Autistic People's Perinatal Experiences II: A Survey of Childbirth and Postnatal Experiences.

Qualitative accounts indicate there are sensory and communication related barriers to adequate childbirth and postnatal healthcare for autistic people. However, little quantitative work has explored the topic. This online survey study explored childbirth and postnatal experiences among 384 autistic and 492 non-autistic people. Compared with non-autistic people, autistic people were more likely to find the sensory aspects of birth overwhelming, and experienced lower satisfaction with birth-related and postnatal healthcare. Autistic people were more likely to experience postnatal depression and anxiety. The findings highlight that sensory and communication adjustments should be made to birth and postnatal healthcare for autistic people. The findings indicate the need for greater autism understanding among professionals and greater postnatal mental health support for autistic people.

Pain catastrophizing, anxiety, and depression in hip pathology.

AIMS: Psychological factors play a critical role in patient presentation, satisfaction, and outcomes. Pain catastrophizing, anxiety, and depression are important to consider, as they are associated with poorer outcomes and are potentially modifiable. The aim of this study was to assess the level of pain catastrophizing, anxiety, and depression in patients with a range of hip pathology and to evaluate their relationship with patient-reported psychosocial and functional outcome measures. PATIENTS AND METHODS: Patients presenting to a tertiary-centre specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, and depression. Validated assessments were undertaken such as: the Pain Catastrophizing Scale (PCS), the Hospital Anxiety Depression Scale (HADS), and the 12-Item Short-Form Health Survey (SF-12). Patient characteristics and demographics were also recorded. Multiple linear regression modelling, with adaptive least absolute shrinkage and selection operator (LASSO) variable selection, was used for analysis. RESULTS: A total of 328 patients were identified for inclusion, with diagnoses of hip dysplasia (DDH; n = 50), femoroacetabular impingement (FAI; n = 55), lateral trochanteric pain syndrome (LTP; n = 23), hip osteoarthrosis (OA; n = 184), and avascular necrosis of the hip (AVN; n = 16) with a mean age of 31.0 years (14 to 65), 38.5 years (18 to 64), 63.7 years (20 to 78), 63.5 years (18 to 91), and 39.4 years (18 to 71), respectively. The percentage of patients with abnormal levels of pain catastrophizing, anxiety, or depression was: 22.0%, 16.0%, and 12.0% for DDH, respectively; 9.1%, 10.9%, and 7.3% for FAI, respectively; 13.0%, 4.3%, and 4.3% for LTP, respectively; 21.7%, 11.4%, and 14.1% for OA, respectively; and 25.0%, 43.8%, and 6.3% for AVN, respectively. HADS Anxiety (HADSA) and Hip Disability Osteoarthritis Outcome Score Activities of Daily Living subscale (HOOS ADL) predicted the PCS total (adjusted R2 = 0.4599). Age, HADS Depression (HADSD), and PCS total predicted HADSA (adjusted R2 = 0.4985). Age, HADSA, patient's percentage of perceived function, PCS total, and HOOS Quality of Life subscale (HOOS QOL) predicted HADSD (adjusted R2 = 0.5802). CONCLUSION: Patients with hip pathology may exhibit significant pain catastrophizing, anxiety, and depression. Identifying these factors and understanding the impact of psychosocial function could help improve patient treatment outcomes. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Cite this article: Bone Joint J 2019;101-B:800-807.

Multinational, pilot audit of a Velcro adjustable compression wrap system for venous and lymphatic conditions.

OBJECTIVE: The aim of this small pilot audit was to record the performance of an adjustable Velcro compression wrap, ReadyWrap, and the experiences of patients and health-care professionals using the system as a self-care option for the management of venous and lymphatic leg conditions in both the treatment and maintenance phases. METHOD: This audit was held within a 4-week review period. Participants included venous leg ulcer (VLU) patients with and without oedema, and patients with lymphoedema. Where open wounds were present they were managed with debridement, skin care and dressings according to clinical need. Lymphoedema patients received manual lymphatic drainage and skin care regimens as per standard practice. The Velcro system evaluated formed part of a treatment pathway with compression bandages and/or compression hosiery as clinically indicated. Patients, carers and health-care professionals applied the garments following assessment and training. Objective data recorded included change in circumferential measurements and improvement in wound status. Observation of health-care professionals, patients and carers with regard to the comfort and ease of application/removal of the device were recorded. RESULTS: There were 17 patients included in the audit. Within the 4-week period a reduction in limb circumference was recorded in all cases. Improvements in open wounds were recorded in most cases. Following the 4-week audit period 94% of the application of the device was performed by either the patient (59%) or the carer (35%) thereby reducing the health-care professional contact that was required for application. CONCLUSION: Early results in this small audit demonstrate that this adjustable Velcro compression wrap may provide a simple, clinically effective and patient-acceptable solution for self-care with compression. Use of this type of device could have the potential to reduce overall health-care burden by reducing necessary skilled treatment visits and/or cost while still achieving good clinical outcomes. Further studies are required to confirm this pilot study and provide additional data.

