Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., & Magnusson, C. (2013). Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: Population based case-control study. BMJ : British Medical Journal (Online), 346 doi:http://dx.doi.org.saintleo.idm.oclc.org/10.1136/bmj.f2059
Parental depression, maternal antidepressant use
during pregnancy, and risk of autism spectrum
disorders: population based case-control study
OPEN ACCESS
Dheeraj Rai clinical lecturer 1 2 3, Brian K Lee assistant professor 4, Christina Dalman associate
professor2, Jean Golding professor emeritus5, Glyn Lewis professor1, Cecilia Magnusson professor2
1Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK;
2Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 3Avon and Wiltshire
Partnership Mental Health NHS Trust, Bristol, UK; 4Department of Epidemiology and Biostatistics, Drexel University School of Public Health,
Philadelphia, PA, USA; 5Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
Abstract
Objective To study the association between parental depression and
maternal antidepressant use during pregnancy with autism spectrum
disorders in offspring.
Design Population based nested case-control study.
Setting Stockholm County, Sweden, 2001-07.
Participants 4429 cases of autism spectrum disorder (1828 with and
2601 without intellectual disability) and 43 277 age and sex matched
controls in the full sample (1679 cases of autism spectrum disorder and
16 845 controls with data on maternal antidepressant use nested within
a cohort (n=589 114) of young people aged 0-17 years.
Main outcome measure A diagnosis of autism spectrum disorder, with
or without intellectual disability.
Exposures Parental depression and other characteristics prospectively
recorded in administrative registers before the birth of the child. Maternal
antidepressant use, recorded at the first antenatal interview, was
available for children born from 1995 onwards.
Results A history of maternal (adjusted odds ratio 1.49, 95% confidence
interval 1.08 to 2.08) but not paternal depression was associated with
an increased risk of autism spectrum disorders in offspring. In the
subsample with available data on drugs, this association was confined
to women reporting antidepressant use during pregnancy (3.34, 1.50 to
7.47, P=0.003), irrespective of whether selective serotonin reuptake
inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were
reported. All associations were higher in cases of autism without
intellectual disability, there being no evidence of an increased risk of
autism with intellectual disability. Assuming an unconfounded, causal
association, antidepressant use during pregnancy explained 0.6% of
the cases of autism sp ...
11. Identifying the Elements of the Limitations & ImplicationsGo tBenitoSumpter862
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
11. Identifying the Elements of the Limitations & ImplicationsGo tSantosConleyha
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
Intrauterine alcohol exposure and offspring mental health: A systematic reviewBARRY STANLEY 2 fasd
2
Abstract
Background: High levels of alcohol use in pregnancy have been shown to be associated with negative physical health consequences in offspring. However, the literature is less clear
on the association of alcohol use in pregnancy and offspring mental health disorders. We conducted a systematic review to evaluate studies examining this association.
Methods: Studies were identified by searching PsycINFO, PubMed and Web of Science, and were included if they examined alcohol use during pregnancy as an exposure and
offspring mental health at age 3 or older as an outcome. We excluded non-English language publications, and studies of foetal alcohol syndrome.
Results: Thirty-three studies were included and were categorised by mental health outcomes: anxiety/depression, emotional problems, total internalising problems, total
problem score, and conduct disorder. Over half of the analyses reported a positive association of intrauterine alcohol exposure and negative offspring mental health outcomes.
Conclusions: Our review suggests that maternal alcohol use during pregnancy is associated with negative offspring mental health outcomes, even at low to moderate levels of alcohol use. Future investigation using methods that allow stronger causal inference are needed to further investigate if these associations shown are causal.
Returning genetic research results in neurodevelopmental disorders: report an...KBHN KT
This report originated from discussions at the Annual Brain Development Conference in
late 2013 between researchers in the Neuroethics Core and Autism Spectrum Disorders
Project of NeuroDevNet. Discussants felt that return of research results is a pertinent
issue but that researchers are missing a comprehensive picture of the recommendations,
approaches and empirical data related to the return of research results in genetics studies
in children, in neurodevelopmental disorders, and specifically in autism.
This report provides an overview of recent genetic studies of autism spectrum disorder
(ASD), and reviews the ethical guidance (policies and peer-reviewed literature) and
best practices on the return of individual research results in adult and pediatric genetic
research. We focus on this case because of the wealth of genetic research being
carried out in families and cohorts to explain the etiology of ASD and because there is a
burgeoning literature on parental perspectives on the return of results in this case. The
empirical perspectives are collected and summarized and provide context with regard to
researcher and parent perspectives on the return of genetic results in ASD studies.
We conclude by making recommendations about the return of both incidental and
ASD-related findings and highlight issues that merit further discussion, including the
role of the child or adolescent with developmental disability in decision-making, and
the importance of risk communication. We believe that the report will be of use not only
for those working in the area of ASD but more broadly in the field of pediatric genetic
research and neurodevelopmental disorder research. For example, the publication of new
evidence showing that genetic alterations play an important role in the etiology of cerebral
palsy in some children means that genetic research may becoming increasingly common
in other areas of the study of neurodevelopmental disorders.
Parents perceptions of autism and theirhealth-seeking behavemelyvalg9
Parents' perceptions of autism and their
health-seeking behaviors
Maria Isabel O. Quilendrino a,*, Mary Anne R. Castor a,
Nenacia Ranali Nirena P. Mendoza b, Jacqueline R. Vea c,
Nina T. Castillo-Carandang c
a Department of Clinical Epidemiology and Department of Pediatrics, College of Medicine, University of the Philippines,
Manila, Philippines
b Department of Clinical Epidemiology and Department of Family and Community Medicine, College of Medicine,
University of the Philippines, Manila, Philippines
c Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 3 ( 2 0 1 5 ) s 1 0 – s 1 5
a r t i c l e i n f o
Article history:
Received 15 September 2015
Accepted 13 November 2015
Available online 7 December 2015
Keywords:
Autism
Autistic disorder
Behavior
Perception
a b s t r a c t
Background: Parents' health-seeking behaviors, which in turn may be related to their per-
ceptions, are hypothesized to be the major determinant of the timing of diagnosis and
subsequent intervention for children with autism.
Objective: The primary objective of this study was to describe parental perceptions of autism
and health-seeking behaviors for urban Filipino children aged 2–6 years.
Methods: This was a cross-sectional study conducted in several phases. The first phase
involved collection of qualitative data from key informant interviews and small group
discussions. The second phase involved the development of a validated and reliable ques-
tionnaire, which was administered to 41 parents of children with autism, aged 2–6 years.
Results: Parents had varying perceptions of autism. They were generally undecided with
regard to the etiology of autism, but were in agreement that psychosocial factors, such as
parental sins and curses, were unlikely to be associated with autism. The most common
presenting symptom noted by parents was a qualitative impairment in social interaction.
There was a noted trend towards earlier age of symptom recognition (mean of 24 months)
and diagnosis of autism (mean of 39 months) among parents with younger children.
Conclusion: The results of this study showed some trends: There is improved awareness
regarding autism and the needs of children with autism. Parents tend to disagree with
previous myths about autism. There was an observable trend toward earlier diagnosis for
this group.
# 2015 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All
rights reserved.
* Corresponding author. Tel.: +63 9178033888; fax: +63 27311631.
E-mail address: [email protected] (M.I.O. Quilendrino).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/cegh
http://dx.doi.org/10.1016/j.cegh.2015.11.003
2213-3984/# 2015 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
http://crossmar ...
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This presentation is a Grand Rounds for the Dept. of Pediatrics at Mt. Sinai Hospital in Chicago. Presented by child psychiatrist, Daniel B. Martinez, M.D. February 9, 2011
A Phenotypic Structure and Neural Correlates ofCompulsive Be.docxransayo
A Phenotypic Structure and Neural Correlates of
Compulsive Behaviors in Adolescents
Chantale Montigny1*, Natalie Castellanos-Ryan1, Robert Whelan7,20, Tobias Banaschewski3,17,19, Gareth J.
Barker5, Christian Büchel4, Jürgen Gallinat6, Herta Flor3,17,19, Karl Mann3,17,19, Marie-Laure Paillère-
Martinot8,9, Frauke Nees3,17,19, Mark Lathrop10, Eva Loth2,5, Tomas Paus11,12,13, Zdenka Pausova18, Marcella
Rietschel3,17,19, Gunter Schumann2,5, Michael N. Smolka14,15, Maren Struve3, Trevor W. Robbins16, Hugh
Garavan7,20, Patricia J. Conrod1,5, and the IMAGEN Consortium¶
1 Department of Psychiatry, Université de Montréal, CHU Ste Justine Hospital, Montreal, Canada, 2 MRC Social, Genetic and Developmental Psychiatry
(SGDP) Centre, London, United Kingdom, 3 Central Institute of Mental Health, Mannheim, Germany, 4 Universitaetsklinikum Hamburg Eppendorf, Hamburg,
Germany, 5 Institute of Psychiatry, King’s College London, United Kingdom, 6 Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité,
Universitätsmedizin Berlin, Germany, 7 Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland, 8 Institut National de la Santé et de la Recherche
Médicale, INSERM CEA Unit 1000 “Imaging & Psychiatry”, University Paris Sud, Orsay, France, 9 AP-HP Department of Adolescent Psychopathology and
Medicine, Maison de Solenn, University Paris Descartes, Paris, France, 10 Centre National de Génotypage, Evry, France, 11 Rotman Research Institute,
University of Toronto, Toronto, Canada, 12 School of Psychology, University of Nottingham, United Kingdom, 13 Montreal Neurological Institute, McGill
University, Montreal, Canada, 14 Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany, 15 Neuroimaging Center,
Department of Psychology, Technische Universität Dresden, Germany, 16 Behavioural and Clinical Neurosciences Institute, Department of Experimental
Psychology, University of Cambridge, United Kingdom, 17 Mannheim Medical Faculty, University of Heidelberg, Germany, 18 The Hospital for Sick Children,
University of Toronto, Toronto, Canada, 19 Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Department of Addictive
Behaviour and Addiction Medicine, Manheim, Germany, 20 Departments of Psychiatry and Psychology, University of Vermont, Burlington, Vermont, United
States of America
Abstract
Background: A compulsivity spectrum has been hypothesized to exist across Obsessive-Compulsive disorder
(OCD), Eating Disorders (ED), substance abuse (SA) and binge-drinking (BD). The objective was to examine the
validity of this compulsivity spectrum, and differentiate it from an externalizing behaviors dimension, but also to look
at hypothesized personality and neural correlates.
Method: A community-sample of adolescents (N=1938; mean age 14.5 years), and their parents were recruited via
high-schools in 8 European study sites. Data on adolescents’ psychiatric symptoms, DSM diagnoses (DAWBA) and
s.
11. Identifying the Elements of the Limitations & ImplicationsGo tBenitoSumpter862
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
11. Identifying the Elements of the Limitations & ImplicationsGo tSantosConleyha
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
Intrauterine alcohol exposure and offspring mental health: A systematic reviewBARRY STANLEY 2 fasd
2
Abstract
Background: High levels of alcohol use in pregnancy have been shown to be associated with negative physical health consequences in offspring. However, the literature is less clear
on the association of alcohol use in pregnancy and offspring mental health disorders. We conducted a systematic review to evaluate studies examining this association.
Methods: Studies were identified by searching PsycINFO, PubMed and Web of Science, and were included if they examined alcohol use during pregnancy as an exposure and
offspring mental health at age 3 or older as an outcome. We excluded non-English language publications, and studies of foetal alcohol syndrome.
Results: Thirty-three studies were included and were categorised by mental health outcomes: anxiety/depression, emotional problems, total internalising problems, total
problem score, and conduct disorder. Over half of the analyses reported a positive association of intrauterine alcohol exposure and negative offspring mental health outcomes.
Conclusions: Our review suggests that maternal alcohol use during pregnancy is associated with negative offspring mental health outcomes, even at low to moderate levels of alcohol use. Future investigation using methods that allow stronger causal inference are needed to further investigate if these associations shown are causal.
Returning genetic research results in neurodevelopmental disorders: report an...KBHN KT
This report originated from discussions at the Annual Brain Development Conference in
late 2013 between researchers in the Neuroethics Core and Autism Spectrum Disorders
Project of NeuroDevNet. Discussants felt that return of research results is a pertinent
issue but that researchers are missing a comprehensive picture of the recommendations,
approaches and empirical data related to the return of research results in genetics studies
in children, in neurodevelopmental disorders, and specifically in autism.
This report provides an overview of recent genetic studies of autism spectrum disorder
(ASD), and reviews the ethical guidance (policies and peer-reviewed literature) and
best practices on the return of individual research results in adult and pediatric genetic
research. We focus on this case because of the wealth of genetic research being
carried out in families and cohorts to explain the etiology of ASD and because there is a
burgeoning literature on parental perspectives on the return of results in this case. The
empirical perspectives are collected and summarized and provide context with regard to
researcher and parent perspectives on the return of genetic results in ASD studies.
We conclude by making recommendations about the return of both incidental and
ASD-related findings and highlight issues that merit further discussion, including the
role of the child or adolescent with developmental disability in decision-making, and
the importance of risk communication. We believe that the report will be of use not only
for those working in the area of ASD but more broadly in the field of pediatric genetic
research and neurodevelopmental disorder research. For example, the publication of new
evidence showing that genetic alterations play an important role in the etiology of cerebral
palsy in some children means that genetic research may becoming increasingly common
in other areas of the study of neurodevelopmental disorders.
