Autism spectrum disorder diagnosis using a new panel of immune- and inflammatory-related serum biomarkers: A case-control multicenter study.

Background and objectives: Children with autism spectrum disorder (ASD) present with distinctive clinical features. No objective laboratory assay has been developed to establish a diagnosis of ASD. Considering the known immunological associations with ASD, immunological biomarkers might enable ASD diagnosis and intervention at an early age when the immature brain has the highest degree of plasticity. This work aimed to identify diagnostic biomarkers discriminating between children with ASD and typically developing (TD) children. Methods: A multicenter, diagnostic case-control study trial was conducted in Israel and Canada between 2014 and 2021. In this trial, a single blood sample was collected from 102 children with ASD as defined in Diagnostic Statistical Manual of Mental Disorders [DSM)-IV (299.00) or DSM-V (299.00)], and from 97 typically developing control children aged 3-12 years. Samples were analyzed using a high-throughput, multiplexed ELISA array which quantifies 1,000 human immune/inflammatory-related proteins. Multiple logistic regression analysis was used to obtain a predictor from these results using 10-fold cross validation. Results: Twelve biomarkers were identified that provided an overall accuracy of 0.82 ± 0.09 (sensitivity: 0.87 ± 0.08; specificity: 0.77 ± 0.14) in diagnosing ASD with a threshold of 0.5. The resulting model had an area under the curve of 0.86 ± 0.06 (95% CI: 0.811-0.889). Of the 102 ASD children included in the study, 13% were negative for this signature. Most of the markers included in all models have been reported to be associated with ASD and/or autoimmune diseases. Conclusion: The identified biomarkers may serve as the basis of an objective assay for early and accurate diagnosis of ASD. In addition, the markers may shed light on ASD etiology and pathogenesis. It should be noted that this was only a pilot, case-control diagnostic study, with a high risk of bias. The findings should be validated in larger prospective cohorts of consecutive children suspected of ASD.

Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic.

The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.

Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study.

Background: Before widespread vaccination, the United States was disproportionately affected by COVID-19 with a mortality rate several times that of other affluent societies. Comparing regions with different rates of health insurance, we assess how much of this excess mortality may be due to the relatively large population without health insurance. Methods: We use daily surveillance data from the US Centers for Disease Control and Prevention (CDC) stratified by region, age group, gender, and race in regression analysis of daily COVID-19 cases, hospitalization, and mortality. COVID-19 data have been matched with structural characteristics of the region including average proportion with health insurance. As checks, we have estimated regressions for different time periods, different groups of states, and by comparing adjacent counties between states with and without Medicaid expansion. Findings: Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization. Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26% of the total death toll in the period of this analysis. Interpretation: Our study demonstrates that a significant share of COVID-19 mortality in the United States, and much of the excess mortality in the United States compared with other countries, is due to our reliance on a system of market-driven healthcare. Providing universal insurance coverage should be part of our campaign to reduce COVID-19 mortality. It also suggests that these concerns should not be restricted to COVID-19 but apply across all diseases, contributing to many unnecessary deaths in the United States each year even apart from the COVID-19 pandemic.

Capacity building in nutrition science: revisiting the curricula for medical professionals.

The current nutrition education curricula for students in U.S. medical schools, and schools of other health professions, such as nursing and oral health, do not provide enough opportunity to gain knowledge of the interactions among micro- and macronutrients, their role in maintaining optimal body functions, factors that interfere with these interactions, or, importantly, how to integrate this knowledge into medical practice. There is a need to better prepare healthcare professionals for identifying nutrition risk and managing hospitalized patients, especially those with chronic conditions, using an interprofessional, team-based approach. A major goal of this report is to revisit current nutrition training programs for physicians and other healthcare professionals in order to explore opportunities for providing healthcare providers with the essential tools of preventative and therapeutic nutrition intervention strategies. The issues addressed include whether a consensus exists on how to integrate basic and applied nutrition into the general healthcare professional curriculum, and if so, at which stages of training and at what depth should these integrations occur; how nutrition education is dealt with and achieved throughout all the health professions; and whether current nutrition education models are sufficient. To help address these issues, the report will review current nutrition education practices-their strengths and weaknesses-as well as evaluate promising new initiatives, and offer proposals for new directions for nutrition education training of future generation of medical practitioners.