Report on a clinical evaluation of the KerraPro Heel silicone heel pad.

Heels are at increased risk of injury due to the posterior prominence and lack of padding over the calcaneus. Pressure injuries, once established, are extremely costly, both in terms of the detrimental effect on psychosocial wellbeing and threat to life, as well as financially due to length of hospital stay and resources used to heal the wounds. A new and inexpensive silicone heel pad has been designed to simplify the necessary decisions and to address the problems associated with pressure injuries to the heels. This article will describe an observational evaluation of the product. KerraPro Heel pads were evaluated in two separate cohorts of 17 participants over a 4-week period with the primary aim to evaluate the efficacy of the product in preventing and alleviating pressure injuries on the heels. All participants had been reported as 'at risk' or 'at high risk' of pressure injury to the heels and had a history of developing such lesions. The KerraPro heel pads were compared with the participant's standard protocol. The outcome of the evaluation demonstrated the effectiveness of the KerraPro Heel pads in the prevention and treatment of heel pressure injuries.

Protein kinase C iota as a therapeutic target in alveolar rhabdomyosarcoma.

Alveolar rhabdomyosarcoma is an aggressive pediatric cancer exhibiting skeletal-muscle differentiation. New therapeutic targets are required to improve the dismal prognosis for invasive or metastatic alveolar rhabdomyosarcoma. Protein kinase C iota (PKCι) has been shown to have an important role in tumorigenesis of many cancers, but little is known about its role in rhabdomyosarcoma. Our gene-expression studies in human tumor samples revealed overexpression of PRKCI. We confirmed overexpression of PKCι at the mRNA and protein levels using our conditional mouse model that authentically recapitulates the progression of rhabdomyosarcoma in humans. Inhibition of Prkci by RNA interference resulted in a dramatic decrease in anchorage-independent colony formation. Interestingly, treatment of primary cell cultures using aurothiomalate (ATM), which is a gold-containing classical anti-rheumatic agent and a PKCι-specific inhibitor, resulted in decreased interaction between PKCι and Par6, decreased Rac1 activity and reduced cell viability at clinically relevant concentrations. Moreover, co-treatment with ATM and vincristine (VCR), a microtubule inhibitor currently used in rhabdomyosarcoma treatment regimens, resulted in a combination index of 0.470-0.793 through cooperative accumulation of non-proliferative multinuclear cells in the G2/M phase, indicating that these two drugs synergize. For in vivo tumor growth inhibition studies, ATM demonstrated a trend toward enhanced VCR sensitivity. Overall, these results suggest that PKCι is functionally important in alveolar rhabdomyosarcoma anchorage-independent growth and tumor-cell proliferation and that combination therapy with ATM and microtubule inhibitors holds promise for the treatment of alveolar rhabdomyosarcoma.

Study to evaluate the effect of low-intensity pulsed electrical currents on levels of oedema in chronic non-healing wounds.

OBJECTIVE: To evaluate the efficacy of a medical device, Accel-Heal, which generates a low-intensity pulsed direct current, on the management of oedema in chronic leg ulcers, using high-frequency diagnostic ultrasound. METHOD: High-frequency diagnostic ultrasound (20MHz) with an axial resolution of 60um was used to assess the effect of an electrical stimulation device delivering a low-intensity pulsed current on levels of oedema in chronic non-healing venous and mixed aetiology leg ulcers for a period of 10 days. Thirty patients' wounds were monitored over a 3-month period, during which time changes in levels of oedema in the wound bed and surrounding tissues were imaged and measured. RESULTS: A significant fall in the, previously high level, of periwound oedema was noted in the patient population after 10 days of device application. By 20 days after the first application of the device the level of periwound oedema had decreased by approximately 60% of the original level, which was maintained up to the 90-day follow-up. Occurring in parallel with this, scans of the wound bed showed a rapid decrease in the levels of oedema as the new wound matrix was laid down. CONCLUSION: The electrical stimulation device appeared to be effective in reducing oedema levels in a range of chronic wounds and their surrounding tissues. CONFLICT OF INTEREST: The study was funded by a grant from Synapse micro-current Ltd.