Parents perceptions of autism and theirhealth-seeking behavemelyvalg9
Parents' perceptions of autism and their
health-seeking behaviors
Maria Isabel O. Quilendrino a,*, Mary Anne R. Castor a,
Nenacia Ranali Nirena P. Mendoza b, Jacqueline R. Vea c,
Nina T. Castillo-Carandang c
a Department of Clinical Epidemiology and Department of Pediatrics, College of Medicine, University of the Philippines,
Manila, Philippines
b Department of Clinical Epidemiology and Department of Family and Community Medicine, College of Medicine,
University of the Philippines, Manila, Philippines
c Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 3 ( 2 0 1 5 ) s 1 0 – s 1 5
a r t i c l e i n f o
Article history:
Received 15 September 2015
Accepted 13 November 2015
Available online 7 December 2015
Keywords:
Autism
Autistic disorder
Behavior
Perception
a b s t r a c t
Background: Parents' health-seeking behaviors, which in turn may be related to their per-
ceptions, are hypothesized to be the major determinant of the timing of diagnosis and
subsequent intervention for children with autism.
Objective: The primary objective of this study was to describe parental perceptions of autism
and health-seeking behaviors for urban Filipino children aged 2–6 years.
Methods: This was a cross-sectional study conducted in several phases. The first phase
involved collection of qualitative data from key informant interviews and small group
discussions. The second phase involved the development of a validated and reliable ques-
tionnaire, which was administered to 41 parents of children with autism, aged 2–6 years.
Results: Parents had varying perceptions of autism. They were generally undecided with
regard to the etiology of autism, but were in agreement that psychosocial factors, such as
parental sins and curses, were unlikely to be associated with autism. The most common
presenting symptom noted by parents was a qualitative impairment in social interaction.
There was a noted trend towards earlier age of symptom recognition (mean of 24 months)
and diagnosis of autism (mean of 39 months) among parents with younger children.
Conclusion: The results of this study showed some trends: There is improved awareness
regarding autism and the needs of children with autism. Parents tend to disagree with
previous myths about autism. There was an observable trend toward earlier diagnosis for
this group.
# 2015 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All
rights reserved.
* Corresponding author. Tel.: +63 9178033888; fax: +63 27311631.
E-mail address: [email protected] (M.I.O. Quilendrino).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/cegh
http://dx.doi.org/10.1016/j.cegh.2015.11.003
2213-3984/# 2015 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
http://crossmar ...
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This presentation is a Grand Rounds for the Dept. of Pediatrics at Mt. Sinai Hospital in Chicago. Presented by child psychiatrist, Daniel B. Martinez, M.D. February 9, 2011
A Phenotypic Structure and Neural Correlates ofCompulsive Be.docxransayo
A Phenotypic Structure and Neural Correlates of
Compulsive Behaviors in Adolescents
Chantale Montigny1*, Natalie Castellanos-Ryan1, Robert Whelan7,20, Tobias Banaschewski3,17,19, Gareth J.
Barker5, Christian Büchel4, Jürgen Gallinat6, Herta Flor3,17,19, Karl Mann3,17,19, Marie-Laure Paillère-
Martinot8,9, Frauke Nees3,17,19, Mark Lathrop10, Eva Loth2,5, Tomas Paus11,12,13, Zdenka Pausova18, Marcella
Rietschel3,17,19, Gunter Schumann2,5, Michael N. Smolka14,15, Maren Struve3, Trevor W. Robbins16, Hugh
Garavan7,20, Patricia J. Conrod1,5, and the IMAGEN Consortium¶
1 Department of Psychiatry, Université de Montréal, CHU Ste Justine Hospital, Montreal, Canada, 2 MRC Social, Genetic and Developmental Psychiatry
(SGDP) Centre, London, United Kingdom, 3 Central Institute of Mental Health, Mannheim, Germany, 4 Universitaetsklinikum Hamburg Eppendorf, Hamburg,
Germany, 5 Institute of Psychiatry, King’s College London, United Kingdom, 6 Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité,
Universitätsmedizin Berlin, Germany, 7 Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland, 8 Institut National de la Santé et de la Recherche
Médicale, INSERM CEA Unit 1000 “Imaging & Psychiatry”, University Paris Sud, Orsay, France, 9 AP-HP Department of Adolescent Psychopathology and
Medicine, Maison de Solenn, University Paris Descartes, Paris, France, 10 Centre National de Génotypage, Evry, France, 11 Rotman Research Institute,
University of Toronto, Toronto, Canada, 12 School of Psychology, University of Nottingham, United Kingdom, 13 Montreal Neurological Institute, McGill
University, Montreal, Canada, 14 Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany, 15 Neuroimaging Center,
Department of Psychology, Technische Universität Dresden, Germany, 16 Behavioural and Clinical Neurosciences Institute, Department of Experimental
Psychology, University of Cambridge, United Kingdom, 17 Mannheim Medical Faculty, University of Heidelberg, Germany, 18 The Hospital for Sick Children,
University of Toronto, Toronto, Canada, 19 Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Department of Addictive
Behaviour and Addiction Medicine, Manheim, Germany, 20 Departments of Psychiatry and Psychology, University of Vermont, Burlington, Vermont, United
States of America
Abstract
Background: A compulsivity spectrum has been hypothesized to exist across Obsessive-Compulsive disorder
(OCD), Eating Disorders (ED), substance abuse (SA) and binge-drinking (BD). The objective was to examine the
validity of this compulsivity spectrum, and differentiate it from an externalizing behaviors dimension, but also to look
at hypothesized personality and neural correlates.
Method: A community-sample of adolescents (N=1938; mean age 14.5 years), and their parents were recruited via
high-schools in 8 European study sites. Data on adolescents’ psychiatric symptoms, DSM diagnoses (DAWBA) and
s.
Screening Tool for Developmental Disorders in ChildrenApollo Hospitals
Developmental problems are a diverse group of conditions that affect and limit children and their life-chances. A ready reference for a Paediatrician would be the first six chapters of the latest edition (18th) of the Nelson Textbook of Pediatrics (The Field of Pediatrics, Growth & Development, Psychological Disorders, Social Issues, Children with Special Health Needs and Nutrition and Human Genetics and Metabolic Diseases).
Do Anxiety Scores of Pregnant Women Correlate with Doppler Indices of Uterine...semualkaira
In The Diagnostic and Statistical Manual of Mental Disorders
(DSM-V), a stressor is defined as any emotional, physical, social,
economic, or otherwise unclassified factor that disrupts the normal
physiological, cognitive, emotional, or behavioural balance of an
individual [1]. Thus, as pregnancy alters the normal physiological
balance of pregnant women, it can be regarded as a stress factor
or stressor for all individuals who experience it
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
Neuroscience Research Australia conducts research across the lifespan from childhood to older age to understand and cure diseases of the brain and nervous system. Their research includes studies of:
1) How negative schemas or self-beliefs in childhood are associated with psychotic-like experiences in children and how early interventions may help improve mental health outcomes.
2) Factors contributing to suboptimal child restraint use in cars and child injuries despite high rates of restraint usage, such as the role of parents' perceptions of child comfort.
3) Differences between children with autism to help predict their developmental outcomes, such as studying subgroups that may share neurobiological traits related to clinical progression.
Anticholinergic Drugs And Risk Of Dementia Case-Control StudySandra Long
This study examined the association between use of anticholinergic drugs and risk of dementia using a nested case-control study of over 40,000 patients with dementia and nearly 284,000 controls without dementia in the UK. The study found that 35% of dementia cases compared to 30% of controls had been prescribed anticholinergic drugs with definite anticholinergic activity. Drugs with definite anticholinergic activity were associated with an 11% increased odds of dementia. Certain classes of anticholinergic drugs including antidepressants, urological drugs, and antiparkinson drugs showed stronger associations with dementia risk compared to gastrointestinal drugs. The risk of dementia increased with greater exposure and longer duration of use for some drug classes.
This study examined factors that influence relapse in people with mental health disorders in Indonesia, specifically in West Sumatera Province. The study found that stress of caregivers was the strongest predictor of relapse, with caregivers experiencing high stress being over 8 times more likely to experience patient relapse than low-stress caregivers. The study also found that lack of home visits from healthcare workers was associated with a higher likelihood of relapse. Improving home visit programs and supporting caregivers to reduce their stress levels could help lower relapse rates. The study was a cross-sectional analysis of 313 caregivers in West Sumatera that examined how demographic characteristics, stigma, home visits and caregiver stress related to patient relapse.
proposal: Influences of Rhetoric in the Debate of Vaccines and Autism hussein opari
This document summarizes a research paper on the influences of rhetoric in the debate about vaccines and autism. The paper introduces the topic by noting the rising rates of autism diagnoses and the debate around potential links to vaccination. It then outlines the study's justification, research questions, and methodology. The study will analyze medical records and interviews to explore the evidence for links between vaccination, mercury levels, and autism rates in children. It will also review previous literature on both sides of the debate. The goal is to determine if vaccination is conclusively linked to autism or if other environmental factors may play a role.
1) According to research, genetics play an important role in ADHD, with heritability estimates between 60-90% from twin and adoption studies. However, genome-wide association studies have not found significant genetic associations, suggesting the genetic factors are complex.
2) Prenatal factors like maternal smoking and stress during pregnancy increase the risk of ADHD in children. Perinatal risks like low birth weight and preterm birth are also associated with higher ADHD risk.
3) Various environmental exposures have been linked to ADHD, including lead, PCBs, pesticides, and certain food dyes and additives which some studies have found can exacerbate ADHD symptoms.
4) However
This study examined the correlation between neonatal magnesium levels and long-term neurodevelopmental outcomes in very preterm infants. The study found that higher average magnesium levels during the neonatal period were associated with a significantly lower risk of abnormal motor exam, such as cerebral palsy, between 20-36 months of age. While infants with higher magnesium levels also had a lower risk of developing epilepsy, this finding was not statistically significant. The study suggests that magnesium supplementation in preterm infants may help improve long-term neurological outcomes, though larger studies are needed to further evaluate this hypothesis.
Prenatal alcohol exposure and offspring mental health: A systematic reviewBARRY STANLEY 2 fasd
A B S T R A C T
Background: High levels of alcohol use in pregnancy have been shown to be associated with negative physical health consequences in offspring. However, the literature is less clear on the association of alcohol use in pregnancy and offspring mental health, specifically for low levels of prenatal alcohol exposure. We conducted a systematic review to evaluate studies examining this association.
Methods: Studies were identified by searching PsycINFO, PubMed and Web of Science, and were included if they examined alcohol use during pregnancy as an exposure and offspring mental health at age 3 or older as an outcome. We excluded non-English language publications and studies of fetal alcohol syndrome.
Results: Thirty-three studies were included and were categorized by mental health outcomes: anxiety/depression, emotional problems, total internalizing problems, total problem score, and conduct disorder. Over half of the analyses reported a positive association of prenatal alcohol exposure and offspring mental health problems.
Conclusions: Our review suggests that maternal alcohol use during pregnancy is associated with offspring mental health problems, even at low to moderate levels of alcohol use. Future investigation using methods that allow stronger causal inference is needed to further investigate if these associations shown are causal.
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
DSM proposal for Sensory Processing Disorder. Of interest to those who want to know more in general, or know more about SPD as it compares to ASD or Misophonia.
This document summarizes a systematic review and meta-analysis of idiopathic sudden sensorineural hearing loss (ISSNHL) in children. The review found that the overall recovery rate for pediatric ISSNHL was 67.91%, similar to adults. A meta-analysis found no significant difference between combined systemic-intratympanic steroid therapy versus solely systemic treatment. The review was limited by the rarity of pediatric ISSNHL and heterogeneity between retrospective case studies. Larger prospective studies are still needed to determine the most effective treatment options for this condition in children.
This study analyzed data from a 30-year longitudinal study of over 500 women in New Zealand to examine the association between pregnancy outcomes and later mental health issues. The study found that after adjusting for potential confounding factors, women who had an abortion had rates of mental health disorders that were about 30% higher than those who did not have an abortion. No consistent associations were found between other pregnancy outcomes like miscarriage or live birth and increased risk of mental health problems. The authors concluded that the evidence suggests abortion may be associated with a small increase in risk of mental disorders.
2016 modifiers of stress related to timing of diagnosis in parents of childre...gisa_legal
This study examined differences in parental stress levels between parents who received a prenatal versus postnatal diagnosis of complex congenital heart disease in their child that required surgery before newborn discharge. The study found that after adjusting for factors like disease severity, parents who received a prenatal diagnosis had lower levels of anxiety and global stress at the time of diagnosis and birth compared to parents receiving a postnatal diagnosis, though there was no difference at follow-up. The differences were primarily seen in fathers. For parents receiving a prenatal diagnosis, mothers had higher stress scores than fathers, and a later gestational age at diagnosis was linked to higher anxiety and stress.
This study examined the associations between parental anxiety/depression and adolescent anxiety/depression, and whether adolescent self-esteem and physical activity moderate or mediate these associations. The study used data from over 5,700 Norwegian adolescents and their parents, collected over 10 years. Structural equation modeling found that parental anxiety/depression predicted adolescent anxiety/depression, and these associations were mediated by current parental symptoms and adolescent self-esteem. Physical activity moderated the association between maternal anxiety/depression and adolescent symptoms. Overall, the findings suggest familial aggregation of anxiety/depression over 10 years and that adolescent self-esteem and physical activity may influence this transmission.
Genetic testing in neurology is becoming more common and offers potential for diagnosis confirmation and prognosis. The neurologist needs to be aware of testing indications, standards, and risks of inappropriate use. Genetic testing can be used for diagnostic, prenatal, predictive, carrier, and disease risk purposes, as well as pharmacogenetics. Providing counseling before and after testing is important to discuss implications and avoid misinterpretations of results.
