Background.Almost one-fifth of United States tuberculosis cases are extrapulmonary; unexplained slower annual case count decreases have occurred in extrapulmonary tuberculosis (EPTB), compared with ...annual case count decreases in pulmonary tuberculosis (PTB) cases. We describe the epidemiology of EPTB by means of US national tuberculosis surveillance data. Methods.US tuberculosis cases reported from 1993 to 2006 were classified as either EPTB or PTB. EPTB encompassed lymphatic, pleural, bone and/or joint, genitourinary, meningeal, peritoneal, and unclassified EPTB cases. We excluded cases with concurrent extrapulmonary-pulmonary tuberculosis and cases of disseminated (miliary) tuberculosis. Demographic characteristics, drug susceptibility test results, and risk factors, including human immunodeficiency virus (HIV) status, were compared for EPTB and PTB cases. Results.Among 253,299 cases, 73.6% were PTB and 18.7% were EPTB, including lymphatic (40.4%), pleural (19.8%), bone and/or joint (11.3%), genitourinary (6.5%), meningeal (5.4%), peritoneal (4.9%), and unclassified EPTB (11.8%) cases. Compared with PTB, EPTB was associated with female sex (odds ratio OR, 1.7; 95% confidence interval CI, 1.7–1.8) and foreign birth (OR, 1.5; CI, 1.5–1.6), almost equally associated with HIV status (OR, 1.1; CI, 1.1–1.1), and negatively associated with multidrug resistance (OR, 0.6; CI, 0.5–0.6) and several tuberculosis risk factors, especially homelessness (OR, 0.3; CI, 0.3–0.3) and excess alcohol use (OR, 0.3; CI, 0.3–0.3). Slower annual decreases in EPTB case counts, compared with annual decreases in PTB case counts, from 1993 through 2006 have caused EPTB to increase from 15.7% of tuberculosis cases in 1993 to 21.0% in 2006. Conclusions.EPTB epidemiology and risk factors differ from those of PTB, and the proportion of EPTB has increased from 1993 through 2006. Further study is needed to identify causes of the proportional increase in EPTB.
Impairments in visual disengagement are a current focus of research in autism spectrum disorders (ASD) and may play a key role in the early expression of social-emotional deficits associated with the ...disorder. This review summarizes current knowledge of visual disengagement and orienting in ASD. Convergent reports from infancy to adulthood indicate that (1) impairments to visual disengagement are apparent on Gap-Overlap tasks, spatial orienting tasks, and tasks involving social stimuli; and (2) these impairments emerge in the first year of life and continue into adulthood. The relationships between visual disengagement, orienting, joint attention, emotional regulation, and IQ are discussed in relation to ASD.
Research concerning temperament in children and adults with autism spectrum disorder (ASD) has suggested a consistent profile of low positive affect, high negative affect, and low regulation (Visser ...et al., 2016). One area receiving less attention is individual differences among children diagnosed with ASD. The primary objective of this study was to use a person‐centered approach to explore heterogeneity of early temperament precursors of regulation in a large sample of infants with elevated familial likelihood of ASD. Early precursors of regulation included temperament assessed at 6, 12, and 24 months whereas outcome measures were diagnosis of ASD, cognitive ability and adaptive behavior at 36 months. Participants included 176 low‐likelihood and 473 elevated‐likelihood infants, 129 of whom were diagnosed with ASD at 3 years. Results supported a three‐profile solution: a well‐regulated profile (high positive affect and high attentional focus and shifting), a low attention focus profile (higher attentional shifting compared to attentional focus), and a low attention shifting profile (higher attentional focus compared to attentional shifting). A higher proportion of children diagnosed with ASD were classified into the low attention shifting profile. Furthermore, children with the well‐regulated profile were differentiated from the other profiles by a pattern of higher social competence and lower dysregulation whereas children with the low attention focus profile were distinguished from the other profiles by higher cognitive ability at 3 years. The findings indicate that the combination of early positive affect with attention measures may provide an enhanced tool for prediction of self‐regulation and later outcomes.
Background
Although early autism spectrum disorder (ASD) detection strategies tend to focus on differences at a point in time, behavioral symptom trajectories may also be informative.