A study of Hassawi rice (Oryza sativa L.) in terms of its carbohydrate hydrolysis (in vitro) and glycaemic and insulinaemic indices (in vivo).

BACKGROUND/OBJECTIVES: A high prevalence of Type 2 diabetes exists in Saudi Arabia. Epidemiological evidence suggests that low glycaemic index (GI) diets reduce diabetes risk. Yet, little is known about the GI of traditional Saudi Arabian staples such as Hassawi rice (HR). HR was evaluated in terms of its GI and insulinaemic index (II). Comparisons were made in vitro assessing glucose released enzymatically. A long-grain rice variety available in both United Kingdom and Saudi Arabia was studied as a comparison. SUBJECTS/METHODS: For GI and II measurements, HR, Uncle Ben's rice (UBR) and a standard glucose solution were consumed by healthy subjects (n=13) on seven randomised occasions. Capillary bloods were collected at specific times over 2 h after food intake. Food and Agriculture Organization/World Health Organization protocols were used to determine GI and II. For the in vitro studies, cooked rice was incubated with hydrolytic enzymes under standardised conditions. Samples were taken at t=20 and t=120 min and rapidly available glucose (RAG) and slowly available glucose (SAG) were computed. RESULTS: Values of RAG and SAG were lower for HR compared with their respective values for UBR (P<0.001 and P=0.011, respectively). However, no significant difference was observed for GI (P>0.05) despite a lower insulin response noted for HR (P=0.007). CONCLUSIONS: HR had a similar GI to UBR, although a lower insulin response was evident. RAG and SAG values were different for the two rice varieties despite similar GI values. These differences may be important in terms of their metabolic impact and outcome on diabetes.

The influence of alcohol consumed with a meal on endothelial function in healthy individuals.

BACKGROUND: Alcohol and polyphenols in wine and fruit juices have been strongly implicated in the favourable effects on of these beverages on vascular function. Despite a wealth of information on the metabolic and vascular effects of alcohol and polyphenols, the combined influences of these substances on vascular function, especially when consumed with food, is poorly understood. A study was designed to determine the effects of a phenolic-rich grape juice, with or without alcohol, on vascular endothelial function in the postprandial state. METHODS: Ten subjects consumed a standard meal with a test drink on three separate occasions. On each occasion, the test drink accompanying the meal was either red grape juice, red grape juice plus alcohol (12% v/v), or water. Endothelial function was measured by flow mediated dilatation (FMD) prior to then 30 and 60 minutes after consuming the meal. Blood samples were taken for the determination of plasma glucose, triacylglycerol (TAG) and non esterified fatty acids (NEFA) at regular intervals. RESULTS: There was a significant effect of the three treatments (P = 0.0026) and time (P = 0.021) on percentage FMD. The meals with the grape juice and grape juice plus alcohol produced similar FMD responses but were both significantly greater than the meal with water. The concentration of plasma glucose, TAG and NEFA were similar after each treatment. CONCLUSION: Alcohol had no effect on vascular function in the early postprandial phase. These findings provide new evidence to support the potential benefit of non-alcoholic components within alcoholic beverages on vascular function in the fed state.

Effect of menopause on melatonin and alertness rhythms investigated in constant routine conditions.