The role of probiotics in the prevention and treatment of antibiotic-associated diarrhea and Clostridium difficile colitis.

Clostridium difficile colitis is the most common gastrointestinal infection, exceeding all other gastrointestinal infections combined. There has been a dramatic increase in Clostridium difficile infection (CDI) worldwide during the past decade. Antibiotic therapy is a trigger precipitating antibiotic-associated diarrhea (AAD), which may lead to CDI. The antibiotic alters the protective, diverse bacteria allowing pathogenic bacteria to cause disease. Probiotics have been effective in reducing AAD and preventing CDI.

Proposal for medical school nutrition education: topics and recommendations.

The mission of increasing the number of physician nutrition experts requires focused nutrition education directed at medical students across the 4-year curriculum and into postgraduate training. Courses should be horizontally and vertically integrated, bridging the basic sciences and clinical medicine. It is anticipated that the Liaison Committee on Medical Education and Association of American Medical Colleges will require competency in nutrition with emphasis on preventive and therapeutic applications. Barriers to implementation of nutrition courses can be overcome by using innovative teaching in association with cooperative course directors. Analysis of prior governmental efforts, through the Nutrition Academic Award, provides a basis for targeting fundamental knowledge and creative methods for achieving educational goals. Recommendations for short-term and long-term ideas for increasing the number of adequate physician nutrition experts are offered.

Compilation of recommendations from summit on increasing physician nutrition experts.

This report compiles the list of recommendations derived from the Summit on Increasing Physician Nutrition Experts. The recommendations represent expert opinion on topics related to increasing the number of physicians who choose nutrition as a career option and on topics related to strengthening multidisciplinary educational programs, research activity, and clinical practice in nutrition in the future. The recommendations should not be interpreted to represent consensus, approval, or endorsement by attendees or participating societies. A simple prioritization scheme identifies those short-term recommendations that should be more feasible, receive more immediate attention, and possibly require fewer resources than those described as long-term. Many of these recommendations are already being acted upon by various groups within the participating societies. The listing of recommendations does not imply responsibility for implementation by Summit attendees. The role for any council arising from this Summit is yet to be defined but may certainly involve facilitating communication and collaboration of initiatives arising from many of the issues listed here.

Microecology, obesity, and probiotics.

PURPOSE OF REVIEW: Description of the role that the microbiota may play in human health, energy harvest, and obesity. RECENT FINDINGS: The adult human gut may contain up to 100 trillion microbial organisms, known as the microbiota. Major advances in defining the quality, quantity, and physiologic activity of the intestinal microbiota were precipitated by the conversion from culture-based techniques to metagenomics. The microbiota may serve various functions including promoting development of the human immune system, modulating inflammation, and affecting calorie extraction. SUMMARY: Recent evidence, in humans and animal models, supports a role for the microbiota in obesity. Not only is the presence of bacteria important, but also the relative proportions of microbial communities, specifically Firmicutes and Bacteriodetes, appear to be important in energy homeostasis. The microbiota may also affect the immune and inflammatory response in human organisms. Although there is limited data supporting the manipulation of the gut microbiota, using probiotics, antibiotics, and/or prebiotics to treat obesity, novel therapeutic agents may be developed.

Advances in paediatric migraine.

Headache is one of the most common complaints of children who present to primary care providers. Although parents are often concerned about sinister pathology, the majority of children with headaches have primary headache syndromes, including migraine and tension-type headaches. Diagnostic criteria for children are currently evolving to better reflect the unique challenges of this group of patients. Advances in migraine pharmacotherapy have been achieved through the understanding of serotonin and its role in migraine pathophysiology. Serotonin agonists, commonly known as 'triptans', are the current standard of care in the management of acute migraine in adults. Recent evidence has confirmed that the efficacy of triptans also occurs in children. The present article focuses on recent advances in the areas of epidemiology, diagnostic criteria and pathophysiology of paediatric migraine. In addition, the present article reviews the evidence of management issues, including neuroimaging and the use of triptans in children.