This study investigated the association between joint physical custody arrangements and psychosomatic problems in children using data from a national survey of Swedish 6th and 9th grade students. The study found that:
1) Children in joint physical custody reported fewer psychosomatic problems than children living mostly or only with one parent, but more problems than children from nuclear families.
2) Satisfaction with material resources and relationships with parents was associated with psychosomatic health but did not fully explain differences between living arrangements.
3) Girls reported more psychosomatic problems overall compared to boys, with sadness being the most common problem reported by girls across living arrangements.
According to Davenport (2014) social media and health care are c.docxmakdul
Social media is collaborating with healthcare to meet the needs of providers and patients, and is moving toward using analytics to evaluate its value within healthcare. The document instructs the reader to research areas of social media that could benefit from an analytic model combining data and value-based analytics, then evaluate a resource by discussing five major social media stakeholder roles, whether social media could improve medical practice and provide rationale, and concluding with main points.
According to (Fatehi, Gordon & Florida, N.D.) theoretical orient.docxmakdul
According to (Fatehi, Gordon & Florida, N.D.) theoretical orientation represent styles of mind for understanding reality. This theoretical orientation can be organized as a continuum from theoretical constructs that are independent and concrete as with the Behavioral/ CBT theories, to theoretical constructs that are interdependent and abstract as with the Psychodynamic theories (Fatehi, Gordon & Florida, N.D.). Family systems and Humanistic/Existential are theoretical midpoints (Fatehi, Gordon & Florida, N.D.). Trait theory tends to focus on the premise that we are born with traits or characteristics that make us unique and explain our behaviors (Cervone& Pervin, 2019). For example, introversion, extroversion, shyness, agreeableness, kindness, etc. all these innate characteristics that we are born help to explain why we behave in a certain manner according to the situations we face, (Cervone& Pervin, 2019). Psychoanalytic perspective on the other hand focuses on childhood experiences and the unconscious mind which plays a role in our personality development, (Cervone& Pervin, 2019).
According to Freud, (Cervone& Pervin, 2019) our unconscious mind includes all our hidden desires and conflicts which form the root cause of our mental health issues or maladaptive behaviors. The main difference between these two perspectives is that trait theory helps to explain why we behave in a certain manner, whereas psychoanalytic theory only describes the personality and predicting behavior and not really explaining why we behave the way we do. There is no such evident similarity between the two perspectives, but kind of rely on underlying mechanisms to explain personality. Also, there is some degree of subjectivity present in both the perspectives. Trait theories involve subjectivity regarding interpretations of which can be considered as important traits that explain our behaviors, and psychoanalytic theory is subjective and vague in the concepts been used like the unconscious mind. My opinions accord with the visible contrasts between the two, one focused on internal features describing our behaviors in clearer words, whilst other concentrating on unconscious mind in anticipating behavior which is ambiguous and harder to grasp.
References
Cervone, D., & Pervin, L. A. (2019). Personality: Theory and research (14th ed.). Wiley.
Fatehi, M., Gordon, R. M., & Florida, O. A Meta-Theoretical Integration of Psychotherapy Orientations.
.
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Developmental problems are a diverse group of conditions that affect and limit children and their life-chances. A ready reference for a Paediatrician would be the first six chapters of the latest edition (18th) of the Nelson Textbook of Pediatrics (The Field of Pediatrics, Growth & Development, Psychological Disorders, Social Issues, Children with Special Health Needs and Nutrition and Human Genetics and Metabolic Diseases).
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In The Diagnostic and Statistical Manual of Mental Disorders
(DSM-V), a stressor is defined as any emotional, physical, social,
economic, or otherwise unclassified factor that disrupts the normal
physiological, cognitive, emotional, or behavioural balance of an
individual [1]. Thus, as pregnancy alters the normal physiological
balance of pregnant women, it can be regarded as a stress factor
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This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
Neuroscience Research Australia conducts research across the lifespan from childhood to older age to understand and cure diseases of the brain and nervous system. Their research includes studies of:
1) How negative schemas or self-beliefs in childhood are associated with psychotic-like experiences in children and how early interventions may help improve mental health outcomes.
2) Factors contributing to suboptimal child restraint use in cars and child injuries despite high rates of restraint usage, such as the role of parents' perceptions of child comfort.
3) Differences between children with autism to help predict their developmental outcomes, such as studying subgroups that may share neurobiological traits related to clinical progression.
Anticholinergic Drugs And Risk Of Dementia Case-Control StudySandra Long
This study examined the association between use of anticholinergic drugs and risk of dementia using a nested case-control study of over 40,000 patients with dementia and nearly 284,000 controls without dementia in the UK. The study found that 35% of dementia cases compared to 30% of controls had been prescribed anticholinergic drugs with definite anticholinergic activity. Drugs with definite anticholinergic activity were associated with an 11% increased odds of dementia. Certain classes of anticholinergic drugs including antidepressants, urological drugs, and antiparkinson drugs showed stronger associations with dementia risk compared to gastrointestinal drugs. The risk of dementia increased with greater exposure and longer duration of use for some drug classes.
This study examined factors that influence relapse in people with mental health disorders in Indonesia, specifically in West Sumatera Province. The study found that stress of caregivers was the strongest predictor of relapse, with caregivers experiencing high stress being over 8 times more likely to experience patient relapse than low-stress caregivers. The study also found that lack of home visits from healthcare workers was associated with a higher likelihood of relapse. Improving home visit programs and supporting caregivers to reduce their stress levels could help lower relapse rates. The study was a cross-sectional analysis of 313 caregivers in West Sumatera that examined how demographic characteristics, stigma, home visits and caregiver stress related to patient relapse.
proposal: Influences of Rhetoric in the Debate of Vaccines and Autism hussein opari
This document summarizes a research paper on the influences of rhetoric in the debate about vaccines and autism. The paper introduces the topic by noting the rising rates of autism diagnoses and the debate around potential links to vaccination. It then outlines the study's justification, research questions, and methodology. The study will analyze medical records and interviews to explore the evidence for links between vaccination, mercury levels, and autism rates in children. It will also review previous literature on both sides of the debate. The goal is to determine if vaccination is conclusively linked to autism or if other environmental factors may play a role.
1) According to research, genetics play an important role in ADHD, with heritability estimates between 60-90% from twin and adoption studies. However, genome-wide association studies have not found significant genetic associations, suggesting the genetic factors are complex.
2) Prenatal factors like maternal smoking and stress during pregnancy increase the risk of ADHD in children. Perinatal risks like low birth weight and preterm birth are also associated with higher ADHD risk.
3) Various environmental exposures have been linked to ADHD, including lead, PCBs, pesticides, and certain food dyes and additives which some studies have found can exacerbate ADHD symptoms.
4) However
This study examined the correlation between neonatal magnesium levels and long-term neurodevelopmental outcomes in very preterm infants. The study found that higher average magnesium levels during the neonatal period were associated with a significantly lower risk of abnormal motor exam, such as cerebral palsy, between 20-36 months of age. While infants with higher magnesium levels also had a lower risk of developing epilepsy, this finding was not statistically significant. The study suggests that magnesium supplementation in preterm infants may help improve long-term neurological outcomes, though larger studies are needed to further evaluate this hypothesis.
Prenatal alcohol exposure and offspring mental health: A systematic reviewBARRY STANLEY 2 fasd
A B S T R A C T
Background: High levels of alcohol use in pregnancy have been shown to be associated with negative physical health consequences in offspring. However, the literature is less clear on the association of alcohol use in pregnancy and offspring mental health, specifically for low levels of prenatal alcohol exposure. We conducted a systematic review to evaluate studies examining this association.
Methods: Studies were identified by searching PsycINFO, PubMed and Web of Science, and were included if they examined alcohol use during pregnancy as an exposure and offspring mental health at age 3 or older as an outcome. We excluded non-English language publications and studies of fetal alcohol syndrome.
Results: Thirty-three studies were included and were categorized by mental health outcomes: anxiety/depression, emotional problems, total internalizing problems, total problem score, and conduct disorder. Over half of the analyses reported a positive association of prenatal alcohol exposure and offspring mental health problems.
Conclusions: Our review suggests that maternal alcohol use during pregnancy is associated with offspring mental health problems, even at low to moderate levels of alcohol use. Future investigation using methods that allow stronger causal inference is needed to further investigate if these associations shown are causal.
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IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
DSM proposal for Sensory Processing Disorder. Of interest to those who want to know more in general, or know more about SPD as it compares to ASD or Misophonia.
This document summarizes a systematic review and meta-analysis of idiopathic sudden sensorineural hearing loss (ISSNHL) in children. The review found that the overall recovery rate for pediatric ISSNHL was 67.91%, similar to adults. A meta-analysis found no significant difference between combined systemic-intratympanic steroid therapy versus solely systemic treatment. The review was limited by the rarity of pediatric ISSNHL and heterogeneity between retrospective case studies. Larger prospective studies are still needed to determine the most effective treatment options for this condition in children.
This study analyzed data from a 30-year longitudinal study of over 500 women in New Zealand to examine the association between pregnancy outcomes and later mental health issues. The study found that after adjusting for potential confounding factors, women who had an abortion had rates of mental health disorders that were about 30% higher than those who did not have an abortion. No consistent associations were found between other pregnancy outcomes like miscarriage or live birth and increased risk of mental health problems. The authors concluded that the evidence suggests abortion may be associated with a small increase in risk of mental disorders.
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This study examined the associations between parental anxiety/depression and adolescent anxiety/depression, and whether adolescent self-esteem and physical activity moderate or mediate these associations. The study used data from over 5,700 Norwegian adolescents and their parents, collected over 10 years. Structural equation modeling found that parental anxiety/depression predicted adolescent anxiety/depression, and these associations were mediated by current parental symptoms and adolescent self-esteem. Physical activity moderated the association between maternal anxiety/depression and adolescent symptoms. Overall, the findings suggest familial aggregation of anxiety/depression over 10 years and that adolescent self-esteem and physical activity may influence this transmission.
Genetic testing in neurology is becoming more common and offers potential for diagnosis confirmation and prognosis. The neurologist needs to be aware of testing indications, standards, and risks of inappropriate use. Genetic testing can be used for diagnostic, prenatal, predictive, carrier, and disease risk purposes, as well as pharmacogenetics. Providing counseling before and after testing is important to discuss implications and avoid misinterpretations of results.
This study investigated the association between joint physical custody arrangements and psychosomatic problems in children using data from a national survey of Swedish 6th and 9th grade students. The study found that:
1) Children in joint physical custody reported fewer psychosomatic problems than children living mostly or only with one parent, but more problems than children from nuclear families.
2) Satisfaction with material resources and relationships with parents was associated with psychosomatic health but did not fully explain differences between living arrangements.
3) Girls reported more psychosomatic problems overall compared to boys, with sadness being the most common problem reported by girls across living arrangements.
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According to (Fatehi, Gordon & Florida, N.D.) theoretical orientation represent styles of mind for understanding reality. This theoretical orientation can be organized as a continuum from theoretical constructs that are independent and concrete as with the Behavioral/ CBT theories, to theoretical constructs that are interdependent and abstract as with the Psychodynamic theories (Fatehi, Gordon & Florida, N.D.). Family systems and Humanistic/Existential are theoretical midpoints (Fatehi, Gordon & Florida, N.D.). Trait theory tends to focus on the premise that we are born with traits or characteristics that make us unique and explain our behaviors (Cervone& Pervin, 2019). For example, introversion, extroversion, shyness, agreeableness, kindness, etc. all these innate characteristics that we are born help to explain why we behave in a certain manner according to the situations we face, (Cervone& Pervin, 2019). Psychoanalytic perspective on the other hand focuses on childhood experiences and the unconscious mind which plays a role in our personality development, (Cervone& Pervin, 2019).
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References
Cervone, D., & Pervin, L. A. (2019). Personality: Theory and research (14th ed.). Wiley.
Fatehi, M., Gordon, R. M., & Florida, O. A Meta-Theoretical Integration of Psychotherapy Orientations.
.
According to Libertarianism, there is no right to any social service.docxmakdul
According to Libertarianism, there is no right to any social services besides those of a night-watchman state, protecting citizens from harming each other via courts, police, and military.
Consider this town
that decided to remove fire rescue as a basic social service. To benefit from it, one had to pay a yearly fee. Do you think libertarians would generally have to support such a policy in order to be consistent? Why or why not? Also, can you think of any other social services that might no longer exist in a libertarian society? (Btw, none has ever existed).
.
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According to cultural deviance theorists like Cohen, deviant sub.docxmakdul
This document discusses how cultural deviance theorists view subcultures as having their own value systems that oppose mainstream society's values. It asks how rap culture has perpetuated these subcultural values and promoted violence and crime among young men. It also asks how theorists would explain the persistence and popularity of rap culture given its deviation from conventional norms and values, citing examples from Tupac Shakur and 50 Cent. The document requests a 750-1000 word essay on this topic supported by 3-5 scholarly sources.
According to Gray et al, (2017) critical appraisal is the proce.docxmakdul
According to Gray et al, (2017) “critical appraisal is the process of carefully and systematically assessing the outcome of all aspects of a study, judging the strengths, limitation, trustworthiness, meaning, and its applicability to practice”. The steps involved in critical appraisal include “identifying the study's elements or processes, determining the strengths and weaknesses, and evaluating the credibility and trustworthiness of the study” (Gray et al., 2017). The journal article chosen is
“change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: a result of a before/after survey study”
by Niederhauser, Zullig, Marschall, Schweiger, John, Kuster, and Schwappach. (2019).