Although studies have reported the effects of the menstrual cycle on melatonin rhythmicity, none has investigated the effects of menopause on the melatonin rhythm. The circadian rhythm in melatonin and its relationship to subjective alertness was investigated in pre- and postmenopausal women under constant routine conditions (controlled posture, dim lighting, calorie intake, temperature, and prolonged wakefulness). Eleven healthy pre-menopausal (42+/-4 yr) and 10 postmenopausal women (55+/-2 yr) participated in the study. Salivary melatonin samples and subjective measures of alertness and sleepiness were assessed hourly during the 22 h constant routine protocol. Postmenopausal women had a significantly earlier melatonin acrophase (1.1+/-0.5 h clock time in decimal h; mean+/-SEM, p<0.05) compared to the pre-menopausal women (2.3+/-0.3 h). There was no significant difference between melatonin onset and amplitude between the pre-menopausal and postmenopausal women. Self-rated alertness declined in both study groups as the length of sleep deprivation increased. Melatonin onset preceded the onset of self-rated sleepiness in both groups. The time interval between melatonin onset and the onset of sleepiness and alertness offset was significantly greater in the postmenopausal women compared to the pre-menopausal women. In conclusion, under controlled experimental conditions the timing of the melatonin rhythm was advanced in postmenopausal women altering its phase relationship to subjective alertness and sleepiness.

Empowering patients to take control of leg ulcer treatment through individualised management.

Leg Clubs have been established to empower patients to become stakeholders in their own treatment. This case report describes how attendance at a Leg Club resulted in healing in a patient who previously was non-concordant with treatment.

The role of the expert witness.

Juries do not have extensive health-care knowledge, so expert witnesses are needed to explain standards of care. Here, expert witness Sylvie Hampton describes this role and how these witnesses participate in court proceedings.

Eczema and early solid feeding in preterm infants.

AIMS: To establish whether development of eczema is influenced by feeding practices in preterm infants, while taking account of confounding factors. METHODS: Data were assembled from 257 infants born prematurely and studied to 12 months post-term. Logistic regression analysis was performed to establish the association between feeding practices and eczema, allowing for potential confounding factors including the infants' gender, parental atopic status, social background, and parental smoking habits. RESULTS: For the development of eczema (with or without other symptoms) by 12 months post-term, the introduction of four or more solid foods by or before 17 weeks post-term was a significant risk (odds ratio 3.49). Male infants were at significantly higher risk (odds ratio 1.84). In addition, having non-atopic parents who introduced solid foods before 10 weeks post-term or having at least one atopic parent represented a significant risk scenario (odds ratio 2.94). CONCLUSIONS: Early introduction of a diverse range of solid foods may predispose the preterm infant to eczema development by 12 months post-term. Furthermore, non-atopic parents who practice early as opposed to late introduction of solid foods may be exposing preterm infants to a greater risk of eczema by 12 months post-term.

A small study in healing rates and symptom control using a new sheet hydrogel dressing.

OBJECTIVE: This study set out to investigate the pain control and absorptive properties of a new sheet hydrogel dressing (ActiFormCool, Activa). METHOD: This was a simple evaluation involving 20 wounds. Compression was used when appropriate, although each patient receiving compression had used short-stretch bandages before entering the study. RESULTS: Pain was reduced from an average of 8.65 to an average of 3.75, where 10 represents the worst pain possible and one represents no pain. Exudate reduction was assessed by the number of dressing changes required each week. The dressing-change rate reduced from an average of 2.8 times weekly to an average of 1.3 times weekly. Skin condition improved in all three cases in which the surrounding skin had been a problem before the study. Over a four-week period, two wounds healed, four healed by 90% and two by 80%, with an overall average healing rate of 46%. CONCLUSION: ActiFormCool provides an optimum wound-healing environment, reduces pain and absorbs fluid, making it an excellent alternative to loose hydrogels.

Postprandial metabolic profiles following meals and snacks eaten during simulated night and day shift work.

