaller entorhinal cortex volume (β = -1275.14, SE = 582.79, p < 0.05) and lower parahippocampal gyrus thickness (β = -3.37, SE = 1.57, p < 0.05) were significantly associated with greater perceived financial exploitation vulnerability. Lower entorhinal cortex thickness was marginally associated with greater perceived financial exploitation vulnerability (β = -2.03, SE = 1.11, p = 0.08). Higher parahippocampal gyrus thickness was associated with better verbal fluency (β = 17.66, SE = 7.01, p < 0.05). Higher entorhinal cortex thickness was associated with better visual memory (β = 4.71, SE = 1.73, p < 0.05). No significant associations were observed between structural brain measures and verbal memory.

These results suggest smaller entorhinal cortex volume and lower parahippocampal gyrus thickness are associated with higher perceived financial exploitation vulnerability in cognitively normal older adults. Additionally, parahippocampal gyrus thickness appears to be associated with verbal fluency abilities while entorhinal cortex thickness appears to be associated with visual memory. Taken together, these findings lend support to the notion that financial exploitation vulnerability may serve as an early behavioral manifestation of preclinical AD. Longitudinal studies are needed to better understand the temporal nature of these relationships.

The relationship between schizophrenia and violence is complex. The aim of this multicentre case–control study was to examine and compare the characteristics of a group of forensic psychiatric patients with a schizophrenia spectrum disorders and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence.

Overall, 398 patients (221 forensic and 177 non-forensic patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardised process.

The most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost always antisocial personality disorder (49.1 v. 0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant.

This study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.

The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies.

To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design.

Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18–81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted.

The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59–3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01).

The results challenge the theoretical validity of the IPTS and its clinical utility – at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.

Serious games are a novel and entertaining approach for digital health education in the younger population. Aim of this pilot study was to evaluate the short-term effectiveness of the serious game “Fit, Food, Fun” (FFF) among a subset of children and adolescents in Germany with regard to nutritional knowledge.

Two Bavarian secondary schools were each allocated to one intervention arm. The gameplay intervention (gameplay group; GG) consisted of a 15-minute gameplay session for each of three days (Tuesday to Thursday), while the teaching intervention (teaching group; TG) was performed as a 15-minute classic lecture for the same number of days. Given nutritional information was based on the recommendations of the “German Nutrition Society e.V.” and was identical for both intervention groups. Nutritional knowledge was evaluated through a standardised questionnaire at baseline (Monday) and post-intervention (Friday). Lifestyle behaviour (diet; physical activity) and anthropometrics (height; weight) were assessed once at baseline. Inclusion criteria were sufficient German language skills and parental consent form. Statistical analyses were performed using the statistical software R (R Core Team, 2018).

In total, 47 students (62% male) were assigned to the GG and 47 students (72% male) to the TG. The mean age was 13.5 years in the GG and 12.8 years in the TG. The mean body mass index was in the normal range (GG: 24.4 kg/m2; TG: 22.0 kg/m2). Data at baseline and post-intervention are analysed for 36 participants in the GG and for 40 participants in the TG. Compared to baseline, results revealed significant improvements (p-value < 0.001) in nutritional knowledge in both intervention groups. There was a between-group difference with significantly (p-value = 0.0139) higher increase of nutritional knowledge in the TG.

This pilot study provides evidence for the short-term efficacy of both game-based and traditional education approaches on the improvement of nutritional knowledge; however, further research in warranted to assess the potential effect of a digital gameplay intervention on nutritional behaviour. Finally, the FFF game might be considered as an appropriate educational tool for imparting nutritional knowledge in an entertaining and effective format among children and adolescents.

To assess the consumption of sugar-sweetened beverages (SSB) and other energy-dense nutrient-poor (EDNP) foods in two Southern low-income communities targeted by the Balance Calories Initiative, a campaign by the top-three American beverage companies intended to reduce the consumption of sugary beverages by 20 % over 10 years.

We conducted self-administered intercept surveys in front of food retail outlets between August and November 2016. We recruited adults with children <18 years living at home and adolescents aged 10–17 years with parental consent.

Retail food outlets in Mississippi and Alabama, USA.

Adults (n 11 311) and adolescents (n 3460).

The percentage of high SSB consumers (≥4 servings/d) was 40·9 % among adult males, 32·3 % among adult females, 43·0 % among adolescent males and 34·4 % among adolescent females (male – female difference, P < 0·0001). In aggregate, respondents also reported consuming a mean of 3 servings of salty snacks, cookies and/or candy in the past 24 h, with adolescent males reporting 4 servings.

SSB should be a primary target of future interventions to improve dietary intake, but EDNP foods likely contribute as many daily kilojoules as SSB among this population. Future campaigns should aim to limit the consumption of all EDNP foods.

Patient registries represent an important method of organizing “real world” patient information for clinical and research purposes. Registries can facilitate clinical trial planning and recruitment and are particularly useful in this regard for uncommon and rare diseases. Neuromuscular diseases (NMDs) are individually rare but in aggregate have a significant prevalence. In Canada, information on NMDs is lacking. Barriers to performing Canadian multicentre NMD research exist which can be overcome by a comprehensive and collaborative NMD registry.

We describe the objectives, design, feasibility and initial recruitment results for the Canadian Neuromuscular Disease Registry (CNDR).

The CNDR is a clinic-based registry which launched nationally in June 2011, incorporates paediatric and adult neuromuscular clinics in British Columbia, Alberta, Ontario, Quebec, New Brunswick and Nova Scotia and, as of December 2012, has recruited 1161 patients from 12 provinces and territories. Complete medical datasets have been captured on 460 “index disease” patients. Another 618 “non-index” patients have been recruited with capture of physician-confirmed diagnosis and contact information. We have demonstrated the feasibility of blended clinic and central office-based recruitment. “Index disease” patients recruited at the time of writing include 253 with Duchenne and Becker muscular dystrophy, 161 with myotonic dystrophy, and 71 with ALS.

The CNDR is a new nationwide registry of patients with NMDs that represents an important advance in Canadian neuromuscular disease research capacity. It provides an innovative platform for organizing patient information to facilitate clinical research and to expedite translation of recent laboratory findings into human studies.