Identifying the study's elements or processes
A significant issue addressed by the study is the nursing “staffs’ perspective towards indwelling urinary catheter (IUC) and evaluation of changes in their perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project” (Niederhauser et al, 2019). the process of the research was conducted in “seven acute care hospitals in Switzerland” (Niederhauser et al, 2019). With a “sample size of 1579 staff members participated in the baseline survey and 1527 participated in the follow-up survey. The survey captures all nursing and medical staff members working at the participating hospitals at the time of survey distribution, using a multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter needs, and staff training were implemented over the course of 9 months” (Niederhauser et al, 2019).
Determining the strengths and weaknesses
A great strength of the study is a large sample size of over 1000 and the use of well-constructed and easy-to-read heading for better understanding. Also, the use of figures, graphs, and tables make the article less cumbersome to read. Another strength is the implementation of the ethical principles of research by enabling informed consent and voluntary participation as well as confidentiality and anonymity of information.
On the other hand, the study has several weaknesses such as the use of “the theory of planned behavior to model intentions to reduce catheter use, but it is not possible to know if changes observed in staff perception led to a true change in practice” (Niederhauser et al, 2019). Another weakness of the study is the repeated survey design which allows assessment of changes in staff perspectives after implementation of a quality improvement intervention but the sustainability of the effects over time could not be evaluated.
Evaluating the credibility and trustworthiness of the study
Although the study used a larger sample size of over 1000, the “use of a single-group design and no control group weakens its credibility and trustworthiness because there are no causal inferences abou.
According to article Insecure Policing Under Racial Capitalism by.docxmakdul
According to article "Insecure: Policing Under Racial Capitalism" by Robin D.G. Kelley and the article "Yes, We Mean Literally Abolish the Police" by Mariame Kaba, the police are no longer an attribute of safety and security. The facts that are given in the articles are similar within the meaning of the content. The police do not serve for the benefit of the whole community. Racial and class division according to social status became the basis of lawlessness and injustice on the part of the police. Kaaba in his article cites several stories confirming the racial hatred that led to the murder of African Americans. After that, people massively took to the streets of many cities in several countries, demanding an end to racial discrimination and the murder of African Americans. Kelley's article describes numerous manifestos where demands for police abolition have been raised, but all have been rejected. In the protests, people suggested that they themselves would take care of each other, which the police could not do. I understand that the police system is far from ideal and the permissiveness of police representatives should be limited. Ruth Wilson Gilmore says that "capitalism is never racial." I think that this phrase she wants to say that the stronger people take away from the weak people and use them for their own well-being. And since the roots of history go back to slavery, then African Americans are the weak link. In this regard, a huge number of prisons and police power appeared. The common and small class do not feel protected, on the contrary; they expect a threat from people who must protect them. The police take an oath to respect and protect human and civil rights and freedoms, regardless of skin color and social status. If this does not happen, then you need to change the system.
.
Abstract In this experiment, examining the equivalence poi.docxmakdul
Abstract:
In this experiment, examining the equivalence point in a titration with NaOH identified an
unknown diprotic acid. The molar mass of the unknown was found to be 100.78 g/mol with pKa
values of 2.6 and 6.6. The closest diprotic acid to this molar mass is malonic acid with a percent
error of 3.48%.
Introduction:
The purpose of the experiment was to determine the identity of an unknown diprotic acid. The
equivalence and half-equivalence points on the titration curve give important information, which
can then be used to calculate the molecular weight of the acid. The equivalence point is the
moment when there is an equal amount of acid and NaOH. Knowing the concentration and
volume of added NaOH at that moment, the amount of moles of NaOH can be determined. The
amount of moles of NaOH is then equivalent to the amount of acid present. Dividing the original
mass of the acid by the moles present gave the molar mass of the acid.
In this particular titration, there were two equivalence points as the acid is diprotic.
Consequently, the titration curve had two inflection points. The acid dissociated in a two-step
process with the net reaction being:
H2X + 2 NaOH Na2X + 2 H2O
This was important to take into consideration when calculating the molar mass of the diprotic
acid. If the first equivalence point was to be used, the ratio of acid to NaOH was 1:1. If the
second equivalence point was used in the calculations, the ratio became 1:2 as now a second
set of NaOH molecules reacted with the acid to dissociate the second hydrogen ion. The
titration curve also showed the pKa values of the acid. This happened at the half-equivalence
point where half of the acid was dissociated to its conjugate base (again, because of the diprotic
properties of the acid, this happens twice on the curve). The Henderson Hasselbalch equation
pH = pKa+log(A-/HA)
shows that at the half-equivalence point, the pKa value equaled the pH and was visually
represented by the flattest part of the graphs.
Discussion:
The titration graph showed that the data was consistent with the methodology and proved to be
an precise execution of the procedure and followed the expected shape. One possible source of
error was the actual mass of the acid solid. While transferring the dust from the weigh boat to
the solution, some remained in the weigh boat this could have altered the molar mass
calculations and shifted the final the final mass lighter than actual.
The Vernier pH method was definitely a much more concrete method of interpreting the results.
It was possible to see which addition of NaOH gave the greatest increase in pH ( greatest 1st
derivative of the titration graph). The relying solely on the indicator color would make it very
difficult to judge at which precise point the color shifted most, as the shift was a lot more gradual
compared to the precise numbers. This may have been a more reliable method if there was a
de.
ACC 403- ASSIGNMENT 2 RUBRIC!!!
Points: 280
Assignment 2: Audit Planning and Control
Criteria
UnacceptableBelow 60% F
Meets Minimum Expectations60-69% D
Fair70-79% C
Proficient80-89% B
Exemplary90-100% A
1. Outline the critical steps inherent in planning an audit and designing an effective audit program. Based upon the type of company selected, provide specific details of the actions that the company should undertake during planning and designing the audit program.
Weight: 15%
Did not submit or incompletely outlined the critical steps inherent in planning an audit and designing an effective audit program. Did not submit or incompletely provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Insufficiently outlined the critical steps inherent in planning an audit and designing an effective audit program. Insufficiently provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Partially outlined the critical steps inherent in planning an audit and designing an effective audit program. Partially provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Satisfactorily outlined the critical steps inherent in planning an audit and designing an effective audit program. Satisfactorily provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
Thoroughly outlined the critical steps inherent in planning an audit and designing an effective audit program. Thoroughly provided specific details of the actions that the company should undertake during planning and designing the audit program, based upon the type of company selected.
2. Examine at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Identify the accounts that you would test, and select at least three (3) analytical procedures that you would use in your audit.
Weight: 15%
Did not submit or incompletely examined at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Did not submit or incompletely identified the accounts that you would test; did not submit or incompletely selected at least three (3) analytical procedures that you would use in your audit.
Insufficiently examined at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Insufficiently identified the accounts that you would test; insufficiently selected at least three (3) analytical procedures that you would use in your audit.
Partially examined at least two (2) performance ratios that you would use in order to determine which analytical tests .
ACC 601 Managerial Accounting Group Case 3 (160 points) .docxmakdul
ACC 601 Managerial Accounting
Group Case 3 (160 points)
Instructions:
1. As a group, complete the following activities in good form. Use excel or
word only. Provide all supporting calculations to show how you arrived at
your numbers
2. Add only the names of group members who participated in the completion
of this assignment.
3. Submit only one copy of your completed work via Moodle. Do not send it to
me by email.
4. Due: No later than the last day of Module 7. Please note that your professor
has the right to change the due date of this assignment.
Part A: Capital Budgeting Decisions
Chee Company has gathered the following data on a proposed investment project:
Investment required in equipment ............. $240,000
Annual cash inflows .................................. $50,000
Salvage value ............................................ $0
Life of the investment ............................... 8 years
Required rate of return .............................. 10%
Assets will be depreciated using straight
line depreciation method
Required:
Using the net present value and the internal rate of return methods, is this a good investment?
Part B: Master Budget
You have just been hired as a new management trainee by Earrings Unlimited, a distributor of
earrings to various retail outlets located in shopping malls across the country. In the past, the
company has done very little in the way of budgeting and at certain times of the year has
experienced a shortage of cash. Since you are well trained in budgeting, you have decided to
prepare a master budget for the upcoming second quarter. To this end, you have worked with
accounting and other areas to gather the information assembled below.
The company sells many styles of earrings, but all are sold for the same price—$10 per pair. Actual
sales of earrings for the last three months and budgeted sales for the next six months follow (in pairs
of earrings):
January (actual) 20,000 June (budget) 50,000
February (actual) 26,000 July (budget) 30,000
March (actual) 40,000 August (budget) 28,000
April (budget) 65,000 September (budget) 25,000
May (budget) 100,000
The concentration of sales before and during May is due to Mother’s Day. Sufficient inventory should
be on hand at the end of each month to supply 40% of the earrings sold in the following month.
Suppliers are paid $4 for a pair of earrings. One-half of a month’s purchases is paid for in the month
of purchase; the other half is paid for in the following month. All sales are on credit. Only 20% of a
month’s sales are collected in the month of sale. An additional 70% is collected in the following
month, and the remaining 10% is collected in the second month following sale. Bad debts have been
negligible.
Monthly operating expenses for the company are given below:
Variable:
Sales commissions 4 % of sales
.
Academic Integrity A Letter to My Students[1] Bill T.docxmakdul
Academic Integrity:
A Letter to My Students[1]
Bill Taylor
Professor of Political Science
Oakton Community College
Des Plaines, IL 60016
[email protected]
Here at the beginning of the semester I want to say something to you about academic integrity.[2]
I’m deeply convinced that integrity is an essential part of any true educational experience, integrity on
my part as a faculty member and integrity on your part as a student.
To take an easy example, would you want to be operated on by a doctor who cheated his way through
medical school? Or would you feel comfortable on a bridge designed by an engineer who cheated her
way through engineering school. Would you trust your tax return to an accountant who copied his
exam answers from his neighbor?
Those are easy examples, but what difference does it make if you as a student or I as a faculty member
violate the principles of academic integrity in a political science course, especially if it’s not in your
major?
For me, the answer is that integrity is important in this course precisely because integrity is important in
all areas of life. If we don’t have integrity in the small things, if we find it possible to justify plagiarism or
cheating or shoddy work in things that don’t seem important, how will we resist doing the same in areas
that really do matter, in areas where money might be at stake, or the possibility of advancement, or our
esteem in the eyes of others?
Personal integrity is not a quality we’re born to naturally. It’s a quality of character we need to nurture,
and this requires practice in both meanings of that word (as in practice the piano and practice a
profession). We can only be a person of integrity if we practice it every day.
What does that involve for each of us in this course? Let’s find out by going through each stage in the
course. As you’ll see, academic integrity basically requires the same things of you as a student as it
requires of me as a teacher.
I. Preparation for Class
What Academic Integrity Requires of Me in This Area
With regard to coming prepared for class, the principles of academic integrity require that I come having
done the things necessary to make the class a worthwhile educational experience for you. This requires
that I:
reread the text (even when I’ve written it myself),
clarify information I might not be clear about,
prepare the class with an eye toward what is current today (that is, not simply rely on past
notes), and
plan the session so that it will make it worth your while to be there.
What Academic Integrity Requires of You in This Area
With regard to coming prepared for class, the principles of academic integrity suggest that you have a
responsibility to yourself, to me, and to the other students to do the things necessary to put yourself in
a position to make fruitful contributions to class discussion. This will require you to:
read the text before.
Access the Center for Disease Control and Prevention’s (CDC’s) Nu.docxmakdul
Access the Center for Disease Control and Prevention’s (CDC’s)
“Nutrition, Physical Activity, and Obesity: Data, Trends and Maps”
database. Choose a state other than your home state and compare their health status and associated behaviors. What behaviors lead to the current obesity status?
Initial discussion post should be approximately 300 words. Any sources used should be cited in APA format.
.
According to DSM 5 This patient had very many symptoms that sugg.docxmakdul
According to DSM 5 This patient had very many symptoms that suggested Major Depressive Disorder.
Objective(s)
Analyze psychometric properties of assessment tools
Evaluate appropriate use of assessment tools in psychotherapy
Compare assessment tools used in psychotherapy
.
Acceptable concerts include professional orchestras, soloists, jazz,.docxmakdul
Acceptable concerts include professional orchestras, soloists, jazz, Broadway musicals and instrumental or vocal ensembles, and comparable college or community groups performing music relevant to the content of this class. (Optionally, either your concert report
or
your concert review - but not both unless advance permission is given - may be based on a concert of non-western music selected from events on the concert list.)
Acceptable concerts include the following:
• Symphony orchestras • Concert bands and wind ensembles • Chamber Music (string quartets, brass and woodwind quintets, etc.) • Solo recitals (piano, voice, etc.) • Choral concerts • Early music concerts • Non-western music • Some jazz concerts • Opera• Broadway Musicals• Flamenco• Ballet• Tango
Assignment Format
The following are required on the concert review assignment and, thus, may affect your grade.
• Must be typed• Must be double-spaced• Must be between
2 and 4 pages
in length
not including the cover sheet
.• Must use conventional size and formatting of text - e.g. 10-12 point serif or sans serif fonts with normal margins. • Must include the printed program from the concert and/or your ticket stubs. Photocopies are unacceptable. (Contact me at least 24 hours before due date if any materials are unavailable.)• All materials (text, program, ticket stub) must be
stapled
together securely. Folded corners, paper clips, etc. instead of staples will not be accepted.• Careful editing, proofreading, and spelling are expected, although minor errors will not affect your grade.
Papers that do not follow these format guidelines may be returned for resubmission, and late penalties will apply.
Concert Review Assignment Content
I. Cover Sheet:
Include the following on a cover sheet attached to the front of your review:
• Title or other description of the event/performers you heard, along with the date and location of the performance. For example:
New World Symphony Orchestra
1258 Lincoln Road
Saturday, June 5, 2013
Lincoln Road Theater, Miami Beach
• Your name, assignment submission date, course. For example:
Pat Romero
October 31, 2013
Humanities 1020 MWF 8:05 a.m.