Methods
...Developmental trajectories of early signs of ASD were examined in younger siblings of children diagnosed with ASD (n = 499) and infants with no family history of ASD (n = 177). Participants were assessed using the Autism Observation Scale for Infants (AOSI) from 6 to 18 months. Diagnostic outcomes were determined at age 3 years blind to previous assessments.
Results
Semiparametric group‐based modeling using AOSI scores identified three distinct trajectories: Group 1 (‘Low’, n = 435, 64.3%) was characterized by a low level and stable evolution of ASD signs, group 2 (‘Intermediate’, n = 180, 26.6%) had intermediate and stable levels, and group 3 (‘Inclining’, n = 61, 9.3%) had higher and progressively elevated levels of ASD signs. Among younger siblings, ASD rates at age 3 varied by trajectory of early signs and were highest in the Inclining group, membership in which was highly specific (94.5%) but poorly sensitive (28.5%) to ASD. Children with ASD assigned to the inclining trajectory had more severe symptoms at age 3, but developmental and adaptive functioning did not differ by trajectory membership.
Conclusions
These prospective data emphasize variable early‐onset patterns and the importance of a multipronged approach to early surveillance and screening for ASD.
This prospective study characterized parents' concerns about infants at high risk for developing autism spectrum disorder (ASD; each with an older sibling with ASD) at multiple time points in the ...first 2 years, and assessed their relation to diagnostic outcome at 3 years.
Parents of low-risk controls (LR) and high-risk infant siblings (HR) reported any concerns that they had regarding their children's development between 6 and 24 months of age regarding sleep, diet, sensory behavior, gross/fine motor skills, repetitive movements, communication, communication regression, social skills, play, and behavioral problems, using a parent concern form designed for this study. At 3 years of age, an independent, gold-standard diagnostic assessment for ASD was conducted for all participants.
As predicted, parents of HR children who received an ASD diagnosis reported more concerns than parents of LR and HR children who did not have ASD. The total number of concerns predicted a subsequent diagnosis of ASD as early as 12 months within the HR group. Concerns regarding sensory behavior and motor development predicted a subsequent diagnosis of ASD as early as 6 months, whereas concerns about social communication and repetitive behaviors did not predict diagnosis of ASD until after 12 months.
Parent-reported concerns can improve earlier recognition of ASD in HR children.
Literature examining emotional regulation in infants with autism spectrum disorder (ASD) has focused on parent report. We examined behavioral and physiological responses during an emotion-evoking ...task designed to elicit emotional states in infants. Infants at an increased likelihood for ASD (IL; have an older sibling with ASD; 96 not classified; 29 classified with ASD at age two) and low likelihood (LL; no family history of ASD;
= 61) completed the task at 6, 12, and 18 months. The main findings were (1) the IL-ASD group displayed higher levels of negative affect during toy removal and negative tasks compared to the IL non-ASD and LL groups, respectively, (2) the IL-ASD group spent more time looking at the baseline task compared to the other two groups, and (3) the IL-ASD group showed a greater increase in heart rate from baseline during the toy removal and negative tasks compared to the LL group. These results suggest that IL children who are classified as ASD at 24 months show differences in affect, gaze, and heart rate during an emotion-evoking task, with potential implications for understanding mechanisms related to emerging ASD.
Delays in motor development are not considered a core feature of autism spectrum disorder (ASD). Yet, recent studies of infant siblings of children with ASD suggest that early delays in motor skills ...may be associated with later delays in developmental areas considered to be core features of an ASD diagnosis. While these studies demonstrate the longitudinal association between core features and motor delays observed at single time points, there is considerable interest in studying the trajectories of motor development over the first 3 years of life. To accomplish this, we investigated early trajectories of motor development in a cohort of 499 infant siblings of children with ASD and 176 children with no family history of ASD. Data for the current study were drawn from the prospective, multi-site, Canadian Infant Sibling Study. We evaluated trajectories of fine and gross motor development over the first 3 years using group-based trajectory modeling. Our results show that membership for both fine and gross motor trajectory groups was related to expressive language skills, receptive language skills, ASD symptom severity scores, and diagnostic classification at age 3. These results provide evidence that the trajectory of a child's early motor development may have important prognostic implications in ASD.