Shift workers are known to have an increased risk of developing cardiovascular disease (CVD) compared with day workers. An important factor contributing to this increased risk could be the increased incidence of postprandial metabolic risk factors for CVD among shift workers, as a consequence of the maladaptation of endogenous circadian rhythms to abrupt changes in shift times. We have previously shown that both simulated and real shift workers showed relatively impaired glucose and lipid tolerance if a single test meal was consumed between 00:00-02:00 h (night shift) compared with 12:00-14:00 h (day shift). The objective of the present study was to extend these observations to compare the cumulative metabolic effect of consecutive snacks/meals, as might normally be consumed throughout a period of night or day shift work. In a randomized crossover study, eight healthy nonobese men (20-33 yrs, BMI 20-25kg/m2) consumed a combination of two meals and a snack on two occasions following a standardized prestudy meal, simulating night and day shift working (total energy 2500 kcal: 40% fat, 50% carbohydrate, 10% protein). Meals were consumed at 01:00/ 13:00 h and 07:00/19:00h, and the snack at 04:00/16:00 h. Blood was taken after an overnight fast, and for 8 h following the first meal on each occasion, for the measurement of glucose, insulin, triacylglycerol (TAG), and nonesterified fatty acids (NEFA). RM-ANOVA (factors time and shift) showed a significant effect of shift for plasma TAG, with higher levels on simulated night compared to day shift (p < 0.05). There was a trend toward an effect of shift for plasma glucose, with higher plasma glucose at night (p = 0.08), and there was a time-shift interaction for plasma insulin levels (p < 0.01). NEFA levels were unaffected by shift. Inspection of the area under the plasma response curve (AUC) following each meal and snack revealed that the differences in lipid tolerance occurred throughout the study, with greatest differences occurring following the mid-shift snack. In contrast, glucose tolerance was relatively impaired following the first night-time meal, with no differences observed following the second meal. Plasma insulin levels were significantly lower following the first meal (p < 0.05), but significantly higher following the second meal (p < 0.01) on the simulated night shift. These findings confirm our previous observations of raised postprandial TAG and glucose at night, and show that sequential meal ingestion has a more pronounced effect on subsequent lipid than carbohydrate tolerance.

Short-stretch compression bandages and the foot pump: their relationship to restricted mobility.

Practitioners are generally advised not to use short-stretch bandages on patients who are immobile. But this appears to reflect confusion about calf muscle function, which research indicates still occurs during periods of limited mobility.

Adaptation of the circadian rhythm of 6-sulphatoxymelatonin to a shift schedule of seven nights followed by seven days in offshore oil installation workers.

This study evaluated circadian adaptation in a 'swing shift' schedule (seven nights, 18:00-06:00 h; then 7 days, 06:00-18:00 h) on North Sea oil installations. Eleven healthy men provided sequential urine collections for the study period offshore. The urinary melatonin metabolite 6-sulphatoxymelatonin (aMT6s) was used as an index of circadian phase. A significant difference (P=0.0004) was found between the mean aMT6s acrophase (calculated peak time) at the start (+/-SD: 05:34+/-2.42 h) and end (+/-SD: 10.95+/-3.34 h) of the night shift week, but not between the start (+/-SD: 11:04+/-4.03 h) and end (+/-SD: 12:59+/-8.83 h) of the day shift week. As a group, the subjects adapted to the night shift but very large individual variations were seen during the day shift. These individual differences clearly require further study.

Factors affecting the introduction of complementary foods in the preterm infant.

OBJECTIVES: The aim of the study was to identify current infant feeding practices among carers of preterm infants. DESIGN: Structured interviews on milk and complementary feeding practices were conducted with mothers of preterm infants at intervals until infants were 12 months corrected age. SETTING: Recruitment took place in three local Surrey hospitals over a 2 y period. SUBJECTS: Two-hundred and fifty-three preterm infants (139 male, 114 female) including 33 sets of twins and three sets of triplets were recruited. RESULTS: Forty-nine percent of the preterm infant group received first solid foods (the commencement of 'weaning') before the current Department of Health (DoH) guideline. The mean+/-s.e.m. weaning age from birth was 17.1+/-0.23 weeks. Ninety-five percent of the infants were weaned before the DoH guideline when the data was examined from term (mean 11.5+/-s.e.m. 0.21 weeks). Twenty-one percent were weaned before the DoH guideline for preterm infants which is that 'the infant weighs at least 5 kg' (mean 5.61+/-s.e.m. 0.01 kg). Human milk-fed infants were significantly lighter at weaning than combined milk-fed infants (5.32+/-0.12 vs 5.72+/-0.01 kg; P<0.05) even though they were weaned at a similar age. Infant formula-fed infants (mean weaning age from term 10.2+/-0.47 weeks) were weaned significantly earlier than both human milk-fed (11.9+/-0.49 weeks; P<0.05) and combined milk-fed (11.9+/-0.25 weeks; P<0.005) infants. CONCLUSIONS: The introduction of complementary foods varied widely between carers of preterm infants and compliance with DoH guidelines was poor. Further studies on preterm infants are necessary to see if weaning practices affect long-term growth and morbidity and to provide a basis for the development of appropriate recommendations. SPONSORSHIP: This work was funded by the MAFF Food Intolerance Programme.