II. Descriptions
The main body of the concert review should include brief discussions of
three of the
pieces
in the concert you attend. In most cases, a single paragraph for each piece should be sufficient, although you may wish to break descriptions of longer pieces into separate short paragraphs, one per movement.
Your description of each piece (song) should include:
• The title of the piece and the composer's name if possible, as listed in the concert program.• A brief description of your reaction to the piece. For example:
When the piece started I thought it was going to be slow and boring, but the faster section in the first movement made it more exciting. A really great flute solo full of fast and high notes in the third movement caught my attention. I'm not sure, but I thought that som.
ACA was passed in 2010, under the presidency of Barack Obama. Pr.docxmakdul
ACA was passed in 2010, under the presidency of Barack Obama. Prior to this new act, there were plenty of votes that did not agree with the notion of accessible insurance. Before 2010, The private sector had been given coverage in such a way that Milstead and Short (2019) called it sickness insurance; meaning companies will risk incurring medical expenses as long as it was balanced by healthy people. They were doing so by excluding people that had pre-existing conditions, becoming a very solvent business (Milstead & Short, 2019). After ACA was passed that was no longer the case. When President Trump came into term he did so by bringing his own healthcare agenda, which attempted to repeal ACA, but ultimately failed to come up with a replacement.
In 2016, the Republican's party platform was to repeal ACA, while continuing Medicare and Medicaid, but on the other hand, democrats put down that Obamacare is a step towards the goals of universal health care, and that this was just the beginning (Physicians for a National Health Program, n.d.). As for the cost analysis of repealing the Affordable Care Act, this would increase the number of uninsured people by 23 million, and it will cost about 350 billion through 2027, as well as creating costly coverage provisions to replace it (Committee for a Responsible Federal Budget, 2017).
(2 references required)
.
Access the FASB website. Once you login, click the FASB Accounting S.docxmakdul
Access the FASB website. Once you login, click the FASB Accounting Standards Codification link. Review the materials in the FASB Codification, especially the links on the left side column. Next, write a 1-page memo to a friend introducing and explaining this new accounting research resource that you have found. Provide at least one APA citation to the FASB Codification and reference that citation using the APA guidelines.
.
Academic Paper Overview This performance task was intended to asse.docxmakdul
This document provides an overview of an academic paper performance task intended to assess students' ability to conduct scholarly research, articulate an evidence-based argument, and effectively communicate a conclusion. Specifically, the performance task evaluates students' capacity to generate a focused research question, explore relationships between multiple scholarly works, develop and support their own argument using relevant evidence, and integrate sources while distinguishing their own voice.
Academic Research Team Project PaperCOVID-19 Open Research Datas.docxmakdul
Academic Research Team Project Paper
COVID-19 Open Research Dataset Challenge (CORD-19)
An AI challenge with AI2, CZI, MSR, Georgetown, NIH & The White House
(1) FULL-LENGTH PROJECT
Dataset Description
In response to the COVID-19 pandemic, the White House and a coalition of leading research groups have prepared the COVID-19 Open Research Dataset (CORD-19). CORD-19 is a resource of over 44,000 scholarly articles, including over 29,000 with full text, about COVID-19, SARS-CoV-2, and related corona viruses. This freely available dataset is provided to the global research community to apply recent advances in natural language processing and other AI techniques to generate new insights in support of the ongoing fight against this infectious disease. There is a growing urgency for these approaches because of the rapid acceleration in new coronavirus literature, making it difficult for the medical research community to keep up.
Call to Action
We are issuing a call to action to the world's artificial intelligence experts to develop text and data mining tools that can help the medical community develop answers to high priority scientific questions. The CORD-19 dataset represents the most extensive machine-readable coronavirus literature collection available for data mining to date. This allows the worldwide AI research community the opportunity to apply text and data mining approaches to find answers to questions within, and connect insights across, this content in support of the ongoing COVID-19 response efforts worldwide. There is a growing urgency for these approaches because of the rapid increase in coronavirus literature, making it difficult for the medical community to keep up.
A list of our initial key questions can be found under the
Tasks
section of this dataset. These key scientific questions are drawn from the NASEM’s SCIED (National Academies of Sciences, Engineering, and Medicine’s Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats)
research topics
and the World Health Organization’s
R&D Blueprint
for COVID-19.
Many of these questions are suitable for text mining, and we encourage researchers to develop text mining tools to provide insights on these questions.
In this project, you will follow your own interests to create a portfolio worthy single-frame viz or multi-frame data story that will be shared in your presentation. You will use all the skills taught in this course to complete this project step-by-step, with guidance from your instructors along the way. You will first create a project proposal to identify your goals for the project, including the question you wish to answer or explore with data. You will then find data that will provide the information you are seeking. You will then import that data into Tableau and prepare it for analysis. Next, you will create a dashboard that will allow you to explore the data in-depth and identify meaningful insights. You will then give structure .
AbstractVoice over Internet Protocol (VoIP) is an advanced t.docxmakdul
Abstract
Voice over Internet Protocol (VoIP) is an advanced telecommunication technology which transfers the voice/video over
high speed network that provides advantages of flexibility, reliability and cost efficient advanced telecommunication
features. Still the issues related to security are averting many organizations to accept VoIP cloud environment due to
security threats, holes or vulnerabilities. So, the novel secured framework is absolutely necessary to prevent all kind of
VoIP security issues. This paper points out the existing VoIP cloud architecture and various security attacks and issues
in the existing framework. It also presents the defense mechanisms to prevent the attacks and proposes a new security
framework called Intrusion Prevention System (IPS) using video watermarking and extraction technique and Liveness
Voice Detection (LVD) technique with biometric features such as face and voice. IPSs updated with new LVD features
protect the VoIP services not only from attacks but also from misuses.
A Comprehensive Survey of Security Issues and
Defense Framework for VoIP Cloud
Ashutosh Satapathy* and L. M. Jenila Livingston
School of Computing Science and Engineering, VIT University, Chennai - 600127, Tamil Nadu, India;
[email protected], [email protected]
Keywords: Defense Mechanisms, Liveness Voice Detection, VoIP Cloud, Voice over Internet Protocol, VoIP Security Issues
1. Introduction
The rapid progress of VoIP over traditional services is
led to a situation that is common to many innovations
and new technologies such as VoIP cloud and peer to
peer services like Skype, Google Hangout etc. VoIP is the
technology that supports sending voice (and video) over
an Internet protocol-based network1,2. This is completely
different than the public circuit-switched telephone net-
work. Circuit switching network allocates resources to
each individual call and path is permanent throughout
the call from start to end. Traditional telephony services
are provided by the protocols/components such as SS7, T
carriers, Plain Old Telephone Service (POTS), the Public
Switch Telephone Network (PSTN), dial up, local loops
and anything under International Telecommunication
Union. IP networks are based on packet switching and
each packet follows different path, has its own header and
is forwarded separately by routers. VoIP network can be
constructed in various ways by using both proprietary
protocols and protocols based on open standards.
1.1 VoIP Layer Architecture
VoIP communication system typically consist of a front
end platform (soft-phone, PBX, gateway, call manager),
back end platform (server, CPU, storage, memory, net-
work) and intermediate platforms such as VoIP protocols,
database, authentication server, web server, operating sys-
tems etc. It is mainly divided into five layers as shown in
Figure1.
1.2 VoIP Cloud Architecture
VoIP cloud is the framework for delivering telephony
services in which resourc.
This study examined a problem, used a particular method to do so, and found results that were interpreted. It concluded by recommending future research on the topic.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., & Magnuss.docx
1. Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., &
Magnusson, C. (2013). Parental depression, maternal
antidepressant use during pregnancy, and risk of autism
spectrum disorders: Population based case-control study. BMJ :
British Medical Journal (Online), 346
doi:http://dx.doi.org.saintleo.idm.oclc.org/10.1136/bmj.f2059
Parental depression, maternal antidepressant use
during pregnancy, and risk of autism spectrum
disorders: population based case-control study
OPEN ACCESS
Dheeraj Rai clinical lecturer 1 2 3, Brian K Lee assistant
professor 4, Christina Dalman associate
professor2, Jean Golding professor emeritus5, Glyn Lewis
professor1, Cecilia Magnusson professor2
1Centre for Mental Health, Addiction and Suicide Research,
School of Social and Community Medicine, University of
Bristol, Bristol BS8 2BN, UK;
2Division of Public Health Epidemiology, Department of Public
Health Sciences, Karolinska Institutet, Stockholm, Sweden;
3Avon and Wiltshire
Partnership Mental Health NHS Trust, Bristol, UK;
4Department of Epidemiology and Biostatistics, Drexel
University School of Public Health,
Philadelphia, PA, USA; 5Centre for Child and Adolescent
Health, School of Social and Community Medicine, University
of Bristol, UK
Abstract
2. Objective To study the association between parental depression
and
maternal antidepressant use during pregnancy with autism
spectrum
disorders in offspring.
Design Population based nested case-control study.
Setting Stockholm County, Sweden, 2001-07.
Participants 4429 cases of autism spectrum disorder (1828 with
and
2601 without intellectual disability) and 43 277 age and sex
matched
controls in the full sample (1679 cases of autism spectrum
disorder and
16 845 controls with data on maternal antidepressant use nested
within
a cohort (n=589 114) of young people aged 0-17 years.
Main outcome measure A diagnosis of autism spectrum
disorder, with
or without intellectual disability.
Exposures Parental depression and other characteristics
prospectively
recorded in administrative registers before the birth of the child.
Maternal
antidepressant use, recorded at the first antenatal interview, was
available for children born from 1995 onwards.
Results A history of maternal (adjusted odds ratio 1.49, 95%
confidence
interval 1.08 to 2.08) but not paternal depression was associated
with
an increased risk of autism spectrum disorders in offspring. In
3. the
subsample with available data on drugs, this association was
confined
to women reporting antidepressant use during pregnancy (3.34,
1.50 to
7.47, P=0.003), irrespective of whether selective serotonin
reuptake
inhibitors (SSRIs) or non-selective monoamine reuptake
inhibitors were
reported. All associations were higher in cases of autism
without
intellectual disability, there being no evidence of an increased
risk of
autism with intellectual disability. Assuming an unconfounded,
causal
association, antidepressant use during pregnancy explained
0.6% of
the cases of autism spectrum disorder.
Conclusions In utero exposure to both SSRIs and non-selective
monoamine reuptake inhibitors (tricyclic antidepressants) was
associated
with an increased risk of autism spectrum disorders, particularly
without
intellectual disability. Whether this association is causal or
reflects the
risk of autism with severe depression during pregnancy requires
further
research. However, assuming causality, antidepressant use
during
pregnancy is unlikely to have contributed significantly towards
the
dramatic increase in observed prevalence of autism spectrum
disorders
as it explained less than 1% of cases.
4. Introduction
The estimated prevalence of autism spectrum disorders in the
United States has dramatically increased from fewer than 5 in
10 000 children in the 1980s to 1 in 88 in 2008.1 Similar
increases have been reported in much of the Western world.2
Better recognition and more inclusive diagnostic criteria for
autism spectrum disorders may explain this rising prevalence,
but a real increase in incidence has not been ruled out.1
Relatively little is known about the causes of autism spectrum
disorders and both genetic and environmental factors are
implicated.3 The identification of modifiable environmental risk
factors may aid in the primary prevention of some cases.
A recently reported association between use of selective
serotonin reuptake inhibitor (SSRI) antidepressants during
pregnancy and autism spectrum disorders in offspring has raised
the possibility of discovering one such modifiable causal
factor.4
There is increasing interest in the role of the serotonergic
system
in the pathophysiology of autism, and prenatal exposure to
serotonergic agents is a biologically plausible pathway.5 SSRIs
have increasingly been used in the treatment of depression
Correspondence to: D Rai [email protected]
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Supplementary tables
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5. Research
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during pregnancy since the 1990s, mirroring the secular rise in
the observed prevalence of autism spectrum disorders.4
However, an association between SSRI use during pregnancy
and autism may not imply a causal relation. An alternative
explanation is confounding by indication—the possibility that
maternal depression is responsible for the associations observed
between SSRIs and autism spectrum disorders in offspring.4 5
Although the relation between parental depression and risk of
autism spectrum disorders is often assumed to be well
established and has a genetic origin,4 6 the supporting evidence
is relatively weak. Two recent meta-analyses were inconclusive
and reported a lack of studies with psychiatric diagnosis of
parents before the birth of the child.7 8
In a large population based study in Sweden, we investigated
whether maternal or paternal depression identified before the
birth of the child is associated with autism spectrum disorders
in offspring; whether maternal antidepressant use during
pregnancy is associated with autism spectrum disorder in
offspring, and, if so, whether this explains any associations
between maternal depression and autism; whether any
associations between antidepressants and autism are unique to
SSRIs or also evident for other antidepressants; and whether all
6. the above associations are similar in offspring with autism with
and without comorbid intellectual disability.
