Time trends in autism diagnosis over 20 years: a UK population-based cohort study.

BACKGROUND: Autism spectrum disorder is a diagnosis that is increasingly applied; however, previous studies have conflicting findings whether rates of diagnosis rates continue to grow in the UK. This study tested whether the proportion of people receiving a new autism diagnosis has been increasing over a twenty-year period, both overall and by subgroups. METHOD: Population-based study utilizing the Clinical Practice Research Datalink (CPRD) primary care database, which contains patients registered with practices contributing data to the CPRD between 1998 and 2018 (N = 6,786,212 in 1998 to N = 9,594,598 in 2018). 65,665 patients had a diagnosis of autism recorded in 2018. Time trend of new (incident) cases of autism diagnosis was plotted for all, and stratified by gender, diagnostic subtypes, and developmental stage: infancy and preschool, 0-5 years old; childhood, 6-11 years old; adolescence, 12-19 years old; adults, over 19 years old. RESULTS: There was a 787%, exponential increase in recorded incidence of autism diagnoses between 1998 and 2018; R2 = 0.98, exponentiated coefficient = 1.07, 95% CI [1.06, 1.08], p < .001. The increase in diagnoses was greater for females than males (exponentiated interaction coefficient = 1.02, 95% CI [1.01, 1.03], p < .001) and moderated by age band, with the greatest rises in diagnostic incidence among adults (exponentiated interaction coefficient = 1.06, 95% CI [1.04, 1.07], p < .001). CONCLUSIONS: Increases could be due to growth in prevalence or, more likely, increased reporting and application of diagnosis. Rising diagnosis among adults, females and higher functioning individuals suggest augmented recognition underpins these changes.

Addressing transport safety and accessibility for people with a disability in developing countries: a formative evaluation of the Journey Access Tool in Cambodia.

BACKGROUND: The intersection between health, disability and transport has significant practical challenges for people with a disability living in low- and middle-income countries (LMICs), where road infrastructure is poor and travel unsafe. Lack of transport access to health, education, employment and other services impedes achievement of the Sustainable Development Goals and affects quality of life. The Journey Access Tool (JAT) combines access audit and road safety audit approaches to identify barriers to transport on journeys taken by people with a disability. To be useful and effective, it must fit the expectations of people with a disability (be acceptable) and be feasible for use in different settings (adoptable). Accordingly, a formative evaluation process was undertaken in Phnom Penh, Cambodia. OBJECTIVES: To undertake a formative evaluation of the JAT using an iterative process to tailor the tool, pilot its use by people with a disability, and develop a template for its implementation in other LMICs. METHODS: An iterative process of consultation and three pilots was undertaken. Participants were people with a disability who undertook journeys with a public transport component accompanied by assistants. Focus groups were held after each pilot, and results were integrated into JAT revisions. RESULTS: Issues of terminology were resolved early, as were process issues related to the length of time taken to complete the JAT. Interpersonal issues were more difficult to address, with assistants tending to exceed their role and record their own comments. Use of the tool provided rich information on barriers. CONCLUSIONS: The JAT was both acceptable and adoptable for people with a disability and other stakeholders, and the experience gained will facilitate adaptation of the tool to new settings. The tool has significant potential to shape and support advocacy for change and engagement with transport services and also health, education, employment and other services.

Pituitary gland of the garter snake (Thamnophis): Morphology and immunocytochemistry.

The three-dimensional gross morphology of the pituitary gland of the garter snake (Thamnophis sirtalis) is presented. Hormone-producing cells of the pars distalis were localized immunocytochemically. Corticotropes and lactotropes occur in the anterior two-thirds of the gland; corticotropes are especially numerous in the area of the pars distalis nearest the median eminence, and lactotropes are most abundant medially. Somatotropes are restricted to the posterior one-third of the pars distalis. Gonadotropes and thyrotropes are scattered throughout the pars distalis and in favorable sections form a network of cells enclosing clusters of peptide-secreting cells.

Seasonal changes in a lizard pituitary: Immunocytochemistry and ultrastructural morphometry of lactotropes, corticotropes, and gonadotropes.

Pituitary glands of adult male lizards (Anolis carolinensis) were studied in an effort to monitor seasonal cytologic changes quantitatively. Cells were identified immunocytochemically and on the basis of ultrastructural characteristics. Electron micrographs of the anterior pars distalis (containing lactotropes, corticotropes, and gonadotropes) of lizards collected in spring and fall were analyzed morphometrically. Lactotropes are the most numerous cell type in this area and occupy the largest volume. They are closely followed by corticotropes. Neither kind of cell undergoes a marked seasonal change in number or size or in the percent of the analyzed volume they occupy. Morphometric and ultrastructural criteria indicate an increased level of activity in all three kinds of secretory cells in the spring, although changes are relatively modest in corticotropes and lactotropes. Gonadotropes occupy less than half the volume of either of the other secretory cells in the analyzed area, but undergo considerable seasonal modification. They are larger (> 40%) and more numerous (20%) in the spring, and show an increase in biosynthetic organelles at this time. Although the density of secretion granules may be reduced in the enlarged spring gonadotropes, the number of granules per cell may not be altered seasonally. Seasonal changes in the three cell types analyzed are moderate in contrast to the cytologic modifications described in pituitary cells following castration or other experimental procedures. Necrotic cells appear to be a normal component of the pituitary gland of Anolis carolinensis throughout the year.