Abstract
Background
In 2016, the World Health Organization (WHO) recommended a shorter (9–12 month) multidrug-resistant tuberculosis (MDR-TB) treatment regimen (as compared to the conventional 18–24 ...month regimen) for patients without extrapulmonary TB, pregnancy, a previous second-line TB medication exposure, or drug resistance to pyrazinamide, ethambutol, kanamycin, moxifloxacin, ethionamide, or clofazimine. The recommendation was based on successful clinical trials conducted in Asia and Africa, but studies, using mainly European data, have shown few patients in higher-resource settings would meet WHO eligibility criteria.
Methods
We assessed eligibility for the shorter regimen among US MDR-TB cases that had full drug susceptibility testing (DST) results and were reported during 2011–2016 to the US National TB Surveillance System. We estimated costs by applying the eligibility criteria for the shorter regimen, and proportional inpatient/outpatient costs from a previous, population-based study, to all MDR-TB patients reported to the National TB Surveillance System.
Results
Of 586 reported MDR-TB cases, 10% (59) were eligible for the shorter regimen. Of 527 ineligible patients, 386 had full DST, of which 246 were resistant to ethambutol and 217 were resistant to pyrazinamide. Compared with conventional MDR-TB treatment, implementing the shorter regimen would have reduced the US annual societal MDR-TB cost burden by 4%, but the cost burden for eligible individuals would have been reduced by 37–46%.
Conclusions
Relying on full DST use, our analysis found a minority of US MDR-TB patients would have been eligible for the shorter regimen. Cost reductions would have been minimal for society, but large for eligible individuals.
Only 10% of US multidrug-resistant tuberculosis cases during 2011–2016 would have been eligible for the World Health Organization–recommended shorter treatment regimen, which would have greatly reduced individual patient costs, but had a small reduction in overall societal cost.
To assess changes in US tuberculosis (TB) incidence rates by age, period, and cohort effects, stratified according to race/ethnicity and nativity.
We used US National Tuberculosis Surveillance System ...data for 1996 to 2016 to estimate trends through age-period-cohort models.
Controlling for cohort and period effects indicated that the highest rates of TB incidence occurred among those 0 to 5 and 20 to 30 years of age. The incidence decreased by age for successive birth cohorts. There were greater estimated annual percentage decreases among US-born individuals (-7.3%; 95% confidence interval CI = -7.5, -7.1) than among non-US-born individuals (-4.3%; 95% CI = -4.5, -4.1). US-born individuals older than 25 years exhibited the largest decreases, a pattern that was not reflected among non-US-born adults. In the case of race/ethnicity, the greatest decreases by nativity were among US-born Blacks (-9.3%; 95% CI = -9.6, -9.1) and non-US-born Hispanics (-5.7%; 95% CI = -6.0, -5.5).
TB has been decreasing among all ages, races and ethnicities, and consecutive cohorts, although these decreases are less pronounced among non-US-born individuals.
Introduction
Emotion regulation, the ability to regulate emotional responses to environmental stimuli, develops in the first years of life and plays an important role in the development of ...personality, social competence, and behavior. Substantial literature suggests a relationship between emotion regulation and cardiac physiology; specifically, heart rate changes in response to positive or negative emotion‐eliciting stimuli.
Method
This systematic review and meta‐analysis provide an in‐depth examination of research that has measured physiological responding during emotional‐evoking tasks in children from birth to 4 years of age.
Results
The review had three main findings. First, meta‐regressions resulted in an age‐related decrease in baseline and task‐related heart rate (HR) and increases in baseline and task‐related respiratory sinus arrhythmia (RSA). Second, meta‐analyses suggest task‐related increases in HR and decreases in RSA and heart rate variability (HRV), regardless of emotional valence of the task. Third, associations between physiological responding and observed behavioral regulation are not consistently present in children aged 4 and younger. The review also provides a summary of the various methodology used to measure physiological reactions to emotional‐evoking tasks, including number of sensors used and placement, various baseline and emotional‐evoking tasks used, methods for extracting RSA, as well as percentage of loss and reasons for loss for each study.
Conclusion
Characterizing the physiological reactivity of typically developing children is important to understanding the role emotional regulation plays in typical and atypical development.
This review examines the physiological responses to emotion‐evoking tasks in children from birth to age 4. We reviewed 64 articles, allowing a thorough and in‐depth exploration of different baseline and emotion tasks across the preschool age. This review provides an overview of results as well as meta‐analyses to explore the strength of the findings.
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