Methods
We conducted a case-control study nested within the Stockholm
youth cohort, which comprises all young people aged 0 to 17
years, residing in Stockholm County between 2001 and 2007
(n=589 114).2 The cohort contains prospectively recorded data
on the probands and their first degree relatives collected by
record linkage with national and regional healthcare, social, and
administrative registries using unique national identity numbers
assigned to all Swedish residents.2 9 10
Sweden has a well developed system of publicly funded
screening, diagnostic, and follow-up services relevant to autism
spectrum disorders, with national and regional registers
recording information about diagnosis and other details.2
Assessments for autism spectrum disorder are typically carried
out by child neuropaediatric or mental health services, and, as
per local guidelines, include diagnostic evaluations covering
the child’s social, medical, and developmental history after
interviews with the parents, observation of the child, and a
structured neuropsychiatric assessment including cognitive
testing.2 11 We identified children with autism spectrum
disorders
in the Stockholm youth cohort using a multisource case
ascertainment method, with registers covering all pathways of
autism diagnosis and care within Stockholm County.2
Diagnoses
recorded in these registers (codes from the international
classification of diseases, ninth and 10th revisions, ICD-9 (299)
and ICD-10 (F84), respectively, or Diagnostic and Statistical
Manual of Mental Disorders, fourth edition, (299)) were
supplemented by a record of care in specialist centres for autism
with and without intellectual disability, where an autism
diagnosis and cognitive testing is a prerequisite. We also
7. identified comorbid intellectual disability status using ICD-9
(317-319), ICD-10 (F70-79), and DSM-IV (317-319) in the
child or adult mental health registers or the national patient
register.2 As of 31 December 2007, over 5000 cases of autism
spectrum disorder have been identified in the Stockholm youth
cohort, almost 43% of whom have a comorbid intellectual
disability.2 Two validation procedures—a case note validation
study by a consultant child psychiatrist and a neuropaediatrician
and a cross validation study with a national twin study—both
found a high validity of the diagnoses for autism spectrum
disorder recorded in the registers used for case ascertainment.2
Figure 1⇓ shows the derivation of the sample for the present
analyses. To ensure completeness of diagnostic data for parent
and children in the registers we excluded from the study sample
those with missing maternal identification numbers, adopted
children, those living in Stockholm County for less than four
years (thus also excluding all children aged 0-3 years who
would
be too young to have a reliable diagnosis). In the remaining
population of the Stockholm youth cohort, we matched each
case of autism spectrum disorder to 10 living controls without
autism by date (month and year) of birth and sex (fig 1).
Parental history of depression
We identified the psychiatric history of parents using two
sources: the Stockholm County adult psychiatric outpatient
register, which records the dates and diagnoses for any contact
with specialist outpatient psychiatric services in Stockholm
County since 1997,12 and the Swedish national patient register,
which contains the dates and discharge diagnoses of all
inpatients (since 1973) and specialist outpatients (since 2001,
although with incomplete psychiatric outpatient data) in
Sweden.13 Using these sources, we identified mothers and
fathers
8. with depression if they had a registered diagnosis of a
depressive
episode, recurrent depressive disorder, persistent mood
disorder,
and other or unspecified mood disorder (see supplementary
table S1 for ICD codes). To avoid the possibility of reverse
causality we considered only diagnoses recorded before the
birth of the child participating in the study.
We used two approaches to handle the presence of more than
one recorded diagnosis for a parent. In our primary strategy, we
used a hierarchy based on ICD-10,14 adapted for a greater
relevance to autism and our research question. This (from
higher
to lower priority) included schizophrenia or non-affective
psychoses or bipolar disorder; neurodevelopmental disorders
or personality disorders; alcohol and drug disorders; and
depression, anxiety, and somatoform or other disorders (see
supplementary table S1 for ICD codes). Depression was
therefore coded conservatively, only higher than anxiety or
somatoform disorders in case of multiple diagnoses. We
grouped
other diagnoses into anxiety disorders, psychotic disorders
(including schizophrenia and bipolar disorder), and other
non-psychotic disorders for use as potential confounders in
analysis. In an alternative strategy we allowed participants to
be included in the different diagnostic groups if more than one
diagnosis had been recorded (and adjusted for these in our
regression models).
Maternal antidepressant use during
pregnancy
Since 1995 the Swedish medical birth register15 contains data
on current drug use reported by mothers at their first antenatal
interview (median 10 weeks’ gestation),16 coded using the
World
Health Organization’s ATC codes (www.whocc.no/atc_ddd_
9. index/). Thus for mothers of children born from 1995 onwards
we retrieved data on any antidepressant use (ATC code N06A),
further divided into the two most commonly used antidepressant
classes—SSRIs (ATC code N06AB) and non-selective
monoamine reuptake inhibitors (ATC code N06AA), which
comprises tricyclic antidepressants (see supplementary table S2
for individual drugs in each group). We could not study other
antidepressant categories since their use in pregnancy was rare.
For the same reason we did not study individual drugs within
any class. The medical birth register has been shown to identify
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78% of all antidepressants prescribed during the first
trimester,17
and the drug name registered in prescription records and that
recorded in the register has been reported to show high
concordance (97%).16 17
Other characteristics
We used prospectively collected data on several parental
characteristics as potential confounders: maternal age (<20,
20-24, 25-29, 30-34, 35-39, >40 years) and paternal age (<25,
10. 25-29, 30-34, 35-39, 40-49, >50 years) at birth of child, fifths
of family income adjusted for year of ascertainment and family
size, highest education of either parent (≤9, 10-12, ≥13 years),
highest occupational class of either parent (higher
professionals,
intermediate non-manual employees, lower non-manual
employees, skilled manual workers, unskilled manual workers,
self employed, or unclassified), maternal region of birth
(Sweden, Europe, Americas, Africa, Asia, or Oceania), parity
(0, 1, 2, ≥3 previous births). These characteristics were chosen
because of their association with autism in the literature.7 9 10
18
We also considered variables with relatively less empirical
evidence linking them to autism but which nevertheless may
be confounders on theoretical grounds, including maternal
smoking reported at the first antenatal interview (non-smoker,
1-9 or ≥10 cigarettes per day), and a diagnosis of maternal
diabetes (yes or no) or hypertension (yes or no). We considered
these in additional analyses since they had a greater proportion
of missing data (18% for maternal smoking and 9% for diabetes
and hypertension). We also considered birth weight for
gestational age (normal for gestational age, small for gestational
age, large for gestational age),19 gestational age at birth (≤32,
33-36, 37-42, ≥43 weeks),19 and Apgar score at five minutes
(<7 or ≥7) 7 20 21 in separate analyses as these are potential
mediators (for example, fetal growth)22 but adjusting for them
could result in biased estimates.23
Statistical analysis
All analyses were conducted using Stata 10.1 for Windows. In
descriptive analysis we calculated proportions of individuals
with autism spectrum disorder (and autism with and without
intellectual disability) with the exposure variables and other
covariates. Using conditional logistic regression models, we
derived odds ratios and their 95% confidence intervals as
11. estimates of relative risks for the relation between a history of
depression in each parent and autism spectrum disorder in
offspring as a group, and dichotomised into autism with or
without intellectual disability. After estimating crude
associations, we adjusted for parental ages, parental income,
education, occupation, region of birth, and parity (model 1). In
model 2, we further adjusted model 1 for other psychiatric
disorders in the parent, and in model 3 we adjusted model 2 for
the presence of psychiatric disorders in the other parent. We
conducted these analyses in a sample with all available data and
those with complete data on all covariates (here we report the
latter analysis to ensure consistent numbers across all the
models; in the supplementary tables we present analyses using
all available data). We used the χ2 test of heterogeneity to
calculate P for heterogeneity values to assess the statistical
significance of any differences between estimates for paternal
and maternal depression and for autism with and without
intellectual disability.
We conducted several secondary analyses for a better
understanding of the implications and robustness of these
findings. Since we did not have data on antidepressants for the
full cohort, to assess whether any observed relations existed
before the majority of SSRIs were licensed in Sweden and came
into use during pregnancy, we restricted the sample to births
before 1990 (children born between 1984 and 1989). We also
repeated the analysis on children of primiparous women only,
to avoid the possibility of observations being due to depression
in mothers related to an older sibling with autism or other
developmental concerns. Thirdly, we restricted the analysis to
parents who were born in Sweden since we have previously
observed noticeably different associations of autism with and
without intellectual disability in relation to parental
immigration
to Sweden,9 and a low take-up of psychiatric services in
migrant
12. adults has been anecdotally reported. Fourthly, we repeated the
main analyses using the alternative coding of psychiatric
disorders, allowing for multiple psychiatric diagnoses in the
parents. Finally, we repeated the analyses in a sample of
children
at least 8 years old (born between 1984 and 1999) since the
diagnosis of autism spectrum disorder may be most reliable in
older children.
To include the antidepressant data, we restricted the sample to
births from 1995 onwards and repeated the analysis for maternal
depression, adjusting for antidepressant use during pregnancy.
We then estimated the associations using a categorical variable
to denote mothers with no history of depression and no
antidepressant use during pregnancy, a history of depression
but no antidepressant use during pregnancy, a history of
depression and antidepressant use during pregnancy, and
antidepressant use reported during pregnancy but no recorded
history of depression. Finally, we estimated the risk of autism
spectrum disorder with antidepressant use during pregnancy,
irrespective of indication, and repeated these analyses after
classifying antidepressants into SSRIs and non-selective
monoamine reuptake inhibitors. For these analyses we excluded
a small number of mothers reporting multiple antidepressant
use. We adjusted these analyses for parental ages, income,
education, occupation, migration status, parity, and a variable
depicting any psychiatric disorder in the mother. In a separate
analysis we further adjusted for any other psychotropic drug
use except antidepressants. We used the resulting adjusted odds
ratios (OR) and prevalence of exposure to antidepressants in
cases (PE) to estimate population attributable fractions (PAF)
using the formula: [PAF=PE(OR−1)/OR]. The population
attributable fractions denote the proportion of cases with autism
that could be prevented if antidepressant use was completely
eliminated from the population, assuming the association was
causal and all confounders had been accounted for.
13. Results
Parental depression and autism spectrum
disorder
The characteristics of cases and controls with all available data
were similar to the 4429 cases (1828 with a recorded
intellectual
disability and 2601 without) and 43 277 controls with complete
data that we used in our main analysis (table 1⇓ ).
Approximately
1% (n=44) of mothers of the 4429 case children with autism
spectrum disorder had depression as defined by our hierarchical
classification, recorded before the birth of the index child,
compared with 0.6% (n=272) of 43 277 control mothers (table
1). A paternal history of depression was found in approximately
0.4% of cases (n=19) as well as in controls (n=155).
Table 2⇓ shows the associations between maternal and paternal
history of depression and the risk of autism spectrum disorder
and autism with and without intellectual disability. Maternal
depression was associated with an approximately 60% increase
in risk of autism spectrum disorder (crude odds ratio 1.61, 95%
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confidence interval 1.17 to 2.23, P=0.004), which was not
substantially attenuated after adjustment for all potential
14. confounders. When autism spectrum disorders were
dichotomised between those with and those without intellectual
disability, it was apparent that the increased risk of autism with
maternal depression largely resulted from an almost twofold
odds of autism without intellectual disability (adjusted odds
ratio 1.86, 95% confidence interval, 1.25 to 2.77, P=0.002),
there being no evidence for an increased odds of autism with
intellectual disability. The odds ratio for autism spectrum
disorder with and without intellectual disability were
statistically
different (P for heterogeneity=0.04). There was no evidence for
an association between depression in fathers and autism
spectrum disorder in offspring, irrespective of intellectual
disability (table 2), but there was no statistical evidence for a
difference between the results for maternal and paternal
depression (P for heterogeneity=0.71).
A similar pattern of associations was observed in the analysis
repeated on a sample restricted to offspring born before 1990,
children of primiparous women, and children of parents who
were born in Sweden, in the analysis using a non-hierarchical
coding of psychiatric disorders and in the analysis restricted to
children at least 8 years old (fig 2⇓ , see supplementary tables
S3 to S7). In all these analyses, an increased risk of autism
spectrum disorder largely without intellectual disability (with
no increased risk with intellectual disability) was observed with
a maternal history of depression. The associations remained
robust when in a smaller sample the regression models were
further adjusted for birth weight for gestational age, gestational
age at birth, Apgar score at five minutes, maternal smoking,
and recorded maternal diabetes or hypertension (see
supplementary table S8).
Maternal depression, antidepressant use
during pregnancy, and autism spectrum
disorder
We had information about antidepressant use during pregnancy
15. for 1679 cases of autism spectrum disorder (743 with
intellectual
disability and 936 without) and 16 845 control children who
were born from 1995 onwards. The associations of maternal
depression and autism spectrum disorder in this sample
followed
a similar trend, albeit with wide confidence intervals (adjusted
odds ratio 1.40, 95% confidence interval 0.91 to 2.17), largely
resulting from associations for autism without intellectual
disability (1.69, 0.97 to 2.97, table 3⇓ ). These estimates
attenuated on adjustment for maternal antidepressant use during
pregnancy (models 1 and 3, table 3).
Table 4⇓ shows the results of analysis using the variable
combining a maternal history of depression and antidepressant
use during pregnancy. Offspring of mothers with a history of
depression who reported antidepressant use during pregnancy
seemed to have strong associations with autism spectrum
disorder, which were also confined to autism without
intellectual
disability and remained robust in adjusted models. A history of
depression without antidepressant use during pregnancy was
not associated with a heightened risk of autism spectrum
disorder (table 4).
Table 5⇓ shows the associations between antidepressant use
and autism spectrum disorder. Any antidepressant use during
pregnancy in mothers of cases was 1.3% compared with 0.6%
of controls equating to an almost twofold increase in risk of
autism spectrum disorder (1.90, 1.15 to 3.14). These
associations
too were largely observed due to associations with autism
without intellectual disability (2.54, 1.37 to 4.68) with no
increased odds for autism with intellectual disability. In an
additional analysis we also explored the potential confounding
effect of any other psychiatric drugs by adjusting for this in the
adjusted model in table 5; these did not result in any noticeable
16. change to the results: fully adjusted odds ratio for any
antidepressant use during pregnancy 1.83 (1.10 to3.04), autism
with intellectual disability 1.09 (0.41 to 2.91), and autism
without intellectual disability 2.37 (1.27 to 4.44). Similar
results
were evident for maternal use of both SSRIs and non-selective
monoaminereuptakeinhibitorantidepressants,althoughnumbers
were small and confidence intervals relatively wide (table 5).
The population attributable fraction estimate suggested that,
assuming an unconfounded causal association, 0.6% of cases
of autism spectrum disorder could be prevented if
antidepressant
use during pregnancy was completely eliminated.
Finally, the results of analyses using all available data instead
of a complete case sample (see supplementary tables S9-S12)
were similar to those presented in tables 2 to 5.
Discussion
A maternal history of depression was associated with a higher
risk of autism in offspring, but there was no evidence of a
relation with paternal depression. These associations were
largely limited to children of mothers who reported using
antidepressants at the first antenatal interview. The increased
risk was observed with SSRIs as well as with other monoamine
reuptake inhibitor antidepressants. All these increased risks
seemed to be confined to autism spectrum disorders without
intellectual disability and persisted after adjustment for several
confounding factors.
Comparison with previous studies
To our knowledge, only one previous study, using data on 298
cases of autism spectrum disorders and 1507 control children
in northern California, simultaneously studied maternal
depression as well as antidepressant use during pregnancy and
risk of autism.4 This study reported a twofold increase in risk
of autism spectrum disorder with a prescription for an SSRI
17. during the year before pregnancy but no increase with maternal
depression in the absence of antidepressant prescription.4
However, no association between antidepressants other than
SSRIs and autism was found, but the numbers were small and
the authors highlighted the need for further work.
Our findings of an association between antidepressant use
during
pregnancy and autism spectrum disorders based on a much
larger sample is consistent with the above findings despite a
different socioeconomic patterning of autism spectrum disorders
in Sweden10 and relatively conservative prescribing during
pregnancy compared with the United States.4 We additionally
highlight the specificity of these findings to children with
autism
without intellectual disability, which include those termed as
having “high functioning autism” and Asperger syndrome.
Furthermore, we found that non-SSRI antidepressants may also
be associated with a heightened risk of autism, an association
that was not observed by in the US study,4 possibly because of
low numbers.
Several previous studies have attempted to characterise the
association between parental depression and autism spectrum
disorders, although they had no data on drugs. However,
limitations such as small samples, lack of prospective data, long
periods of recall, and the inability to study depression
separately
from other psychiatric (particularly affective and non affective
psychotic) disorders, made causal inferences difficult and led
to inconclusive meta-analyses.7 8 More recent population based
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studies have also not been able to rule out reverse causality,6
study the specific associations between depression and autism
spectrum disorders,24 or differentiate between maternal and
paternal depression.25 26 It is notable that despite the
uncertainty
in the literature, it is commonly assumed that a causal
association with parental depression exists and that it occurs
through a genetic pathway.4 6
Potential mechanisms
Our finding that maternal but not paternal depression was
associated with autism spectrum disorders is noticeable in some
previous studies6 25 but has escaped attention. An association
with depression in fathers cannot, however, be ruled out, since
the numbers were few and confidence intervals relatively wide.
However, our findings suggest that caution is warranted before
concluding that an association between parental depression and
autism in offspring reflects common genetic pathways4 6; any
such pathways would have to explain the seemingly discrepant
risks between maternal compared with paternal depression and
autism spectrum disorders.
An alternative explanation is that the heightened risk for
maternal depression and autism is conferred through an
environmental pathway such as in utero exposure to
serotonergic
agents. It has been estimated that over 20% of children with
autism spectrum disorder have hyperserotonaemia.5 Serotonin
can be detected in the fetal brain by the fifth week of gestation
and is involved in critical neurodevelopmental processes
19. including neurogenesis or neuronal removal, or both; neuronal
differentiation; and synaptogenesis.27 Antidepressants cross the
placental barrier, and intrauterine exposure to serotonergic
agents has been shown to promote persistent changes in brain
circuitry, decreased serotonergic reactivity, and behavioural
features analogous to autism in animal models.28-31
Although SSRIs selectively act on the serotonergic system,
almost all other antidepressants also have serotonergic
activity.32
Therefore if in utero exposure to serotonin was a possible
causal
mechanism, an association with non-selective monoamine
reuptake inhibitors would be expected. The increased risks of
autism spectrum disorders observed with maternal depression
in children born before SSRIs started being used in Sweden
further highlight the argument that SSRIs are unlikely to be the
sole explanatory mechanism in these observations.
Other potential environmental pathways may also explain the
observed associations. For instance, antidepressant use may be
a marker of the severest forms of depression during pregnancy.
It should be noted that while the antidepressant data were
contemporaneous, the depression diagnosis in the US study4
and our study was not restricted to pregnancy. It was therefore
impossible to ascertain whether the antidepressant use was a
marker for active depression during pregnancy, which has been
hypothesised to affect “fetal programming” of the
hypothalamic-pituitary-adrenal axis as a result of chronically
raised levels of glucocorticoids.33 However, although this
environmental “stress” hypothesis of autism has some empirical
support, mainly in animal models, the literature in humans is
limited and inconsistent.33 34 Yet another hypothesis which has
support in animal models, but with insufficient evidence in
humans, is the association between immune activation and
infections related to depression and autism in offspring.35 36
Other explanations such as alcohol or drug use during
20. pregnancy
not severe enough to require health services are plausible.
It is important to note that all the associations were consistently
observed for autism spectrum disorders without intellectual
disability; and this reinforces the possibility that autism with
and without intellectual disability may have partly different
causes, and efforts should be made to study them separately.9
The idea of a differential association between parental
depression and autism based on intellectual disability has been
highlighted previously,37 but the mechanisms behind these
findings are unclear and require further work.
Limitations of the study
Several limitations of this study need to be acknowledged.
Firstly, depression was identified using specialist psychiatric
care records and therefore was certainly under-ascertained,
since
most people with depressive disorders do not seek help or are
managed in primary care. It was also not possible to assess
either
the severity or the course of depressive symptoms in relation
to the pregnancy. This is common to all previous population
based studies on this topic,6 24-26 and would have led to an
underestimation of the odds ratios between depression and
autism spectrum disorder if non-differential in relation to
autism.38 However, a bias in either direction is also
theoretically
possible, since depression is a debilitating disorder
characterised
by lack of energy and motivation, possibly leading to depressed
women not seeking help for developmental problems in their
children; or conversely, services more promptly assessing and
recognising autism in children of women already known to
psychiatric services (Berksonian bias).
Although autism spectrum disorders were also ascertained
21. through service use, our multisource case ascertainment
approach is likely to have minimised outcome misclassification,
compared with studies ascertaining autism spectrum disorders
solely from inpatient records. The antidepressant data were
abstracted from the first antenatal interview (median
approximately 10 weeks’ gestation) and were only available for
cohorts born from 1995 onwards, limiting our statistical power
and warranting caution when comparing with results of the
larger study. Although the possibility of some reporting bias in
these data cannot be excluded, the contemporaneously recorded
report of the drugs the mother was taking at the antenatal
interview are more likely to reflect actual use than studies
utilising prescription data (for which use and compliance is
often impossible to ascertain).
Importantly, it is not possible to conclude whether the
association between antidepressant use and autism spectrum
disorder reflects severe depression during pregnancy or is a
direct effect of the drug. There was insufficient power to
investigate a record of depression during the immediate prenatal
period, which would have allowed further scrutiny of this
possibility. The under-ascertainment of depression may have
led to partial control for confounding in the relation between
antidepressant use and autism spectrum disorder in offspring.
Assuming a non-differential misclassification of depression and
no qualitative interactions between depression and
antidepressant
use in relation to autism, the true odds ratio for the relation
between antidepressant use and autism spectrum disorder can
be estimated to lie between the crude and the adjusted estimates
presented.39 However, residual confounding due to other
unmeasured characteristics cannot be ruled out.
Implications and future directions
Caution is required before making causal assumptions or
clinical
decisions based on observational studies. However, it is
22. unlikely
that conclusive randomised trial evidence on this issue will ever
be available since pregnant women are routinely excluded from
drug trials, and even if ethically permissible, such a study
would
require a very large sample and a relatively long period of
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follow-up. It is therefore likely that a consensus on the potential
risk of antidepressant use during pregnancy in relation to autism
in offspring will be developed, as further observational data
either supporting or refuting these findings are published.
Until that happens, the results of the present study as well as
the US study4 present a major dilemma in relation to clinical
advice to pregnant women with depression. If antidepressants
increase the risk of autism spectrum disorder, it would be
reasonable to warn women about this possibility. However, if
the association actually reflects the risk of autism spectrum
disorder related to the non-genetic effects of severe depression
during pregnancy, treatment may reduce the risk. Informed
decisions would also need to consider weighing the wider risks
of untreated depression40 41 with the other adverse outcomes
related to antidepressant use.40 42-46 With the current
evidence,
23. if the potential risk of autism were a consideration in the
decision making process, it may be reasonable to think about,
wherever appropriate, non-drug approaches such as
psychological treatments. However, their timely availability to
pregnant women will need to be enhanced. From a public health
perspective, if antidepressant use had a causal relation with
autism spectrum disorders, it would explain less than 1% of
cases, and therefore would be unlikely to explain the dramatic
increase in the observed prevalence of these disorders. Future,
larger studies, with access to both diagnostic and treatment data
at multiple stages of pregnancy may help disentangle the role
of maternal depression and the individual drugs used to treat it
in the risk of autism spectrum disorder.
We thank Henrik Dal and Michael Lundberg, statisticians at the
Department of Public Health Sciences, Karolinska Institutet for
their
contributions to data management and the coding of key
variables used
in this paper.
Contributors: DR, CM, and BKL had the research idea, and CD,
JG,
and GL helped with its development. DR conducted the analysis
and
wrote the first and subsequent drafts of the paper with important
intellectual input from all coauthors. All authors had full access
to the
data, specifically, the statistical reports and tables arising from
the data,
and take responsibility of the integrity of the data and accuracy
of the
data analysis. All authors have approved the final version of the
manuscript submitted for publication. DR and CM act as
guarantors.
Funding: This study was funded by the Swedish Research
Council
24. (grant No 2012-3017). The data linkages and staff costs have
also been
supported by grants from the Stockholm County Council
(2007008),
Swedish Council for Working Life and Social Research (2007-
2064),
Swedish Research Council (523-2010-1052), and Swedish
Regional
agreement on medical training and clinical research (ALF). No
funder
had any role in the study design; data collection, analysis, or
interpretation; in the writing of the report; or in the decision to
submit
the article for publication. The views expressed are those of the
authors
and not necessarily those of any of the funders or organisations
they
represent.
Competing interests: All authors have completed the ICMJE
uniform
disclosure form at www.icmje.org/coi_disclosure.pdf (available
on
request from the corresponding author) and declare: no support
from
any organisation for the submitted work; no financial
relationships with
any organisations that might have an interest in the submitted
work in
the previous three years; no other relationships or activities that
could
appear to have influenced the submitted work.
Ethical approval: This study was approved by the research
ethics
committee at Karolinska Institutet, Stockholm (DNR 2007/545-
31 for
main Stockholm youth cohort record linkages, and DNR
25. 2011/1393-32
for additional linkage of maternal antidepressant use data).
Data sharing: No additional data available.
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DA, Feychting M, et al. Parental
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31. What is already known on this topic
Parental depression is considered a risk factor for autism
spectrum disorder (autism) but meta-analytical evidence is
inconclusive
One study suggested an association between prescriptions for
selective serotonin reuptake inhibitors (SSRIs) during
pregnancy and
autism in offspring
This suggestion may have led to a preferential use of other
antidepressants over SSRIs during pregnancy
What this study adds
A maternal but not paternal history of depression was associated
with a higher risk of autism in offspring
The increased risk of autism was largely found in children of
mothers reporting antidepressant use at the first antenatal
interview.
However, SSRIs as well as non-selective monoamine reuptake
inhibitors were associated with increased risks for autism,
suggesting
non-SSRIs may not be “safer” alternatives in this context.
Associations were largely limited to autism without intellectual
disability, suggesting that autism with and without intellectual
disability
may have partially different causes
39 Ogburn EL, VanderWeele TJ. On the nondifferential
misclassification of a binary
confounder. Epidemiology 2012;23:433-9.
40 Stewart DE. Clinical practice. Depression during pregnancy.
N Engl J Med
2011;365:1605-11.
32. 41 Spinelli M. Antidepressant treatment during pregnancy. Am J
Psychiatry 2012;169:121-4.
42 Rahimi R, Nikfar S, Abdollahi M. Pregnancy outcomes
following exposure to serotonin
reuptake inhibitors: a meta-analysis of clinical trials. Reprod
Toxicol 2006;22:571-5.
43 Lund N, Pedersen LH, Henriksen TB. Selective serotonin
reuptake inhibitor exposure in
utero and pregnancy outcomes. Arch Pediatr Adolesc Med
2009;163:949-54.
44 Oberlander TF, Warburton W, Misri S, Aghajanian J,
Hertzman C. Neonatal outcomes
after prenatal exposure to selective serotonin reuptake inhibitor
antidepressants and
maternal depression using population-based linked health data.
Arch Gen Psychiatry
2006;63:898-906.
45 Reis M, Kallen B. Delivery outcome after maternal use of
antidepressant drugs in
pregnancy: an update using Swedish data. Psychol Med
2010;40:1723-33.
46 Occhiogrosso M, Omran SS, Altemus M. Persistent
pulmonary hypertension of the newborn
and selective serotonin reuptake inhibitors: lessons from
clinical and translational studies.
Am J Psychiatry 2012;169:134-40.
Accepted: 12 March 2013
Cite this as: BMJ 2013;346:f2059
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Tables
Table 1| Descriptive characteristics of cases of autism spectrum
disorder and controls in complete case sample (current paper),
and full
sample with all available data
Full sampleComplete case sample*
Characteristics P value†ControlsCasesP value†ControlsCases
n=49 520n=4952n=43 277n=4429Cases with autism spectrum
34. disorder
0.0010.61.00.0040.61.0Maternal depression
0.4990.30.40.4390.40.4Paternal depression
Maternal history of other psychiatric disorders‡:
0.0160.60.90.0550.60.9Anxiety disorder
<0.0010.30.7<0.0010.30.8Psychotic disorders
<0.0010.91.9<0.0011.02.1Other psychiatric disorder
Paternal history of other psychiatric disorders‡:
0.1330.30.40.1200.30.4Anxiety disorder
<0.0010.30.7<0.0010.30.7Psychotic disorder
<0.0011.22.3<0.0011.32.4Other psychiatric disorder
<0.00129.3 (5.2)29.7 (5.5)<0.00129.5 (5.1)29.7 (5.5)Mean (SD)
maternal age (years)§
<0.00132.4 (6.3)32.8 (6.7)<0.00132.4 (6.3)32.7 (6.7)Mean (SD)
paternal age (years)§
Family income:
<0.00119.916.8<0.00121.317.41st fifth (highest)
20.119.415.516.75th fifth (lowest)
Parental education:
35. 0.00648.446.10.00148.845.9>12 years
43.245.643.946.510-12 years
8.48.37.37.6<9 years
Occupational class:
<0.00117.716.7<0.00119.017.6Higher professionals
19.117.420.718.1Intermediate non-manual employees
14.013.115.013.6Lower non-manual employees
13.415.214.315.8Skilled manual workers
13.617.313.817.7Unskilled manual workers
4.63.84.93.9Self employed
17.716.512.313.3Unclassified
Maternal country of birth:
<0.00173.274.4<0.00178.477.5Sweden
9.610.58.59.4Europe
2.83.42.33.1Americas
2.93.42.13.1Africa
11.58.38.76.9Asia or Oceania
Parity (previous births):
36. <0.00144.447.6<0.00144.2847.50
35.633.235.933.21
14.113.214.113.22
5.96.05.76.1≥3
n=28 550n=2855n=24 986n=2601Cases of autism spectrum
disorder without intellectual disability
<0.0010.61.2<0.0010.61.2Maternal depression
0.9870.30.40.8930.40.4Paternal depression
Maternal history of other psychiatric disorders‡:
0.0230.61.00.0290.61.0Anxiety disorder
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Table 1 (continued)
Full sampleComplete case sample*
37. Characteristics P value†ControlsCasesP value†ControlsCases
0.0030.30.60.0040.30.7Psychotic disorders
<0.0010.92.1<0.0011.02.2Other psychiatric disorder
Paternal history of other psychiatric disorders‡:
0.0820.30.40.0660.30.5Anxiety disorder
0.1870.30.40.3380.30.4Psychotic disorder
<0.0011.22.5<0.0011.32.5Other psychiatric disorder
0.02129.3 (5.2)29.5 (5.5)0.00129.5 (5.1)29.4 (5.5)Mean (SD)
maternal age (years)§
0.02632.4 (6.3)32.3 (6.5)0.00332.4 (6.3)32.2 (6.5)Mean (SD)
paternal age (years)§
Family income:
<0.00119.817.4<0.00121.317.71st fifth (highest)
20.316.215.514.65th fifth (lowest)
Parental education:
0.02147.946.40.03748.346.1>12 years
43.445.944.146.810-12 years
8.77.77.67.2<9 years
Occupational class:
39. n=20 970n=2097n=18 291n=1828Autism spectrum disorder
cases with intellectual disability
0.8700.60.60.9500.70.7Maternal depression
0.3620.40.30.2930.30.5Paternal depression
Maternal history of other psychiatric disorder‡:
0.3140.50.70.7390.60.7Anxiety disorder
<0.0010.30.8<0.0010.30.9Psychotic disorder
<0.0010.91.7<0.0011.01.9Other psychiatric disorder
Paternal history of other psychiatric disorder‡:
0.7930.30.30.8130.30.3Anxiety disorder
<0.0010.31.0<0.0010.31.2Psychotic disorder
0.0021.21.90.0021.22.1Other psychiatric disorder
<0.00129.4 (5.2)29.9 (5.6)<0.00129.5 (5.1)30.0 (5.5)Mean (SD)
maternal age (years)§
<0.00132.4 (6.3)33.4 (6.8)<0.00132.3 (6.2)33.3 (6.8)Mean (SD)
paternal age (years)§
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Table 1 (continued)
Full sampleComplete case sample*
Characteristics P value†ControlsCasesP value†ControlsCases
Family income:
<0.00120.116.1<0.00121.416.91st fifth (highest)
20.023.715.519.85th fifth (lowest)
Parental education:
0.01049.245.80.00649.445.7>12 years
42.945.043.746.210-12 years
8.09.26.98.2<9 years
Occupational class:
<0.00117.717.2<0.00118.918.4Higher professionals
19.215.220.816.0Intermediate non-manual
13.811.814.812.4Lower non-manual employees
13.114.614.015.7Skilled manual workers
41. 13.516.913.817.7Unskilled manual workers
4.64.24.94.4Self employed
18.120.012.815.4Unclassified
Maternal country of birth:
<0.00173.566.0<0.00178.770.4Sweden
9.511.08.49.7Europe
2.74.22.23.7Americas
2.86.62.16.0Africa
11.412.38.610.3Asia or Oceania
Parity (previous births):
0.11644.642.50.02744.542.30
35.535.735.835.61
14.214.914.215.02
5.76.95.57.1≥3
*No missing data in any variables.
†P values derived from conditional logistic regression to
account for matching of cases and controls by age and sex.
‡History of psychiatric disorders refers to specialist outpatient
or inpatient psychiatric care.
§Ages are categorised in paper.
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Table 2| Odds ratios depicting relation between parental
depression before birth of child and autism spectrum disorder
and autism spectrum
disorder with and without intellectual disability in children born
between 1984 and 2003
Odds ratio (95% CI)Crude odds ratio (95%
CI)
No of
cases/controlsVariables Model 3‡Model 2†Model 1*
Maternal depression:
1.49 (1.08 to 2.08)1.54 (1.11 to 2.13)1.50 (1.08 to 2.08)1.61
(1.17 to 2.23)44/272Autism spectrum disorder
0.96 (0.52 to 1.77)0.98 (0.53 to 1.80)0.96 (0.52 to 1.76)1.02
(0.56 to 1.86)12/121Autism spectrum disorder with
intellectual disability
1.86 (1.25 to 2.77)1.90 (1.28 to 2.82)1.85 (1.24 to 2.74)2.07
(1.40 to 3.06)32/151Autism spectrum disorder
without intellectual disability
43. Paternal depression:
1.12 (0.69 to 1.82)1.13 (0.70 to 1.83)1.11 (0.68 to 1.79)1.21
(0.75 to 1.96)19/155Autism spectrum disorder
1.35 (0.66 to 2.77)1.36 (0.67 to 2.78)1.33 (0.65 to 2.72)1.46
(0.72 to 2.96)9/63Autism spectrum disorder with
intellectual disability
0.97 (0.50 to 1.89)0.98 (0.51 to 1.91)0.96 (0.50 to 1.87)1.05
(0.54 to 2.02)10/92Autism spectrum disorder
without intellectual disability
Children with autism spectrum disorder: cases n=4429, controls
n=43 277.
Children with autism spectrum disorder with intellectual
disability: cases n=1828, controls n=18 291.
Children with autism spectrum disorder without intellectual
disability: cases n=2601, controls n=24 986.
*Adjusted for parental ages, income, education, occupation,
migration status, and parity.
†Model 1 further adjusted for any other psychiatric condition
(including anxiety disorders, affective (bipolar) and non
affective psychoses (schizophrenia), somatoform,
neurodevelopmental, and personality or drug and alcohol misuse
disorders).
‡Model 2 further adjusted for depression in both parents and
other psychiatric condition in both parents.
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Table 3| Odds ratios depicting relation between maternal
depression before birth of child and autism spectrum disorder in
offspring,
adjusting for antidepressant use during pregnancy in children
born between 1995 and 2003
Odds ratio (95% CI)
Crude odds ratio (95% CI)No of cases/controlsDisorder type in
offspring Model 3‡Model 2†Model 1*
1.19 (0.76 to 1.87)1.34 (0.87 to 2.08)1.24 (0.79 to 1.94)1.40
(0.91 to 2.17)24/174Autism spectrum disorder
1.04 (0.50 to 2.13)1.06 (0.52 to 2.16)1.08 (0.53 to 2.20)1.09
(0.54 to 2.20)9/85Autism spectrum disorder with intellectual
disability
1.30 (0.72 to 2.34)1.58 (0.90 to 2.79)1.35 (0.75 to 2.45)1.69
(0.97 to 2.97)15/89Autism spectrum disorder without
intellectual
disability
Children with autism spectrum disorder: cases n=1679, controls
n=16 845.
Children with autism spectrum disorder with intellectual
disability: cases n=743, controls n=7584.
Children with autism spectrum disorder without intellectual
disability: cases n=936, controls n=9261.
45. *Adjusted for antidepressant use only during pregnancy.
†Adjusted for parental ages, income, education, occupation,
migration status, and parity.
‡Model 2 adjusted for antidepressant use during pregnancy.
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Table 4| Odds ratios depicting relation between maternal
depression, antidepressant use during pregnancy, and autism
spectrum disorder
in offspring (with and without intellectual disability) in children
born between 1995 and 2003
Autism spectrum disorder without
intellectual disability
Autism spectrum disorder with
intellectual disabilityAutism spectrum disorder
Variables
Adjusted
odds ratio*
(95% CI)
46. Crude odds
ratio (95%
CI)
No of
cases/control
Adjusted
odds ratio*
(95% CI)
Crude odds
ratio (95%
CI)
No of
cases/controls
Adjusted
odds ratio*
(95% CI)
Crude
odds ratio
(95% CI)
No of
cases/controls
No
antidepressant
use:
1.00
48. 24/189Depression†
Antidepressant
use:
4.94 (1.85 to
13.23)
5.58 (2.14 to
14.51)
7/141.81 (0.39 to
8.56)
1.69 (0.37 to
7.71)
2/133.34 (1.50
to 7.47)
3.69 (1.68
to 8.10)
9/27Depression†
2.10 (0.97 to
4.57)
2.65 (1.25 to
5.62)
9/360.93 (0.27 to
3.21)
0.89 (0.27 to
49. 2.95)
3/351.61 (0.85
to 3.06)
1.78 (0.95
to 3.34)
12/71No
depression‡
*Adjusted for history of psychiatric disorders other than
depression, parental ages, income, education, occupation,
migration status, and parity.
†Any outpatient (secondary care) or inpatient record of
depression before birth of child. Antidepressant use refers to
any antidepressant use recorded at first
antenatal interview.
‡Psychiatric indication other than depression was identified in
22 out of 83 women reporting use of antidepressants without a
record of depression. Others are
likely to have been prescribed in primary care but diagnostic
information was not available.
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50. Table 5| Odds ratios depicting relation between antidepressant
use during pregnancy and autism spectrum disorder, and autism
spectrum
disorder with and without intellectual disability in children born
between 1995 and 2003
Autism spectrum disorder without
intellectual disability
Autism spectrum disorder with intellectual
disabilityAutism spectrum disorder
Antidepressant
use
Adjusted
odds ratio*
(95% CI)
Crude odds
ratio (95% CI)
No of
cases/controls
Adjusted
odds ratio*
(95% CI)
Crude odds
ratio (95% CI)
No of
cases/controls
51. Adjusted
odds ratio*
(95% CI)
Crude odds
ratio (95%
CI)
No of
cases/controls
2.54 (1.37 to
4.68)
3.42 (1.91 to
6.14)
16/501.09 (0.41 to
2.88)
1.09 (0.43 to
2.79)
5/481.90 (1.15 to
3.14)
2.27 (1.40 to
3.71)
21/98Any
2.34 (1.09 to
5.06)
3.25 (1.55 to
52. 6.81)
10/321.01 (0.34 to
2.98)
1.05 (0.37 to
2.98)
4/391.65 (0.90 to
3.03)
2.03 (1.13 to
3.66)
14/71SSRIs
2.93 (0.98 to
8.82)
4.15 (1.44 to
11.96)
5/131.72 (0.20 to
15.03)
1.48 (0.18 to
12.35)
1/72.69 (1.04 to
6.96)
3.20 (1.26 to
8.12)
6/20Non-selective
MRIs
53. SSRIs=selective serotonin reuptake inhibitors; non-selective
MRIs=non-selective monoamine reuptake inhibitors.
*Adjusted for any maternal psychiatric disorder, maternal age,
paternal age, parental income, education, occupation, maternal
country of birth, and birth parity.
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BMJ 2013;346:f2059 doi: 10.1136/bmj.f2059 (Published 19
April 2013) Page 14 of 15
RESEARCH
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Figures
Fig 1 Derivation of analytical sample
Fig 2 Adjusted odds ratios (95% confidence intervals) for
relation between maternal depression and autism spectrum
disorder overall and autism with and without intellectual
disability in main and supplementary analyses (tables S3-S7)
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BMJ 2013;346:f2059 doi: 10.1136/bmj.f2059 (Published 19
April 2013) Page 15 of 15